Lecture 5 Flashcards
___ is a type of injection that anesthetizes a small area (one or two teeth and associated areas), where the anesthesia is deposited at nerve terminals and must be deposited as close to the nerve as possible
local infiltraiton
___ is the fear of needles
trypanophobia
___ is a type of injection that anesthetizes a larger area, and anesthesia is deposited near larger nerve trunks
nerve block
what are the 6 types of maxillary nerve blocks?
- posterior superior alveolar nerve block
- middle superior alveolar nerve block
- anterior superior alveolar nerve block
- greater palatine block
- infraorbital block
- nasopalatine block
what are the 6 mandibular nerve blocks?
- inferior alveolar nerve block
- buccal block
- mental block
- incisive block
- gow-gates mandibular nerve block
- vizirani-akinosi block
T or F:
if LA administration fails, you should try again using the same method
false, you should never re-administer using the same method
why should you never inject into an area with an abscess or other type of abnormality?
- can track the infection
- change the needle if injecting into an abscess
what local anesthetics fall under category B for pregnant patients?
lidocaine, prilocaine, etidocaine
what local anesthetics fall under category C for pregnant patients?
articaine, bupivacaine, mepivacaine
___ is through anesthesia of each nerve’s dental branches as they extend into the pulp tissue via the apical foramen
pulpal (supraperiosteal) anesthesia
___ is through the interdental and interadicular branches
periodontal anesthesia
___ involves soft and hard tissues of the palatal periodontium (gingiva, periodontal ligaments, alveolar bone)
palatal anesthesia
___ is recommended for maxillary molar teeth and associated buccal tissues in ONE quadrant
PSA block
___ is recommended for maxillary premolars and associated buccal tissues
MSA block
___ is recommended for maxillary canine and the incisors in ONE quadrant
ASA block
___ is recommended for palatal tissues distal to the maxillary canine in ONE quadrant
greater palatine block (V2)
___ is recommended for palatal tissues between the right and left maxillary canines
nasopalatine block
what does the PSA nerve block cover?
- pulpal anesthesia of the maxillary 3rd, 2nd, and 1st molars
- required for procedures involving two or more molars
- sometimes anesthesia of the 1st molar also requires block of the MSA nerve
- associated buccal periodontium overlying these molars
- including the associated buccal gingiva, periodontal ligament, and alveolar bone
- useful for periodontal work on this area
how is the PSA nerve block administered?
- as it enters the maxilla through the PSA foramen on the maxilla’s infratemporal surface
- into the tissues of the mucobuccal fold at the apex of the 2nd maxillary molar
- mandible is extended toward the side of the injection, pull the tissues at the injection site until taut
- needle is inserted distal and medial to the tooth and maxilla
- depth varies from 10 to 16 mm depending on age of patient
are there overt symptoms with the PSA nerve block?
no (no lip or tongue involvement)
the ___ nerve block can damage the pterygoid plexus and maxillary artery
PSA
for this reason, you must aspirate
blanching of the cheek will indicate depth if too deep
the ___ nerve block has limited clinical usefulness
MSA
what is the MSA nerve block used for?
- can be used to extend the infraorbital block distal to the maxillary canine
- can be indicated for work on maxillary pre-molars and mesiobuccal root of 1st molar
- blocks the pulp tissue of the 1st and 2nd maxillary premolars and possibly the 1st molar + associated buccal tissues and alveolar bone
- useful for periodontal work in this area
- to block the palatine tissues in this area – may require a greater palatine block
if the MSA is absent, the area is innervated by the ___
ASA
describe how the MSA block is administered
- target area: MSA nerve at the apex of the maxillary 2nd premolar mandible extended towards injection site
- stretch the upper lip to tighten the injection site
- needle is inserted into the mucobuccal fold
- tip is located well above the apex of the 2nd premolar
- harmless tingling or numbness of the upper lip
- over-insertion is rare
harmless tingling or numbness of the upper lip can occur with the ___ block
MSA
is over-insertion common with the MSA block?
no, it is rare
what is the ASA block useful for?
- used in conjunction with an MSA block
- used in procedures involving the maxillary canines and incisors and their associated facial tissues
- pulpal and facial tissues involved – restorative and periodontal work
- blocks the pulp tissue + the gingiva, periodontal ligaments and alveolar bone in that area
the ASA block can be considered a ___
local infiltration
which nerve block can cross the midline?
the ASA - can cross the maxilla onto the opposite side
describe how the ASA block is administered
- target: ASA nerve at the apex of the maxillary canine
- at the mucobuccal fold at the apex of the maxillary canine
- harmless tingling or numbness of the upper lip
- over insertion is rare
what is the infraorbital nerve block useful for?
