Dear friends and colleagues, Todays topic: How to profoundly anesthetize the hot lower molar before initiating root canal treatment. I am sure many of my clinical colleagues have encountered the hot lower molar (Irreversible pulpitis) wherein they administered at least two carpules of local anesthetic (e.g., lidocaine 1:100,000) for block anesthesia of the inferior alveolar neurovascular bundle + 0.5cc of the anesthetic for the long buccal nerve and waited a good five minutes for the anesthetic to take effect. The patient may report that both the tongue and the lip feel quite numb on that side. The clinician then proceeds to apply a rubber dam and initiate the access opening. As soon as the clinician penetrates the DEJ, the patient suddenly feels a strong sharp pain, even though the patient is ostensibly anesthetized. This problem is common and the solution is simple. Assuming the patient has no systemic disease and no periodontal disease, here is what to do. BEFORE applying the rubber dam, administer 0.2 mL of the local anesthetic with 1:100,000 vasoconstrictor into the distal sulcus and the mesial sulcus. Then apply the rubber dam. From my many years of experience in treating problems of this nature, I can attest as a clinician that this approach is remarkably effective in preventing the patient from experiencing any pain at any time during treatment. Try this the next time you encounter a hot lower molar with irreversible and let me know if your experience matches up with my own experience. You will find your patients will be most grateful for relieving their dire distress and a painless way! SC
Posted on: Sat, 29 Mar 2014 20:43:58 +0000
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