Local Anesthesia Techniques Overview

Questions and Answers

What is a disadvantage of using one injection compared to three infiltrations?

Less time-consuming procedure

Easier technique due to landmarks

Increased volume of anesthetic needed

Higher risk of intraoral hematoma (correct)

What percentage of the population has the middle superior alveolar nerve?

50%

15%

70%

30% (correct)

What is a common complication that can occur due to needle positioning during the PSANB technique?

Increased patient anxiety

Excessive salivation

Injury to the pterygoid plexus (correct)

Nerve regeneration failure

What is the main function of the anterior superior alveolar nerve?

Carries the function of the MSA nerve Signup and view all the answers

Which factor contributes to the failure of the PSANB technique when the needle is not high enough?

Insufficient anesthesia of the area Signup and view all the answers

What must be done if the needle is positioned too laterally during PSANB?

Redirect the needle tip medially Signup and view all the answers

Which teeth are primarily anesthetized by the anterior superior alveolar nerve block?

Maxillary anterior teeth and premolars Signup and view all the answers

What is a necessary follow-up when performing PSANB on the first molar?

Second injection for first molar Signup and view all the answers

What is a common reason for the lack of popularity of the anterior superior alveolar nerve block?

Fear of injury to the patient's eye Signup and view all the answers

What is a significant risk when inserting the needle too far posteriorly during the PSANB technique?

Maxillary artery perforation Signup and view all the answers

Which nerve is NOT anesthetized by the anterior superior alveolar nerve block?

Inferior alveolar nerve Signup and view all the answers

Why is it critical to pay attention to penetration depth during the PSANB procedure?

To avoid vascular complications Signup and view all the answers

When is the anterior superior alveolar nerve block indicated?

In procedures involving more than two maxillary anterior teeth Signup and view all the answers

What happens if adequate pressure cannot be applied to stop bleeding during a hematoma in the buccal tissues?

The bleeding will continue Signup and view all the answers

What is a possible contraindication for the anterior superior alveolar nerve block?

Presence of cellulitis Signup and view all the answers

What does the infraorbital nerve block anesthetize?

Terminal branches of the infraorbital nerve Signup and view all the answers

What is the preferred injection technique for discrete treatment areas involving one or two teeth?

Supraperiosteal injection Signup and view all the answers

What is a significant advantage of the supraperiosteal injection compared to the infiltration technique?

Minimizes needle punctures Signup and view all the answers

What is the estimated percentage for positive aspiration during the anterior superior alveolar nerve block?

0.7% Signup and view all the answers

What is one of the disadvantages of the anterior superior alveolar nerve block?

Doesn't provide hemostasis in the operative field Signup and view all the answers

What armamentarium is not considered basic for the anterior superior alveolar nerve block?

Hemostat & college cotton tweezer Signup and view all the answers

In what position should a patient be placed for an anterior superior alveolar nerve block?

Supine or semisupine Signup and view all the answers

Where should the tissue be prepared for the injection in the anterior superior alveolar nerve block?

At the height of the mucobuccal fold Signup and view all the answers

What is the first step in locating the infraorbital foramen for the anterior superior alveolar nerve block?

Feeling the infraorbital notch Signup and view all the answers

What is a common subjective clinical finding after an anterior superior alveolar nerve block?

Numbness of the ipsilateral lower eyelid Signup and view all the answers

What is indicated by an absence of response to an Electric Pulp Tester during an ASANB?

Successful anesthesia of targeted teeth Signup and view all the answers

What might occur if the needle contacts bone inferior to the infraorbital foramen?

Anesthesia of the upper lip and lower eyelid Signup and view all the answers

What should be maintained to avoid failure of the ASANB due to needle deviation?

Orientation towards the foramen Signup and view all the answers

Which technique can serve as a supplementary injection method during dental procedures?

Maxillary nerve block Signup and view all the answers

What is a potential complication of an anterior superior alveolar nerve block?

Hematoma across the lower eyelid Signup and view all the answers

What is suggested as a corrective measure if the needle contacts bone during ASANB?

Align the needle with the infraorbital foramen Signup and view all the answers

Which of the following is NOT a method to test for successful anesthesia in the ASA nerve block?

Response to thermal pulp test Signup and view all the answers

What is the average penetration depth of a needle for an adult of average height?

16 mm Signup and view all the answers

Where should the needle contact to prevent over-insertion during an anterior superior alveolar nerve block?

