In this video, I have explained six strategies which are easy to understand, which will help anesthetize the hot tooth which were impossible to anesthetize by other means
Inconceivable pain and it did not stop even after repeated intrapulpal injection 14 times. My dentist took multiple days to process the RCT and I was in a lot of pain every appointment. The dentist told me that I am super sensitive to pain. For information, I had a broken arm to 45° once in my childhood and I recently went through a colonoscopy without any anesthesia and apart from this add to the list of sufferings in pain four times sprained ankle over time - nothing was as painful as this hot tooth during RCT.
Had a REALLY hot wisdom tooth a couple years ago, and ended up getting an intra-pulpal anesthesia. Yeah, it's painful... for about a couple of seconds. But not worse than the pain that you get from the hot tooth in the first place.
Omg sir where you were in so long. I always check out your channel for updates but it has been long scince you posted. Today i feel happy you are back again. No one beats your presentation whether its stepback or cavity preparation or on composite (That was really a masterpiece) I request you sir plz don't stop uploading video's and give us more clinical based knowledge of endodontics
Super interesting video. as a well read amateur dentist LOL (real M.D.) I can confirm mandibular molar and premolar RCT worse than other more anterior teeth. What about intraosseous injection?? for intractable pain???
Today I had hottest 36 of my 12 year old practice. After access opening pain was not there but after completing pre-Endo build up ,patient started getting pain in medial canals only. I repeated IANB again but not help. Access opening was made so pulpal anaesthesia was not a successful option. Had to reappoint the patient with anti inflammatory and antibiotic medication. 😢😢
What if we try to do intra pulpal even if u did access cavity , by using a cotton pellet at the orifice to give me some kind of closed canal enough to make it happen, and insert the needle through the cotton pellet and preform intra-pulpal anaesthesia . What do you think DR of this technique?
@@AhmadM-on6vb Cotton pellet may not be adequate to withstand the high pressure during intrapulpal injection. I wish instead we shall use thin needle and inject inside each canal separately. I have found this very effective
Why wasn't intraossious injection mentioned here? I had an intrapulpal injection during a root canal of a mandibular lateral incisor which was absolutely the worst pain I've ever felt. In reading since then I have found multiple sources (all from dental professionals or professional associations) stating that intrapulpal injection should be an absolute last resort, as well as a number of similar sources indicating that the intraossious injection is significantly less painful while being up to 90% effective. Is this not correct?
Doctor Benin I have problem with alcoholic patients ,, 28 yo patient ex-smoker and alcoholic , with a class 2 caries on lower 6 not endodontically involved , so he doesn't even have hot tooth ,, I did 2 blocks with second block at higher level , buccal lingual infiltrations , pdl injections twice all around the tooth at 4 corners ,mid-buccal and mid-lingual , everything is anesthetized except the tooth , and was about only 2.5 mm deep in the cavity occlusally , so I left some caries behind and put ZOE temp. for couple weeks , hopefully get better result next time , maybe it will not help ,, what's your opinion pls
Hello Doctor Hama..... This looks very strange as the cavity depth is very less. I guess the following 1. DEJ is a more sensitive area while caries excavation compared to other depths within dentine. So at the level of DEJ the pain or sensitivity may be more apprehended by the patient. I guess the cavity depth of 2.5 mm could be exactly at DEJ. May be a deeper depth may resolve the situation. Although it has no scientific support, few drops of LA solution kept for a minute inside the cavity in a cotton pellet can relieve the extreme sensitivity or pain in some patients 2. I occasionally get patients with extreme pain or sensitivity in teeth having old restoration, most often tooth would be non-vital. Any vital tooth definitely would get anesthetized by these injections 3. One of the senior faculty working in my institution (who is also an Endodontist) has the same condition. His tooth never gets anesthetized whatever the technique is and how many injections are given. May be there is something beyond our understanding. Thanks a lot for initiating the discussion .....
@@smartdentistry thank you doctor , I'm sure the tooth is vital , simple air stream from air-syringe is painful , slow speed handpiece was a little bit less painful I think the air and water from turbine were the most painful ,, I had another example , irreversible pulpitis on lower premolar "also alcoholic patient" . And another alcoholic young patient that wasn't numb and dismissed with prescription , saw him another day and said that he got numb when he reached home about 40 minutes after the injections , and he enjoyed eating kebab on that tooth when he was numb haha
well, in Russia we can use paraformaldehyde devitalisation . I know it is banned in Europe, but it really helps with these cases. Sometimes Articaine doesn’t work, not intrapulpal, not intraseptal
Yes. We shall use paraformaldehyde but occasionally it could give extreme pain for the patient for couple of days. So whenever we are placing paraformaldehyde, a passive placement of the material followed by passive placement of temporary filling material without pushing it deep, thus making the pulp devitalizing material not coming under pressure with the pulp
Hi. Thank you for such a informative video. I have been practicing for almost 12 years. One thing i have come across is that incidence of low anaesthetic effect is more in patients with pulp stones compared to patients without pulp stones.is there any relevant study for this?
