Strategies to Accomplish Effective Pulpal Anesthesia During Endodontic Therapy in Mandibular Molars

Abstract

Introduction: Fear of pain during endodontic treatment is a main cause of not seeking endodontic therapy among patients, which significantly affects patients’ oral health and clinicians’ dental practice. Hence, it is important for clinicians to know the cause of dental pain and various strategies for achieving profound analgesia during endodontic therapy. Moreover, achieving profound anesthesia in mandibular teeth is more difficult than maxillary because of the variations in the anatomical landmarks and compact bone of the mandible compared to porous bone of maxilla in the mandibular posterior region with irreversible pulpitis, is one of the challenging issues in endodontic practice.

Standard inferior alveolar nerve block (IANB) is the most common and frequently used anesthesia in endodontic therapy for mandibular molars. However, dentists can fail to achieve profound anesthesia during IANB for various reasons. Perhaps the most essential expertise a dentist can develop is to provide safe and effective local anesthesia (LA). Acutely inflamed pulp and periradicular tissues, acute periapical/periodontal abscess, trauma, altered landmarks, altered course of nerve, additional nerve supply, patient apprehension and lowered pain threshold, etc. can make the patient experience more painful during endodontic therapy. Almost all painful conditions can be managed by LA in endodontics. Hence, dentists’ skill in administering LA is very important to obtain adequate analgesia.

The present narrative review describes the various techniques for anesthetizing mandibular teeth and reasons for the failure of IANB during endodontic therapy. Additionally, it reviews various supplementary anesthetic techniques to achieve profound pulpal anesthesia during root canal therapy, especially in cases of acute irreversible pulpitis.