The document provides information on various types of maxillary anesthesia techniques:
1. Supraperiosteal injection is commonly used to anesthetize one or two maxillary teeth and soft tissues. It has a low risk of intravascular administration.
2. Posterior superior alveolar nerve block anesthetizes maxillary molars and buccal tissues through the posterior superior alveolar nerve. It has a high success rate but risks hematoma formation.
3. Nasopalatine nerve block provides wide palatal soft tissue anesthesia using a minimum volume of local anesthetic, minimizing the need for multiple injections.
Normal Pulp
Reversible Pulpitis (Hyperaemia Of Pulp)
Symptomatic Irreversible Pulpitis
Total Necrosis Of Pulp
Suppurative Pulpitis
Apical Periodontitis Of Vital Teeth
Apical Periodontitis Of Non Vital Teeth
Acute Apical Abscess Relieved By Clenching Of Teeth
Chronic Apical Abscess
Normal Pulp
Reversible Pulpitis (Hyperaemia Of Pulp)
Symptomatic Irreversible Pulpitis
Total Necrosis Of Pulp
Suppurative Pulpitis
Apical Periodontitis Of Vital Teeth
Apical Periodontitis Of Non Vital Teeth
Acute Apical Abscess Relieved By Clenching Of Teeth
Chronic Apical Abscess
Non –pharmacological behavior management in childrenDr. Harsh Shah
Overview on nonpharmacological managent of behaviour in children
Presented by : Mayuri Karad
SDDCH Parbhani
Guided by : Dr. Rehan Khan
Dept, of Pediatric and preventive dentistry
DENTIN HYPERSENSITIVITY - ETIOLOGY, DIAGNOSIS AND TREATMENTDr.Shraddha Kode
Dentinal Hypersensitivity is a common clinical condition which is sharp in character and of short duration in response to stimuli. It is associated with exposed dentin surfaces. This presentation provides a brief overview - its etiology, diagnosis and treatment.
Prosthodontics seminar 3rd stage University of Anbar College Of Dentistry
Created By Mohammed Amer Hekma
Supervised by: Dr Osama Abdul Rasool Hammoodi
References
• FUNDAMENTALS OF REMOVABLE PARTIAL PROSTHODONTIC DESIGN by Kenneth R. McHenry, D.D.S., M.S and Terrence McLean, D.D.S.
• Stewart's Clinical Removable Partial Prosthodontics, Fourth Edition by Rodney D Phoenix, D.D.S, M.S, David R Cagna, D.M.D, M.S and Charles F DeFreest, D.D.S
• McCRACKEN’S REMOVABLE PARTIAL PROSTHODONTICS, TWELFTH EDITION BY Alan B. Carr, D.M.D, M.S, and David T. Brown, DDS, MS
Non –pharmacological behavior management in childrenDr. Harsh Shah
Overview on nonpharmacological managent of behaviour in children
Presented by : Mayuri Karad
SDDCH Parbhani
Guided by : Dr. Rehan Khan
Dept, of Pediatric and preventive dentistry
DENTIN HYPERSENSITIVITY - ETIOLOGY, DIAGNOSIS AND TREATMENTDr.Shraddha Kode
Dentinal Hypersensitivity is a common clinical condition which is sharp in character and of short duration in response to stimuli. It is associated with exposed dentin surfaces. This presentation provides a brief overview - its etiology, diagnosis and treatment.
Prosthodontics seminar 3rd stage University of Anbar College Of Dentistry
Created By Mohammed Amer Hekma
Supervised by: Dr Osama Abdul Rasool Hammoodi
References
• FUNDAMENTALS OF REMOVABLE PARTIAL PROSTHODONTIC DESIGN by Kenneth R. McHenry, D.D.S., M.S and Terrence McLean, D.D.S.
• Stewart's Clinical Removable Partial Prosthodontics, Fourth Edition by Rodney D Phoenix, D.D.S, M.S, David R Cagna, D.M.D, M.S and Charles F DeFreest, D.D.S
• McCRACKEN’S REMOVABLE PARTIAL PROSTHODONTICS, TWELFTH EDITION BY Alan B. Carr, D.M.D, M.S, and David T. Brown, DDS, MS
Dr, Kathirvel Gopalakrishnan
M.D.S (OMFS)
Presentation on Maxillary nerve block which helps for a quick refresh.
Applied aspects described well and slides contains images for easy understanding of the subject.
brief description on posterior superior alveolar nerve block.
its uses in dentistry, technique and action. locating PSA nerve is easy and this is the most used nerve block in dentistry.
oral surgery - techniques of local anesthesia powerpoint Mustafatj1
Credit goes to meryem hilal for making this powerpoint
Check this youtube channel if you want to help me back.
https://youtube.com/user/mustafabk1
Make sure to spread love.
