Cocaine and Achieving Rapid Pulpal Anesthesia Prior to Extirpation.

Prior to the effective use of local anesthetics to achieve profound pulpal anesthesia before extirpation, whether in the form of a nerve block or infiltration, or in some cases the use of intrapulpal injections,1, 2 the clinician was faced with a challenge to ensure that the patient would be pain free during the procedure. In these cases the use of nitrous oxide and oxygen was common. Not so common was the use of cocaine or a solution of cocaine hydrochloride that was advocated to penetrate the dentinal tubules and create pulpal insensibility in the late 1800s.3, 4.