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Questions and Answers
What is the primary indication for using the Gow-Gates mandibular nerve block?
What is the primary indication for using the Gow-Gates mandibular nerve block?
Which of the following is NOT a contraindication for the Gow-Gates mandibular nerve block?
Which of the following is NOT a contraindication for the Gow-Gates mandibular nerve block?
Which area is NOT anesthetized by the Gow-Gates mandibular nerve block?
Which area is NOT anesthetized by the Gow-Gates mandibular nerve block?
What is one major advantage of the Gow-Gates mandibular nerve block compared to other methods?
What is one major advantage of the Gow-Gates mandibular nerve block compared to other methods?
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Which factor contributes to the longer time to onset of anesthesia with the Gow-Gates technique?
Which factor contributes to the longer time to onset of anesthesia with the Gow-Gates technique?
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What is a common post-injection complication associated with the Gow-Gates mandibular nerve block?
What is a common post-injection complication associated with the Gow-Gates mandibular nerve block?
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What is one alternative technique to the Gow-Gates mandibular nerve block?
What is one alternative technique to the Gow-Gates mandibular nerve block?
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Which statement about the learning curve for the Gow-Gates technique is true?
Which statement about the learning curve for the Gow-Gates technique is true?
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What area does the incisive nerve block primarily target?
What area does the incisive nerve block primarily target?
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Where is the mental nerve block administered?
Where is the mental nerve block administered?
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What is the recommended volume for a supraperiosteal injection using buffered articaine hydrochloride?
What is the recommended volume for a supraperiosteal injection using buffered articaine hydrochloride?
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Which technique involves injecting anesthetic directly into the bone?
Which technique involves injecting anesthetic directly into the bone?
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What anatomical landmark is used to locate the Gow Gates mandibular nerve block?
What anatomical landmark is used to locate the Gow Gates mandibular nerve block?
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During a Gow Gates mandibular nerve block, what should the patient do?
During a Gow Gates mandibular nerve block, what should the patient do?
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What does the buccal nerve block anesthetize?
What does the buccal nerve block anesthetize?
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What is the purpose of the PDL injection technique?
What is the purpose of the PDL injection technique?
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What does tingling or numbness of the lower lip indicate during a Gow-Gates mandibular nerve block?
What does tingling or numbness of the lower lip indicate during a Gow-Gates mandibular nerve block?
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Which of the following is a good indication of successful anesthesia of the Gow-Gates mandibular nerve block?
Which of the following is a good indication of successful anesthesia of the Gow-Gates mandibular nerve block?
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What is the recommended action if bone is not contacted during the Gow-Gates mandibular nerve block?
What is the recommended action if bone is not contacted during the Gow-Gates mandibular nerve block?
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What is one of the safety features of the Gow-Gates mandibular nerve block?
What is one of the safety features of the Gow-Gates mandibular nerve block?
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What is the expected outcome of using a freezing spray or EPT in assessing pulpal anesthesia?
What is the expected outcome of using a freezing spray or EPT in assessing pulpal anesthesia?
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What is the aspiration rate associated with the Gow-Gates mandibular nerve block?
What is the aspiration rate associated with the Gow-Gates mandibular nerve block?
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Which of the following indicates anesthesia of the lingual nerve during a Gow-Gates mandibular nerve block?
Which of the following indicates anesthesia of the lingual nerve during a Gow-Gates mandibular nerve block?
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During the Gow-Gates mandibular nerve block, what should be done if aspirations are negative?
During the Gow-Gates mandibular nerve block, what should be done if aspirations are negative?
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What is one of the primary indications for using the Gow-Gates mandibular nerve block?
What is one of the primary indications for using the Gow-Gates mandibular nerve block?
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Which nerve is NOT anesthetized by the Gow-Gates mandibular nerve block?
Which nerve is NOT anesthetized by the Gow-Gates mandibular nerve block?
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How long has the Gow-Gates mandibular nerve block been available?
How long has the Gow-Gates mandibular nerve block been available?
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Which of the following nerves is responsible for sensation to the incisor region?
Which of the following nerves is responsible for sensation to the incisor region?
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What percentage of clinicians trained in the Gow-Gates technique used it as their primary mandibular technique according to a survey?
What percentage of clinicians trained in the Gow-Gates technique used it as their primary mandibular technique according to a survey?
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Which additional soft tissue requires infiltration in conjunction with the Gow-Gates technique when necessary?
Which additional soft tissue requires infiltration in conjunction with the Gow-Gates technique when necessary?
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Which of the following nerves is involved in the sensory innervation of the tongue?
Which of the following nerves is involved in the sensory innervation of the tongue?
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What advantage does the Gow-Gates technique provide over other methods for difficult-to-anesthetize patients?
