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What are the three basic types of obtaining pain control with Local Anesthesia?

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Local Infiltration. Field Block. Nerve Block.

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What is local infiltration also known as?

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supraperiosteal.

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Local Infiltration -

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Small terminal ends of nerve branches are flooded with local anesthesia in direct contact with those areas to be dentally treated.

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An example of local infiltration:

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Example- a papilla adjacent to a pocket that is to be treated.

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Field Block-

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Local anesthetic is deposited closer to the larger terminal branches so that the area will be circumscribed. The area can be slightly away from the area injected.

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Example of a field block:

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Example- Maxillary injections made above the tooth where the terminal trunk enters the apex of the tooth.

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Nerve Block-

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A main trunk of a nerve is anesthetized, far away from the area to be treated.

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Example of a nerve block:

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Example- Inferior alveolar block, Posterior superior block.

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Most of the time, especially in the upper arch, local infiltration is actually:

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a field block.

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Why is local infiltration a field block in the maxilla, most of the time?

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This is because of the porous nature of the maxilla.

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The difference in area between field blocks and nerve blocks:

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Field blocks achieve a circular area of anesthesia, while nerve blocks can anesthetize a wide area located far away from the injection sites.

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Buccal -

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pulpal and soft tissue, placement in buccal surfaces

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Inter alveolar placement -

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more applicable to mandibular teeth.

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Palatal -

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injection in the area of the palate.

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Supraperiostal Injection (misnamed local infiltration)-

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-Most frequently used. -Multiple injections raises dose of Anesthetic. -Indicated especially whenever treatment is confined to a small maxillary area.

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What branches do supraperiostal injection numb up?

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the terminal branches.

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Supraperiostal Injection indications:

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Pulpal anesthesia to few maxillary teeth.

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Supraperiostal Injection contraindications:

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Infection in area, dense bone in area.

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Infiltration Injection Definition:

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Type of injection that anesthetizes a small area - one or two teeth and associated structures - when the local anesthetic agent is deposited near terminal nerve endings.

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Needle gauge of infiltration technique (field block)-

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25 or 26 gauge short needle.

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Infiltration area of insertion-

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height of the mucobuccal fold.

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Infiltration landmarks:

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- Clean with dry gauze. - Apply topical anesthetic. - Apply topical for approximately 1 minute.

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Infiltration Technique Procedure:

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Target area : Apical region of tooth to be anesthetized. Lift lip so that tissue is taut. Insert needle into height of mucobuccal fold over target tooth. Advance needle until bevel is at or above the apical region of the tooth. Depth of penetration should be no more than a few millimeters.

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What is the PSA block used to achieve?

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pulpal anesthesia in the maxillary third, second, and first molars in most patients.

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The PSA block also anesthetizes:

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the buccal periodontium overlying the maxillary third, second, and first molars, including the associated gingiva, periodontal ligament, and alveolar bone.

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The target area for the PSA block is the PSA nerve as it enters:

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the maxilla through the posterior superior alveolar foramina on the maxilla's infratemporal surface.

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The target area of the PSA:

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is posterosuperior and medial on the maxillary tuberosity.

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The injection site for the PSA block is:

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the tissues at the height of the mucobuccal fold at the apex of the maxillary second molar, distal to the zygomatic process of the maxilla.

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The needle for the PSA block is inserted into the mucobuccal fold tissues in: (direction)

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a distal and medial direction to the tooth and maxilla, avoiding the maxillary bone to reduce trauma, and the injection is administered.

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Angulation of the needle for PSA block should be:

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upward, or superior, at a 45-degree angle to the occlusal plane; inward, or medial, at a 45-degree angle to the occlusal plane; and backward, or posterior, at a 45-degree angle to the long axis of the second maxillary molar.

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PSA-The syringe should be extended from the:

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ipsilateral labial commissure.

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The MSA block, is indicated for:

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dental procedures on the maxillary premolars and mesiobuccal root of the maxillary first molar.

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The MSA block anesthetizes the:

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pulp tissue of the maxillary first and second premolars, and possibly the mesiobuccal root of the maxillary first molar and the associated buccal periodontal tissues (which include the gingiva, periodontal ligament, and alveolar bone if the MSA nerve is present).

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The target area for the MSA block is:

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the MSA nerve at the apex of the maxillary second premolar.

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The injection site for the MSA block is:

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the tissues at the height of the mucobuccal fold located at the apex of the maxillary second premolar.

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The anterior superior alveolar block, or ASA block, in conjunction with:

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an MSA block, is commonly used instead of an IO block.

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The ASA block anesthetizes:

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the pulp tissue of the maxillary canine and incisor teeth, as well as the associated facial periodontal tissues which is the gingiva, periodontal ligament, and alveolar bone.

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The target area for the ASA block is:

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the ASA nerve at the apex of the maxillary canine.