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Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
5. Supraperiosteal Injection
Most common in maxilla
Indication:
Pulpal anesthesia of one or two
maxillary teeth
Soft tissue anesthesia when
indicated
Hemostasis
7. Areas Anesthetized
Entire area innervated by the large terminal nerve branches:
Tooth pulp and root area
Buccal periosteum
Mucous membrane and connective tissue
27. Posterior Superior Alveolar Nerve Block
Nerve Anesthetized:
Posterior Superior Alveolar Nerve (PSA)
- for maxillary molars and buccal tissue
28.
29. Advantages
Atraumatic; when administered properly, no pain is experienced by the patient
receiving the PSA because of the relatively large area of soft tissue into which
the local anesthetic is deposited and the fact that bone is not contacted
2. High success rate (>95%)
3. Minimum number of necessary injections
a. One injection compared with option of three infiltrations
4. Minimizes the total volume of local anesthetic solution administered
a. Equivalent volume of anesthetic solution necessary for three supraperiosteal
injections = 1.8 mL
30. Disadvantages
Risk of hematoma, which is usually diffuse; also discomfiting and visually
embarrassing to the patient
2. Technique somewhat arbitrary: no bony landmarks during insertion
3. Second injection necessary for treatment of the first molar (mesiobuccal
root) in 28% of patients
32. Alternatives
Supraperiosteal or PDL injections for pulpal and root anesthesia
2. Infiltrations for the buccal periodontium and hard tissues
3. Maxillary nerve block
33. Technique
1. A 27-gauge short needle recommended
2. Area of insertion: height of the mucobuccal fold above the maxillary second
molar
3. Target area: PSA nerve-posterior superior, and medial to the posterior
border of the maxilla
4. Landmarks:
a. Mucobuccal fold
b. Maxillary tuberosity
c. Zygomatic process of the maxilla
34. 5. Orientation of the bevel: toward bone during the injection. If bone is
accidentally touched, the sensation is less unpleasant.
6. Procedure:
a. Assume the correct position .
(1) For a left PSA nerve block, a right-handed
administrator should sit at the 10 o'clock position facing the patient.
(2) For a right PSA block, a right-handed administrator should sit at the 8
o'clock position facing the patient.
44. Middle Superior Alveolar Nerve Block
The middle superior alveolar (MSA) nerve is present in only about 28% of the population
45. Areas Anesthetized
1. Pulps of the maxillary first and second premolars, mesiobuccal root of the first molar
2. Buccal periodontal tissues and bone over these same teeth
46. Indications
1. Where the ASA nerve block fails to provide pulpal anesthesia distal to the maxillary
canine
2. Dental procedures involving both maxillary premolars only
47. Contraindications
1. Infection or inflammation in the area of injection or needle insertion or drug
deposition
2. Where the MSA nerve is absent, innervation is through the anterior superior
alveolar (ASA) nerve; branches of the ASA innervating the premolars and the
mesiobuccal root of the first molar can be anesthetized by means of the MSA
technique.
50. Technique
1. A 27-gauge short or long needle is recommended.
2. Area of insertion: height of the mucobuccal fold above the maxillary second
premolar
3. Target area: maxillary bone above the apex of the maxillary second
premolar
4. Landmark: mucobuccal fold above the maxillary second premolar
51. Orientation of the bevel: toward bone
6. Procedure:
a. Assume the correct position.
(1) For a right MSA nerve block, night-handed administrator should face the
patient from the 10 o'clock position.
(2) For a left MSA nerve block, a right-handed administrator should face the
patient directly from the 8 or 9 o'clock position.
b. Prepare the tissues at the site of injection.
52. Precautions.
To prevent pain, do not insert too close to the periosteum and do not inject too rapidly; the
MSA should be an atraumatic injection.
53. Failures of Anesthesia
1. Anesthetic solution not deposited high above the apex of the second
premolar
a. To correct: Check radiographs and increase the depth of penetration.
2. Deposition of solution too far from the maxillary bone with the needle
placed in tissues lateral to the height of the mucobuccal fold
a. To correct: Reinsert at the height of the mucobuccal fold.
3. Bone of the zygomatic arch at the site of injection preventing the diffusion
of anesthetic
a. To correct: Use the supraperiosteal, ASA, or PSA injection in place of the
MSA.
54.
55.
56.
