Maxillary Anaesthesia

Question 1

Name the branches of V2 relevant to maxillary anaesthesia

Answer 1

Posterior superior alveolar; middle superior alveolar; anterior superior alveolar; infraorbital

Question 2

What does the posterior superior alveolar nerve numb when anaesthetised?

Answer 2

the molars - excluding the mesio-buccal root of U6.

Question 3

What does the middle superior alveolar nerve numb when anaesthetised?

Answer 3

the premolars and the mesio-buccal root of U6.

Question 4

What does the anterior superior alveolar nerve numb when anaesthetised?

Answer 4

the ipsilateral incisors and canine

Question 5

Name the nerves of the palate relevant to maxillary anaesthesia

Answer 5

Incisive branch of nasopalatine nerve
Greater palatine nerve
Lesser palatine nerve

Question 6

What does the incisive branch of nasopalatine nerve numb when anaesthetised?

Answer 6

palatal mucosa around maxillary 3-3 (in a wee triangle)

Question 7

What does the greater palatine nerve numb when anaesthetised?

Answer 7

palatal mucosa of hard palate from 4-8

Question 8

What does the lesser palatine nerve numb when anaesthetised?

Answer 8

soft palate

Question 9

What are the uses of topical anaesthesia?

Answer 9

aid to pain-free injections
very minor surgical procedures
abscess incision
rubber dam clamps

Question 10

How long does topical anaesthesia gel take to act?

Answer 10

2-5 mins

Question 11

What needle is used for maxillary infiltrations?

Answer 11

25 mm (short), 30 gauge

Question 12

What is the LA solution used for maxillary infiltrations?

Answer 12

2.2ml of 2% lidocaine hydrochloride with 1:80,000 adrenaline

Question 13

What is the aim of maxillary infiltrations?

Answer 13

deposition and diffusion of LA solution close to or in the target tissue

Question 14

Where do infiltrations using lidocaine work best?

Answer 14

Thin porous bone i.e. in the maxilla or anterior mandible

Question 15

Where do infiltrations using lidocaine not work and what is the alternative?

Answer 15

Very dense cortical bone i.e. the posterior mandible, 4% articaine infiltrations often do work

Question 16

Where can it be difficult for infiltrations using lidocaine to work?

Answer 16

thicker bone due to zygomatic process, divergent roots (upper 1st molars)

Question 17

What are maxillary infiltrations used for?

Answer 17

pulpal for most upper teeth and soft tissue anaesthesia where you deposit the LA solution

Question 18

What can maxillary infiltrations be difficult for?

Answer 18

Pulpal anaesthesia of upper 1st molars - due to thickened bone for zygomatic process and possibly because of divergent roots

Question 19

What must be done prior to injection?

Answer 19

Injection site must be dried with 3 in 1 and topical LA gel applied on cotton wool roll for 2-5 mins

Question 20

What should be used for soft tissue retraction for maxillary infiltrations?

Answer 20

dental examination mirror to decrease chances of needle stick injury for practioner

Question 21

Where should the bevel of the needle be facing?

Answer 21

BEVEL TO BONE

Question 22

What angle should needle be at to the bone?

Answer 22

approx 45 degrees

Question 23

How much La solution should be deposited and how quickly?

Answer 23

1ml a minute (SLOWLY)

Question 24

What does slow deposition of LA solution do?

Answer 24

less painful for patient

Question 25

Why are palatal infiltrations often more uncomfortable for the patient?

Answer 25

Not much space between soft tissue and bone for LA to go

Question 26

What distraction technique can be used to lessen the discomfort in the palate?

Answer 26

Use the end of the mirror near injection site to trick brain

Question 27

When would maxillary blocks be useful?

Answer 27

Surgery involving palatal soft tissues in quadrant

Question 28

What is the most common maxillary block?

Answer 28

Palatal block - incisive or greater palatine

Question 29

Why would maxillary blocks be use?

Answer 29

Reduces dose cf. multiple palatal infiltrations

More comfortable than multiple palatal infiltrations