Podcast
Questions and Answers
Which nerve is primarily anesthetized during an inferior alveolar nerve block?
Which nerve is primarily anesthetized during an inferior alveolar nerve block?
What is a common indication for performing an inferior alveolar nerve block?
What is a common indication for performing an inferior alveolar nerve block?
Which of the following is a contraindication for the inferior alveolar nerve block?
Which of the following is a contraindication for the inferior alveolar nerve block?
What is a disadvantage of the inferior alveolar nerve block concerning its efficacy?
What is a disadvantage of the inferior alveolar nerve block concerning its efficacy?
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Which alternative technique is best suited for buccal soft-tissue anesthesia anterior to the first molar?
Which alternative technique is best suited for buccal soft-tissue anesthesia anterior to the first molar?
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What is a reported positive aspiration rate for the inferior alveolar nerve block?
What is a reported positive aspiration rate for the inferior alveolar nerve block?
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What could lead to partial anesthesia occurring during an inferior alveolar nerve block?
What could lead to partial anesthesia occurring during an inferior alveolar nerve block?
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Which of the following nerves is part of the posterior division of the mandibular nerve?
Which of the following nerves is part of the posterior division of the mandibular nerve?
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Which technique involves injecting a 25-gauge long needle into the mucous membrane on the medial side of the mandibular ramus?
Which technique involves injecting a 25-gauge long needle into the mucous membrane on the medial side of the mandibular ramus?
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What is the primary target area for the inferior alveolar nerve block injection?
What is the primary target area for the inferior alveolar nerve block injection?
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What is a key anatomical landmark used for the inferior alveolar nerve block?
What is a key anatomical landmark used for the inferior alveolar nerve block?
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Which of the following is NOT a method of achieving anesthesia in the mandibular region?
Which of the following is NOT a method of achieving anesthesia in the mandibular region?
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Which injection is primarily indicated for osseous anesthesia of molars?
Which injection is primarily indicated for osseous anesthesia of molars?
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What is the injection technique that provides pulpal anesthesia for any mandibular tooth?
What is the injection technique that provides pulpal anesthesia for any mandibular tooth?
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The target area for a successful inferior alveolar nerve block is found before the nerve enters which anatomical structure?
The target area for a successful inferior alveolar nerve block is found before the nerve enters which anatomical structure?
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Which of the following options accurately describes the intersection for needle insertion in the inferior alveolar nerve block?
Which of the following options accurately describes the intersection for needle insertion in the inferior alveolar nerve block?
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What gauge of needle is preferred for the inferior alveolar nerve block?
What gauge of needle is preferred for the inferior alveolar nerve block?
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Which of the following best describes the area of insertion for the inferior alveolar nerve block?
Which of the following best describes the area of insertion for the inferior alveolar nerve block?
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When administering an inferior alveolar nerve block, where should the patient’s head be positioned?
When administering an inferior alveolar nerve block, where should the patient’s head be positioned?
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What is the target area for the inferior alveolar nerve block?
What is the target area for the inferior alveolar nerve block?
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Which landmark is identified when palpating the anterior border of the ramus?
Which landmark is identified when palpating the anterior border of the ramus?
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What position should a right-handed administrator be in while performing the right inferior alveolar nerve block?
What position should a right-handed administrator be in while performing the right inferior alveolar nerve block?
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Which structure does the inferior alveolar nerve typically follow as it approaches the mandibular foramen?
Which structure does the inferior alveolar nerve typically follow as it approaches the mandibular foramen?
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What is the first step in palpating for intraoral landmarks during the inferior alveolar nerve block?
What is the first step in palpating for intraoral landmarks during the inferior alveolar nerve block?
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What is the appropriate angle for needle insertion during the right inferior alveolar nerve block?
What is the appropriate angle for needle insertion during the right inferior alveolar nerve block?
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How deep should the needle be inserted on average during the inferior alveolar nerve block for adults?
How deep should the needle be inserted on average during the inferior alveolar nerve block for adults?
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What is the proper technique after contacting bone during needle insertion?
What is the proper technique after contacting bone during needle insertion?
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Which of the following steps is recommended before depositing anesthetic?
Which of the following steps is recommended before depositing anesthetic?
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Why is reaspiration necessary during the injection process?
Why is reaspiration necessary during the injection process?
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What is usually not necessary in most patients when administering the right inferior alveolar nerve block?
What is usually not necessary in most patients when administering the right inferior alveolar nerve block?
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Which area is palpated to determine the height of the mandibular sulcus?
Which area is palpated to determine the height of the mandibular sulcus?
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What is the gauge and length of the needle recommended for the procedure?
What is the gauge and length of the needle recommended for the procedure?
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What indicates successful anesthesia of the inferior alveolar nerve during the procedure?
What indicates successful anesthesia of the inferior alveolar nerve during the procedure?
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Which position should a right-handed administrator sit in for a left inferior alveolar nerve block?
Which position should a right-handed administrator sit in for a left inferior alveolar nerve block?
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Why should the needle tip contact bone during an inferior alveolar nerve block?
Why should the needle tip contact bone during an inferior alveolar nerve block?
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What could happen if local anesthetic is deposited without contacting bone?
What could happen if local anesthetic is deposited without contacting bone?
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What is considered a reliable sign of successful pulpal anesthesia?
What is considered a reliable sign of successful pulpal anesthesia?
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What should be done to manage a hematoma that occurs after anesthetic deposition?
What should be done to manage a hematoma that occurs after anesthetic deposition?
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Which of the following is NOT a common cause of failure in achieving anesthesia with an inferior alveolar nerve block?
Which of the following is NOT a common cause of failure in achieving anesthesia with an inferior alveolar nerve block?
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What symptom typically indicates anesthesia of the lingual nerve during the procedure?
