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This document discusses local anesthesia used in dentistry. It describes the trigeminal nerve and its branches that provide sensation to the face and motor control of jaw muscles. It outlines the instruments used for local anesthesia like syringes, needles, and anesthetic cartridges. It explains techniques for maxillary and mandibular anesthesia including infiltration, field block, and nerve block injections. Complications of local anesthesia like needle breakage, facial paralysis, and paresthesia are also summarized.

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50 views

Presentation 1

This document discusses local anesthesia used in dentistry. It describes the trigeminal nerve and its branches that provide sensation to the face and motor control of jaw muscles. It outlines the instruments used for local anesthesia like syringes, needles, and anesthetic cartridges. It explains techniques for maxillary and mandibular anesthesia including infiltration, field block, and nerve block injections. Complications of local anesthesia like needle breakage, facial paralysis, and paresthesia are also summarized.

Uploaded by

anamiqbal
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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LOCAL ANESTHESIA

ANATOMY:
TRIGEMINAL NERVE:
SENSORY DIVISION:
 Opthalmic nerve V1
 Maxilary division V2
 Mandibular division V3
MOTOR DIVISION:
 Masticatory muscles-messeter,temporalis,medial,laterla
pterydoids
 Mylohyoid
 An t.belly of digastric
 Tensor tympani
 Tensor veli palatini
MAXILARY DIVISION:
Pure sensory
Leaves the skull through foramen rotumdum and crosses the upper
part of the pterygopalatine fossa.
Brances are divided into four groups:
In the cranium meningeal
In the pterygopalatine fossa ganglionic
 zygomatic
 posterior superior
 alveolar nerve
In the infraorbital canal middle superior
 alveolar nerve
 ant.sup alveolar nerve
On the face palpebral
 Nasal
 Sup labial
MANDIBULAR DIVISION:
LARGEST BRANCH
SENSORY AND MOTOR
LOCAL ANESTHETIC INSTRUMENTS:
Anesthetic carpules
Syringe
Needle
Mouth props
retractors
CARPULES:
 1.7 to 1.8 cc.
 Premade in blister
packs and canisters
 Contains epinephrine
and local anesthetics.
SYRINGE:
 aspirating
 non-aspirating
NEEDLE:
Multiple gauges used:
 25g
 27g
 30g
Length
 Short-26mm
 Long-36mm
monobeveled
TOPICAL ANESTHESIA:
BENZOCAINE(20%)
Prior to local injction to dec discomfirt the patient.
MAXILLARY ANESTHESIA:
3 major types of injections:
Local infiltration
Field block
Nerve block
FIELD BLOCK:
Field block anesthesia techniques deposit the solution
near terminal branches of nerves to provide anesthesia
for a wider area of treatment. This would provide
anesthesia for two or three teeth
Periapical injections.
NERVE BLOCK:
Nerve block techniques deposit the anesthetic close to
the main nerve trunk and allow for a wider area of
treatment with profound anesthesia. An example is the
mandibular nerve block that anesthetizes the teeth,
tissue, and tongue of the patient on the side of
administration.
Infraorbital post sup alveolar
Greater palatine middle sup alveolar
Nasopalatine ant.sup alveolar
INFILTRATION:
Performed in maxilla due to thin cortical bone.
Supraperiosteal injection
Intraseptal
Pdl injections
 Technique:
 A short 25 or 27 gauge needle is recommended
. It is inserted at the height of the mucobuccal fold near the apex of
the tooth to be treated
. The bevel of the needle should be toward the bone.
Slowly deposit approximately 1/3 of the cartridge of anesthetic
near the apex of the tooth after negative aspiration
 The area should be anesthetized within 5 minutes of injection.
Posterior Superior Alveolar Nerve Block

maxillary molars
Technique:
The short 25 or 27 gauge needle
. The needle is inserted at the mucobuccal fold by the
maxillary second molar with the bevel toward the bone
Insertion:15-20mm
 Aspirate twice, while depositing a few drops of local in
this area. Deposit approximately 1/4 of the cartridge of
anesthetic and aspirate again. Repeat this process of
aspiration and injection until 3/4 to a full cartridge of
anesthetic has been deposited with no positive aspiration.
Middle Superior Alveolar Nerve Block

