Anatomy Of Local Anesthesia

Front 1

Local filtration

Back 1

injection placed near apices of teeth and anesthetizes small area of one or 2 teeth

Front 2

Nerve Block

Back 2

-anesthesia is deposited near nerve trunk
-affects larger area

Front 3

Maxillary Nerve Blocks, more successful than mandiublar b/c

Back 3

-bone is less dense over facial surface of max teeth
-less variation in anatomy and landmarks

Front 4

PSA BLOCK

Back 4

-PULP ANESTHESIA: max 123 molars, may not include MB of max 1st
-BUCCAL PERIODONTIUM: gingiva, PDL, and alveolar bone, 123 molars
-LINGUAL PERIODONTIUM: achieved by greater palatine block

Front 5

PSA BLOCK: target area

Back 5

posterior, superior and medial on the max tuberosity

Front 6

PSA BLOCK: injection and topical anesthesia

Back 6

-mucobuccal fold @ apex of max 2nd molar DISTAL to zygomatic process of max
-concavity in mucobuccal fold DISTAL to MAX TUBEROSITY

Front 7

PSA BLOCK: possible complications

Back 7

-needle to far DISTALLY into tissue may penetrate pterygoid plexus of veins and max. artery causing a HEMOTOMA

Front 8

MSA BLOCK

Back 8

-PULP ANESTHESIA: max PREMOLARS and MB root of max 1ST MOLAR
-BUCCAL PERIODONTIUM: gingiva, PDL, alveolar bone, max premolars and MB root of 1st molar
-LINGUAL PERIODONTIUM: achieved by GREATER PALATINE BLOCK

Front 9

MSA BLOCK: target area

Back 9

-mucobuccal fold at apex of max 2nd PREMOLAR

Front 10

MSA BLOCK: injection and topical anesthetic placement

Back 10

-mucobuccal fold @ apex of max 2nd PREMOLAR
-well above apex of max 2nd PREMOLAR
-for injection stretch upper lip taught

Front 11

MSA BLOCK: symptoms and complications

Back 11

-harmless tingling or numbness of upper lip
-HEMOTOMA is rare

Front 12

ASA BLOCK

Back 12

-PULP ANESTHESIA: max canine and incisors
-ASA nerve may cross midline, so no need to inject twice
FACIAL PERIODONTIUM: gingiva, PDL, alveolar bone, max canine and incisors
LINGUAL PERIODONTIUM: achieved by NASOPALATINE BLOCK

Front 13

ASA BLOCK: target area

Back 13

-mucobuccal fold @ apex of max. CANINE

Front 14

ASA BLOCK: injection and topical anesthetic placement

Back 14

-ant. and parallel to CANINE EMINECE
-inject approx. 10 degrees off imaginary line to long axis of canine

Front 15

ASA BLOCK: symptoms and complications

Back 15

-harmless tingling or numbness of UPPER LIP
-HEMOTOMA is RARE

Front 16

IO BLOCK:

Back 16

-PULP ANESTHESIA: max PREMOLARS, CANINE & INCISORS
-IO nerve may cross the midline, requires bilateral injection
FACIAL PERODONTIUM: gingiva, PDL, alveolar bone
LINGUAL PERIODONTIUM: achieved by NASOPALATINE BLOCK

Front 17

IO BLOCK: target area

Back 17

-ASA and MSA as they ascend to join the INFRAORBITAL NERVE

Front 18

IO BLOCK: injection and topical anesthetic placement

Back 18

-mucobuccal fold @ apex of max. 1ST PREMOLAR
-palpate extraorally infraorbital RIM, then move downward 10 mm

Front 19

IO BLOCK: symptoms and complications

Back 19

-harmless tingling or numbness of EYELID, NOSE AND UPPER LIP
-HEMOTOMA is rare

Front 20

GP BLOCK

Back 20

-ANESTHETIZES: post. portion of hard palate, anterior to max 1ST PREMOLAR, & medially to midline of palate

Front 21

GP BLOCK: may use or require

Back 21

-ASA, MSA, PSA, or IO block
-may require NASOPALATINE BLOCK

Front 22

GP BLOCK: target area

Back 22

-GREATER PALATINE FORAMEN, located @ jct. of max alveolar process & posterior hard palate

Front 23

GP BLOCK: injection and topical anesthetic placement

Back 23

-apex of max 2 &3 MOLAR, about 10 MM medial and above GINGIVAL MARGIN
-midway b/t medial palatine raphae and lingual gingiva margin of MOLAR TEETH

Front 24

GP BLOCK: apply cotton tip applicator to site before and after to

Back 24

-create pressure anesthesia

Front 25

GP BLOCK: symptoms and complications

Back 25

-numbness in POST. PORTION OF PALATE
-some patients may GAG

Front 26

NP BLOCK

Back 26

-anesthetizes: PALATAL soft tissues, BILATERAL ant. hard palate, and M Max RIGHT 1ST PREMOLAR to M of Max LEFT 1st PREMOLAR

Front 27

NP BLOCK: preanesthetize

Back 27

-to lesson discomfort
-labial soft tissue b/t MAX CENTRAL

Front 28

NP BLOCK: target area

Back 28

-R and L NASOPLATINE nerves as enter INCISIVE PAPILLA

Front 29

NP BLOCK: injection and topical anesthetic placement

Back 29

-palatal tissue LATERAL to incisive papilla
-10 mm lingual to max. centrals
-apply cotton tip applicator to create pressure anesthesia