Sedation dentistry will be helpful to calm down an apprehensive patient. But whether sedation would be alternative to anesthesia is highly questionable..
Thanks for the video, sir. Last week a patient have come with pain in lower molar. But the tooth had opened before me and then i had problem even when i determined the working length. I used every possible anaesthesia plus intrapulpal but without success. What do you recommend?
Lidocaine works about as well as articaine for IAN, and doesn't have as many reports of paresthesia, so probably safer to use lido for the IAN. Articaine works better than lidocaine for B infiltration (and perhaps L), and pretty much no risk of paresthesia here. After soft tissue signs of numbness, check with cold test. When necessary, consider intraosseous before intrapulpal. You and patient will be much happier!
@@nihadabdulhameed7365 Thank you for the question. There are two systems commonly available in the U.S., X-tip and Stabident. (Though I'm not sure if Stabident is still on the market, it was not available for a few months anyway.) With either system, you have to perforate the cortical plate first with a hole just large enough to allow the guide sleeve (X-tip) or needle (Stabident). If you can find a dental colleague who also wants to learn (and you trust) you can practice on each other.
Very late ...but if someone could give some advice --lower 1st molar 2 nerve blocks ,intraligamentary ,infil, even intrapuplal was given ...by me as well as my professor but the said Hot tooth was still "hot" what can else could have been done for the patient??
@@smartdentistry i tried that doctor, the patient was complaining of pain whenever i attempt that.. So i had to let him go under metronidazol. His next appointment went smooth like butter.. But still worried of getting patients in similar situations in the future.. 😢😢
Hi sir Can you make a video about devitalizing agents during RCT In many clinical practice after acess opening they are placing a cotton soaked with formocresol in the acess cavity Is it correct method or not - I think formocresol is for pulpotomy Is it good to use devitalizing agent after acess opening or not in every patient In case of large pulp root canal like canine - I experienced uncontrollable bleeding from the canal even after complete cleaning and shaping -in one patient I had enlarged canal upto F3 size whenever I flood the canal with Hypochloride and I activate with endo activator I experience a uncontrollable bleeding from the canal - can you please share your ideas about it sir
Kindly watch tip No:6 in in the video which I already uploaded czcams.com/video/Jdq6B6uBDgw/video.html After watching that, we shall have a discussion Thank you
@@smartdentistry Hi sir I had watched the video Thank you sir my doubts got cleared And one final question sir please share your ideas sir If there is vital pulp with pain in patient not cooperative to place even a file to extrupate the pulp and further shaping We can place devitalizing paste and ask the patient to come at next appointment where the pulp will get necrosed we might easily remove it without pain What is the normal duration between appointment after placing devitalizing paste and shaping of canal - sir you said we should not place it for longer duration in the canal - what is the duration period in your opinion sir Recently I came across a patient with non vital open cavity to pulp in 11 with history of pain and normal gingiva with no swelling where I started cleaning and shaping with step back preparation method and placed intra canal medicament calcium hydroxide - closed dressing placed and sealed the acess cavity & the after two days patient reported with huge swelling in the mucobuccal fold in relation to 11 with no pain and the swelling rupture on its own. What might be the cause for these swelling in your opinion sir Some practioners are advicing to give open dressing with cotton pellets in these case what's your opinion about it sir
Why not just go to intrapulpal first? It's going to be a painful procedure for your patient anyway right? C'mon. No. The ONLY goal for the patient with a hot tooth is PAIN RELIEF- not having the dentist go down some useless treatment rabbit hole employing Draconian techniques like intrapulpal anesthesia, as this will very likely cause even more stress and pain anyway. This is a horrible and fruitless experience for all involved - and yet it is 100% avoidable. Highly inflamed (HOT) pulps DO NOT ANESTHETIZE - In the 21st century, use of a steroid anti-inflammatory eg., dexamethasone 4mg bid for 3-4 days to cover inflammation-based pain, an appropriate antibiotic and opiate pain medication like Tylenol #3 or Tramacet is needed ASAP. This pharmacologic shot-gun approach will produce the pain relief for your patient which again is the Actual treatment of the tooth later on in the necroticprocess once the pain crisis has been managed is a far better approach.
