2. •Contraindicated to give
anesthesia at the area of
infection .
• If there is need for
anesthesia give nerve block
anesthesia to start
incision .
3. •Diagnostic: to isolate a
source of pain
•Therapeutic: to reduce
or abolish the pain of
apathological condition .
•Perioperative: to achieve
Uses of local
anesthesia
4. Order of sensory function block
1. pain
2. cold
3. warmth
4. touch
5. deep pressure
6. motor
Recovery in reverse order
5. Nerve Block
In this type of
anesthesia, a local
anesthetic is injected
around a nerve that leads
to the operative site.
6. Mxillary nerve block
Posterior Superior Alveolar Nerve Block
•Give
pulpal
anesthesia
of the
maxillary
3rd, 2nd
and 1st
molars
•Give
associated
buccal
gingiva,
periodontal
ligament and
alveolar
bone
•Give
associated
buccal
periodonteum
overlying
these
molars
7. Steps:
1. Apply topical anesthetic
for at least one minute
2. Have patient open their
mouth half way which
makes more room .
3. Insert needle at height
of mucobuccal fold over
the 2nd maxillary molar
4. Advance needle upward,
inward and backward
direction .
5. Deposit 0.9 ml of a
cartridge (1/2
cartridge) .
6. Wait 3 to 5 minutes to
start treatment .
8. MSA block
•Blocks the pulp tissue
of the 1st and 2nd
maxillary premolars
and possibly the 1st
molar + associated
buccal tissues and
alveolar bone .
•target area: MSA
nerve at the apex of
the maxillary 2nd
premolar .
9. ASA nerveASA nerve block
•Can cross the midline of the
maxilla onto the opposite side!
•Used in procedures involving
the maxillary canines and
incisors and their associated
facial tissues .
•Blocks the pulp tissue + the
gingiva, periodontal ligaments
and alveolar bone in that area .
•Target: ASA nerve at the
apex of the maxillary canine.
10. Infraorbital Nerve Block
•Anesthetizes both the MSA
and ASA
•Used for anesthesia of the
maxillary premolars, canine
and incisors
•also numbs the gingiva,
periodontal ligaments and
alveolar bone in that area
•Locate the tissues at
the mucobuccal fold at
the apex of the 1st
premolar
•Must Contact bone in
infraorbital region during
insertion
11. GP Nerve Block
•(soft tissue and bone only)
•Anesthetizes palatal soft
tissue distal and medially to
the canine
(posterior portion of the
palate)
Indications for palatal
injections:
1) Scaling and root
planing
2) Subgingival
restorations
3) Deep placed matrix
bands
4) Extractions (oral
surgery)
12. Nasopalatine
Block
•From the mesial of the
right maxillary 1st
premolar to the mesial
of the left 1st premolar
•Blocks both right and left
nerves
•Target: both right and left
nerves as they enter the
incisive foramen from the
mucosa of the anterior hard
palate
•Injection site is lateral to
the incisive papilla
• Slowly deposit ¼ cartridge over
a 30 second .
13. Mandinular
nerve block
Inferior Alveolar Block
•Target: slightly superior
to the mandibular
foramen
•palpate the coronoid
notch – above the 3rd
molar
•Height of injection 6 - 10
mm above the occlusal
table of the mandibular
teeth
•Approach area of injection
from contralateral premolar
region
•Use the non dominant hand
to retract the buccal soft
tissue (thumb in coronoid
notch of mandible; index
finger on posterior border of
14. Mental nerve block
•Mental and incisive nerves are
the terminal branches for the
inferior alveolar nerve
•Provides sensory input for the
lower lip skin,
mucous membrane, pulpal/alveolar
tissue for the premolars, canine,
and incisors on side blocked.
•Area of injection mucobuccal
fold at or anterior to the mental
foramen. This lies between the
mandibular premolars
•Avoid contact with the mandible
with the needle
•Depth is 5 to 6mm
