This strategy states that the patient s anticipated level of pain should be determined based on presenting symptoms, pulpal status, history of tolerance to pain, difficulty of the procedure, and other factors, and should be classified as mild, moderate or severe. For mild pain, an effective dose of nonnarcotic analgesic should be prescribed. If this is insufficient, or moderate pain is anticipated, a nonnarcotic-narcotic combination should be given. Careful pre-operative assessment of the pulpal status and the morphology of the tooth are necessary to devise a maximally effective plan to safely and accurately access into the root canal system. Every attempt should be made to remove as much of the pulp and diseased dentin from that system via chemomechanical debridement.
Various adjuncts are available which can enhance the practitioner s ability to do so.
Intracanal medication should be placed when it is believed that significant residual bacteria remain following instrumentation. It cannot be overemphasized that removal of the etiology is the most important factor in providing successful pulpectomy therapy. Treatment of deep caries. Principles and Practice of Endodontics . Reasons for local anesthesia failures .