Infraorbital foramen Signup and view all the answers

What is the recommended procedure for aspiration before administering local anesthetic?

Aspiration should be performed at least twice. Signup and view all the answers

What should be done after feeling the needle during the procedure?

Redirect the needle toward the target area. Signup and view all the answers

What is the typical amount of local anesthetic to deposit during the procedure?

0.9 ml to 1.2 ml Signup and view all the answers

What is the purpose of applying finger pressure over the injection site after administering the local anesthetic?

To increase the diffusion of the anesthetic solution. Signup and view all the answers

What is the maximum amount of anesthetic solution to be deposited over 30 to 40 seconds?

0.9 ml to 1.2 ml Signup and view all the answers

Why should the syringe be rotated 45 degrees during the second aspiration test?

To exclude the possibility of false negative aspiration. Signup and view all the answers

Study Notes

Anesthetic Techniques Overview

Minimum injections needed: one injection versus three infiltrations
Total volume minimized; three supraperiosteal injections equal 1.8 ml of anesthetic
Risks include diffuse intraoral hematoma in buccal mandibular region and no clear bony landmarks for needle insertion
A second injection may be needed for first molar anesthesia in about 30% of cases

Posterior Superior Alveolar Nerve Block (PSANB) Technique

Common issues leading to failures:
- Needle too lateral → redirect medially
- Needle not high enough → redirect superiorly
- Needle too far posterior → withdraw to proper depth

Hematoma Considerations

Hematomas may arise from injecting anesthetic outside the desired location
Injury to pterygoid plexus or maxillary artery can occur if needle is inserted too far posteriorly
No accessible intraoral area for applying pressure to stop hemorrhage

Anterior Superior Alveolar Nerve Block (ASA/Infraorbital Nerve Block)

MSA nerve present in only 30% of people; ASA nerve compensates in 70%
Provides anesthesia for maxillary incisors, canine, premolars, and mesiobuccal root of first molar
Terminal branches affected include inferior palpebral, lateral nasal, and superior labial nerves

Clinical Insights

ASA nerve block less popular due to inexperience and fear of eye injury, despite high success and safety when properly administered
Indications:
- More than two maxillary anterior teeth involved
- Ineffective supraperiosteal injections
- Cases with inflammation/infection (cellulitis may require maxillary nerve block instead)

ASA Block Protocol

Advantages: minimizes volume and number of punctures for anesthesia with a longer effect
Disadvantages: does not provide localized hemostasis
Positive aspiration rate negligible (0.7%)

Armamentarium Required

Basic: Long needle, aspirating syringe, local anesthetic cartridge, possible vasoconstrictor
Auxiliary: Topical antiseptic, topical anesthetic, hemostat, cotton tweezers

Injection Procedure

Position patient in supine/semi-supine position with neck extension
Dentist's position: right side of the chair for right-handed dentists
Prepare injection site: dry area, optionally apply antiseptic and anesthetic

Locating Infraorbital Foramen

Identify infraorbital notch and pressure downwards to detect the convex bone of the infraorbital foramen
Average needle penetration depth: 16 mm for adults

Safety Measures

Advance needle slowly until bone is contacted to avoid over-insertion
Aspiration recommended at least twice to confirm no blood vessel contact

Injecting Anesthetic

Deposit 0.9 ml to 1.2 ml using a 25-gauge long needle over 30-40 seconds
Maintain pressure on injection site for 1-2 minutes post-injection
Wait 3-5 minutes before starting the dental procedure

Clinical Findings

Subjective: Tingling and numbness in the affected regions
Objective:
- Probing tests show no pain
- No response with electric pulp testing or thermal tests
- No pain during treatment

Causes of ASANB Failure

Incorrect needle contact with bone below infraorbital foramen results in anesthesia in areas but not the teeth
Needle deviation from foramen during advancement can lead to inadequate targeting

Alternative Techniques and Complications

Basic injection options: infiltration technique or maxillary nerve block
Supplementary options: periodontal ligament injection
Complications may include hematoma under the eyelid and temporary double vision (horizontal diplopia)

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

This quiz explores various techniques of administering local anesthesia, comparing the effectiveness and volume of solutions required for procedures. It discusses the advantages and disadvantages of using one injection versus multiple infiltrations, highlighting potential risks and considerations for practitioners.