Tackling Local Anesthetic Failure in Endodontics

Abstract

Achieving anesthesia in a hot tooth or tooth with inflamed pulp is challenging, especially during endodontic treatment. In the presence of symptomatic irreversible pulpitis, mainly in mandibular teeth, pose even more challenge to attain profound anesthesia. Tetradoxin resistant channel is a class of sodium channel that is found to be increased in such condition and is found to resist local anesthesia. The pH also determines the success of local anesthesia. In inflammatory conditions, the surrounding area\'s pH, which eventually decreases the amount of base form of local anesthetic penetration into the nerve membrane, thereby causing anesthetic failure. In such conditions, the excitability threshold is reduced, leading to failure in achieving anesthesia. This chapter highlights and discusses the cause of anesthetic failure and its management in obtaining profound anesthesia during endodontic treatment.

A Prospective Clinical Study Evaluating the Efficacy of Intra-Ligamentary Anesthetic Solutions in Mandibular Molars Diagnosed as Symptomatic Irreversible Pulpitis with Symptomatic Apical Periodontitis

“…This led to the search for an efficient anesthetic technique/solution over the decades that will achieve efficient anesthesia. Additionally, in symptomatic irreversible pulpitis cases, IANB showed less than a 30% success rate of anesthesia [ 4 , 5 , 17 ] due to the inflammation-related activation of specific receptors such as tetrodotoxin-resistant receptors [ 35 ] directly resisting the concentration of local anesthetic agents and reducing their efficacy [ 33 , 36 , 37 ].…”