The document discusses local anesthesia techniques for pediatric patients. It notes that the mandibular foramen is lower in children than adults, so the inferior alveolar nerve block injection must be made slightly lower and more posterior. The technique involves opening the patient's mouth wide, placing the thumb on the coronoid notch and fingers on the posterior mandible, then inserting the needle parallel to the bone at the occlusal plane level between ridges and injecting adjacent to the bone. A long buccal nerve block can also be used to anesthetize molar gingiva by injecting in the mucobuccal fold distal to the most posterior molar.

1. Local anesthesia in pediatric
MANDIBULAR NERVE BLOCK
DR. ABDULLAH AL NASSER

2. General Considerations for Local Anesthesia
Operator Technique
Communication in language the child can understand is necessary .
The dentist may have to modify his or her wording to accommodate the level of the child's
understanding when discussing the injection. Like the tooth is going to sleep after alittle pinch.
The dentist should not deny that the injection might hurt because this denial may cause the
child to lose trust in the dentist and confidence about the procedure.
The discomfort of the injection may be lessened by counterirritation, distraction .

3. ANESTHETIC TOXICITY
children are more likely to experience toxic reactions because of their lower body weight.

4. INFERIOR ALVEOLAR NERVE BLOCK
The mandibular foramen is situated at a level lower than the occlusal plane of the primary
teeth of the pediatric patient.
Therefore the injection must be made slightly lower and more posteriorly than for an adult
patient. In adults, it averages 7 mm above the occlusal plane. .

5. Technique
For the inferior alveolar nerve block
The Child is requested to open his or her mouth as far as possible.
Mouth props may aid in maintaining this position for the child.
The ball of the thumb is positioned on the coronoid notch of the anterior border of the ramus,
and the fingers are placed on the posterior border of the ramus.
The barrel of the syringe overlies the two primary mandibular molars on the opposite side of
the arch and parallels the occlusal plane.


6. Technique
For the inferior alveolar nerve block SUMMARY
With patient's mouth opened as wide as possible, place the ball of the thumb on the coronoid
notch on the anterior border of the mandible.
Position the index and middle fingers on the external posterior border of the mandible.
Insert the needle with bevel oriented parallel to the bone and at the level of the occlusal plane
between the internal oblique ridge and the pterygomandibular raphe. The barrel of the syringe
between the two primary molars on the opposite side of the arch.
Insert the needle to a depth that is adjacent to the bone. Aspirate. Slowly inject

7. LONG BUCCAL NERVE BLOCK
The long buccal nerve supplies the molar buccal gingivae and may provide accessory
innervation to the teeth.
A small quantity of solution is deposited in the mucobuccal fold at a point distal and buccal to
the most posterior molar