What Next?
What to do if you do not achieve
adequate anesthesia
After administering a PSA nerve
block to your patient, he complains
of cold sensitivity when you are
scaling around tooth #3. What
injection should you administer to
eliminate the sensation on tooth #3?
Answer:
MSA nerve block to
innervation to the mesialbuccal root of #14
After administering a MSA nerve
block to your patient, he
complains of pain when scaling
around tooth #5. What injection
should you administer to eliminate
the sensation on tooth #5?
1. Supraperiosteal injection in the
mucobuccal fold above tooth #5
2. ASA (Infraorbital) nerve block
You administer a PSA nerve block
to a 10 year old child for an
operative dentistry procedure on
tooth #3. The child complains of
pain when the dentist begins to
excavate decay on the tooth. What
injection should you administer
next?
1. Re-administer the PSA nerve
block inserting the needle more
to the distal of tooth #3
2. Administer a MSA nerve block
above tooth #4 to block
innervation to the mesial-buccal
root of #3
You administer a supraperiosteal
injection above tooth #6, but it
does not achieve adequate
anesthesia. What injection should
you administer next?
1. Insert the needle further to insure
that the anesthetic is being injected
above the root apex of #6.
2. Administer an ASA (Infraorbital)
nerve block.
On which tooth in the mandible
will a supraperiosteal injection
most likely be successful at
achieving adequate anesthesia?
Lateral incisor
Your dentist wants to perform
restorative dentistry on teeth #20
and #29 but he does not want
bilateral anesthesia of the patient’s
tongue. What injection will
achieve adequate pulpal
anesthesia without anesthetizing
the anterior 2/3 of the tongue?
Bilateral Mental – Incisive (MI)
nerve blocks
You do not achieve profound
anesthesia with an Inferior Alveolar
Nerve Block (IANB). What are
your options for achieving adequate
anesthesia?
1. Re-inject IANB at a higher site
2. Gow-Gates (GG) nerve block
3. Mylohyoid nerve block
administered on the lingual
ridge at the level of the root apex
of the most distal root of the tooth
4. PDL, Intraosseous injections