LOCAL ANESTHESIA WORKSHEETS

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Define Local infiltration/supraperiosteal:

Small terminal nerve endings in the area of the dental treatment are flooded with local anesthesia solution. Incision is made into the same area in when local anesthesia has been deposited.

Define Field block:

Local anesthesia solution is deposited near the larger terminal nerve branches So the anesthetized area will be circumscribed preventing the passage of impulses from the tooth to the CNS. Incision or treatment is made into an area away from injection site max. injections made above apex of tooth are properly termed field blocks.

Define Nerve block

local anesthesia is deposited close to main trunk usually at a distance from the site of operative intervention. Examples P S A and I A

Supraperiosteal injection (infiltration):
What area (hard and soft tissues) will be anesthetized?

Pulp and root of the tooth, buccal periosteum, connective tissues, and mucous membrane

Supraperiosteal injection (infiltration):
What nerves will be anesthetized?

The large terminal branches of the dental plexus

Supraperiosteal injection (infiltration):
Why would you want to do this injection (indications and advantages)?

Indications: Pulpal anesthesia of maxillary teeth as apposed to a block
Advantages: High accurate rate technically easy injection usually atraumatic

Supraperiosteal injection (infiltration):
List some contraindications and disadvantages

contraindications: Infection or acute inflammation in area of injection and dense bone covering apices of teeth
disadvantages: not recommended for large areas because of the need for multiple needle insertions and the necessity to administer larger total volume of local anesthesia

Supraperiosteal injection (infiltration):
What is the risk of positive aspiration?

negligible, but less than 1% possible

Supraperiosteal injection (infiltration):
What length and gauge needle will you use?

25-27 gauge short needle

Supraperiosteal injection (infiltration):
What is the area of insertion?

height of mucobuccal fold above apex of tooth being anesthetized

Supraperiosteal injection (infiltration):
What is the target area?

apical region of tooth to be anesthetized

Supraperiosteal injection (infiltration):
What is the length of the root of this tooth, and why is that significant?

16.1 mm length of the root. This is significant because you have to advance the needle until the bevel is at or above the apical region of the tooth

Supraperiosteal injection (infiltration):
What landmarks are you looking for?

mucobuccal fold, crown of tooth, root contour of the tooth

Supraperiosteal injection (infiltration):
How is the bevel of the needle oriented, and why?

orient needle bevel towards the bone and to prevent tearing of the peiosteum

Supraperiosteal injection (infiltration):
How should the syringe be held, in relation to the tooth?

hold the syringe parallel with the long axis of the tooth

Supraperiosteal injection (infiltration):
How deep does the needle penetrate the soft tissue here?

only a few milimeters

Supraperiosteal injection (infiltration):
Is it necessary to contact bone before administering the anesthetic solution?

No

Supraperiosteal injection (infiltration):
Is a fulcrum necessary?

Yes

Supraperiosteal injection (infiltration):
When do you aspirate?

Aspirate two times. When the needle is a few milimeters in the soft tissue and once again if the first aspiration was negative

Supraperiosteal injection (infiltration):
How much anesthetic solution should be deposited?

0.6 ml = 1/3 cartridge

Supraperiosteal injection (infiltration):
What does it mean if there is "ballooning"of the soft tissue during or after the injection?

anesthetic was delivered too quickly

Supraperiosteal injection (infiltration):
What are safety features for this injection?

normal risk of intravascular administration and slowness of injection aspiration

Supraperiosteal injection (infiltration):
Why might you have failure of anesthesia with this injection?

needle tip below apex of tooth, resulting in soft tissue anesthesia only
needle tip too far from the bone and solution deposited in the buccal soft tissue only

Middle Superior Alveolar Nerve Block (MSA)
What nerves are anesthetized with this injection?

middle superior alveolar nerve and it's terminal branches

Middle Superior Alveolar Nerve Block (MSA)
What areas (hard and soft tissues) are anesthetized with this injection?

pulps Maxillary 1st and 2nd premolars and Mesial Buccal root of 1st molar, buccal periodontal tissues and bone over the same teeth

Middle Superior Alveolar Nerve Block (MSA)
Is it necessary to administer this injection on all patients when scaling in this area? Why or why not? What are the indications and advantages for this injection?

