Problems attaining local anesthesia with endodontic emergencies.

The attainment of profound local anesthesia in the management of pulpal and periradicular pain often eludes even the most skilled clinician; various reasons for this include, but are not limited to, localized inflammation, osseous and neural variations, and poor technique of the operator. This paper reviews these potential impediments while focusing on recognizing occurrences, understanding mechanisms, and applying clinical techniques to effectively eliminate their impact on dental pain management.