Type of injection that anesthetizes the buccal soft tissue of the mandibular molars
Buccal block
Overlap of terminal nerve fibers from the contralateral side
Crossover-innervation
Target area where local anesthetic will be deposited
Deposit location
Describes needle depth covered in tissue when target area is reached
Depth of needle penetration
Type of injection that anesthetizes most of the mandibular nerve
Gow-Gates mandibular block (GG Block)
Type of injection that anesthetizes the teeth assoc. periodontium as well as facial soft tissue to the mental foamen
Incisive block
Type of injection that anesthetizes the mandibular teeth and their assoc. periodontium and lingual soft tissue to the midline.
Inferior alveolar (IA) block
Type of injection that anesthetizes the facial soft tissue anterior to the mental foramen.
Mental block
Injection site where bevel of needle is covered with tissue
Needle insertion point
Type of injection that anesthetizes a larger area than the local infiltration due to the local anesthetic agent deposited near large nerve trunks
Nerve block
Persistent anesthesia beyond the expected duration, or altered sensation such as tingling or itching that is beyond a normal level
Paraesthesia
Supplemental injection used when pulpal anesthesia is indicated on a single tooth, is administered directly into the periodontium of the tooth to be anesthetized.
Periodontal ligament (PDL) injection
Type of injection that anesthetizes a small area-- 1 or 2 teeth and assoc. structures--due to the local anesthetic agent deposited near terminal nerve endings.
Supraperiosteal injection
An instrument used to measure pain
Visual analog scale (VAS)
What nerves are affected in the IA?
IA, Incisive, Mental, Lingual
What areas are anesthetized in the IA?
Pupal tissue of MD teeth in 1 quad, lingual tissue of quad and buccal tissue of premolars and anteriors in the quad, lower lip to midline, anterior 2/3rds of the tongue and floor of the mouth
What needle is used in the IA?
LONG
-CC uses 32mm 27 guage
What is the point of needle penetration for the IA?
Height
of the coronoid notch
just lateral
to the pterygomandibular raphe
What is the barrel placement in the IA?
-Parallel with the occlusal plane (there is equal distance in height between the MD teeth and the barrel)
-Above the mandibular canine on the opposite side
-For most pt's the barrel will be over the commissure on the opposite side without touching it and
Should the barrel swing past the 1st MD molar in the IA?
No, at deposition, barrel should be above the premolars
What is the optimum depth of penetration in the IA?
20-25mm
If the operator is at the
optimum angle and depth of penetration
for the IA, how much of the needle remains visible?
7-12mm
What is the deposition site for the IA?
SUPERIOR
to the mandibular foramen
-If inferior, gravity will not help
What is the amount of LA deposited for the IA?
minimum of 1.5 ml (approx. 3/4 of cartridge)
-Less than this and you'll have to reinject
What is the
most common error
of the IA injection?
Point of penetration is too low / inferior
What injection is
most likely
to produce a positive aspiration?
The IA = 10%-15%
What injection anesthetizes
the most
(greatest # of teeth) of the 8 injections we learn?
IA
What is the deepest injection we learn?
IA
How much of the tongue does the IA anesthetize?
To the midline of the tongue (lingual nerve)
Do we allow IA injections on both right and left side of the mandible in clinic?
No
If bone is not contacted should you deposit LA in the IA?
NO, slow down at 15mm, bone is close, once contacted back up 1mm and then deposit
Why is it recommended to seat the pt. in the upright position for 3-5 minutes after the IA injection is administered?
Gravity will aid with the flow of the anesthetic to the nerve
What nerves are affected in the buccal injection?
Buccal nerve (branch of V3)
What areas are anesthetized in the buccal injection?
Soft tissue & periosteum buccal to the mandibular molars
When giving the buccal injection what should your needle selection be?
LONG
= it is acceptable to use a
long needle
when administering a buccal injection immediately following the IA
ONLY
SHORT
= if you are giving a buccal injection to numb the tissue of the MD molars without administering the IA injection you would use a
sh
When is it acceptable to use a long needle for a buccal injection?
immediately following the IA
When should you use a short needle for the buccal injection?