No, because the MSA is present in 28% of the population.
Indications: When the I O nerve block fails to provide pulpal anesthesia distal to the maxillary canines and when dental procedures involve both maxillary premolars only.
Advantages: Minimizes the number of injections and volume of solution

Middle Superior Alveolar Nerve Block (MSA)
List any contraindications and disadvantages for this injection.

Contraindications: infection or inflammation in area of needle injection or needle insertion or drug deposition. Where the MSA nerve is absent. Innervations is through the ASA nerve these branches can be anesthetized using MSA technique.
No disadvantages

Middle Superior Alveolar Nerve Block (MSA)
What is the best alternative to this injection, in order to anesthetize from the central incisor through the 2nd premolar?

Local infiltrations, P D L, or I O injections

Middle Superior Alveolar Nerve Block (MSA)
What is the MOST likely needle length and gauge size to be used?

27 gauge short needle

Middle Superior Alveolar Nerve Block (MSA)
What is the area of insertion?

height of the mucobuccal fold above the maxillary 2nd pre-molar

Middle Superior Alveolar Nerve Block (MSA)
What is the target area?

maxillary bone above the apex of the maxillary 2nd pre-molar

Middle Superior Alveolar Nerve Block (MSA)
How is the bevel oriented?

toward bone

Middle Superior Alveolar Nerve Block (MSA)
How far is the needle advanced? Should you touch bone with the needle tip?

Into the height of the mucobuccal fold.
No bone is contacted.

Middle Superior Alveolar Nerve Block (MSA)
How much anesthetic solution should you deposit?

0.9 to 1.2 ml = ½ -2/3 cartridge

Middle Superior Alveolar Nerve Block (MSA)
What are the causes of failure of anesthesia from this injection?

anesthetic solution not deposited high enough the apex of the second premolar
deposition of the anesthetic delivered too far from the maxillary bone
bone of the zygomatic arch at the site of injection preventing the diffusion of anesthetic

Posterior Superior Alveolar Nerve Block (PSA)
What nerves are anesthetized with this injection?

Posterior superior alveolar and branches

Posterior Superior Alveolar Nerve Block (PSA)
What hard and soft tissues are anesthetized?

pulps the of maxillary 3rd, 2nd, and 1st molar with the exception of the Mesial Buccal root of the Maxillary 1st molar and Buccal periodontum and bone overlying these teeth.

Posterior Superior Alveolar Nerve Block (PSA)
How successful is this injection?

highly successful more than 95 %

Posterior Superior Alveolar Nerve Block (PSA)
State the advantages and indications for this injection.

Indication: when treatment involves 2 or more molars; when supraperiosteal (local infiltration) is contraindicated or has been ineffective.
Advantages: when administered properly, no pain is experienced due to the large area of soft tissue the anesthetic is deposited into and no bone is contacted. High success rate. Minimizes the number of injections needed when compared to infiltration and minimizes amount of anesthesia administered

Posterior Superior Alveolar Nerve Block (PSA)
State the disadvantages and contraindications for this injection.

Contraindications: when the risk of hemorrhage is too great (hemophiliac) in which case a suprepereosteal or PDL is recommended
Disadvantages: risk of hematoma, technique is somewhat arbitrary due to no bony landmarks and Second injection necessary for treatment on Mesial Buccal root of 1st molars in 28% of patients

Posterior Superior Alveolar Nerve Block (PSA)
What length and gauge of needle is MOST likely to be used for this injection?

a 25 or 27 gauge short needle

Posterior Superior Alveolar Nerve Block (PSA)
What is the area of insertion?

height of the muccobuccal fold above the maxillary 2nd molar

Posterior Superior Alveolar Nerve Block (PSA)
What is the target area?

PSA nerve-posteriors, superiors, and medial to the posterior border of the maxilla

Posterior Superior Alveolar Nerve Block (PSA)
What are the landmarks?

muccobuccal fold, maxillary tuberosity, and zygomatic process of the maxilla

Posterior Superior Alveolar Nerve Block (PSA)
How is the bevel of the needle oriented?

bevel of the needle toward bone

Posterior Superior Alveolar Nerve Block (PSA)
How do you access the area to insert the needle properly?

For left P S A nerve block, a right handed administer should sit at the 10 o'clock position facing the patient
For a right P S A never block, right handed administer should sit at 8 o'clock position facing the patient.