Thanks for your opinion. But pharmacological management for hot tooth is better said than done. The pain will be extremely severe and may not respond to drugs. Anyhow.... opinion differs ....
intrapulpar is the last choice, antibiotics are not going to work , there is no sistemic infection. Opioids are addictive and you dont know how much opioid will be neeed for a hot tooth so is dangerous and not recommended. Even with corticoids if you are going to drill and acces to the pulp can be very painful. The way to treat this is with paracetamol, ibuprofen or metamizol.
Inconceivable pain and it did not stop even after repeated intrapulpal injection 14 times. My dentist took multiple days to process the RCT and I was in a lot of pain every appointment.
The dentist told me that I am super sensitive to pain. For information, I had a broken arm to 45° once in my childhood and I recently went through a colonoscopy without any anesthesia and apart from this add to the list of sufferings in pain four times sprained ankle over time - nothing was as painful as this hot tooth during RCT.
I had the same. Also had it with a tooth removal. Feeling the dentist break the tooth apart to remove it sucked
Beautiful explanation with practical techniques. Thank you very much for sharing, sir.
Had a REALLY hot wisdom tooth a couple years ago, and ended up getting an intra-pulpal anesthesia. Yeah, it's painful... for about a couple of seconds. But not worse than the pain that you get from the hot tooth in the first place.
Yes sir.... as a last resort, intra pulpal injections are helpful for the tooth that cannot be anesthetized by any other techniques....
Omg sir where you were in so long.
I always check out your channel for updates but it has been long scince you posted.
Today i feel happy you are back again. No one beats your presentation whether its stepback or cavity preparation or on composite (That was really a masterpiece)
I request you sir plz don't stop uploading video's and give us more clinical based knowledge of endodontics
Thanks a lot. I am sorry I was away for a bit long time. I will be regular from now onwards...
Same here
Great info. As always. Thank you.
Really helpful sir👌
Super interesting video. as a well read amateur dentist LOL (real M.D.) I can confirm mandibular molar and premolar RCT worse than other more anterior teeth. What about intraosseous injection?? for intractable pain???
Yes. That is definitely an option. In the future it sure will become an option in clinical practice.
great presentation!!!
Thank you!
Sometimes i use nerve to mylohyoid anesthesia for hot pulp in lower molars
Great .....👍
Thanks 😊
Helpful ❤
Thank u so much for the guidance 😊
My pleasure 😊
Really very informative!!
Thank you...
Thanks for sharing sir...
Most welcome
Today I had hottest 36 of my 12 year old practice. After access opening pain was not there but after completing pre-Endo build up ,patient started getting pain in medial canals only. I repeated IANB again but not help. Access opening was made so pulpal anaesthesia was not a successful option. Had to reappoint the patient with anti inflammatory and antibiotic medication. 😢😢
Try to give buccal infiltration with Articaine. I find it very effective in many cases
What if we try to do intra pulpal even if u did access cavity , by using a cotton pellet at the orifice to give me some kind of closed canal enough to make it happen, and insert the needle through the cotton pellet and preform intra-pulpal anaesthesia . What do you think DR of this technique?
@@AhmadM-on6vb Cotton pellet may not be adequate to withstand the high pressure during intrapulpal injection. I wish instead we shall use thin needle and inject inside each canal separately. I have found this very effective
@@smartdentistrythanks for sharing 😊❤
@@smartdentistrywhat gauge needle ??
use articaine it's also helpful sir........but i used only septodent
Sir, 5th is good suggestion. Thanks.
Does cool anaesthetic agent for intra pulpal anaesthesia better?
Now i understand what is happening to me today . In the process of root canal i feel pain
Why wasn't intraossious injection mentioned here? I had an intrapulpal injection during a root canal of a mandibular lateral incisor which was absolutely the worst pain I've ever felt. In reading since then I have found multiple sources (all from dental professionals or professional associations) stating that intrapulpal injection should be an absolute last resort, as well as a number of similar sources indicating that the intraossious injection is significantly less painful while being up to 90% effective. Is this not correct?
