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Evaluation of mandibular infiltration versus block anesthesia in pediatric

dentistry

Article · November 1992

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Franklin Garcia-Godoy
The University of Tennessee Health Science Center
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Evaluation of mandibular infiltration
versus block anesthesia in
pediatric dentistry
Historically. the anesthesia technique of choice for
mandibular primary and permanent molars has been
the inferior alveolar nerve block (mandibular block}.1.2
Infiltration anesthesia for the mandibular primary me-
lars has been suggested based on personal experience
or in studies evaluating the technique.P'" This latter
study suggested that the infiltration technique should
be investigated as a possible alternative to mandibular
block anesthesia in young children.
The purpose of this study was to compare the clinical
effectiveness of the mandibular infiltration versus the
mandibular block techniques for the operative and sur-
gical treatments of primary molars.
MATERIALS AND MEfHODS
Eighteen children ages six to nine years old who re-
quired bilateral identical dental treatment on mandi-
bular primary molars were selected for this study. The
bilaterally selected teeth for treatment had no more
than one third root resorption evident. Informed con-
sent was obtained from the parent or guardian for the
Dr. Donohue is in private practice, Dr. Carcia-Godoy is Professor
and Director, Predoctornl Division. Dr. King is Professor and Di-
rector of the postdoctoral Division. Department of Pediatric Den-
tistry. and Dr. Barnwell is an Associate Professor, Department
Pathology. Medical School. Health Science Center at San Antonio,
San Antonio. Texas.
104 MARCH-APRIL 1993
JOURNAL OF DENTISTRY FOR Cl-DLoIttN
Daniel Donohue, DDS
Franklin Garcia-Godoy, DDS, MS
David L. King, DDS, PhD
George M. Barnwell, PhD
re
ul
es
m
Ii
ea
child's participation in the study. The same operator
performed all procedures without the parent or guard-
ian present and was assisted by a trained dental assist-
ea
ant. Nitrous oxide was gradually introduced and when (p
the desired effect of the nitrous oxide was achieved. p<
anesthetic solution was administered to the patient using sc
inferior alveolar nerve block or a supraperiosteal infil- th
tration technique. A random number table was used ex
to determine which side of the mouth was to receive
the block or the infiltration technique and a coin toss
determined which would be administered first. A stan-
dard technique for the inferior alveolar nerve block was
used.'
For both the mandibular block and infiltration tech-
niques. a short 27 gauge needle was used to inject a 2
percent lidocaine solution with 1:100.000 epinephrine.
Topical anesthetic was applied before injection in both
techniques. The lip and/or cheek was shaken to provide
distraction. In the mandibular block technique, ap-
proximately 1.3 ml of anesthetic was placed near the
inferior alveolar nerve. 0.5 ml as a long buccal infiltra-
tion distal to the permanent first molar or well distal
to the second primary molar. In the infiltration tech-
nique. 0.4 ml of the anesthetic solution was placed in
the bottom of the sulcus and 0.2 ml. in the mesial and
distal peplllas of the primary tooth being treated (fig-
of
ure) until blanching of the lingual tissue was observed.
This made a total of 0.8 ml injected. The patient was
 1993 105 DONOHUE, GARCIA-GODOY, KING, BARNSWELL

'REN MANDIBULAR lNFIL TRA TION VS BLOCK ANESTHESIA

•c
--
Table 0 CompariJon of the mandibuIar

F-etor evaluated
block 1lfnW

Mean (S.D.)
the 1n6Jtbtion

.......
3.72 {Ul}
3.11 (l."17J
0.525-
.n 0..... .......
~y 'T1TTTTITfIl1~~rrrw- '""'"
In8Ilratioa
p",,~
1.67 (2-00)
1.33 (2.1'9)
0.547-
3.39("-68)
2.44(3.01)
0.101-
~ ><- K K~Arr:.::s"c <~ • Not significant

Figure. Infiltration sites. A Bottom of sulcm; B. Distal pa-

lDS pilla; C. Mesial papilla.
MS
Patients exhibiting obvious anxiety or uncooperative
PhD behavior were not included in this study.
PhD re-oxygenated with 100 percent oxygen for five min- The following factors were evaluated:
utes. Bilateral identical procedures were performed on o Dentist's response to injection.
each patient in the study during the same appoint- D Dentist's response to clinical procedure.
ment.: These procedures included amalgam restora- D Patient's response to injection.
tions. stainless steel crowns. pulp therapy. and o Patient's response to work.
extractions. A rubber dam and Molt bite block were Statistical evaluation of the data was performed using
-ator
used for restorative procedures. a paired t-test.
ard-
Upon completion of treatment and prior to dismissal.
sist-
each patient was asked to rate the level of discomfort RESULTS
.hen
(pain) for the injection as well as for the procedure
ved, The paired t-test indicated there was no significant dif-
performed. The questionnaire consisted of a numbered
Ising
scaleand instructions were explained to the patient by ference between the block and infiltration techniques
nfil-
the dental assistant. The operator rated the patient's for any of the factors evaluated (Table).
ised
exhibited level of discomfort for the injection and the
etve
procedure. independent of the patient. The operator DISCUSSION
toss
based his ratings on patient cooperation, facialand body
nan-
language. vocalization of the patient during the injec- This study confirms a previous one by Carcta-Codoy
was
tion and procedure. and tearing of the patient's eyes. demonstrating that satisfactory anesthesia for the pri-
echo All patients were age six to nine years old with the mary mandibular teeth of children can be obtained with
cognitive skills to understand what was asked of them. the infiltration tecbmque."
t a2