57. Anterior Superior Alveolar Nerve Block
(lnfraorbital Nerve Block)
The ASA nerve block does not enjoy the popularity of the PSA block,
primarily because there is a general lack of experience with this highly
successful and extremely safe technique.
It provides profound pulpal and buccal soft tissue anesthesia from the
maxillary central incisor through the premolars in about 72% of patients.
58. Nerves Anesthetized
1. Anterior superior alveolar
2. Middle superior alveolar
3. Infraorbital nerve
a. Inferior palpebral
b. Lateral nasal
c. Superior labial
59. Areas Anesthetized
Pulps of the maxillary central incisor through the canine on the injected side
2. In about 72% of patients, pulps of the maxillary premolars and mesiobuccal
root of the first molar
3. Buccal (labial) periodontium and bone of these same teeth
4. Lower eyelid, lateral aspect of the nose, upper lip
60.
61. Indications
Dental procedures involving more than two maxillary teeth and their
overlying buccal tissues
2. Inflammation or infection (which contraindicates supraperiosteal injection):
If a cellulitis is present, the maxillary nerve block may be indicated in lieu of
the ASA nerve block.
3. When supraperiosteal injections have been ineffective because of dense
cortical bone
62. Contraindications
1. Discrete treatment areas (one or two teeth only; supraperiosteal preferred)
2. Hemostasis of localized areas, when desirable, cannot be adequately achieved with this
injection; local infiltration into the treatment area is indicated
63. Advantages
1. Comparatively simple technique
2. Comparatively safe; minimizes the volume of solution used and the number of needle
punctures necessary to achieve anesthesia
64. Disadvantages
Psychological:
a. Administrator: There may be an initial fear of injury to the patient's eye
(experience with the technique leads to confidence).
b. Patient: An extraoral approach to the infraorbital nerve may prove
disturbing; however, intraoral techniques are rarely a problem.
2. Anatomic: difficulty defining landmarks (rare)
67. Technique
1. A 25- or 27-gauge long needle is recommended, although the 27-gauge
short also may be used, especially for children and smaller adults.
2. Area of insertion: height of the mucobuccal fold directly over the first
premolar
68. 3. Target area: infraorbital foramen (below the infraorbital
notch).
4. Landmarks:
a. Mucobuccal fold
b. Infraorbital notch
c. Infraorbital foramen
5. Orientation of the bevel: toward bone
69. Locate the infraorbital foramen .
( 1) Feel the infraorbital notch.
(2) Move your finger downward from the notch, applying gentle pressure to the
tissues.
(3) The bone immediately inferior to the notch is convex (felt as an outward
bulge). This represents the lower border of the orbit and the
roof of the infraorbital foramen .
( 4) As your finger continues inferiorly, a concavity is felt; this is the infraorbital
foramen.
(5) While applying pressure, feel the outlines of the infraorbital foramen at this
site. The patient senses a mild soreness when the foramen is
palpated as the infraorbital nerve is pressed against bone.
70. Slowly deposit 0.9 to 1.2 mL (over 30 to 40 seconds) . Little or no swelling
should be visible as the solution is deposited. If the needle tip is properly
inserted at the opening of the foramen, solution is directed toward the foramen
77. The steps in the atraumatic administration of palatal anesthesia are as follows:
1. Provide adequate topical anesthesia at the site of needle
penetration.
2. Use pressure anesthesia at the site both before and during needle insertion and the
deposition of solution.
3. Maintain control over the needle.
4. Deposit the anesthetic solution slowly.
5. Trust yourself ... that you can complete the procedure atraumatically.
78. Indications
1. When palatal soft tissue anesthesia is necessary for restorative therapy on more than
two teeth (e.g., with subgingival restorations, with insertion of matrix bands
subgingivally)
2. For pain control during periodontal or oral surgical procedures involving the palatal
soft and hard tissues
84. Technique
1. A 27-gauge short needle is recommended.
2. Area of insertion: soft tissue slightly anterior to the greater palatine foramen
3. Target area: greater (anterior) palatine nerve as it passes anteriorly between soft
tissues and bone of the hard palate
4. Landmarks: greater palatine foramen and junction of the maxillary alveolar process
and palatine bone
5. Path of insertion: advance the syringe from the opposite
side of the mouth at a right angle to the target area
6. Orientation of the bevel: toward the palatal soft tissues
85. For a right greater palatine nerve block, a right-handed administrator should sit facing
the patient at the 7 or 8 o'clock position.
(2) For a left greater palatine nerve block, a right handed administrator should sit
facing in the same direction as the patient at the 11 o'clock position.
86.
87.
88.
89.
90.
91.
