Inferior Alveolar Nerve Block

• Nerves anesthetized by an inferior alveolar nerve block:
  • Inferior alveolar nerve
  • Buccal nerve
  • Lingual nerve
  • Nerve to medial pterygoid
  • Mental nerve
  • Incisive nerve
  • Auriculotemporal nerve
  • Mandibular nerve
  • Infraorbital nerve
  • Mylohyoid nerve
• The incidence of positive aspiration seen in an inferior alveolar nerve block is 10% - 15%
• Alternative injections for Inferior Alveolar Nerve Block:
  • Mental nerve block
  • Intra-osseous injection
  • Incisive nerve block
  • Supraperiosteal injections
  • Intraseptal injection
  • Pdl injections
  • Gow-Gates nerve block
  • Vazirani-Akinosi nerve block
• The Buccal nerve block isn't an alternative injection for IANB
• Landmarks for an inferior alveolar nerve block:
  • Greatest concavity on the anterior border of ramus
  • Occlusal plane of the maxillary posterior teeth
  • Mucous membrane distal to the third molar
  • Horizontal/Vertical plane of the pterygomandibular raphe
  • Occlusal plane of the mandibular anterior/posterior teeth
• The parameters that decide the area of insertion for an inferior alveolar nerve block:
  • A line parallel to the mandibular occlusal plane at a height of 6-10mm
  • Positioning of syringe barrel over the contralateral mandibular lateral incisors
  • Three-fourth of the anteroposterior distance from the coronoid notch to the deepest part of pterygomandibular raphe
  • Two-third or three-fourth the depth of the short dental needle

Local Anesthetics

• Local anesthetics are ineffective when injected into an area of infection or inflammation because infected tissue has an acidic PH
• Potential drug interactions with vasoconstrictors:
  • Tricyclic antidepressants
  • Monoamine oxidase inhibitors
  • Digoxin
  • Calcium channel blockers
  • Beta-Blockers
  • Non-steroidal anti-inflammatory drugs
• Clinical manifestations of local anesthetic toxicity:
  • Muscle twitching
  • Auditory hallucination
  • Tonic-clonic seizures
  • Dizziness
  • Hypertension
  • Hypomagnesemia
  • Tachycardia
  • Sinus bradycardia
  • Cardiac arrest
  • Hyperglycemia

Anesthetic Information

• Prilocaine and Benzocaine as types of local anesthetic agent can cause methemoglobinemia
• Local anesthetic agents safe to be given for a pregnant or a lactating patient:
  • Category B: Lidocaine
  • Category B: Prilocaine
• Amide local anesthetics are metabolized by Cytochrome P450 enzymes produced in the liver
• Ester local anesthetics are metabolized by Cytochrome P450 enzymes produced in the liver
• Articaine undergoes partial hydrolysis by plasma cholinesterase
• The Pka of local anesthetics is the PH at which equal concentrations of ionized and unionized forms exist

Extractions and Anatomy

• Catechol O Methyl Transferase is the Mechanism of degradation of epinephrine
• Palatal root of maxillary first molar is the roots of which tooth are most often dislodged into the maxillary sinus during extraction
• The muscles insert on the pterygomandibular raphe:
  • Superior constrictor of pharynx
  • Buccinator
• The area anesthetized by buccal nerve block is the mucoperiosteum buccal to mandibular molar teeth only
• Landmarks for a Gow-gates block:
  • Lower border of tragus
  • Inter-tragic notch
  • External auditory meatus
  • Corner of the mouth of the contralateral side.
  • Mesiopalatal cusp of maxillary second molar
• Landmarks of a Vazirani-Akinosi block:
  • Mucogingival junction of the maxillary third molar
  • Maxillary tuberosity
  • Coronoid notch