What is the best method to confirm complete pulpal anesthesia before initiating endodontic treatment on a mandibular molar?

Confirming soft tissue anesthesia (numb lip/tongue) confirms nerve block success for the inferior alveolar nerve, but does NOT confirm pulpal anesthesia. The pulp may remain vital and sensitive even when the lip and tongue are numb — a phenomenon common in 'hot teeth' with symptomatic irreversible pulpitis. The gold standard for confirming pulpal anesthesia is a positive pulp vitality test response (cold test) followed by absence of response after anesthesia, or direct testing by probing the pulp chamber without pain. A cold test that elicits no response after anesthesia confirms adequate pulpal anesthesia before initiating access.