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When you hear the term mandibular block, which injection do you envision first? For most dental professionals we automatically think of the Inferior Alveolar injection. After all, that is the one we talk about the most. It’s one of the injections dental hygienists are tested on to demonstrate anesthesia proficiency and it seems to be the one with the biggest question marks on how to effectively administer it.
But here’s the thing, we can’t forget about the other mandibular blocks we have at our disposal. For kicks and giggles here’s a brief overview of these three injections. Perhaps it will open your thoughts to expanding your anesthesia skill set.
INFERIOR ALVEOLAR INJECTION:
This is the basic technique most clinicians use. Of all three mandibular blocks this one is fairly simple to administer due to the easily visible landmarks. That is if our patients have an identifiable pterygomandibular raphe. It takes care of the pulps and lingual tissue of all the mandibular teeth on the side injected. However, it is important to note the buccal tissue of the mandibular molars is not anesthetized. A follow-up long buccal injection is needed for true quadrant anesthesia. The downside of the IA is the low success rate in comparison to the G-G and VA. Also, because the Inferior Alveolar artery is a running buddy with the IA nerve there is a high rate of positive aspiration. This means we must start our injections all over and stick our patients again. Which most people prefer not to do.
GOW-GATES INJECTION:
This is a true mandibular nerve block due to anesthetizing the long buccal and auriculotemporal nerves. This means with proper technique you can anesthetize your patient with just one shot. I know my patients appreciate this, plus it is a time saver too. One thing to note, is there is a steep learning curve but once mastered it’s extremely successful. As with most things there is a downside. The drawback is the patient must be able to open wide to effectively bathe the IA nerve as it travels down the ramus of the mandible. Opening wide allows the condyle to move in a forward/anterior fashion, which allows us to gain better access to the nerve. I highly recommend reviewing basic neural and boney anatomy for this injection so you can gain a true understanding of how to give it. Something that can be of concern for some clinicians is the depth of insertion. This is one of the deepest injections we give. I know this can shake the confidence of some. But if you review your anatomical landmarks, hitting this shot spot on is simple. With all that said, the G-G is growing in popularity because of it’s increased rate of profound anesthesia.
VAZIRANI-AKINOSI INJECTION:
This injection may look like a maxillary one, but it really bathes those mandibular nerves. The VA is a closed mouth technique and is probably the least used of all the mandibular blocks. Many people tell me they avoid it due to the challenges of seeing the anatomical landmarks. After all the patient’s mouth is closed, and it can be hard to see where you are going. Honestly, once you understand how to administer it, this no longer becomes an issue. The VA will anesthetize all the teeth in the quadrant and the soft tissue, but due to anatomical variations we can’t always guarantee the buccal tissue of the molars will be numb. The win with the VA is it’s easy on the patient. Their mouth is in a closed relaxed state, and they may not even feel the injection happening. This is a great option for our patients who can’t open well or for a long period of time. Or for those patients with really large tongues that get in the way! This injection also has a high success rate once mastered and an incredibly low positive aspiration rate.
One of the keys to remember with all three injections is they require increased time to facilitate profound anesthesia. The Inferior Alveolar nerve is thick, so it takes more time for the anesthetic to soak into the center portion of the nerve bundle. Patients will feel the soft tissue become numb before the pulp. So, make sure to give yourself enough time if you need true pulpal anesthesia.
Next time you are preparing for your mandibular blocks I encourage you to give one of these other injections a try. Remember, with practice you can Hit Your Best Shot!
Cheers,
Tina
You can learn more about these injections and how to give them with this special 1 CEU course called Mandibular Blocks. This course reviews anatomy, techniques, and reasons why you would select one injection over the other. Click this link to sign up today.
https://teachertina.thinkific.com/courses/mandibular-blocks