Only about 20% of patients will have a middle


superior alveolar (MSA) nerve.
If the infraorbital nerve block does not provide
adequate anesthesia to the premolars
Used to anesthetize max.premolars,buccal
tissle,bone,pulp.
Infraorbital Nerve Block:
Used to anesthetize ant.maxillary incisros and canines
and pre-molars.alveolar bone,buccal gingiva
Technique:
. Locate the infraorbital foramen near the lower border
of the orbit
. A 25 gauge long needle is recommended
 insertedmuccobuccal fold of frst.pre-molar /canine
area.
Needle depth:16mm
Inject 0.9 -1.2cc
MANDIBULAR ANESTHESIA:
It involves blocking the inferior alveolar nerve prior to
entry into mandibular lingula on the medial aspect of
mandible ramus
Inferior alveolar nerve block:
Insrtion on mucous membrane on the medial border of
mandibular ramus at intersection of horizontal(height
of injection) and vertical line(anteroposterior plane)
6-10mm above occulusal plane
Depth of injection:25mm
MANDIBULAR ANESTHESIA|:
Contralateral premolar region
Use non-dominan handto retract the buccal soft
tissue(thumb in coronoid notchof the mandible,index
finger on the post border of extraoral mandible)
Inject 0.5-1.0cc
Continue 0.5cc on removal to anestetize the lingual
branch.
Inject remaing in coronoid notch in mucous membrane
distal and buccal to most distal molar to perform a
long buccal nerve block.
PHARMACOLOGY:
A local anesthetic prevents the generation and
conduction of a nerve's impulse.
 For a local anesthetic to be clinically useful, it should be:
compatible with the tissues (not irritating), and
temporary
completely reversible
hypoallergenic,
rapid onset of anesthesia with a duration of action
sufficient to complete the dental procedure comfortably.
LOCAL ANESTHETICS:
Esters procaine, cocaine, and novocaine
Amides lidocaine (or xylocaine), mepivacaine
(or carbocaine), prilocaine (or citanest), bupivacaine
(or marcaine), and etidocaine
USE OF VASOCONSTRICTORS:
Epinephrine and levonordefrin (neo-cobefrin) are the
most commonly used vasoconstrictors in dentistry.
Epinephrine is sensitive to heat and can be inactivated
if left too warm
Epinephrine is available in concentrations of 1:50,000
for better hemostasis
medically compromised by high blood pressure,
cardiovascular disease, or hyperthyroidism.
The vasodilation activity of local anesthetics produce
an increased rate of absorption. This results in
decreased effectiveness, short duration of anesthesia,
and a higher risk of toxicity. Bleeding in the area of
injection is increased
COMPLICATIONS:
Pain on injection
Paresthesia
Needle breakage
Hematoma
Infection
Trismus
Toxixity
Allergic reaction
Facial palsy
Needle braekage:
The most common cause of needle breakage is sudden
unexpected movement of the patient. Smaller gauge needles (size
30) are more likely to break than larger ones (size 25). Some
practitioners habitually bend the needle and the metal is
weakened in this area. A needle that breaks with part of it visible
can be easily removed with a hemostat. Needles that break
within the tissue may require removal by surgery.
The best way to avoid needle breakage is to routinely use a 25-
gauge needle for any injection where there is a significant
penetration of tissue. The hub is the weakest part of a needle, so
unless the injection technique specifically requires it, the needle
should not be inserted all the way to the hub. A longer needle
should
Facial paralysis:
If the local is injected into the parotid gland, it will
affect the facial nerve and the patient will notice facial
drooping and will not be able to close their eye. If the
needle is directed too posteriorly during an inferior
alveolar nerve block or is over inserted during an
Akinosi nerve block, the parotid gland may be
anesthetized. Bone should be contacted before
deposition of solution in the inferior alveolar nerve
block to make sure the tip of the needle is not in the
parotid gland. Inferior alveolar nerve anesthesia will
not develop if the solution is in the parotid gland.
PARESTHESIA:
If the needle passes through a nerve in the area of
injection, it may damage the nerve and cause
paresthesia. The injury is usually not long term or
permanent. if the patient reports a shooting feeling
during the injection that would indicate needle contact
with the nerve.
The condition may resolve itself within 2 months
without treatment.

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