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<p>Strategies for Achieving Profound Pulpal Anesthesia in the Mandible<br>Richard Campbell, CAPT, DC, USN, John Allemang, CAPT, DC, USN (ret), Patricia Tordik, CAPT, DC, USN<br><br>Introduction<br>Studies on inferior alveolar nerve blocks (IANB) suggest that it is only 19% to 56% effective in achieving profound pulpal anesthesia in teeth with irreversible pulpitis. This may be explained by mandibular nerve anatomy and physiology. Nerves in the periphery of the mandibular bundle supply molar teeth while those closer to the core innervate incisors. Anesthetic solution is unable to diffuse into the nerve trunk in concentrations high enough to completely block impulses, resulting in higher anesthetic failure rates for mandibular anterior teeth. Neurons associated with inflamed tissue have altered resting potentials and decreased excitability thresholds. Tetrodotoxin-resistant sodium channels have increased expression in irreversibly inflamed pulp and are less sensitive to lo-cal anesthetics. Pre-existing pain and apprehension, the patient’s response to pain and the dentist’s approach may also lower pain thresholds.
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<br>Subjects: Anesthesia; Local; Anesthetics; Dental Pulp; Dentists</div>
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U.S. Navy. Naval Postgraduate Dental School</div>
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