Prior to initiating endodontic treatment, achieving profound anesthesia is of primary importance. A patient’s assessment of the treatment and the dentist’s skills is largely based on achieving complete anesthesia. Many of the “horror stories” that patients relate about pain and root canal therapy are probably due to inadequate anesthesia.
This chapter will review the causes of anesthetic problems and how they are best managed. There are some cases that are more likely than others to experience anesthetic problems. It is helpful to identify those potential problem cases before treatment.
An example of an anesthetic problem is treatment of a “hot tooth” (presence of a numb lip but pain persists). Most often, this problem is associated with long-standing irreversible pulpitis in a mandibular molar. Predictable anesthetic strategies to resolve that problem are presented. The use of a variety of supplemental injections and nitrous oxide is also reviewed.
Determining the presence of profound anesthesia is essential and using a numb lip or sticking the gingiva are not dependable tests. An evidence-based approach to recognizing profound anesthesia is described.
The greatest evil is physical pain. Saint Augustine
