Topic 15: Anaesthesia of lower teeth

Question 1

Anaesthesia of lower teeth

Answer 1

Anaesthesia of lower teeth
 The mandible has thick cortical bone which inhibits anaesthetic diffusing to the apices.
 So generally we use block anaesthesia for the lower teeth (usually Szocolozy’s method).

Mandibular block anaesthesias:
 Szokoloczy (Inferior Alveolar N. and Lingual N)
 Mental foramen (Mental N)
 Lingual nerve block
 Buccal nerve block
 Gow Gates
 Akinosi

Question 2

Szokolóczy’s method: Structures anesthetised

Answer 2

Szokolóczy’s method: Structures anesthetised
 If we infiltrate the anaesthetic to the area of the lingula we can anaesthetise the inferior alveolar nerve and the lingual nerve at the same time.
 Nerve anesthetised is the Inf. Alveolar N. and Lingual N.

Structures anesthetised:
 Teeth: All of Lower Teeth
 Soft Tissues: Lower Lip, Tongue, Chin

Question 3

Szokolóczy’s method: method

Answer 3

Szokolóczy’s method: method
 Stand in front of patient. Index finger on TMJ, ring finger on angle, middle finger inbetween the two.
 Then thumb in the mouth at the retromolar space, palpating the crista temporalis on the lateral side at the
same level as the middle finger.
 Just behind the tip of the thumb is where we insert (this is the pterygomandibular space [bordered by the ant.
margin of the med pterygoid M. medially and crista
temporalis laterally]).
 The starting direction is from the contralateral premolars in the occlusal plane, we infiltrate until we reach bone, then bring the needle direction parallel to the ramus and infiltrate around 15mm
 Then when we are in the right spot we return back to the original starting direction and infiltrate untill we
hit bone.
 We then first aspirate to make sure we haven’t hit a BV and if there is no blood we inject 1.8ml here
 USE LONG NEEDLE
 Total movement should be 20-25mm
 Takes around 5-10min for complete numbness

Question 4

Szokolóczy’s method: failures

Answer 4

Szokolóczy’s method: failures
 Needle does not go deep enough - only the tongue will be numb
 Needle goes too deep - the tongue is not or just partially numb, numbness occurs on the lip and around the ear

Question 5

Lingual N. Block: structures anesthetised and method

Answer 5

Lingual N. Block: structures anesthetised and method
 Used for surgeries done on the tongue and floor of the mouth.

Method:
 By the 2nd and 3rd molars, inject lingually by the floor of the mouth

Question 6

Mental N. Block: structures anesthetised and method

Answer 6

Mental N. Block: structures anesthetised and method
 Used for soft tissue surgeries done on the lower lip, chin or vestibule

Method:
 Anaesthesia is infiltrated to mental foramen which is located between the apices of the 1st and 2nd premolar
 On the right side, stand behind the patient and insert the needle from distal side to the foramen

Question 7

Buccal N. Block: structures anesthetised and method

Answer 7

Buccal N. Block: structures anesthetised and method
 Soft tissues: the buccal vestibulum till the
canine

Method:
 The nerve is located in the retromolar fossa.
 Insertion point is 1cm from the distal surface of the lower 3rd molar
(Nerve can be anesthetised terminally as well whic is often more effective)

Question 8

Gow-Gates:

Answer 8

Gow-Gates:

 Used when Inf. Alveolar N. Block has failed/cannot be done.

Question 9

Akinosi:

Answer 9

Akinosi:

 Used when there is trismus or TMJ ankylosis.

Question 10

Anaesthesia for individual teeth:

Answer 10

Anaesthesia for individual teeth:
 The mandible has thick cortical bone which inhibits anaesthetic diffusing to the apices.
 So generally we use block anaesthesia for the lower teeth (usually Szocolozy’s method).

Sometimes terminal supplements are required in the case of:
 Incisors + canines (due to overlapping innervation from the opposite sides)
 Premolars and molars: (due to the anaesthesia of the buccal mucous membrane is not deinnervated by Szocolozy’s method)