4.20 Oral nerve blocks

What to do:

• Inferior alveolar nerve block provides rapid relief of pain in all teeth on one side of the mandible and the lower lip and chin.
  • Palpate the retromolar fossa with the index finger and identify the convexity of the mandibular ramus.
  • Hold the syringe parallel to the occlusal surfaces of the teeth so that its barrel is in line between the first and second premolars on the opposite side of the mandible.
  • Retract the soft tissue towards the cheek and find the pterygomandibular triangle.
  • Puncture the triangle, making sure the needle passes through the ligaments and muscles of the medial mandibular surface.
  • Stop advancing the needle when it reaches the bone, withdraw it a few millimeters, aspirate to be sure the tip is not in a vein, and deposit 1-2ml of local anesthetic.
• Supraperiosteal infiltration provides intraoral local anesthesia for pain arising from maxillary teeth.
  • Pucture the mucobuccal fold, holding the bevel of the needle toward the bone, aspirate the area and then inject 1-2ml of anesthetic near the apex of the affected tooth. This technique usually produces full anesthesia in 5-10 minutes. For best results inject as close as possible to the tooth-bearing maxillary bone.