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Hot tooth

Hot tooth does not mean a tooth of excessive attractiveness or a tooth with exothermic reaction.

It normally refers to a pulp that has been diagnosed with irreversible pulpitis (Symptomatic Irreversible Pulpitis) with spontaneous, moderate-to severe pain.  Significance of Hot Tooth is that it is difficult to anesthetize, creating an emotional appeal of root canal procedure being a painful and frightful experience.

For instance, the inferior alveolar nerve (IAN) block is associated with a lapse rate of 15% in patients with normal tissue, whereas IAN fails 44-81% of the time in patients with irreversible pulpitis.

A typical example of hot tooth is a patient sitting in the waiting room, sipping on a large glass of ice water to help control the pain.

Causes for Anesthetic failure in Patients with a Hot Tooth

  • Local anesthetics commonly fail in endodontic patients with inflamed tissue. Inflamed tissue has a lower pH, which bring down the amount of the base form of anesthetic that invade the nerve membrane. Consequently, smaller extent of the ionized form is available in the nerve to attain anesthesia.
  • Another factor might be the tetrodotoxin resistant (TTX-R) sodium channels. These channels are relatively resistant to local anesthetics, are sensitized by prostaglandins and are more in inflamed dental pulp.
  • Activation of nociceptors in the occurrence of inflammation is one of the strongest theories explaining the lower efficacy of anesthesia.

Management of Hot Tooth

  • Supplemental injections
  • Intraligamentary (Periodontal Ligament) injection
  • Intraosseous Injection
  • Mandibular Buccal Infiltration Injection with Articaine
  • Intrapulpal Injection
  • Oral medications like acetaminophen and ibuprofen before treatment has hopes of improving the success rate of the IANB injection

To learn more about the techniques and improve your skills in dentistry, contact our counselors today.

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