Posterior Superior Alveolar Nerve Block (PSA)
How is the needle advanced, and at what angles, in order to reach the site of the deposit of the anesthetic?

advanced needle slowly upward, inward and backward in one movement (not three)
upward - superiorly at a 45 degree angle to the occlusal plane
inward - medially toward the midline at a 45 degree angle to the occlusal plane
backward - posteriorly at the 45 degree angle to the long axis of the 2nd molar

Posterior Superior Alveolar Nerve Block (PSA)
Should you contact bone with the needle with this injection?

no

Posterior Superior Alveolar Nerve Block (PSA)
How far should the needle penetrate for this injection?
How much of the needle should remain visible when at the proper depth of penetration?

normal size adult; 16 mm places the needle tip in the immediate vicinity of the foramina through which the P S A nerves enter the posterior surface of the maxilla. With a short needle (average length 20 mm), approximately 4 mm should remain visible

Posterior Superior Alveolar Nerve Block (PSA)
Discuss aspiration techniques for this injection. Is positive aspiration likely?

aspirate in 2 planes- rotate syringe barrel (needle bevel) ¼ turn to re-aspirate.
Positive aspiration is 3.1 % (likely)

Posterior Superior Alveolar Nerve Block (PSA)
How much anesthetic solution should be deposited for this injection?

0.9 - 1.8 ml of anesthetic solution

Posterior Superior Alveolar Nerve Block (PSA)
What precautions should be taken with this injection?

depth of the needle penetration should be checked
over insertion (too deep) increases risk of hematoma
Too shallow might still provide adequate anesthesia

Posterior Superior Alveolar Nerve Block (PSA)
What are the causes and remedies for failure of anesthesia from this injection?

Needle too lateral-correction—redirect needle tip medially.
Needle not high enough -correction—redirect needle tip superiorly
Needle too far posterior—correction--- withdraw needle to proper depth.

Posterior Superior Alveolar Nerve Block (PSA)
Discuss the 2 major complications from this injection.

1.- hematoma--- produced by over insertion of needle into the pterygoid plexus of veins. Max. artery may also be perforated. Hematoma develops in the buccal tissue within minutes.
2.- Mandibular anesthesia---V3 is located lateral to PSA nerve. Deposition of anesthetic lateral to desired location may produce varying degrees of mandibular anesthesia.

Anterior Superior Alveolar Nerve Block (ASA) or Infraorbital Nerve Block
What nerves are anesthetized with this injection?

ASA, MSA, and IO nerves : inferior palpebral , lateral nasal,and superior labial

Anterior Superior Alveolar Nerve Block (ASA) or Infraorbital Nerve Block
What areas (hard and soft tissues) are anesthetized with this injection?

Pulps of maxillary central incisors through canines on injected side and Mesial Buccal root of the 1st molar. Buccal (labial) periodontium and bone of the same teeth. Lower eyelid, lateral aspect of the nose, and upper lip

Anterior Superior Alveolar Nerve Block (ASA) or Infraorbital Nerve Block
What are the indications and advantages for this injection?

Indications: dental procedures involving more than 2 max. teeth and their overlying buccal tissues. Inflammation or infection (which contraindicates supraperiosteal injection); if cellulitis is present, the maxillary nerve block may be indicated in lieu of the I O nerve block. When supraperiosteal injections have been ineffective because od dense cortical bone.
Advantages: simple technique; comparatively safe with minimal amounts of anesthesia solution used and needle punctures.

Anterior Superior Alveolar Nerve Block (ASA) or Infraorbital Nerve Block
List any contraindications and disadvantages for this injection.

Contraindications: discrete treatment areas (1-2 teeth only), hemostasis of localized area can not be achieved adequately.
Disadvantages: psychological fear for the administrator, anatomical difficulty defining landmarks and for patients: an extraoral approach to the infraorbital nerve may prove disturbing.

Anterior Superior Alveolar Nerve Block (ASA) or Infraorbital Nerve Block
What injections could be used as an alternative to this injection, in order to anesthetize from the central incisor through the 2nd premolar?

Supraperiosteal, P D L, or I O injection for each tooth
Infiltration for the periodontium and hard tissues
Maxillary nerve block

Anterior Superior Alveolar Nerve Block (ASA) or Infraorbital Nerve Block
What is the PREFERRED needle length and gauge size to be used?

