Local anesthesia for endodontic pain

Why do patients avoid going to the dentist? According to a survey from the American Dental Association (1), fear of pain is the greatest factor that prevents patients from visiting their dentist. Additional surveys (2, 3) have found that 90% of dentists have some anesthetic difficulties during restorative dentistry procedures. In endodontics, Wallace and coworkers (4) surveyed Diplomates of the American Board of Endodontics and found 84% of the respondents did not achieve anesthesia after a clinically successful nerve block. Recognizing that adequate pulpal anesthesia is a clinical problem, we have performed research on local anesthesia over the last 17years. Some of the findings we are reviewing in this paper. Because failure occurs most often with the inferior alveolar nerve block (2), we would like first to concentrate on mandibular anesthesia.