What symptom typically indicates anesthesia of the lingual nerve during the procedure?
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Study Notes
Mandibular Nerve
- The mandibular nerve is a branch of the trigeminal nerve
- It has an undivided nerve and a divided nerve with anterior and posterior divisions
- The undivided nerve includes the nerve to the medial pterygoid muscle and the nervus spinosus
- The anterior division include: nerve to lateral pterygoid muscle, nerve to masseter muscle, nerve to temporal muscle and buccal nerve
- The posterior division includes: auriculotemporal nerve, lingual nerve, mylohyoid nerve, inferior alveolar nerve with dental branches, and incisive branch with dental branches and mental nerve
Inferior Alveolar Nerve Block
Nerves Anesthetized
- Inferior alveolar nerve
- Incisive nerve
- Mental nerve
- Lingual nerve (commonly)
Indications
- Procedures on multiple mandibular teeth in one quadrant
- When buccal soft-tissue anesthesia is needed (anterior to the first molar)
- When lingual soft-tissue anesthesia is needed
Contraindications
- Infection or acute inflammation in the injection area (rare)
- Patients who might bite the lip or tongue (e.g., young children, physically or mentally challenged adults)
Advantages
- One injection provides a wide area of anesthesia (useful for quadrant dentistry)
Disadvantages
- Wide area of anesthesia (not necessary for localized procedures)
- Rate of inadequate anesthesia (15% to 20%)
- Intraoral landmarks are not consistently reliable
- Positive aspiration (10% to 15%, highest rate of all intraoral injection techniques)
- Lingual and lower lip anesthesia, potentially discomforting
- Partial anesthesia possible with bifid inferior alveolar nerve and bifid mandibular canals
Alternatives
- Mental nerve block (buccal soft-tissue anesthesia anterior to the first molar)
- Incisive nerve block (pulpal and buccal soft-tissue anesthesia of teeth anterior to the mental foramen)
- Supraperiosteal injection (pulpal anesthesia of central and lateral incisors, and sometimes premolars)
- Gow-Gates mandibular nerve block
- Vazirani-Akinosi mandibular nerve block
- PDL injection (pulpal anesthesia of any mandibular tooth)
- Intraosseous (IO) injection (osseous and soft-tissue anesthesia of any mandibular region, especially molars)
- Intraseptal injection (osseous and soft-tissue anesthesia of any mandibular region)
Technique
- 25-gauge long needle recommended for adult patients
- Area of insertion: mucous membrane on medial side of mandibular ramus, at the intersection of horizontal and vertical lines
Landmarks
- Coronoid notch (greatest concavity on anterior border of the ramus)
- Pterygomandibular raphe
- Occlusal plane of mandibular posterior teeth
Operator Position
- Right-handed administrator sits at 8 o'clock position, facing patient
Positioning the patient
- Supine or semi-supine
- Head positioned so mandible is parallel to the floor when mouth is open
Palpation of Intraoral Landmarks
- Palpate mucobuccal fold with left index finger or thumb
- Move finger/thumb posteriorly to external oblique ridge on anterior border of mandibular ramus
- Move finger/thumb up and down to identify coronoid notch (in line with mandibular sulcus)
- Move finger lingually across retromolar triangle and onto internal oblique ridge
Needle Insertion
- Syringe with 1 5/8 inch, 25-gauge needle
- Insert parallel to the occlusal plane of mandibular teeth, opposite side of the mouth
- Bisect finger/thumb level, penetrate pterygotemporal depression, enter pterygomandibular space
- Patient should keep mouth wide open during insertion
- Penetrate tissues to the internal surface of the mandibular ramus to make bony contact
- Average depth of penetration is 20-25mm (approximately two-thirds to three-fourths length of long dental needle)
Technique: Right Inferior Alveolar Nerve Block
- Withdraw approximately 1 mm when bone is contacted to prevent subperiosteal injection
- Aspirate in two planes
- If negative, deposit 1.5 mL of anesthetic over 60 seconds (slow injection, reaspiration, slow injection, reaspiration is recommended)
- Slowly withdraw syringe; reaspirate when approximately half length remains within tissues
- Deposit a portion of the remaining solution (0.2 mL) to anesthetize the lingual nerve (often not necessary)
Technique: Left Inferior Alveolar Nerve Block
- Right-handed administrator sits at 10 o'clock position, facing patient
- Left arm of dentist placed around patient's head for palpating landmarks with left index finger or thumb
Signs and Symptoms
- Subjective: Tingling or numbness of lower lip (mental nerve)
- Subjective: Tingling or numbness of tongue (lingual nerve)
- Objective: Use of freezing spray/electric pulp tester (EPT) showing no response after maximal output (80/80) for two tests (at least 2 minutes apart) - considered a "guarantee" (approximately 99%)
- Objective: No pain during dental therapy
Precautions
- Don't deposit local anesthetic if bone is not contacted (needle tip could be in parotid gland near facial nerve, leading to transient paralysis)
- Avoid forcefully contacting bone
Failures of Anesthesia
- Deposition of anesthetic too low (below mandibular foramen)
- Deposition of anesthetic too far anteriorly/laterally on the ramus
- Accessory innervation to the mandibular teeth
Complications
- Hematoma (rare): swelling of tissues on medial side of mandibular ramus; manage with pressure and cold
- Trismus (rare): muscle soreness, limited movement, may be slight or severe
- Transient facial paralysis: local anesthetic deposition into parotid gland; inability to close lower eyelid, drooping upper lip
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Description
Explore the anatomy of the mandibular nerve, its branches, and functions. This quiz covers the details about the inferior alveolar nerve block, including indications and contraindications. Test your knowledge of nerve anesthetization and its applications in dental procedures.
