1-SmileLineNewsSUM2021 - Flipbook - Page 23
When vertical cracks occur or they extend through the
pulpal floor (or below the level of the alveolar bone),
the prognosis is hopeless and the tooth should
Another subject drawing attention today is the changing
landscape of pain management for cracked teeth and/or
irreversible pulpitis (IP). A cracked tooth often presents
itself as a “HOT TOOTH” due to irreversible pulpitis.
When I was in training, it was sufficient to know that
local anesthetics work by blocking sodium channels.
Extensive research done by Dr. Kenneth Hargreaves D.D.S.,
PhD has revealed that these Na channels come in nine or
ten different flavors or classes. This new information was
featured in the American Association of Endodontists
podcast Episode 21, which was released on March 5.
Eight of these channels are easily blocked by Tetrodotoxin
(a neurotoxin found in nature) and by our local anesthetics.
On the other hand, two classes of Na channels are known
as TTX resistant. It is these two channels that are resistant
to local anesthetics. The two resistant channels (also
labeled NaV1.8 and NaV1.9) show up regulation of
six times and three times respectively in the presence of
We also are aware of the increased presence of
prostaglandins during IP which in turn may double
the intake of Na through the channels. Multiple clinical
trials have now shown that prophylaxis with NSAIDs
will decrease prostaglandin activity during IP and aid in
anesthetizing the hot tooth.
For instance, if we have a patient of known medical
history, and can take NSAIDs, we prophylactically
administer 400 - 600 mg of Ibuprofen before they come
for their appointment. If the patient is new and you clear
the past medical history for NSAIDs, you can administer
a fast-acting NSAID such as Advil Liqui-Gel or Ibuprofen
NaSalt 400 - 600mg, and have them wait while you see
another patient. Once you return, anesthesia should be
more manageable. For these cases requiring additional
anesthesia such as intra-pulpal or intraosseous infiltrate,
Articaine has shown to be 3x more effective than
The current consensus on managing the postoperative pain
is most definitely shifting away from narcotics, due to the
rise in the opioid crisis especially during the pandemic.
Dr. Lily Kaykha, D.M.D.
Dr. Lily Kaykha earned her Doctorate of Dental
Medicine from Tufts University in 1990. After
completing her D.M.D. degree, Dr. Kaykha received
her certificate for advanced studies in the field of
endodontics from Boston University's Henry M.
Goldman School of Dentistry in 1992 where she
was trained by Dr. Herbert Schilder, one of the
world leaders in the field of endodontics.
After graduation, Dr. Kaykha practiced as an
endodontist in the Boston area. She then was
married and moved to Long Island, New York
where she maintained a private practice limited to
endodontics for eleven years. During this time she
also volunteered as an associate clinic professor
at the Stony Brook School of Dental Medicine.
Dr. Kaykha started a private practice in the Monterey
Peninsula, where she currently resides with
She is a member of The American Association of
Endodontists, The California Dental Association,
The Monterey Dental Society, and The Monterey
Peninsula Chamber of Commerce. Outside of her
passion for endodontics, Dr. Kaykha enjoys spending
time with her two children and also finds pleasure
in exploring the beautiful Monterey Peninsula.
www.mbdsdentist.com I MONTEREY BAY SMILELINE – SUMMER 2021