- used for anesthesia of the maxillary premolars, canine and incisors
- indicated when more than one premolar or anterior teeth
- pulpal tissues – for restorative work
- facial tissues – for periodontal work
- also numbs the gingiva, periodontal ligaments and alveolar bone in that area
- the maxillary central incisor may also be innervated by the nasopalatine nerve branches
the infraorbital nerve block anesthetizes both the ___ and the ___
MSA and the ASA
describe how the IO block is administered
- target: union of the ASA and MSA with the IO nerve after the IO enters the IO foramen
- Also anesthetizes the lower eyelid, side of nose and upper lip
- IO foramen is gently palpated along the IO rim
–move slightly down about 10mm until you feel the depression of the IO foramen
–locate the tissues at the mucobuccal fold at the apex of the 1st premolar
- place one finger at the IO foramen and the other on the injection site
- locate the IO foramen, retract the upper lip and pull the tissues taut
- the needle is inserted parallel to the long axis of the tooth to avoid hitting the bone
- harmless tingling or numbness of the upper lip, side of nose and eyelid
what is the greater palatine block used for?
- used in restorative procedures that involve more than two maxillary posterior teeth or palatal tissues distal to the canine
- also used in periodontal work – since it blocks the associated lingual tissues
- anesthetizes the posterior portion of the hard palate – from the 1st premolar to the molars and medially to the palate midline
- does NOT provide pulpal anesthesia – may also need to use ASA, PSA, MSA or IO blocks
- may also need to be combined with nasopalatine block
describe how the greater palatine block is administered
- target: GP nerve as it enters the GP foramen
- located at the junction of the maxillary alveolar process and the hard palate – at the maxillary 2nd or 3rd molar
- palpate the GP foramen – midway between the median palatine raphe and lingual gingival margin of the molar tooth
- can reduce discomfort by applying pressure to the site before and during the injection
- produces a dull ache to block pain impulses
- also slow deposition of anesthesia will also help
- needle is inserted at a 90 degree angle to the palate
what is the nasopalatine block useful for?
- useful for anesthesia of the bilateral portion of the hard palate
- from the mesial of the right maxillary 1st premolar to the mesial of the left 1st premolar
- for palatal soft tissue anesthesia
- periodontal treatment
- required for two or more anterior maxillary teeth
- for restorative procedures or extraction of the anterior maxillary teeth – may need an ASA or MSA block also
does the nasopalatine block work for both the right and left nerves?
yes
describe how the nasopalatine block is administered
- target: both right and left nerves as they enter the incisive foramen from the mucosa of the anterior hard palate
- posterior to the incisive papilla
- injection site is lateral to the incisive papilla
- head turned to the left or right
- inserted at a 45 degree angle about 6-10 mm – gently contact the maxillary bone and withdraw about 1mm before administering
- can reduce discomfort by applying pressure to the site before and during the injection
- produces a dull ache to block pain impulses
- also slow deposition of anesthesia will also help
- can anesthetize the labial tissues between the central incisors prior to palatal block
- can block some branches of the nasopalatine prior to injection
are mandibular blocks more or less successful than maxillary anesthesia?
they are not as successful as maxillary anesthesia
___ has substantial variability in the anatomy of landmarks when compared to the ___
mandible, maxilla
the ___ block is for mandibular teeth + associated lingual tissues and for the facial tissues anterior to the mandibular first molar
inferior alveolar block
the ___ block is for tissues buccal to the mandibular molars
buccal
the ___ block is for facial tissues anterior to the mental foramen (mandibular premolars and anterior teeth)
mental
the ___ block is for teeth and facial tissues anterior to the mental foramen
incisive
the ___ covers most of the mandibular nerve and is used for quadrant dentistry
gow-gates
the inferior alveolar block is also called the ___ block
mandibular
the ___ block is the most commonly used in dentistry
inferior alveolar
what is the inferior alveolar block useful for?
