Dental Nerve Blocks

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


   imagesTrauma requiring intraoral or facial laceration repair


   imagesDental trauma resulting in fractured teeth


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


CONTRAINDICATIONS



imagesAbsolute Contraindications


   imagesHypersensitivity/allergic reaction to local anesthetic agents


imagesRelative Contraindications


   imagesCoagulopathy


   imagesUncooperative or obtunded patients


LANDMARKS AND TECHNIQUE



imagesEquipment and Patient Positioning


   imagesAdjust examination chair to accommodate patient height


   imagesEnsure adequate lighting to visualize oral landmarks


   imagesAssemble the necessary tools


      imagesSterile “thumb-control” Monoject aspirating dental syringe


      images1½-inch 25- to 27-gauge needle


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


      imagesCotton-tipped applicators for administering topical anesthetic and controlling bleeding


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


   imagesUse 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


   imagesBuffering with bicarbonate is not recommended


SUPRAPERIOSTEAL NERVE BLOCK



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


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


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


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


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


imagesIf 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



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


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


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










TABLE 79.1.


TYPES OF DENTAL BLOCKS



images

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Aug 9, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on Dental Nerve Blocks
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