,.
Satisfactory anesthe§ia is obtainable usm~
the infiltration 'technlque, with fewer risks.
 106 MARCH·APRIL 1993
JOURNAL OF DENTISTRY FOR CHILnRtN

The anesthesia obtained in children with the man-
dibular infiltration technique could be due to the greater
porosity of the cortical layer of bone in young children
pennitting diffusion of the anesthetic solution through
the bone."
The infiltration technique described in this study is
not a mental nerve block. because in small children
the mental foramen is located near the apex of the
mesial root of the first primary molar and the infiltra-
tion technique injects between the two primary molars
and the mesial and distal papillas. The infiltration of
the papillas to the lingual area would anesthetize the
lingual nerve filaments. With the mandibular block.
many times the lingual nerve is not anesthetized and
a lingual infiltration is required to supplement the block."
The infiltration technique could also be considered
useful in hemophiliacs without replacement of defi-
cient factor. 6 In these patients. cervical hematomas and
death have occurred after mandibular block anes-
thesia."
One of the most common complications following
mandibular block anesthesia is trauma to the soft tissue
filtration technique. the lip is not anesthetized and fewer
incidences of self-inflicted soft tissue trauma, there.
fore. should be expected. Because of the localized ef.
feet of the infiltration technique. bilateral dental work
may be completed in one appointment, reducing the
amount of anesthetic solution, and a decreased risk of
self-inflicted injuries.
REFERENCES
1. McDonald, R.E. and Avery, D.R.: Dent£ltry for ~ child and
adolescent. 5th ed. St. Louis: C.V. Mosby Co., 1985, pp 3OS..
306.
2. Kisby. L.: Pain control in pedodontics. In White, C.E. CUnic4J
oral pedwtrlc8. Chicago: Quintessence Pub. Co., 1981, p 207.
3. Northrop, P.M.: Practical techniques in administration of1ocal
anesthetic agents: II. Questions and answers. J Am Dent Assoc,
38;444-448. April 1949.
4. Shiere, F.R.: Oral anesthesia for children. J Am Dent Assoc.
41;414-418, October 1950.
5. Garcia-Godoy, F.M.: A simplified local anesthetic technique for
mandibular primary molars. Acta Odontol Pedtatr, 3:53-56. De-
cember 1982.
6. Steinle. C.J. and Kisker, C.T.: Pediatric dentistry for the child
with hemophilia.
1970.
New Eng J Moo. 283:1325-13.26, December

7. Areher, W.H. and Zubrow. H.J.: Fatal hemorrhage following

]
caused by biting the anesthetized lip. tongue and/or regional anesthesia for operative dentistry in hemophiliac. Oral b
inner surface of the cheek. 1 With the mandibular in- Surg. 7:464-470, April 1954. u
ti

a
F
UPTAKE AND CLEARANCE OF FLUORIDE FROM THE a
BUCCAL MUCOSA u
p
It is well established that the salivary clearance of topically applied fluoride follows f,
a multiexponential curve. The initial rapid decline in fluoride concentration has been o
attributed to swallowing and dilution by freshly secreted saliva [Dawes, 1983; Dawes p
and Weatherell, 1990]. but those factors which influence the other .components of
the curve remain obscure. It has been suggested that one important aspect may be
the existence of some form of intraoral fluoride store [Duckworth et al., 1987; White
and Nancclles, 1990] which is replenished when the fluoride concentration in saliva
is high and depleted as the concentration falls. It has also been postulated that the
relatively high fluoride levels found in plaque may fulfil this function or. alterna-
tively. that CaF2 associated with the dental hard. tissues may release fluoride into
saliva when the conditions are favourable [0gaard. et al .• 1983]. The possibility also
exists. however. that Iluojide Isabsorbed/adsorbed by the oral soft tissues, partic-
ularly the non-keratinized mucosa. and subsequently released over an extended
period.
Jacobson. A.P.M, et al: Fluoride uptake and clearance from the buccal mucosa
following mouthrinsing.
Caries Res, 26:56-58, January-February 1992.

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