To provide temporary analgesia for intraoral or facial pain related to the following:

    Trauma requiring intraoral or facial laceration repair

    Dental trauma resulting in fractured teeth

    Infection (tooth abscess, root impaction, gum disease) (TABLE 79.1)

CONTRAINDICATIONS

 Absolute Contraindications

    Hypersensitivity/allergic reaction to local anesthetic agents

 Relative Contraindications

    Coagulopathy

    Uncooperative or obtunded patients

LANDMARKS AND TECHNIQUE

 Equipment and Patient Positioning

    Adjust examination chair to accommodate patient height

    Ensure adequate lighting to visualize oral landmarks

    Assemble the necessary tools

       Sterile “thumb-control” Monoject aspirating dental syringe

       1½-inch 25- to 27-gauge needle

       Carpule cartridges containing anesthetic (either 2% lidocaine or 0.5% bupivacaine each with epinephrine 1:100,000 and 1:200,000 respectively)

       Cotton-tipped applicators for administering topical anesthetic and controlling bleeding

    Apply topical anesthetic (20% benzocaine or 5% to 10% lidocaine ointment) to mucosa before injection

    Use lidocaine for laceration repairs and bupivacaine for dental blocks; 0.5% bupivacaine provides roughly 1 to 3 hours of dental pulp analgesia and 4 to 9 hours of soft-tissue analgesia

    Buffering with bicarbonate is not recommended

SUPRAPERIOSTEAL NERVE BLOCK

 Apply topical anesthetic to apex of mucobuccal fold adjacent to the affected tooth

 Lift the patient’s upper lip and pull the tissue taut

 Orient needle and syringe parallel to the long axis of the tooth

 Insert needle into the target area with the bevel facing the bone

 Advance and aspirate until the needle is a few millimeters beyond the apex of the tooth

 If aspiration is negative then inject approximately 2 mL of anesthetic (FIGURE 79.1)

INFRAORBITAL NERVE BLOCK

See Chapter 80 (Facial Nerve Blocks)

POSTERIOR SUPERIOR ALVEOLAR NERVE BLOCK

 Apply topical anesthetic to apex of mucobuccal fold above the second maxillary molar

 Have the patient partially open the mouth and deviate the mandible toward the side of the pain to create more room

 Use your index finger to retract the patient’s cheek on the side being injected and pull the tissue taut

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