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International Journal of Zoology and Applied Biosciences Review Article
The hot tooth: Beating the anesthetic barrier in endodontic emergencies
Shyam B, Vinay Kumar Reddy T, Vijay Venkatesh K, Seetha KK
Year : 2026 | Volume: 11 | Issue: 5 | Pages: 226-239
Received on: 03/06/2026
Revised on: 28/07/2026
Accepted on: 22/08/2026
Published on: 30/09/2026
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Shyam B, Vinay Kumar Reddy T, Vijay Venkatesh K, Seetha KK( 2026).
The hot tooth: Beating the anesthetic barrier in endodontic emergencies
. International Journal of Zoology and Applied Biosciences, 11( 5), 226-239.
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Abstract
The “hot tooth,” a tooth with symptomatic irreversible pulpitis that does not respond to traditional local anesthetic techniques, is one of the most challenging clinical scenarios in endodontics. This phenomenon is based on inflammation-induced peripheral sensitization, altered sodium channel expression, and tissue acidosis, resulting in reduced efficacy of the standard inferior alveolar nerve block (IANB) in mandibular teeth. This manuscript covers the current evidence on ten themes: definition and diagnostic criteria for the hot tooth; etiology and neurobiological basis; clinical features and differential diagnosis; challenges with local anesthesia; supplemental anesthetic strategies; pharmacological premedication; endodontic treatment approaches, including pulpotomy versus root canal therapy; postoperative pain management; psychological considerations; and evidence-based clinical recommendations. Recent advances in vital pulp therapy, bioceramic materials, and computer-controlled anesthesia delivery systems have expanded the clinician’s armamentarium. A systematic stepwise protocol with combined use of these modalities provides the best chance for a patient-centered pain-free endodontic treatment.
Keywords
Hot Tooth, Irreversible Pulpitis, Inferior Alveolar Nerve Block, Supplemental Anaesthesia.
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© The Author(s) 2026. This article is published by International Journal of Zoology and Applied Biosciences under the terms of the Creative Commons Attribution 4.0 International License (creativecommons.org), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
