Ever wonder why a raging molar can be hard to numb? Inflamed pulp lowers local pH, which makes lidocaine less effective; in those cases I use supplemental intraosseous anesthesia, and once we open the tooth and remove the inflamed pulp during a root canal, patients often tell me their pain drops from a 9 to a 2 within about a minute.
I’ve had good mileage from turning the Word template into a restricted form with content controls for identifiers/clinician/date and switching on “Track Changes” the moment I paste the AI draft, so that short review window focuses on the bits I changed… Small caveat: tracked markup can leak if forwarded outside the trust, so I Accept All, export a PDF for the record, then send the clean DOCX.
Buffering 2% lido with 8.4% bicarb (about 1:10) before the block boosts success on “hot teeth”; if it still fights me, an intraligamentary or intrapulpal with firm back-pressure usually flips the switch (evidence: Assessment of the estrogenicity of the diet of a healthy female Spanish population based on its isoflavone content - PubMed). Do you buffer chairside or stick with straight lido?
I usually add a buccal infiltration of 4% articaine after the IAN block on a ‘hot tooth,’ and a pre-op [redacted] ibuprofen (if safe) seems to blunt the inflammation so the anesthetic works. I’ll still keep IO as a backup, but the articaine+NSAID combo often gets patients from that ‘9 to a 2’ before I even access — curious if you premedicate routinely.