An IAN block was given for tooth #30. The patient got profound anesthesia of the lip and tongue but started getting pain when endo treatment began on the mandibular first molar. What should you do?

Correct answer: C. Give one more IAN block directing the needle bevel towards bone

• A. While articaine infiltrations can supplement IAN blocks in the mandible (better bone penetration), repeating the IAN block with bevel toward bone is the first-line approach per the source answer.
• B. Continuing while the patient is in pain is ethically and clinically inappropriate.
• C. When profound lip/tongue anesthesia confirms nerve block but intrapulpal pain persists (hot tooth/irreversible pulpitis with inflamed pulp harder to anesthetize), the recommended next step is to REPEAT THE IAN BLOCK with the needle BEVEL DIRECTED TOWARD BONE (Malamed technique). This achieves better periosteal deposition and additional diffusion. Alternatively, intraosseous or intrapulpal injection may be used.
• D. Waiting 90 minutes is excessive and would prolong patient suffering. The clinical response is immediate supplemental anesthesia.