Block Injections Flashcards
(34 cards)
What guides the decision for use of block or infiltration techniques on the mandible? (3)
- Age of patient
- Tooth of interest
- LA agent being used
Where is anaesthetic deposited in the block technique?
Close to main nerve trunk
When is the block technique used? (3)
- Alveolar bone is too thick to permit infiltration anaesthesia
- Wider area of anaesthesia required with one injection
- When its necessary to avoid area of infection
Which of the mandible or maxilla is more successful in anaesthesia
- Maxilla more successful
- 1 in 5 Mandibular needs re-injection
Why is the success rate of inferior alveolar nerve blocks lower? (3)
- Anatomical considerations in mandible
- Greater depth of soft tissue penetration necessary
- Administration must accurately deposit solution to within 1mm of target nerve
What do we need to do before a block technique procedure? (3)
- Check medical history
- Prepare correct equipment
- Know anatomy of area
What is the needle dimensions in an inferior alveolar nerve block?
- Long needle
- 27 Gauge
What position would you want your patient to be in for a block technique?
- Slightly inclined
- Mandibular occlusal plane almost horizontal
What are the 6 steps in finding the Pterygomandibular space?
- Locate the coronoid notch
- Palpate the internal oblique ridge
- Identify the pterygomandibular raphe
- Locate the surface triangle
- Locate the nerve
- Pull back injection after hitting bone
What is the coronoid notch?
How do we locate it?
- Greatest concavity on anterior border of ramus
- Using thumb of non dominant hand
How can you correctly angle a block injection to target the nerve in the pterygomandibular raphe?
By introducing the needle from over the premolars on the opposite side
What is the appropriate volume of solution to deliver for an inferior alveolar nerve block?
2ml
What are the 6 steps of an inferior alveolar nerve block?
- Apply topical anaestehtic
- Identify intraoral landmarks
- Correctly position syringe
- Needle entry and bony contact
- Aspiration and delivery
- Withdraw needle
Generally what is used for an inferior alveolar nerve block?
- 27 Gauge
- Long needle
- 2% lidocaine (1:80000)
What can aid a block technique needle entry?
Stretching mucosa
During block technique needle entry what depth of needle is inserted?
15-25 mm
What is the rate at which solution should be deposited in a block injection?
2ml over 60 seconds
What could happen if your block needle is not angled enough? (over the incisors)
What do you do?
- Lead to no bone contact
- Might be in parotid gland
- Take out and try again
What do you do if your block needle is too angled? (Hits bone early)
- You can keep needle in tissue but realign more posteriorly
(Indirect technique)
How can you check if an inferior alveolar nerve block is successful?
Ask the patient if their lip is numb
What type of inferior alveolar nerve blocks should you avoid?
Bilateral IANBs
Suggest how appointments involving inferior alveolar nerve blocks can be scheduled for full mouth root surface debridement (2)
- 4 appointments for each quadrant (preferred)
- 2 appointments for each side
What type of technique is an articaine infiltration?
What does it replace?
- Supracrestal injection
- Replacement of inferior alveolar nerve blocks by buccal infiltration
What needle is used for articaine infiltrations?
- 27 Gauge
- Short needle