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The injection site for the ASA block is:

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the tissues at the height of the mucobuccal fold at the apex of the maxially canine, just anterior to and parallel with the canine eminence.

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The needle tip for the ASA block is placed:

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superior to the apex of the maxillary canine, avoiding the bone to reduce trauma, and the injection is administered.

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Once the infraorbital nerve exits the foramen it branches are and go to the face:

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-Inferior palpebral. -Lateral nasal. -Superior labial.

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The infraorbital block, or IO block, is useful because:

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it anesthetizes both the middle and anterior superior alveolar nerves.

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The IO block is used for anesthesia of:

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the maxillary premolars, maxillary canines, and maxillary incisors.

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The IO block is indicated when:

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dental procedures involve more than two maxillary premolars or anterior teeth, and the overlying facial periodontium (including the gingiva, periodontal ligament, and alveolar bone).

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The target area for the IO block is:

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the ASA and MSA nerves as they ascend to join the infraorbital nerve after it enters the infraorbital foramen.

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The injection site for the IO block is:

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the tissues at the height of the muccobuccal fold located at the apex of the maxillary first premolar.

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The needle for the IO block is inserted into:

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the mucobuccal fold tissues while the finger of the other hand is kept on the infraorbital foramen. This helps to keep the syringe angled toward the foramen during the injection.

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(IO block)The needle is advanced while keeping it parallel with the long axis of the tooth to:

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avoid premature contact with the maxillary bone. The point of contact of the needle with the maxillary bone should be the upper rim of the infraorbital foramen.

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The greater palatine block, or GP block, is used during dental procedures that involve:

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more than two maxillary posterior teeth or palatal soft tissues distal to the maxillary canine.

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This maxillary block (GP) anesthetizes:

answer

the posterior portion of the hard palate, anteriorly as far as the maxillary first premolar and medially to the midline.

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The target area for the GP block is:

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anterior to the point where the greater palatine nerve enters the greater palatine foramen from its location between the mucoperiosteum and bone of the hard palate.

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The greater palatine foramen is located.

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at the junction of the maxillary alveolar process and posterior hard palate—at the apex of the maxillary second molar in children, or the maxillary third molar in adults— about 10 mm medial and directly superior to the lingual gingival margin.

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The site of injection for the GP block is:

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in palatal tissues anterior to the depression created by the greater palatine foramen.

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The depression created by the GP foramen can be palpated about midway between:

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the median palatine raphe and the lingual gingival margin of the molar tooth.

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The needle for the GP block is inserted into the:

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previously blanched palatal tissues at a 90-degree angle to the palate.

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The needle is advanced during the greater palatine block until:

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the palatine bone is contacted. Then the injection is administered.

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The injection site for the NP block is:

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the palatal tissues lateral to the incisive papilla, which is located at the midline, about 10 mm lingual to the maxillary central incisor teeth.

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For the NP block pressure anesthesia is performed on:

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palatal tissues on the contralateral side of the incisive papilla.

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The needle for the NP block is inserted into:

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the previously blanched palatal tissues at a 45-degree angle to the palate.

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For the NP block the needle is advanced into the tissues until:

answer

the maxillary bone is contacted. Then the injection is administered.

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The anterior middle superior alveolar block, or AMSA block, is useful for:

answer

soft tissue and pulpal anesthesia of the area covered by the ASA, MSA, GP, and NP blocks in the maxillary arch.

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The AMSA can anesthetize:

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multiple teeth (from the second premolar through the central incisor) without causing the typical collateral anesthesia to the soft tissues of the patient's lip and face.

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The target area for the AMSA block is the:

answer

tissues of the hard palate.

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This block, the AMSA takes advantage of a number of:

answer

small pores located in this section of the maxillary bone and the tight attachment of the palatal tissues.

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As the agent penetrates the pores, it has access to the anterior to middle portion of the dental plexus, which then:

answer

anesthetizes the teeth and associated facial tissues, as well as the lingual tissues of the surrounding palate.

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The injection site for the AMSA block is:

answer

an area bisecting the apex of the maxillary premolars and midway between the lingual gingival margin and the median palatal suture.

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Orientation of the syringe for AMSA block should be from:

answer

the contralateral premolars.

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AMSA block-The previously blanched tissue is approached with the needle at a:

answer

45-degree angle until the palatal tissues are penetrated and the maxillary bone is contacted. At this point, the injection is administered.

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Maxillary, V2 Nerve Block: High tuberosity approach-

answer

-Maxillary nerve as it passes through the pterygopalatine fossa. -10:00 o'clock position buccal to maxillary second molar , under zygomatic arch. -Very technique sensitive. -High incidence of hematoma of maxillary artery.

question

Maxillary, V2 Nerve Block: Greater palatine approach -

answer

-through the greater palatine foramen. -Navigate up through greater palatine foramen and into pterygopalatine fossa. -Very difficult.

Chapter 13: Maxillary Anesthesia – Flashcards

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