If you are giving the injection to numb the tissues of the MD molars without administering the IA
What is the point of insertion / point of penetration in the buccal injection?
Mucous membrane distal and lateral (buccal) to the most distal molar in the quad at the height of the occlusal plane.
What is the depth of the buccal injection?
1-4mm
What is the amount of LA deposited in the buccal injection?
0.3 - 0.45 ml (1/8 to 1/4 cartridge)
What injection other than the buccal injection also anesthetizes the nerve but we do not perform?
Gow Gates
-The buccal block is the only injection we learn that anesthetizes buccal tissue of the MD molars
How does
flow back with shallow injections
occur?
Bevel is not totally buried and solution will be in the mouth
What happens to the tissue in the buccal injection if the rate of deposition is too rapid?
Tissue could balloon
What is the nerve anesthetized in the Incisive/Mental injection?
Terminal branches of the inferior alveolar nerve
What needle length should you use in the Incisive/Mental injection?
Short
Which injection anesthetizes buccal tissue and skin of the lower lip and chin?
Mental injeciton
Which injection anesthetizes pulpal premolars and anterior teeth to the midline as well as buccal tissue, lower lip and chin?
Incisive Injection
How is the anesthetization of the pulpal tissue in the premolars and anterior teeth to the midline achieved?
By applying (blanching) pressure at deposition site, apex of the MD 2nd premolar for 2 minutes
What is the point of insertion for the Incisive / Mental injection?
Depth of mucobuccal fold anterior to the mental foramen, usually between the MD 1st and 2nd premolars.
What is the point of deposition and optimum angle and depth for the Incisive / Mental injection?
At the mental foramen between the apices and the MD premolars
What is the amount of LA given in the Incisive / Mental Injection?
Minimum amount
= 0.6 ml (1/3 cartridge)
Area Anesthetic
MX and MAND Injections
Area Anesthetized by IA
All teeth in 1 MD quad. Buccal tissue to premolars and anteriors. Floor of mouth, 1/2 of the tongue lingual tissue of quadrant
Target area for IA
Injection site for IA
At intersection of horizontal imaginary line and imaginary vertical line using coronoid notch and pterygomandibular fold; middle of pterygomandibular space at 6-10 mm superior to occlusal plane of mandibular molars
Target area for Buccal
Anesthetizes tissue buccal to MD molars
Injection site for Buccal
Mucous membrane distal and lateral to posterior molar
Target area for Mental and Incisive
Mental
= Anesthetizes facial tissue pre's to midline
Incisive
= Pulpal & tissue pre's to midline
Injection site for either mental or incisive
Mucobuccal fold at the mental foramen
Example of crossover innervation
1. What is the approximate needle penetration depth into soft tissue for the inferior alveolar local anesthetic block in most cases?
A.10 mm
B.15 mm
C.16 mm
D.20 mm
D.20 mm
2 The mandibular nerve or division is a branch of which cranial nerve?
A.X
B.V
C.VII
D.IV
B.V
3. The posterior part of the mandible is MORE dense than the anterior part, which allows for MORE successful molar anesthesia.
A.Both the statement and the reason are correct and related.
B.Both the statement and the reason are correct but NOT related.
C.
C.The statement is correct, but the reason is NOT.
4. Which injection is usually recommended to be administered along with the inferior alveolar local anesthetic block to provide complete anesthesia of a mandibular quadrant on a patient before nonsurgical periodontal therapy WITHOUT any overlapping covera
A.Buccal block
5. Which of the following local anesthesia blocks will NOT provide pulpal anesthesia to tooth #23 before restorative dental procedures?
A.Inferior alveolar block
B.Incisive block
C.Gow-Gates mandibular block
D.Buccal block
D.Buccal block
6. After administering a mental local anesthetic block, the patient reports slight numbness of the chin. What should the clinician do?