What advantage does the Gow-Gates technique provide over other methods for difficult-to-anesthetize patients?
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Study Notes
Gow-Gates Mandibular Nerve Block
- The Gow-Gates mandibular nerve block is a technique that has been around for about 45 years
- It is used as a primary mandibular anesthesia technique by 3.7% to 16.1% of clinicians
- Nerves anesthetized:
- Inferior alveolar nerve
- Mental nerve
- Incisive nerve
- Lingual nerve
- Mylohyoid nerve
- Auriculotemporal nerve
- Buccal nerve (in 75% of patients)
- Areas anesthetized:
- Mandibular teeth to the midline
- Buccal mucoperiosteum and mucous membranes on the side of injection
- Anterior two-thirds of the tongue and floor of the oral cavity
- Lingual soft tissues and periosteum
- Body of the mandible, inferior portion of the ramus
- Skin over the zygoma, posterior portion of the cheek, and temporal regions
Indications
- Multiple procedures on mandibular teeth
- When buccal soft tissue anesthesia, from the third molar to the midline, is necessary
- When lingual soft tissue anesthesia is necessary
- When a conventional IANB is unsuccessful
Contraindications
- Infection or acute inflammation in the area of injection (rare)
- Patients who might bite their lip or their tongue, such as young children and physically or mentally handicapped adults
- Patients who are unable to open their mouth wide (e.g., trismus)
Advantages
- Requires only one injection; a buccal nerve block is usually unnecessary (accessory innervation has been blocked)
- High success rate (>95%), with experience
- Minimum aspiration rate (∼2%)
- Few postinjection complications (e.g., trismus)
- Provides successful anesthesia where a bifid IAN and bifid mandibular canals are present
Disadvantages
- Lingual and lower-lip anesthesia is uncomfortable for many patients and is possibly dangerous for certain individuals.
- The time to onset of anesthesia is somewhat longer than with an IANB, primarily because of the size of the nerve trunk being anesthetized and the distance of the nerve trunk from the deposition site (approximately 5 to 10 mm).
- There is a learning curve with the Gow-Gates mandibular nerve block technique. Clinical experience is necessary to truly learn the technique and to fully take advantage of its greater success rate. This learning curve may prove frustrating for some persons.
Alternatives
- IANB and buccal nerve block
- Vazirani-Akinosi closed-mouth mandibular block
- Incisive nerve block: pulpal and buccal soft tissue anterior to the mental foramen
- Mental nerve block: buccal soft tissue anterior to the first molar
- Buccal nerve block: buccal soft tissue from the third to the mental foramen region
- Supraperiosteal injection (infiltration): using (buffered) articaine hydrochloride, depositing 0.6 to 0.9 mL in the buccal fold adjacent to the tooth to be treated
- Intraosseous technique
- PDL injection technique
Technique
- The patient should be positioned so that the condyle on the side being injected is pointing more forward
- Extraoral landmarks:
- Intertragic notch
- Corner of the mouth on the contralateral side
- Place the left index finger or thumb on the coronoid notch
- The needle is placed just below the mesiolingual cusp of the maxillary second molar and then moved to a point just distal to the molar
Signs and Symptoms
-
Subjective:
- Tingling or numbness of the lower lip indicates anesthesia of the mental nerve, a terminal branch of the inferior alveolar nerve. It is also a good indication that the IAN may be anesthetized.
- Tingling or numbness of the tongue indicates anesthesia of the lingual nerve, a branch of the posterior division of the mandibular nerve. It is always present in a successful Gow-Gates mandibular nerve block.
-
Objective:
- Use of a freezing spray (e.g., Endo-Ice) or an EPT with no response to maximal output (80/80) on two consecutive tests at least 2 minutes apart serves as a “guarantee” (∼99%) of successful pulpal anesthesia in nonpulpitic teeth.
- No pain is felt during dental therapy.
Safety Features
- Needle contacting bone, thereby preventing over insertion.
- Very low positive aspiration rate (2%); minimizes the risk of intravascular injection (the internal maxillary artery lies inferior to the injection site)
Precautions
- If bone is not contacted, do not deposit any local anesthetic:
- Withdraw the needle slightly.
- Ask the patient to open his or her mouth wider.
- Reinsert the needle. Make gentle contact with bone.
- Withdraw the needle 1 mm and aspirate in two planes.
- Inject if aspirations are negative.
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Description
Explore the Gow-Gates mandibular nerve block technique, an essential method used for mandibular anesthesia. Learn about the nerves and areas anesthetized, as well as the indications for this technique in dental procedures. This quiz is perfect for dental students or professionals looking to enhance their understanding of mandibular anesthesia.