Doctor Benin I have problem with alcoholic patients ,, 28 yo patient ex-smoker and alcoholic , with a class 2 caries on lower 6 not endodontically involved , so he doesn't even have hot tooth ,, I did 2 blocks with second block at higher level , buccal lingual infiltrations , pdl injections twice all around the tooth at 4 corners ,mid-buccal and mid-lingual , everything is anesthetized except the tooth , and was about only 2.5 mm deep in the cavity occlusally , so I left some caries behind and put ZOE temp. for couple weeks , hopefully get better result next time , maybe it will not help ,, what's your opinion pls
Hello Doctor Hama..... This looks very strange as the cavity depth is very less. I guess the following
1. DEJ is a more sensitive area while caries excavation compared to other depths within dentine. So at the level of DEJ the pain or sensitivity may be more apprehended by the patient. I guess the cavity depth of 2.5 mm could be exactly at DEJ. May be a deeper depth may resolve the situation. Although it has no scientific support, few drops of LA solution kept for a minute inside the cavity in a cotton pellet can relieve the extreme sensitivity or pain in some patients
2. I occasionally get patients with extreme pain or sensitivity in teeth having old restoration, most often tooth would be non-vital. Any vital tooth definitely would get anesthetized by these injections
3. One of the senior faculty working in my institution (who is also an Endodontist) has the same condition. His tooth never gets anesthetized whatever the technique is and how many injections are given. May be there is something beyond our understanding.
Thanks a lot for initiating the discussion .....
@@smartdentistry thank you doctor , I'm sure the tooth is vital , simple air stream from air-syringe is painful , slow speed handpiece was a little bit less painful I think the air and water from turbine were the most painful ,, I had another example , irreversible pulpitis on lower premolar "also alcoholic patient" . And another alcoholic young patient that wasn't numb and dismissed with prescription , saw him another day and said that he got numb when he reached home about 40 minutes after the injections , and he enjoyed eating kebab on that tooth when he was numb haha
Acute pulpitis cases tooth can't be anaesthetised 1st visit.
Helpful sir
Nice tips dear
Thanks for liking
Sir u r awesome thq very
much
Most welcome
Good vedio
Thank you
well, in Russia we can use paraformaldehyde devitalisation . I know it is banned in Europe, but it really helps with these cases. Sometimes Articaine doesn’t work, not intrapulpal, not intraseptal
I also heard some reports that 400-600 mg of Ibuprofen taken before treatment can help
Yes. We shall use paraformaldehyde but occasionally it could give extreme pain for the patient for couple of days. So whenever we are placing paraformaldehyde, a passive placement of the material followed by passive placement of temporary filling material without pushing it deep, thus making the pulp devitalizing material not coming under pressure with the pulp
Hi. Thank you for
such a informative video. I have been practicing for almost 12 years. One thing i have come across is that incidence of low anaesthetic effect is more in patients with pulp stones compared to patients without pulp stones.is there any relevant study for this?
Good one. I have never thought about this. Let me concentrate in upcoming cases.. Thanks for this eye opener.
The intra-pulpal injection is very painful. Would sedation dentistry where the patient is asleep work instead?
Sedation dentistry will be helpful to calm down an apprehensive patient. But whether sedation would be alternative to anesthesia is highly questionable..
Thanks for the video, sir. Last week a patient have come with pain in lower molar. But the tooth had opened before me and then i had problem even when i determined the working length. I used every possible anaesthesia plus intrapulpal but without success. What do you recommend?
Take an xray to see what the cause could be, if the tooth is beyond saving, extraction may be the best route
Watched all three videos about rct.very much educative & helpful. Thank you for making such wonderful videos sir.
Thanks and welcome
I have gone through the intra pulpal process but still its not working.plz share something’s else 😢
Lidocaine works about as well as articaine for IAN, and doesn't have as many reports of paresthesia, so probably safer to use lido for the IAN.
Articaine works better than lidocaine for B infiltration (and perhaps L), and pretty much no risk of paresthesia here.
After soft tissue signs of numbness, check with cold test.
When necessary, consider intraosseous before intrapulpal. You and patient will be much happier!
Thanks a lot for your valuable suggestions....
How to do intraosseues anesthesia
@@nihadabdulhameed7365 Thank you for the question. There are two systems commonly available in the U.S., X-tip and Stabident. (Though I'm not sure if Stabident is still on the market, it was not available for a few months anyway.) With either system, you have to perforate the cortical plate first with a hole just large enough to allow the guide sleeve (X-tip) or needle (Stabident). If you can find a dental colleague who also wants to learn (and you trust) you can practice on each other.
@@duggyfresh44 hmm both stabident and xtip not available in india
@@nihadabdulhameed7365 sorry, that's all I've got
Very late ...but if someone could give some advice --lower 1st molar 2 nerve blocks ,intraligamentary ,infil, even intrapuplal was given ...by me as well as my professor but the said Hot tooth was still "hot" what can else could have been done for the patient??
