Had a hot mandibular molar yesterday that needed an IAN block (2% lidocaine 1:100k), then buccal 4% articaine and PDL with a 30‑gauge before an intrapulpal finally let us instrument comfortably under rubber dam. Does anyone have a simple, printable protocol for assistant steps — pre-op NSAID timing, anesthesia sequence, when to add supplemental injections, and post-op pain check calls — that’s worked reliably chairside?
These expire so fast, . I got traction with @PATLive by attaching a 30‑second call-handling clip and a fast.com speed test, and by naming dental triage (new patient vs emergency) plus insurance eligibility in the first lines. “Apply promptly” is real, but if you miss the window, set alerts so you’re in the first review batch next time.
Made a one-page “hot molar” card: [redacted] ibuprofen 30–45 min pre‑op if appropriate (or 1,[redacted] acetaminophen if NSAIDs aren’t), then a 7‑min timer after the “2% lidocaine 1:100k” IAN; if no lip/tingle, we set up 4% articaine buccal + 30‑gauge PDL and have the intrapulpal ready. Quick EPT recheck before access; if still reactive, firm‑pressure intrapulpal for 5–10 seconds. Post‑op handout defaults to alternating ibuprofen 400–[redacted] and acetaminophen 500–1,[redacted] for 24 h.
Quick tip we use: assistant starts a 6‑minute countdown after the IAN, preps the PDL syringe and a snug rubber stop for intrapulpal, and if “lip is numb but tooth still yells,” we do a slow PDL on the mesial before re‑testing cold. We also schedule a post‑op text at 2–3 hours to catch rebound pain and only suggest alternating acetaminophen/ibuprofen if it’s medically appropriate. Clean printout to adapt: AAE pain management page https://www.aae.org/specialty/clinical-resources/pain-management/.
Switched to buffered 2% lido for the IAN and have the assistant warm the carpule to about 37°C; onset’s quicker and we rarely need more than the buccal 4% articaine before PDL on the real scorchers. We added a simple “cold at 4 min” Endo Ice check, and if it still pops, we prep intraosseous and often skip intrapulpal. Minor caveat: buffering adds a step unless you’ve got an Onset kit, but it’s been worth it; @b_jones1987, your card could slot those two.
On the assistant side, we stopped using a 30-gauge for the PDL and switched to a 27-short — less bend, better back-pressure — and I keep a tiny “intrapulpal” kit ready (pre-bent 27-g irrigating needle with a rubber stop and a dry cotton pellet) so the doc can seat it immediately under dam. If the IAN with 2% lidocaine 1:100k gives lip numbness but the tooth still screams, we jump to a quick Stabident intraosseous that I set up ahead — adds a minute but usually avoids chasing more shots, .