INFERIOR ALVEOLAR INJECTION

DHYG 149 PAIN CONTROL

Local Anesthesia

Welcome to Dental Analgesia

This is a self-paced learning module designed for the student wishing to prepare for or review the inferior alveolar injection technique. The inferior alveolar injection is the most common local anesthesia injection given. It is also a required performance for the Western Regional Examining Board Anesthesia Exam.

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Overview

IndicationsMandibular anatomyInferior alveolar injection techniqueProblems and correctionsLab exerciseBasic injection technique

Indications

Procedures involving multiple mandibular teeth

Procedures requiring lingual anesthesia

Mandibular Anatomy

IA nerve and lingual nerve will be anesthetized

Target point is slightly above mandibular foramen

Coronoid notch is a guiding landmark

Evers, p. 76

Coronoid notch

Lingual nerve

IA nerve

Mandibular foramen

Evers, p. 71

Mental foramen

Mandibular foramen

Inferior Alveolar Nerve

Provides sensory innervation to:

Lower teeth on one side

Buccal bone from premolars to incisors

Soft tissue of lip and chin

Lingual Nerve

Provides sensory innervation to:

Lingual soft tissue

Anterior two-thirds of tongue

Evers p. 72

Mandibular foramen

Lingual nerve

Tissues Anesthetized

MolarsPremolarsCaninesIncisorsLingual soft tissueTongueBuccal soft tissue

from mental foramen to midline

Evers, p. 87

Pterygomandibular Space

The soft tissues in the

vicinity of the injection

site form a space which

should be identified.

Evers, p 72

Target Point

Medial pterygoid muscle

Correct Needle Pathway

The barrel of thesyringe should be

overthe opposite

premolars. Bone should becontacted prior todepositing

anesthetic.

Pterygoid raphe

Lingual nerve

Medial pterygoid muscleParotid gland

IA nerve

Incorrect Needle Pathway

The barrel of the syringe is lying over theincisors. This errordirects the needleposterior to the targetpoint, possibly resultingin trismus or facialnerve paralysis.

Pterygoid raphe

Lingual nerve

Medial pterygoid muscleParotid gland

IA nerve

Incorrect Needle Pathway

The barrel of thesyringe is lying over

themolars. This error results in prematurecontact of bone and failure of anesthesia.

Pterygoid raphe

Lingual nerve

Medial pterygoid muscleParotid gland

IA nerve

Intraoral Landmarks

The pterygoid rapheand the coronoid

notchform an imaginarytriangle. It is in approximately the center of this triangle that the needle should inserted.

Pterygoid rapheCoronoid notch

Evers, p. 80

Insertion Point

Insert needle into thedepression or

imaginarytriangle between thepterygoid raphe and

thecoronoid process 1centimeter above themandibular occlusalplane.

Evers. P 81

Target Point

Advance needle until bone is contacted.

Evers p 84

Evers p 77

Evers, p77

Deposition

You are ready to deposit the anesthetic. Don’t forget to:Aspirate in two planesDeposit at a rate of 1 ml/minuteDeposit 3/4 to 1 full cartridge

Failures of Anesthesia

ProblemDeposited below

mandibular foramenDeposited anterior to

mandibular foramen

Deposited posterior to mandibular foramen

CorrectionReinject at height of

triangleBring barrel of

syringemesially over premolars

Bring barrel distally over premolars and contact bone

Review technique

Lab Exercise

Practice this injection at your next lab.

Remember:Use 25 gauge needle for this injectionLook for intraoral landmarksVisualize mandibular anatomyApply the basics of all injection

techniques

Basic Injection Technique

Review patient health history, medications and

vitals

Determine injection technique based on

procedure to be performed

Select appropriate anesthetic

Basic Injection Technique continued

Prepare syringe use 25, 27, or 30 gauge needle

use aspirating syringe

Check flow of anesthetic

Position patient

Dry tissue

Apply topical antiseptic (optional)

Basic Injection Technique, continued

Apply topical anesthetic

Establish fulcrum

Stretch tissue

Keep syringe out of patient’s sight

Insert needle

Advance needle

Aspirate in two planes

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Basic Injection Techniquecontinued

Slowly deposit anesthetic

Withdraw syringe

Observe patient

Record injection and anesthetic in patient’s

chart

Always communicate with patient throughout

entire procedure

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Acknowledgements

Hans Evers, Glenn Haegerstam, Introduction to Local Anesthesia, 2nd edition Mediglobe 1990

Margaret Ferenbach, Susan Herring, Illustrated Anatomy of the Head and Neck, W.B. Saunders 1996

Prof. Jill Torres, Oregon Institute of Technology, Department of Dental Hygiene