92. Nasopalatine Nerve Block
Nasopalatine nerve block is an invaluable technique for palatal pain control in
that, with administration of a minimum volume of anesthetic solution
(maximally, one quarter of a cartridge), a wide area of palatal soft tissue
anesthesia is achieved, thereby minimizing the need for multiple palatal
injections.
93. Two approaches to this injection are presented:
The first approach involves only one tissue penetration, lateral to the incisive papilla
on the palatal aspect of the maxillary central incisors.
2.It involves three needle punctures but, when carried out properly, is significantly less
traumatic than the more direct one puncture technique.
In it, the labial soft tissues between maxillary central incisors are anesthetized
(injection #1), then the needle is directed from the labial aspect through the
interproximal papilla between the central incisors toward the incisive papilla on the
palate to anesthetize the superficial tissues in this area (injection #2). A third injection,
directly into the now partially anesthetized palatal soft tissues overlying the
nasopalatine nerve, is necessary
94. Areas Anesthetized
Anterior portion of the hard palate (soft and hard tissues) bilaterally from the mesial of the
right first premolar to the mesial of the left first premolar
95.
96. Indications
When palatal soft tissue anesthesia is necessary for restorative treatment on
more than two teeth (e.g., subgingival restorations, insertion of matrix bands
subgingivally)
2. For pain control during periodontal or oral surgical procedures involving
palatal soft and hard tissues
98. Advantages
1. Minimizes needle penetrations and volume of solution
2. Minimal patient discomfort from multiple needle penetrations
99. Disadvantages
1. No hemostasis except in the immediate area of injection
2. Potentially the most traumatic intraoral injection; however, the protocol for an atraumatic
injection or use of a C-CLAD system or a buffered local anesthetic
solution can minimize or entirely eliminate discomfort
101. Technique (Single-Needle Penetration of the
Palate)
1. A 27-gauge short needle is recommended.
2. Area of insertion: palatal mucosa just lateral to the incisive papilla (located in the
midline behind the central incisors); the tissue here is more sensitive than other palatal
mucosa
3. Target area: incisive foramen, beneath the incisive papilla
4. Landmarks: central incisors and incisive papilla
5. Path of insertion: Approach the injection site at a
45-degree angle toward the incisive papilla.
6. Orientation of the bevel: toward the palatal soft tissues (review procedure for the
basic palatal injection)
7. Procedure: a. Sit at the 9 or 10 o'clock position facing in the same
102. Aspirate in two planes.
1. If negative, slowly deposit (15- to 30-second minimum) not more than one
fourth of a cartridge (0.45 mL).
(1) In some patients, it is difficult to deposit 0.45 mL of anesthetic solution in
this injection.
Injection of anesthetic can cease when the area of ischemia noted at the injection
site has expanded from that produced by the application
of pressure alone.
103.
104.
105. Local Infiltration of the Palate
Indications
1. Primarily for achieving hemostasis during surgical procedures
2. Palatogingival pain control when limited areas of anesthesia are necessary
for application of a rubber dam clamp, packing of retraction cord in the
gingival sulcus, or operative procedures on not more than two teeth
106. Technique
1. A 27-gauge short needle is recommended.
2. Area of insertion: the attached gingiva 5 to 10 mm from the free gingival margin
3. Target area: gingival tissues 5 to 10 mm from the free gingival margin
4. Landmark: gingival tissue in the estimated center of the treatment area
5. Pathway of insertion: approaching the injection site at a 45-degree angle
6. Orientation of the bevel: toward palatal soft tissues
107.
108. Maxillary Nerve Block
The maxillary (second division or V2 ) nerve block is an effective method of achieving
profound anesthesia of a hemimaxilla.
109. Indications
1. Pain control before extensive oral surgical, periodontal, or restorative
procedures requiring anesthesia of the entire maxillary division
2. When tissue inflammation or infection precludes the use of other regional
nerve blocks (e.g., PSA, ASA, AMSA, P-ASA) or supraperiosteal injection
3. Diagnostic or therapeutic procedures for neuralgias or tics of the second
division of the trigeminal nerve
110. Contraindications
1. Inexperienced administrator
2. Pediatric patients
a. More difficult because of smaller anatomic dimensions
b. A cooperative patient is needed.
c. Usually unnecessary in children because of the high success rate of other regional
block techniques Uncooperative patients
4. Inflammation or infection of tissues overlying the
injection site
5. When hemorrhage is risky (e.g., in a hemophiliac)
6. In the greater palatine canal approach: inability to gain access to the canal; bony
obstructions may be present in 5% to 15% of canals