25 gauge long (recommended) or short needle for children and smaller adults

Anterior Superior Alveolar Nerve Block (ASA) or Infraorbital Nerve Block
What landmarks are useful for this injection? What should you palpate?

Mucobuccal fold, infraorbital notch, and infraorbital foramen. Palpate the infraorbital foramen

Anterior Superior Alveolar Nerve Block (ASA) or Infraorbital Nerve Block
What is the pathway the syringe should follow?

The syringe is oriented toward the infraorbital foramen, the needle is held parallel to the long axis of the tooth

Anterior Superior Alveolar Nerve Block (ASA) or Infraorbital Nerve Block
What is the area of insertion?

Needle is inserted at the height of the mucobuccal fold over the 1st pre-molar

Anterior Superior Alveolar Nerve Block (ASA) or Infraorbital Nerve Block
What is the target area?

Infraorbital foramen

Anterior Superior Alveolar Nerve Block (ASA) or Infraorbital Nerve Block
How is the bevel oriented?

Toward bone

Anterior Superior Alveolar Nerve Block (ASA) or Infraorbital Nerve Block
How far is the needle advanced? Should you touch bone with the needle tip?

Approx. 16 mm for adult of average height. In a patient with a high (deep) mucobuccal fold or a low infraorbital foramen, less tissue penetration is necessary than in one with a shallow mucobuccal fold or high infraorbital foramen.
No, the needle tip should not touch bone, the bevel of the needle should be facing into the infraorbital foramen and the needle tip touching the roof of the foramen.

Anterior Superior Alveolar Nerve Block (ASA) or Infraorbital Nerve Block
How much anesthetic solution should you deposit?

0.9-1.2 ml of anesthetic solution

Anterior Superior Alveolar Nerve Block (ASA) or Infraorbital Nerve Block
What are the causes of failure of anesthesia from this injection?

Needle contacts bone below IO foramen. Needle deviation medial or lateral to IO foramen

Anterior Superior Alveolar Nerve Block (ASA) or Infraorbital Nerve Block
What, if any, complications can occur from this injection?

Rarely, a hematoma may develop across the lower eyelid and tissues between it and the IO foramen

Greater Palatine
Discuss some strategies for atraumatic palatal injections.

-provide adequate topical anesthesia to site of needle penetration.
-use pressure anesthesia at the site before and during needle insertion and deposition.
-maintain control over needle.
Deposit anesthesia solution slowly
-trust your abilities in completing procedures

Greater Palatine
What nerve is anesthetized with this injection?

Greater palatine nerve

Greater Palatine
What areas (hard and soft tissues) are anesthetized with this injection?

Posterior portion of hard palate and its overlying tissue, extending to 1st pre-molar and medially to midline.

Greater Palatine
What are the indications and advantages for this injection?

Indications: palatal soft tissue is necessary for restorative therapy on 2 or more teeth and for pain control during perio or oral surgery involving palatal soft or hard tissue.
Advantages: minimizes needle penetration and volume of solution; minimizes patient discomfort

Greater Palatine
List any contraindications and disadvantages for this injection.

Contraindication: inflammation or infection at injection site and smaller areas of therapy
Disadvantages: no hemostasis except in the immediate area of injection and potentially traumatic

Greater Palatine
What is the MOST likely needle length and gauge size to be used?

27 gauge short needle

Greater Palatine
What is the area of insertion?

Soft tissue slightly anterior to the GP foramen

Greater Palatine
What is the target area? What are the landmarks?

Target: Greater palatine nerve
Landmarks: G P foramen and junction of the maxillary alveolar process and palatine bone.

Greater Palatine
How is the bevel oriented?

Toward the palatal soft tissue

Greater Palatine
What is the pathway of the syringe?

Advance syringe from the opposite side of mouth at a right angle to the target area

Greater Palatine
What are the correct patient and operator positions?

Patient: in supine position, extended neck, mouth wide open and head turned left or right for improved visibility
Operator: sit facing patient at 7 or 8 o'clock position for right GP block and for left GP block sit facing same direction as patient at 11 o'clock.

Greater Palatine
How do you find the greater palatine foramen?

With a cotton swab apply pressure at the junction of hard palate and alveolar process medial of 1st molar. Palpate posteriorly until swab falls into a depression of the GP foramen

Greater Palatine
How long do you apply pressure to the injection site?

