Patients with acute pulpitis pose a significant anesthetic challenge. They often present with high pre existing pain levels and hypersensitivity to painful stimuli, producing substantial anxiety in both the patient and the practitioner. To date, practitioners have relied on several different management strategies to achieve anesthetic success. However, there is no general agreement about which strategy is most effective, despite numerous published studies on this topic . An assessment of current literature on this topic is needed to provide a comprehensive and informative appraisal of the current state of evidence regarding which anesthetic choice and which types of injections are most associated with successful pulpal anesthesia.