Techniques of Mandibular Anesthesia

mandibular teeth to midline

lingual periodontium & gingiva to midline

facial periodontium & gingiva anterior to midline

lower lip

anterior 2/3 of tongue

floor of mouth to midline

inferior alveolar (IA)

long buccal nerve

buccal gingival tissue of mandibular molars

buccal (B)

facial gingival tissue anterior to mental foramen

lower lip and chin to midline

mental (M)

mandibular teeth, periodontium, and facial soft tissue anterior to the mental foramen

anterior teeth and premolars

incisive (I)

inferior alveolar (IA) landmarks

coronoid notch, pterygomandibular raphe, and mandibular occusal plane

buccal (LB) landmarks

parallel to the occlusal plane

inject buccal to the retromolar pad at the height of the occlusal plane

mental (M) landmarks

mandibular premolars, mental foramen, and mucobuccal fold

NO pressure or massage

incisive (I) landmarks

mandibular premolars, mental foramen, and mucobuccal fold

apply firm pressure/massage over the mental foramen

What is the difference between the incisive and mental block injections?

The mental injection ONLY anesthetizes soft tissues while the incisive injection also anesthetizes teeth because firm pressure/massaging is applied to the mental foramen

What are the similarities between the mental and the incisive blocks?

They have the same injection site

What happens if you inject into an infected area?

the bacteria can be pushed deeper in the tissues causing an increase risk of more severe complications

What happens to the anesthetic acidity in an infection?

An infection lowers the tissue pH, causing the local anesthetic to become heavily ionized and unable to effectively penetrate nerve membranes

Why would you want to move the cheek during an injection? And how could this complicate the injection by doing so?

shaking the cheek distracts your nerves and reduces pain

moving the tissue makes it easier to accidentally miss the target area and possibly injure a vessel

Which mandibular injection can have the highest failure rate, highest aspiration rate, and can cause a hematoma if there is an aspiration?

inferior alveolar (IA)

Should you show the patient the hematoma if this happens?  What else goes along with this?

Yes, you should let them see the bruising and give clear postanesthetic directions

you should also apply pressure with gauze to the area

What happens to the periosteum if you inject anesthetic right on the bone? What should you do if you hit bone?

direct mechanical contact can irritate the periosteal tissue, triggering acute, sharp local pain

if you hit bone when not necessary, withdraw the needle

Which mandibular injections do you want to find the bone during? What should you do if you contact bone?

You must contact bone for the IA block

Once you contact bone, you should pull the needle back about 1 mm

Which mandibular injection has the second highest rate of ending up with a hematoma?

mental nerve block

5.7%

What happens if you are unsuccessful with your IANB injection and why could this happen if you are right on your landmark?

crossover innervation from contralateral incisive nerve or bifid inferior alveolar nerve

How do you anesthetize the lingual nerve? What happens if you receive a shock type of reaction in the tongue?

The lingual nerve is anesthetized by the IANB

The “lingual shock” is felt by the patient upon injection as the needle passes by the lingual nerve

What does the pterygomandibular fold separate?

oral cavity and pharynx

What happens if you inadvertently anesthetize the 7^th Cranial Nerve? Where is that located?

The nerve may inadvertently be anesthetized, which may cause transient facial paralysis (Bell’s palsy)

It is located within the parotid salivary gland

Why can you use a Supraperiosteal injection in the lower anterior easier than in the posterior mandible?

They are more effective on the mandible of the anterior teeth and can be successfully administered for crossover innervations, because the bone is thinner and more porous than in the posterior

What does it mean to achieve a positive lip and tongue sign with your anesthesia? Does this mean you are good to go with your treatment plan?

It means the lingual nerve has been anesthetized, but it does NOT mean the inferior alveolar nerve is anesthetized

You should NOT proceed with tx

What happens if the tissue bubbles up and balloons during the Long Buccal or Buccal Block? What should you do?

This is caused by rapid deposit of solution

This can be corrected by slowing down the injection