Dentaltown December 2019 - 68
Fig. 3: I prefer to put about a 20-degree angle on my
anesthetic needles. In dental school, we were told to
never bend an anesthetic needle, but modern, heattreatable stainless steel needles are malleable to an
extent. I've angled my needles for every injection over
the past 36 years of my career and have never had
one break. (Only bend a needle once, however!) A bent
needle allows me to keep my elbows more at my side
and prevents me from leaning more often out of my
ergonomic position. Anything to help with posture,
because it adds up by the end of the day.
Fig. 4: There is a theory as to why moving this tissue
during the injection procedure is effective. The large
sensory fibers that carry the cutaneous sensory input have
collaterals that activate inhibitory interneurons. These
inhibit pain transmission carried by the pain fibers. This
non-noxious input "closes the gate" to noxious input.
Fig. 5: For the inferior alveolar block, I use a 27-gauge
long needle with 2% lidocaine epi 1:100,000 unless
contraindicated. For every IAN block procedure,
I give two injections and (surprisingly) have not
heard a complaint about this yet. This should really
improve your success rate. The first will be in a high
position and the second lower, as pictured, in the
pterygomandibular depression lateral to the raphe.
This is helpful because the position where the inferior
alveolar nerve enters the mandibular canal in the
ramus varies from patient to patient.
Fig. 6: Again, there is that momentary pause before simultaneously
advancing the cheek/buccal mucosa grasped between your thumb
(in the coronoid notch) and opposing finger and quickly advancing
the needle into the mucosa. Gently feel for the needle bump
into the medial surface of the ramus, slightly anterior to where
you estimate the mandibular canal to be. Withdraw slightly, then
advance the needle posteriorly to the appropriate depth, aspirate,
then express the anesthetic. Have the patient open and close a
few times after the first injection before giving the second. Again,
use the same slow administration, soft tissue movement and calm
reassurance to the patient while administering.
68
DECEMBER 2019 // dentaltown.com
http://www.dentaltown.com
Dentaltown December 2019
Table of Contents for the Digital Edition of Dentaltown December 2019
Dentaltown December 2019 - Intro
Dentaltown December 2019 - Cover1
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