For a minimal of 30 seconds

Greater Palatine
How far is the needle advanced? Should you touch bone with the needle tip?

Less than 10 mm.
No, you should not touch bone with the needle tip.

Greater Palatine
How much anesthetic solution should you deposit?

0.45-.06 ml of solution

Greater Palatine
What change in the tissue do you notice as you deposit more solution?

Ischemia (blanching)

Greater Palatine
What safety features are in place for this injection?

Contact with bone and aspirating

Greater Palatine
What are the causes of failure of anesthesia from this injection?

Unilateral anesthesia: if the solution is deposited to one side of the incisive canal
Inadequate palatal soft-tissue anesthesia: if fibers of the G P nerve overlap those of the nasopalatine nerve

Greater Palatine
What complications can occur with this injection?

Ischemia and necrosis of soft tissue when highly concentrated vasoconstrictor solution used for hemostasis over prolonged period of time ( never use norepinephrone)
Hematoma is possible but rare
Some patients may be uncomfortable if their soft palate becomes anesthetized

Nasopalatine Nerve Block
What nerves are anesthetized with this injection?

Nasopalatine nerves bilaterally

Nasopalatine Nerve Block
State the advantages and indications for this injection.

Advantages: minimizes needle penetration, volume of solution, minimizes patient discomfort from multiple needle penetrations
Indications: when palatal soft tissue anesthesia is necessary for restorative therapy on more than 2 teeth. For pain control during perio or oral surgical procedures involving palatal soft and hard tissue

Nasopalatine Nerve Block
State the disadvantages and contraindications for this injection.

Disadvantages: no hemostasis except in the immediate area of injection and potentially the most traumatic intraoral injection.
Contraindications: inflammation or infection at the injection site and smaller area of therapy (one or two teeth)

Nasopalatine Nerve Block
What length and gauge of needle is MOST likely to be used for this injection?

27 gauge short needle

Nasopalatine Nerve Block
What is the area of insertion?

Palatal mucosa just lateral to the incisive papilla

Nasopalatine Nerve Block
What is the target area?

Incisive foramen beneath the incisive papilla

Nasopalatine Nerve Block
What are the landmarks?

Central incisors and incisive papilla

Nasopalatine Nerve Block
How is the bevel of the needle oriented?

Toward the palatal soft tissue

Nasopalatine Nerve Block
What are the proper patient and operator positions?

Patient: in supine position, mouth open wide, neck extended, and head turned to the left or right for improved visibility
Operator: sit at 9 or 10 o'clock position facing in the same direction as the patient.

Nasopalatine Nerve Block
How do you minimize trauma for this injection?

Use the multiple needle penetrating technique involving 2 to 3 injections. 1st injection: infiltration of 0.3ml into labial frenum, 2nd injection: penetration through the labial aspect of the papilla between the maxiallary central incisors toward the incisive papilla and 3rd injection: use only when the second injection does not provide adequate palatal anesthesia

Nasopalatine Nerve Block
How do you stabilize the syringe during the injection?

Palm up, using finger support, and fulcrum

Nasopalatine Nerve Block
How long do you apply pressure at the site?

Pressure is maintained until deposition of solution is complete

Nasopalatine Nerve Block
How is the needle advanced in order to reach the site of the deposit of the anesthetic?

Advance needle slowly at a 45 degree angle toward the incisive foramen until bone is gently contacted depositing small volumes of anesthetic along the way approx. 5 mm

Nasopalatine Nerve Block
How much anesthetic solution should be deposited for this injection? Is it always possible or necessary to deposit the maximum amount stated?

0.45 ml or less= ¼ cartridge and no, it is not always necessary to deposit the maximum amount stated

Nasopalatine Nerve Block
What are safety features associated with this injection?

Aspiration and contact with bone

Nasopalatine Nerve Block
What precautions should be taken with this injection?

Against pain - do not insert directly into incisive papilla. Do not deposit solution too fast. Do not deposit too much solution
Against infection - do not insert needle through the incisive canal

Nasopalatine Nerve Block
What are the causes and remedies for failure of anesthesia from this injection

Unilateral anesthesia if solution is deposit to one side of incisive canal reinserted into anesthetized tissue and re-inject into un-anesthetized area
Inadequate palatal soft tissue anesthesia in area of max. canine and 1st pre-molar
Local infiltration may be necessary as a supplement in anesthetized area

Nasopalatine Nerve Block
Discuss the major complications from this injection.

