Mechanisms and Management

Successful management of pain emergencies is a strong component of clinical excellence. Although clinical studies indicate that comparatively few patients experience pain after endodontic procedures, it has been estimated that about 20% of patients experience moderate-to-severe pain after treatment (1, 2, 3). An additional small fraction of patients (about 1– 2%) will experience a sudden ‘flare-up’ of severe pain or swelling after endodontic treatment. To compound the problem, the clinical management of endodontic patients is often problematic due to inadequate local anesthesia. Many of these issues will be reviewed in articles in subsequent issues of Endodontic Topics, which will summarize the latest clinical research and relevant biological foundations from the perspective of providing guidance for the efficient and effective management of endodontic pain conditions. In this inaugural issue, we will review the problem of local anesthetic failures in endodontic patients. Why are local anesthetics less effective in endodontic pain patients? How can we better identify these patients before treatment? And, more importantly, what is the best current evidence available for recommending strategies in producing clinically acceptable anesthesia in these patients?