- for restorative, extraction and periodontal work
- pulpal anesthesia for extractions and restorative
- lingual periodontal anesthesia
- facial periodontal anesthesia of anterior mandibular teeth and premolars
- may be combined with the buccal block
- can overlap with the incisive block
- local infiltrations in the anterior area are more successful than posterior injections
- variability in the location of the mandibular foramen on the ramus can lessen the success of this injection
- usually avoid bi-lateral injections since they will completely anesthetize the entire tongue and can affect swallowing and speech
describe how the IA block is administered
- target: slightly superior to the mandibular foramen
- the medial border of the ramus
- will also anesthetize the adjacent anterior lingual nerve
- injection site is found using hard landmarks
- palpate the coronoid notch – above the 3rd molar
- imagine a horizontal line from the coronoid notch to the pterygomandibular fold which covers the pterygomandibular raphe
- this fold becomes more prominent as the patient opens their mouth wider
- needle is inserted into the pterygomandibular space until the mandible is felt – retract about 1 mm
- average depth: 20-25mm
- diffusion of anesthesia will affect the lingual nerve
- symptoms: harmless tingling and numbness of the lower lip due to block of the mental nerve
what can indicate lingual nerve involvement from an IA block?
tingling and numbness of the body of the tongue and floor of mouth
what are the possible complications from an IA block?
- failure to penetrate enough can numb the tongue but not block sufficiently
- lingual shock – involuntary movement as the needle passes the lingual nerve
- transient facial paralysis – facial nerve involvement if inserted into the deeper parotid gland
- inability to close the eye and drooping of the lips on the affected side
- hematoma can occur
- some muscle soreness
- patient-inflicted trauma – lip biting etc…
what is the long buccal block useful for?
- for buccal periodontium of mandibular molars, gingiva, periodontal ligament and alveolar bone
- for restorative and periodontal work
- buccal nerve is readily located on the surface of the tissue and not within bone
describe the administration of the long buccal block
- target: buccal nerve as it passes over the anterior border of the ramus through the buccinator
- injection site is the buccal tissues distal and buccal to the most distal molar – on the anterior border of the ramus as it meets the body
- pull the buccal tissue tight and advance the needle until you feel bone – only about 1 to 2mm
- patient-inflicted trauma – lip biting etc…
what is the mental block useful for?
- for facial periodontium of mandibular premolars and anterior teeth on one side
- for restorative work – incisive block should be considered instead
describe the administation of the mental block
- target site: mental nerve before it enters the mental foramen where it joins with the incisive nerve to form the IA nerve
- palpate the foramen between the apices of the 1st and 2nd premolars
- palpate it intraorally – find the muccobuccal fold between the apices of the 1st and 2nd premolars
- in adults, the foramen faces posterosuperiorly
- may be anterior or posterior
- can be found using radiographs
- insertion site is the muccobuccal fold tissue directly over or slight anterior to the foramen site
- avoid contact with the mandible with the needle
- depth is 5 to 6mm
- no need to enter the foramen
what is the incisive block useful for?
- for pulp and facial tissues of the teeth anterior to the mental foramen
- same as the mental block except pulpal anesthesia is provided also
- restorative and periodontal work
- IA block indicated for extractions – no lingual anesthesia with an incisive block
describe the administration of the incisive block
- target: mental foramen
- injection site same as for the mental block
- directly over or anterior to the mental foramen
- in the mucobuccal fold at the apices of the 1st and 2nd premolars
- pull the buccal tissues laterally
- more anesthesia is used for this block when compared to the mental block
- pressure is applied during the injection – forces for anesthetic solution into the foramen and block the deeper incisive nerve
- the increased injection solution may balloon the facial tissues
what is the gow-gates useful for?
- blocks the IA, mental, incisive, lingual, mylohyoid, Auriculotemporal and buccal nerves
- used for quadrant dentistry
- buccal and lingual soft tissue from most distal molar to the midline
- greater success than an IA block
describe the administration of the gow-gates
- target site: anteromedial border of the mandibular condylar neck
- just inferior to the insertion of the lateral pterygoid muscle
- injection site is intraoral
- locate the intertragic notch and labial commissure extra-orally
- draw a line from the tragus/intertragic notch to the labial commissure
- place your thumb on the condyle (just in front of the tragus when the mouth is open)
- pull buccal tissue away
- place the needle inferior to the mesiolingual cusp of the MAXILLARY 2nd molar
- the needle penetrates distal to the maxillary 2nd molar
what are the nerves anesthetized from the vazirani-akinosi block?
IAN, incisive, mental, lingual, mylohyoid
why is the akanosi injection indicated?
trismus of occlusion
closed mouth approach
describe the administration of the akanosi injection
- Difficult to visualize
- No bony contact
- Insert in soft tissue on lingual border of mandible
- Bevel oriented away from bone
- Landmarks; maxillary tuberosity/mucogingival junction of third or second molar
- Advance 25mm into tissue
what are the possible complications from the akanosi injection?
Hematoma/Trismus/Facial nerve paralysis due to inject into parotid
___ needles are appropriate for the maxilla, and ___ needles are appropriate for the mandible
short, long
it is important to always keep track of the carpule count and risks of certain anesthetic agents. when in doubt, stop after ___ carpules
1.5