Ischemia and necrosis of soft tissues, when highly concentrated vasoconstrictor solution is used for hemostasis over prolonged period of time ( never use norepinephrone)
Hematoma is possible but rare because of the density and firm adherence of palatal soft tissues to bone
Due to the density of the soft tissues, anesthetic solution may "squirt" back out the needle puncture site either during administration or after needle withdrawal.

Inferior Alveolar including Lingual (Mandibular) Nerve Block
What is the success rate for this injection and why?

85-90 %, due to intraoral landmarks not consistently reliable

Inferior Alveolar including Lingual (Mandibular) Nerve Block
What area (hard and soft tissues) will be anesthetized?

Mand. Teeth to midline, body of mand. Inferior portion of ramus, buccal mucoperiosteum, mucous membrane anterior to mand. 1st molar, anterior 2/3 of tongue and floor of the oral cavity, lingual soft tissue and periosteum

Inferior Alveolar including Lingual (Mandibular) Nerve Block
What nerves will be anesthetized?

Inferior alveolar, incisive, mental and lingual nerve

Inferior Alveolar including Lingual (Mandibular) Nerve Block
Why would you want to do this injection (indications and advantages)?

Indications: procedure on multiple mand. teeth in one quadrant, when buccal soft tissue anesthesia is necessary, and when lingual soft tissue anesthesia is necessary
Advantages: one injection provides a wide area of anesthesia

Inferior Alveolar including Lingual (Mandibular) Nerve Block
List some contraindications and disadvantages.

Contraindications: infection or acute inflammation and patients who might bite their lip or tongue
Disadvantages: wide area of anesthesia, rate of inadequate anesthesia, intraoral landmarks not consistently reliable and positive aspiration is high

Inferior Alveolar including Lingual (Mandibular) Nerve Block
What is the risk of positive aspiration?

10-15%

Inferior Alveolar including Lingual (Mandibular) Nerve Block
What length and gauge needle will you use?

25 gauge long needle

Inferior Alveolar including Lingual (Mandibular) Nerve Block
What is the area of insertion?

Mucosa membrane on medial side of ramus

Inferior Alveolar including Lingual (Mandibular) Nerve Block
What is the target area?

I A nerve as if passes downward toward the mand. foramen, but before it enters into the foramen

Inferior Alveolar including Lingual (Mandibular) Nerve Block
What landmarks are you looking for?

Coronoid notch
Pterygoimandibular raphe
Occlusal plane of mand. posterior teeth

Inferior Alveolar including Lingual (Mandibular) Nerve Block
How is the bevel of the needle oriented, and why?

Less critical with this block because needle approaches IA nerve at a right angle

Inferior Alveolar including Lingual (Mandibular) Nerve Block
What are the correct patient and operator positions for giving this injection?

Patient: in supine position, mouth open wide to permit greater visibility and access to the injection site.
Operator: for right I A N B, a right handed operator should sit at 8 o'clock position facing the patient
for a left I A N B, a right handed operator should sit at the 10 o'clock position facing the patient

Inferior Alveolar including Lingual (Mandibular) Nerve Block
Where should you keep your finger or thumb during the injection?

Finger or thumb of the left hand on the coronoid notch

Inferior Alveolar including Lingual (Mandibular) Nerve Block
What is the correct pathway for the syringe to follow?

Barrel of syringe is placed contra-laterally in corner of mouth over the mand. pre-molars

Inferior Alveolar including Lingual (Mandibular) Nerve Block
How do you stabilize the syringe during the injection?

Palm up and finger support

Inferior Alveolar including Lingual (Mandibular) Nerve Block
What 3 parameters must you consider regarding the needle penetration?

1. height of injection
2. anterioroposterior site of injection
3. penetration depth

Inferior Alveolar including Lingual (Mandibular) Nerve Block
What is the reason and remedy, if you contact bone before you reach site to deposit anesthetic?

The needle tip is usually too far anteriorly (laterally) on ramus -slightly withdraw the needle but do not remove from the tissue and redirect the needle until a more appropriate depth of insertion is obtained

Inferior Alveolar including Lingual (Mandibular) Nerve Block
What is the reason and remedy, if you do not contact bone?

