palatal anesthesia and greater palatine nerve block

when is palatal anesthesia needed?

whenever a procedure involves the palatal soft tissues or hard palate, such as: periodontal surgery, oral surgery, subgingival restorative procedures on the palatal side, and procedures requiring palatal tissue manipulation

why are palatal injections often considered painful?

the palatal mucosa is dense and tightly attached to bone

there is very little room for tissue expansion when anesthetic is deposited

injecting too quickly increases pressure and discomfort

(most pain comes from tissue pressure, not the tissue itself)

how can palatal injections be made less painful?

apply topical anesthesia

use pressure anesthesia before and during injection

maintain good needle control

inject slowly

reassure the patient

what is pressure anesthesia?

applying firm pressure near the injection site while administering the injection

purpose: helps reduce pain perception, distracts the patient from the injection

what needle is recommended for palatal injections?

27-gauge short needle

bc people cannot distinguish between the different gauges, the 270gauge needle offers better control

which palatal injections provide pulpal anesthesia?

most palatal injections DO NOT provide pulpal anesthesia

these primarily anesthetize the palatal soft tissues

exceptions: AMSA, P-ASA (??)

what is the greater palatine nerve block used for?

anesthetizes the posterior hard palate and its overlying soft tissues

primarily used for procedures involving the palatal tissues distal to the canine

what is another name for the greater palatine nerve block

anterior palatine nerve block

which nerve is anesthetized during the greater palatine nerve block

the greater palatine nerve

what areas are anesthetized by the greater palatine block

posterior hard palate, palatal soft tissues, extends anteriorly to about the first premolar, extends medially to the midline

does NOT anesthetize the pulps of any teeth

when is a greater palatine nerve block contraindicated?

hen infection or inflammation is present

when only one or two teeth require palatal anesthesia

(for a small area, use a local palatal infiltration instead)

advantages of the greater palatine block

fewer needle penetrations

less anesthetic required

less patient discomfort than multiple palatal infiltrations

disadvantages of the greater palatine block

provides hemostasis only near the injection site while

can be uncomfortable if not administered properly

potentially traumatic if technique is poor

alternatives to the greater palatine block

local palatine infiltration

maxillary nerve block

greater palatine technique

needle: 27-gauge short

insertion: soft tissues primarily used just anterior tot he greater palatine foramen

target: greater palatine nerve as it exits the foramen

landmarks: greater palatine foramen, junction of the maxillary alveolar process and palatine bone

operator position for a greater palatine blocks

right-handed position:

right side 7-8 o’clock

left side 11 o’clock

patient should be supine

what precaution should be taken during a greater palatine block?

do NOT enter the greater palatine canal

what complications can occur with a greater palatine block?

soft tissue ischemia or necrosis (with prolonged use of highly concentrated vasoconstrictors)

rare hematoma

soft palate anesthesia, which some patients find uncomfortable

a patient needs SRP on the palatal surfaces of maxilary molars. a PSA block has already been given. is another injection needed?

yes, since the PSA anesthetizes the buccal tissues and pulps, but does not anesthetize the palatal soft tissues