Week Four: Local Anaesthetic Techniques Flashcards
Name the first six steps of basic local anaesthetic.
- Identify structures that need to be anesthetised. 2. Decide upon most suitable technique for individual patient to achieve anaesthesia of identified structures. i. age ii. bone density 3. Choose local anaesthetic type. i. length of anaesthesia required ii. Client age iii. Client medical history (illness and medications) iv. identify any precautions that need to be taken 4. Prepare syringe: i. cartridge: load and engage with piston ii. needle short or long? iii. check flow. 5, Place patient in supine position.
Once the patient is in supine position what are the next steps in administering local anaesthetic?
- Visualise the bony target area 7. Identify soft tissue landmarks and orientation of syringe required to access this area 8. prepare tissue i. dry target area ii. Apply topical anaesthetic > 1-2mins 9. Retraction. i. Retract cheek/lip with mirror, pulling the tissues taught, to ensure can clearly see landmarks identifying target area 10. Orient needle so that bevel face bone 11. Insert needle gently into target area 12. Advance needle to required depth
Once you have inserted the needle into the required depth, what are your final last steps?
- Aspirate i. in two planes for blocks ii. +ve: (blood in cartridge) discard cartridge, do not deposit solution. New Cartridge required. iii. -ve: safe to deposit solution 15. Deposit suitable amount for target area 16. Withdraw 17. Dispose of needle safely 18. Wait for onset of action i. differs amongst types of LA, and site of administration ii. Assess client
What is the infiltration technique?
Infiltration technique is able to be performed in the maxilla due to the thin cortical bone permitting diffusion of anaesthetic solution through the bone to the target nerve. It involves injecting into tissues immediately adjacent to the site that you want to anaesthetise. In doing this you also subsequently anaesthetise terminal branches of a larger nerve trunk.
What are the two types of infiltration techniques?
Buccal infiltrations Palatal Infiltrations
What is an indication for using a buccal infiltration technique?
Suitable if you require pulpal anaesthesia of one or two teeth.
What nerve is targeted in a buccal infiltration of the Maxilla?
PSA (Posterior Superior Alveolar), MSA (Middle Superior Alveolar) and ASA (Anterior Superior Alveolar)
What area is anaesthetised in a buccal infiltration?
Terminal branches on the innervating nerve of the adjacent tooth This results in anaesthesia of local pulp, root, buccal periosteum, connective tissue, buccal gingiva and mucous membrane.
What is the target bony site for a buccal infiltration?
Slightly distal and superior to the apex of the target tooth.
What is the soft tissue landmark for a buccal infiltration?
The height of the mucobuccalfold fold of the vestibule adjacent to the target tooth.
What is the orientation of the syringe for a buccal infiltration?
The syringe should be parallel to the long axis of the tooth - if it is an anterior tooth. It becomes more oblique as you move posteriorly.
What needle length is suggested for a buccal infiltration?
Short needle
What is the insertion for a buccal infiltration?
Approx 3-5mm (anterior -posterior)
What amount is deposited for a buccal infiltration?
0.5ml-1ml - (1/4 cartridge to 1/2 cartridge)
What is this picture of?

Buccal infiltration
What is this also a picture of? IMAGE

Buccal infiltration
What is this a diagram of? IMAGE

Buccal infiltration
What else is a buccal infiltration called?
Supraperiosteal injection
What are some considerations for a supraperiosteal injection?
When injecting a deciduous tooth you must note that it has flared roots. You must do the distal injection first. You must also consider the shape of the maxilla and the shape of the tooth root, Upper laterals have a slight distal inclination - if it can not achieve pulpal anaesthesia from the buccal aspect you may need to deposit palatally. It is important to consider that there are areas of poor diffusion in the maxilla. i.e. Where the cortical bone is thicker (attachment of zygomatic arch - zygoma)
What’s a cool trick with a buccal infiltration if you want to anaesthetise two teeth?
You can inject interproximally between apices of two teeth to target both.
Consideration: Is there a chance at multiple innervation with a buccal infiltration?
Yes there is. e.g. 16/26 can occur.
Although buccal infiltrations are useful, to minimise the use of them what should you consider?
Consider a block technique instead. PSA block, MSA block, ASA Blocks.
What is the indication for a palatal infiltration?
Anaesthetises the palatal gingiva of the corresponding tooth only.
What nerve is targeted for a palatal infiltration?
It is dependant on the region you want to anaesthetise. However it is the nasopalatine or the greater palatine.

























