Effective anaesthesia of the acutely inflamed pulp: part 1. The acutely inflamed pulp

Achieving profound pulpal anaesthesia in a mandibular molar diagnosed with irreversible pulpitis can be argued to be the most testing of dental anaesthetic challenges. This can be attributed to the technical complexities of conventional techniques and the presence of pulp pathosis. Reasons for why the latter influences the ability to attain pulpal anaesthesia is not yet fully understood, but its frequent occurrence is well documented. In light of overcoming this it has become common practice to prescribe antibiotics, refer onto secondary care or to even commence treatment without appropriately anaesthetising the tooth. Therefore, this two part series aims to help practitioners attain clinically acceptable pulpal anaesthesia in the most testing of scenarios; the acutely inflamed mandibular molar. They should then be able to apply these same principles to other teeth presenting with similar symptoms. This section outlines the clinical presentation and pathophysiology associated with an acutely inflamed pulp, defines what it is to attain pulpal anaesthesia and critically analyses theories as to why these teeth are up to eight times more difficult to anaesthetise than their healthy counterparts.