Front 30

NP BLOCK: symptoms and complications

Back 30

- numbness in ant. portion of PALATE

Front 31

AMSA-(anterior middle superior alveolar block)

Back 31

-anesthesia of large areas
-pulpal from 2nd PREMOLAR thru CEN. INCISOR
-commonly used in anesthetic/comsetic

Front 32

AMSA BLOCK: target area

Back 32

-tissues of hard palate

Front 33

AMSA BLOCK: symptoms and complications

Back 33

-tissue ISCHEMIA(blanching) and SLOUGHING

Front 34

MANDIBULAR NERVE ANESTHESIA:

Back 34

-nerve blocks used more often than local infiltration
-mandible more dense than max
-more anatomical variation in landmarks

Front 35

IA BLOCK (inferior alveolar block)

Back 35

-pulp anesthesia: all mand. teeth
-facial periodontium: gingiva, PDL, alveolar bone, mand. central, lateral, canine and mand. PREMOLARS
-lingual periodontium: all mand teeth on side of injection

Front 36

IA BLOCK: target area

Back 36

-above entry point of the inf. alveolar nerve into mand. foramen
-lingual nerve will also be anesthesized
-commonly used/not always successful

Front 37

IA BLOCK: target area

Back 37

-solution must be delivered w/in 1mm of target area
-use the cornoid notch and occlucsal plane of mand. molars to locate target area

Front 38

IA BLOCK: injection and topical anesthetic

Back 38

-palpate cornoid notch
-imaginary horizontal line from coronoid notch to ptyergomand. fold as it turns upward toward the palate
-usually 6 to 10 mm above occ. plane of mand molar teeth

Front 39

IA BLOCK: injection and topical anesthetic placement, cont'd

Back 39

-the syringe barrel is usually over the mand. 2nd PREMOLAR of the side opposite the injection

Front 40

IA BLOCK: symptoms and complications

Back 40

-numbness and tingling of lower lip, BODY OF TONGUE and FLOOR OF THE MOUTH
-LINGUAL SHOCK
-transient FACIAL PARALYSIS/inablility to close eyelid and drooping of lips

Front 41

BUCCAL BLOCK

Back 41

-Pulpal anesthesia: none
-Buccal periodontium: gingiva, PDL, alveolar bone and mand. molars

Front 42

BUCCAL BLOCK: target area

Back 42

-long buccal nerve as passes over the ant. border of ramus

Front 43

BUCCAL BLOCK: injection and topical placement

Back 43

-bucall tissue D to B to the last molar in arch on ant. border of ramus

Front 44

BUCCAL BLOCK: symptoms and complication

Back 44

-none

Front 45

MENTAL BLOCK

Back 45

-Pulpal anesthesia: none
-Facial periodontium: gingiva, PDL, alveolar bone, MAND. PREMOLARS and ANT. TEETH

Front 46

MENTAL BLOCK: target area

Back 46

-mental nerve before entering the mental foramen

Front 47

MENTAL BLOCK: injection and topical

Back 47

- mucobuccal fold tissues over or ant. to depression created by mental foramen
-PALATAL MUCOBUCCAL fold intraorally b/t the apices of mand 1st and 2nd PREMOLARS

Front 48

MENTAL BLOCK: symptoms and complications

Back 48

-numbness and tingling of lower lip

Front 49

INCISIVE BLOCK

Back 49

-Pulp anesthesia: mand. teeth ANT. to mental foramen(PREMOLARS & MOLARS)
-Facial Periodontium: mand. teeth ant. to mental foramen (PREMOLAR AND MOLARS)

Front 50

INCISIVE BLOCK: target area

Back 50

-MENTAL FORAMEN

Front 51

INCISIVE BLOCK: injection and topical

Back 51

-same as mental block
-mucobuccal fold tissues over or ant. to depression created by mental foramen
-palpate mucobuccal fold intraorally b/t apices of mand. 1 & 2nd PREMOLAR

Front 52

INCISIVE BLOCK: injection and topical cont'd

Back 52

-more anesthetic solution is used and pressure applied
-numbs mental and deeper incisive nerve

Front 53

INCISIVE BLOCK: symptoms and complications

Back 53

- numbness and tingling of lower lip

Front 54

GOW-GATES MAND. NERVE BLOCK

Back 54

-Inf. alveolar, mental, incisive, lingual, mylohyoid auriculotomporal and long buccal
-used in quadrent dentistry

Front 55

GOW-GATES MAND NERVE BLOCK: target area

Back 55

-anteriomedial border of mand. condyle neck

Front 56

GOW-GATES MAND. NERVE BLOCK: injection and topical

Back 56

-oral mucosa M of mand. RAMUS, D to height of ML cusp of MAX 2ND MOLAR
-syringe barrel is over CANINE to PREMOLAR region oppoiste side
-following line extraorally form intertragic notch of ear to same side labial commis. b/t trageus and ear lobe

Front 57

GOW-GATES MAND. NERVE BLOCK: symptoms and complications

Back 57

-injection contradicted in patients with limited ability to open mouth