The needle tip is usually to far posterior (medially) slightly withdraw needle and reposition syringe barrel more posteriorly

Inferior Alveolar including Lingual (Mandibular) Nerve Block
When do you aspirate? How common is positive aspiration with this injection?

After bone is contacted, withdraw approx. 1 mm and aspirate.
10-15 %.

Inferior Alveolar including Lingual (Mandibular) Nerve Block
How much anesthetic solution should be deposited?

1.5 ml solution over 60 seconds

Inferior Alveolar including Lingual (Mandibular) Nerve Block
How and when do you anesthetize the lingual nerve?

After the second negative aspiration, deposit a portion of the remaining solution (0.1 ml) to anesthetize the lingual nerve

Inferior Alveolar including Lingual (Mandibular) Nerve Block
What are safety features for this injection?

Needle contacting bone preventing overinsertion

Inferior Alveolar including Lingual (Mandibular) Nerve Block
Why might you have failure of anesthesia with this injection, and how would you remedy that?

Deposition of anesthesia too low, to correct: reinject at a higher site
Deposition of anesthetic too far anteriorly, to correct: redirect the needle tip posteriorly

Inferior Alveolar including Lingual (Mandibular) Nerve Block
What complications may occur?

Hematoma
Trismus (muscle soreness)
Transient facial paralysis

What should you do if the patient gets a hematoma?

Pressure and cold to the area for 3-5 minutes

Buccal Nerve Block
What nerve is anesthetized with this injection?

Buccal Nerve

Buccal Nerve Block
What areas (hard and soft tissues) are anesthetized with this injection?

Soft tissues and the periodontum buccal to the mandibular molar teeth

Buccal Nerve Block
What are the indications and advantages for this injection?

Indications: when buccal soft tissue anesthesia is needed for dental procedures in the mand. molar region
Advantages: high success rate and technically easy.

Buccal Nerve Block
List any contraindications and disadvantages for this injection.

Contraindications: infection on acute inflammation in area of injection
Disadvantages: painful if needle contacts periosteum during injection

Buccal Nerve Block
What is the MOST likely needle length and gauge size to be used?

25 gauge long needle

Buccal Nerve Block
What is the area of insertion?

Mucous membrane distal and buccal to the most distal tooth in mand. arch

Buccal Nerve Block
What is the target area? What are the landmarks?

Target area: Buccal nerve as it passes over the anterior border of ramus
Landmarks: mand. molars and mucobuccal fold

Buccal Nerve Block
How is the bevel oriented?

Toward bone during injection

Buccal Nerve Block
What is the pathway of the syringe?

Syringe is directed toward injection site with bevel facing down, toward bone and syringe aligned parallel with the occlusal plane on the side of injection.

Buccal Nerve Block
What are the correct patient and operator positions?

Patient is in supine position
For right buccal nerve block, operator is sitting at 8 o'clock facing the patient.
For left buccal nerve block, operator is sitting at 10 o'clock facing in the same direction as the patient

Buccal Nerve Block
How far is the needle advanced? Should you touch bone with the needle tip?

Usually 1-2 mm; seldom more than 2-4 mm
Yes, you should touch bone with the needle tip

Buccal Nerve Block
How much anesthetic solution should you deposit?

0.3 ml =1/8th of a cartridge over 10 seconds.

Buccal Nerve Block
What safety features and precautions are in place for this injection?

Needle contacting bone to prevent over insertion. Minimum positive aspiration
Precautions: Pain on insertion from striking unnesthetized periosteum and local anesthetic solution not being retained at the injection site

Buccal Nerve Block
What is a cause of failure of anesthesia from this injection?

inadequate volume of anesthetic retained in the tissues

Buccal Nerve Block
What complications can occur with this injection?

hemotoma

Mental/Incisive Nerve Block
What nerve is anesthetized with this injection?

Mental and terminal branches of I A nerve

Mental/Incisive Nerve Block
What hard and soft tissues are anesthetized?

Buccal mucosa membrane anterior to mental foramen around 2nd pre-molar to the midline and skin of lower lip

Mental/Incisive Nerve Block
State the advantages and indications for this injection.

Indications: when buccal soft tissue anesthesia is necessary for procedures in the mand. anterior to the mental foramen
Advantages: high success rate, technically easy, and atraumatic

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