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 intraligamentary injection. My first choice for a few years has been using a syringe called Paroject. This syringe is used for intraligamental injections which is essentially a form of intraosseous injection 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.

Paroject syringe
Paroject by Septodont

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“.

Dr. Mahmoud Ektefaie @ vanendo

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