A.Stop treatment and explain facial nerve paralysis to the patient
B.Explain to the patient this is normal and continue
B.Explain to the patient this is normal and continue with treatment
7. After a few minutes following the administration of a mental local anesthetic block, a patient reports that some of her contralateral mandibular anterior teeth feel numb. What caused the patient's anterior teeth to become anesthetized?
A.Diffusion of t
A.Diffusion of the anesthetic into the incisive nerve
8. What injection uses the mesiolingual cusp of the maxillary second molar as a landmark during administration?
A.Gow-Gates mandibular block
B.Inferior alveolar block
C.Mental block
D.Buccal block
...
9. When administering the inferior alveolar local anesthetic block, the barrel of the syringe should be in what relation the mandibular occlusal plane?
A.Perpendicular
B.Parallel
C.At a 45� angle
D.At a 90� angle
B.Parallel
10. When administering the inferior alveolar local anesthetic block, the barrel of the syringe should usually be over which mandibular tooth?
A.Premolar on the injection side
B.Premolar on the contralateral side
C.First molar on the contralateral side
D.F
B.Premolar on the contralateral side
11. If lingual gingival anesthesia is required for #25-27, an incisive block is adequate BECAUSE it anesthetizes both the facial and lingual soft tissue of the mandibular anterior teeth.
A.Both the statement and the reason are correct and related.
B.Both
E.NEITHER the statement NOR the reason is correct.
12. Which of the following local anesthetic blocks has the HIGHEST risk of hematoma for the patient after administration?
A.Posterior superior alveolar block
B.Inferior alveolar block
C.Gow-Gates mandibular block
D.Mental or incisive blocks
A.Posterior superior alveolar block
13. While administering the inferior alveolar local anesthetic block, the clinician contacts bone at a depth of 10 mm on an adult patient. What should the clinician do?
A.Aspirate correctly and then deposit anesthetic agent at the site
B.Withdraw the need
B.Withdraw the needle almost completely and redirect the syringe barrel more anteriorly
14. While administering the inferior alveolar local anesthetic block, the clinician does not contact bone. What should the clinician do?
A.Aspirate correctly and then deposit anesthetic agent at the site
B.Withdraw the needle almost completely and redirec
C.Withdraw the needle partially or completely and redirect the syringe barrel more posteriorly
15 The target area for the incisive local anesthetic block is the same as the mental block, but during the mental local anesthetic block the clinician must place pressure to the injection site following the injection.
A.Both statements are true.
B.Both st
C.First statement is true and the second is false.
-You place pressure on the incisive block
16. There is no need to palpate for the mental foramen prior to performing the mental local anesthetic block BECAUSE the mental foramen is commonly in the same place on all patients.
A.Both the statement and the reason are correct and related.
B.Both the
E.NEITHER the statement NOR the reason is correct.
17 Which of the following local anesthetic blocks anesthetizes the mylohyoid, mental, and the auriculotemporal nerves?
A.Gow-Gates mandibular block
B.Inferior alveolar block
C.Mental block
D.Buccal block
A.Gow-Gates mandibular block
18. Which mandibular local anesthetic blocks require the clinician to contact the mandibular bone with the anesthetic needle?
A.Inferior alveolar block, infraorbital block
B.Inferior alveolar block, Gow-Gates mandibular block
C.Buccal block, mental block
B.Inferior alveolar block, Gow-Gates mandibular block
19. Which of the following situations is NOT related to incomplete anesthesia on the usual areas of the mandible on an adult patient after performing an inferior alveolar local anesthetic block?
A.Bifid inferior alveolar nerve
B.Accessory innervation by t
E.Patient experiencing lingual shock during the injection
20. Which of the following local anesthetic blocks uses BOTH the maxillary and mandibular occlusal planes as well as the pterygomandibular raphe as landmarks for administration?
A.Gow-Gates mandibular block
B.Inferior alveolar block
C.Mental block
D.Incis
B.Inferior alveolar block