We can try articaine infiltration In many cases, I find it very helpful
Today i had a very hard time dealing with hot tooth.. I tried nerve block and infiltrations.. It didn't work..
Intrapulpal injection would be helpful....but to give intrapulpal injection we need certain amount of anesthesia.
@@smartdentistry i tried that doctor, the patient was complaining of pain whenever i attempt that.. So i had to let him go under metronidazol. His next appointment went smooth like butter.. But still worried of getting patients in similar situations in the future.. 😢😢
Very informative, thank you sir🙏
Most welcome
Sir please do videos on retreatment
Sure .. I will make soon ..
My doc injected 4 local anaesthesia still its not getting numb// i can’t extract or root-canal plz provide some knowledge if anyone knows ❤
Left mine today with an appointment in a week to go to sleep.
I need update from both of you I'm going through the same I had to leave mid appointment because the pain was unbearable
Its impossible in 1st visit if tooth pain is acute pulpitis. History of hot cold few days ago
.
yes
Two carpule lido IA or septo
Lidocaine
@@smartdentistry ma man
Hi sir
Can you make a video about devitalizing agents during RCT
In many clinical practice after acess opening they are placing a cotton soaked with formocresol in the acess cavity
Is it correct method or not - I think formocresol is for pulpotomy
Is it good to use devitalizing agent after acess opening or not in every patient
In case of large pulp root canal like canine - I experienced uncontrollable bleeding from the canal even after complete cleaning and shaping -in one patient I had enlarged canal upto F3 size whenever I flood the canal with Hypochloride and I activate with endo activator I experience a uncontrollable bleeding from the canal - can you please share your ideas about it sir
Kindly watch tip No:6 in in the video which I already uploaded
czcams.com/video/Jdq6B6uBDgw/video.html
After watching that, we shall have a discussion
Thank you
@@smartdentistry
Hi sir
I had watched the video
Thank you sir my doubts got cleared
And one final question sir please share your ideas sir
If there is vital pulp with pain in patient not cooperative to place even a file to extrupate the pulp and further shaping
We can place devitalizing paste and ask the patient to come at next appointment where the pulp will get necrosed we might easily remove it without pain
What is the normal duration between appointment after placing devitalizing paste and shaping of canal - sir you said we should not place it for longer duration in the canal - what is the duration period in your opinion sir
Recently I came across a patient with non vital open cavity to pulp in 11 with history of pain and normal gingiva with no swelling where I started cleaning and shaping with step back preparation method and placed intra canal medicament calcium hydroxide - closed dressing placed and sealed the acess cavity & the after two days patient reported with huge swelling in the mucobuccal fold in relation to 11 with no pain and the swelling rupture on its own.
What might be the cause for these swelling in your opinion sir
Some practioners are advicing to give open dressing with cotton pellets in these case what's your opinion about it sir
X-tips
Why not just go to intrapulpal first? It's going to be a painful procedure for your patient anyway right? C'mon. No.
The ONLY goal for the patient with a hot tooth is PAIN RELIEF- not having the dentist go down some useless treatment rabbit hole employing Draconian techniques like intrapulpal anesthesia, as this will very likely cause even more stress and pain anyway. This is a horrible and fruitless experience for all involved - and yet it is 100% avoidable.
Highly inflamed (HOT) pulps DO NOT ANESTHETIZE -
In the 21st century, use of a steroid anti-inflammatory eg., dexamethasone 4mg bid for 3-4 days to cover inflammation-based pain, an appropriate antibiotic and opiate pain medication like Tylenol #3 or Tramacet is needed ASAP. This pharmacologic shot-gun approach will produce the pain relief for your patient which again is the Actual treatment of the tooth later on in the necroticprocess once the pain crisis has been managed is a far better approach.
Thanks for your opinion. But pharmacological management for hot tooth is better said than done. The pain will be extremely severe and may not respond to drugs. Anyhow.... opinion differs ....
intrapulpar is the last choice, antibiotics are not going to work , there is no sistemic infection. Opioids are addictive and you dont know how much opioid will be neeed for a hot tooth so is dangerous and not recommended. Even with corticoids if you are going to drill and acces to the pulp can be very painful. The way to treat this is with paracetamol, ibuprofen or metamizol.
@@smartdentistry Right. Follow my advice and you'll be able to better serve your patients without exposing them the hellish pain.
@@jalubo420
@@jalubo420 Wow. You must be right out of dental school. Go ahead and manage your patients on your own advice and see where that gets you. Godspeed.