Unit 8 Flashcards
What are some general considerations when doing mandibular LA?
Overall, the mandible is denser than the maxilla, making supraperiosteal injections of the mandible not as successful.
Supraperiosteal injections are more effective on the mandible of the anterior teeth and can be successfully administered for crossover innervations.
Substantial variation in the anatomy landmarks of the mandibular bone and nerves complicates mandibular anesthesia.
What are some problem solving techniques when doing the IANB?
Failure rate of IANB: 15% to 20 %
Hints:
- Seat the patient upright or semiupright after the injection
- Use the Gow-Gates mandibular block
- If bone is contacted too soon, bring syringe more closely superior to mandibular anterior teeth to move the needle tip more posteriorly.
- If bone is not contacted, bring syringe more closely superior to mandibular molars to move the needle tip more anteriorly.
What are some precautions when working around the lingual nerve??
- Clinicians – be prepared!
- As the needle passes by the lingual nerve, the moving needle shocks the nerve.
- Symptom is only momentary and unavoidable.
- Prepare the patient for this normal occurrence.
- Depositing small amounts of solution as the needle advances will NOT prevent “lingual shock”.
What are the properties with doing the buccal nerve block?
- Indications: Usually given immediately after IANB to complete quadrant anesthesia
- Nerves and other structures anesthetized: Long buccal nerve and buccal gingival tissue of mandibular molars
- Needle gauge & length: Use 25-gauge, long immediately after IA block or use 27-gauge, short if buccal block is given alone
What are some problem solving techniques when administering a buccal block?
Leakage of solution at injection site
- Caused by bevel of needle only partially in the tissue
- Correct by deeper penetration on reinsertion
Ballooning of tissue
- Caused by rapid deposit of solution
- Correct by slowing down the injection
Cheek biting
-Correct by educating patient
What are some problem solving techniques when administering a buccal block?
Leakage of solution at injection site
- Caused by bevel of needle only partially in the tissue
- Correct by deeper penetration on reinsertion
Ballooning of tissue
- Caused by rapid deposit of solution
- Correct by slowing down the injection
Cheek biting
-Correct by educating patient
What are some clinical considerations with the Gow Gates injection?
Advantage:
- Higher success rate than IANB
- Injection lasts longer than IANB
Disadvantage:
- Anesthesia of the lower lip and temporal area
- May take longer to acquire anesthesia
Contraindicated:
-Patients with limited ability to open mouth
Complication:
- Hematoma
- Apply pressure with gauze to the area
- Reassure patient
When would Gow Gates be recommended?
for extensive procedures during quadrant dentistry or with failure of the IA block
What nerves are anesthetized with the Gow gates?
True mandibular block!!
Auriculotemporal nerve Inferior alveolar nerve Mylohyoid nerve Lingual nerve Long buccal nerve Mental nerve Incisive nerve
What nerves are anesthetized with the Gow gates?
True mandibular block!!
Auriculotemporal nerve Inferior alveolar nerve Mylohyoid nerve Lingual nerve Long buccal nerve Mental nerve Incisive nerve
Anesthetizes the mandibular teeth to the midline, the periodontium, the buccal and lingual gingival of the anesthetized teeth; the lower lip to midline, anterior two thirds of tongue and floor of mouth; and the skin over the zygoma and posterior part of the cheek and temporal regions.
What are the properties of the incisive nerve block?
- Incisive block is recommended for anesthesia of the teeth and periodontium and facial soft tissue anterior to the mental foramen, usually the anterior teeth and premolars.
- Useful when there is a crossover of the contralateral incisive nerve and there is still discomfort on the mandibular anterior teeth after giving an IANB
- Useful for nonsurgical perio or routine maintenance of sensitive anteriors
- Aspirate in two planes ( 45˚turn)
What are the differences between a mental block and an incisive block?
- Difference: Incisive block anesthetizes teeth
- Needle gauge & length: 27-gauge, short
- Operator position: same
- Syringe stabilization: same
- Landmarks: same
- Needle insertion point, penetration, and location: same
- Amount of anesthetic: same
- Length of time to deposit: same
So, what is the difference between the mental block and the incisive block?
- the incisive block anesthetizes the mandibular anterior teeth
- the technique after the injection
What are the landmarks of the Gow Gates?
Landmarks: Extraoral: lower border of the tragus and labial commissure
Intraoral: Mesiolingual cusp of maxillary second molar and soft tissue just distal to maxillary second molar
What are the landmarks of the Gow Gates?
Landmarks: Extraoral: lower border of the tragus and labial commissure
Intraoral: Mesiolingual cusp of maxillary second molar and soft tissue just distal to maxillary second molar
What are some technique differences with the mental and incisive block?
- Do not massage the tissue after the mental block injection
- Do apply gentle pressure or a soothing massage to the injection area for at least 2 minutes after the incisive injection
- Also helpful to position patient upright or in semi-upright position after the injection to help with diffusion of anesthetic solution
What is the purpose of the gentle massage of tissue after the incisive block?
forces more local anesthetic agent into the mental forament
Why do you have to massage the local anesthetic agent into the mental foramen after the mental block?
Because the mental nerve is located closer to the tissue surface than the deeper located incisive nerve. Anesthesia of the mental nerve and of the soft tissue precedes the pulpal anesthesia of the incisive nerve.
Why do you have to massage the local anesthetic agent into the mental foramen after the mental block?
Because the mental nerve is located closer to the tissue surface than the deeper located incisive nerve. Anesthesia of the mental nerve and of the soft tissue precedes the pulpal anesthesia of the incisive nerve.
How do you trouble shoot inadequate anesthesia during the incisive block?
Causes: inadequate volume of anesthetic or inadequate duration of pressure over mental foramen
Correction: reinject in correct location and apply firm pressure to deposition site for minimum of 2 minutes
How do you trouble shoot hematoma’s from an incisive block?
- Same percentage as for mental block; occurrence is still rare
- Apply pressure with gauze to the area
- Reassure patient
What are the properties of the periodontal ligament injection (PDL) - Ligamejet
- Absence of lip or tongue anesthesia
- Single dose and minimal volume of anesthetic
- Alternative when other methods are ineffective
- Minimal postinjection discomfort
- Postoperative complications are unlikely
- Minimizes bleeding in area of treatment
- Decreased risk of toxicity
What are the properties of the periodontal ligament injection (PDL) - Ligamejet
- Absence of lip or tongue anesthesia
- Single dose and minimal volume of anesthetic
- Alternative when other methods are ineffective
- Minimal postinjection discomfort
- Postoperative complications are unlikely
- Minimizes bleeding in area of treatment
- Decreased risk of toxicity
What are some challenges with using the PDL injection technique?
- Needle placement may be difficult and experience is necessary
- Anesthetic may leak into the patient’s mouth causing bitter taste
- Short duration of pulpal anesthesia
- Contraindicated in areas with infection or severe inflammation
- Excessive pressure needed for the injection, which may cause breakage of glass cartridge in standard syringe and may cause tissue damage)?
