LA ergonomics Flashcards
anterior superior alveolar nerve
the pulp
investing structures
labial mucoperiosteum of anterior teeth (1, 2, 3)
posterior superior alveolar nerve
the pulp
investing structures
buccal periosteum of upper molars except mesiobuccal root of 1st molar
middle superior alveolar nerve
the pulp
insting structure
buccal periosteum of the premolars (4, 5) and MB root of 1st molar (6)
greater (anterior) palatine nerve
palate mucoperiosteum of maxillary molars (6, 7, 8) and premolars (4, 5)
nasopalatine nerve
palatal mucoperisoteum of maxillary anterior teeth (1, 2, 3)
incisive nerve
the pulp
investing structures
of the lower anterior (1, 2, 3)
inferior alveolar nerve
the pulp
investing structures
of the lower premolars (4, 5) and molar teeth (6, 7, 8)
inferior dental plexus
labial and buccal mucoperiosteum of the anterior teeth (1, 2, 3) and premolar (4, 5)
long buccal nerve
buccal mucoperiosteum of the lower molars
lingual nerve
lingual periosteum of all the lower teeth (1-8)
preparation
Wear nonsterile gloves and a mask and safety glasses, or a face shield.
Use gauze to thoroughly dry the pterygomandibular triangle. Use suction as needed to keep the area dry.
Apply a small amount of topical anesthetic with cotton-tipped applicators and wait 2 to 3 minutes for the anesthesia to occur.
inject the LA
Instruct the patient to open the mouth comfortably wide.
Place the tip of your thumb or forefinger into the coronoid notch, to help visualize the vertical height at which the needle will enter, and retract the cheek to expose the pterygomandibular triangle.
Place and maintain the barrel of the syringe over the contralateral lower 1st and 2nd premolars.
Keep the needle parallel to—and about 1 cm above—the mandibular occlusal plane, at the vertical plane of the coronoid notch.
establishing the correct angle of approach
rest the side of the needle tip against the lateral edge of the pterygomandibular raphe, such that the tip now aims into the pterygomandibular triangle, with the bevel facing the ramus.
Maintain this angle of insertion as you advance the needle.
advancing the needle
slightly into the mucosa. Aspirate, to rule out intravascular placement, and inject a few drops of anesthetic to relieve the pain of the needle insertion itself. Repeat these small injections after incremental advancements of slightly < 1 cm.
if the patient experiences a sudden, sharp parenthesis
If the patient experiences a sudden, sharp paresthesia, reassure the patient that means the needle is in the right spot. Slightly withdrawing and then redirecting the needle may relieve this sensation, but maintain direction toward the medial ramus and mandibular foramen.
Hitting bone
Advance the needle until it is stopped by the ramus (typically after about 2 to 2.5 cm of insertion) and withdraw needle 1 mm away from bone.
If the needle does not hit mandibular bone,it may be too far posterior (eg, into the parotid). Withdraw the needle and redirect it (more anteriorly/laterally).
Once contact with the ramus is made, withdraw the needle 1 mm away from the bone.
if aspirations reveals instravascular placement
withdraw the needle 2 to 3 mm, then re-aspirate prior to injection.
Slowly inject about 2 to 4 mL anesthetic, but leave about 0.5 mL in the syringe to block the buccal nerve.
block the buccal nerve
Withdraw the syringe and reinsert it just anterior and lateral to the anterior edge of the ramus at the level of the occlusal surface of the most posterior molar. Advance the needle posteriorly about 3 to 5 mm. Aspirate, to rule out intravascular placement, and inject about 0.25 mL of anesthetic.
