My Local Anesthetic Recipe for Endodontic Success

Have you ever had trouble getting a Mandibular Molar Numb?

I have!! And in my line of business it is paramount that I do not hurt my patient.

Luckily, I have learned a few tricks on how to numb that “Hot” tooth that needs endodontic therapy. Here is my Recipe Book:

Step 1: Give the patient 400mg Advil or Ibuprofen prior to Treatment.

Step 2: Use articaine (4% 1:200,000 epi) and aim slightly higher or use a Gow –Gates block for the Inferior alveolar nerve block.

NOW WAIT 10 mins. Allow the to Local to work.

Before you ever pick up the drill – Use a refrigerant, like Endo Ice to ensure the tooth can no longer sense the cold stimulus.

If the patient can still feel the cold…….. THEN DO NOT start drilling. Go to Step 3

Step 3: Use supplemental injections Like The PDL injection or intra-osseous to achieve profound anesthesia.

Again test with cold refrigerant – If the patient can no longer feel the cold then start with endodontic therapy immediately.

Step 4: Enter the the pulp chamber as efficiently as possible, once you enter the pulp chamber, keep the initial access as small as possible. Now give an intra-pulpal injection if the tooth is vital, even if the patient is fully numb.

I know that this is a “Belt and Suspenders” approach to Local anesthetic, but trust me you and your patient will be happy if they are numb for your entire endodontic procedure and do not feel any discomfort. It is horrible timing when you are about to obturate your tooth and the patient starts to flinch with pain.

I hope these tips help you achieve outstanding endodontic success. Happy filing:)

Dr. Pommy Hallen, DMD, FRCD(C)