Too Hot to Handle!

One common question that many of my friends ask me is “How do you deal with a hot tooth?”

After giving adequate block injections and local infiltrations, I usually use intraligamental or intraosseous type of injections. My first choice for a few years has been using a syringe called Paroject. This syringe is used for intraligamental injections which is in a way intraosseous as well since the pressurized anesthetic solution in the PDL space will penetrate into the adjacent cancellous bone. I give 6-point intraligamental injection around the hot tooth using local anesthetic without epi and this usually does wonders.

Another effective method is using the intraosseous anesthesia with the Stabident and X-Tip systems. The details of the two systems can be reviewed in the article “Intraosseous Anesthesia” from the Endodontics: Colleagues for Excellence (Winter 2009) publication by the American Association of Endodontists (AAE).

Have I been 100% successful with all the hot teeth I have dealt with in the past few years? Absolutely not! If that happens, don’t forget there is always the good old practice-builder technique: the “Intrapulpal Injection“.


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