A few of text book call to an status of dental pulp "hot tooth" where the tooth afected can be treate even using anesthesic agents cause the pain remaining. Anybody hear about this?
Thank you in advance.
Hi Alain,
You'll find a nice review about the topic in "Local Anesthesia Strategies for the Patient With a “Hot” Tooth. John M. Nusstein et al. Dent Clin North Am. Volume 54, Issue 2, April 2010, Pages 237–247. It's open acces on endoexperience.com. A "hot tooth" is the term used to refer a tooth with irreversible pulpitis, high pain and a low response to local anesthesia or even fail. There are multiple factors related to this problem, in special factors involving the inflammatory process. To overcome the situation, some authors have proposed to use pre-medication with NSAIDS before applying the local anesthetic to get better results on the blocking. Check also the paper of our team to know more about this strategy: Efficacy of preoperative ibuprofen on the success of inferior alveolar nerve block in patients with symptomatic irreversible pulpitis: a randomized clinical trial. Noguera et al. Int Endod J. 2013; 11; 1056. The paper is here in RG.
¡Saludos!
Bernardino
Dear Bernardino,
Thank you very much for your answer.
Best regards
Hot tooth or hot pulp is a tooth which either do not respond to LA or respond partially. Though the exact etiology is not been established the presence of chronic low grade infection in the pulp which interferes with the action of the local anesthetic. Treating a hot tooth is slightly frustrating to the clinician as in many cases patient complains of numbness in the anesthetized area but pulp remains sensitive. There are many clinical methods recommended to overcome this situation but difficult to recommend any one as a best or reliable one. Hence good to use combination techniques to achieve better possible pulpal anesthesia.
Hot tooth is a phenomenon in which the tooth with irreversible pulpitis does not respond to most routinely used local anesthesia like lidocaine. Patient though subjectively and objectively will have the classical signs of having achieved anesthesia but will not allow drilling of such a tooth in order to prepare the access cavity for root canal therapy to commence. Multiple factors may be responsible for this but commonest is due to presence of tetrodotoxin resistant site present in such patients. Premedication with NSAID have been very useful and the choice of anesthetic agent should be a long acting anesthetic agent like Macaine, and Articaine has also been very useful
Thank you for your very interesting answer Iyabode... Best regards.
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