LOCAL ANESTHESIA

CLASSIFICATION;
CONTENTS OF
CARTRIDGE +
FUNCTIONS;
IANB TECHNIQUE
DEFINITION
 LA is defined as a loss of sensation in a circumscribed area
of the body caused by depression of excitation of nerves
endings or an inhibition of the conduction process in
peripheral nerves.
 LOSS OF SENSATION WITHOUT LOSS OF
CONSCIOUSNESS.
 Properties of LA
 Should be non-irritating to tissue
 Not cause any permanent alteration of nerve structure.
 Time of onset should be short
 Effective
 Duration of action should be long
 It should be either sterile or be capable of being sterilized by heat
without deterioration.
 Systemic toxicity should be low.
 Free from producing allergic reactions
 It should be stable in solution and should readily undergo
biotransformation in the body.
MODE OF ACTION OF LA

 They prevent both the generation and conduction

of a nerve impulse.
 LA interfere with the excitation process in a nerve
membrane in one or more of the following ways;
 Altering the basic resting potential of the nerve
membrane
 Altering the threshold potential
 Decreasing the rate of depolarization
 Prolonging the rate of repolarization.
 WHERE DO LA WORK?
 The nerve membrane is the site where local
anesthetic agent exert their pharmacologic actions.
CLASSIFICATION
 According to mode of action;
 Block
 Infiltration
 topical
 Based on surface anesthetics;
 1.Soluble agents ( cocaine lidocaine, )
 2. insoluble agents ( benzocaine)
 Based on the chemistry;
 1.esters
 2. amides
 3. quinilones (centbucridine)
CONTENTS OF CARTRIDGE
 Anesthetic agent (xylocaine,lignocaine)
• Blocks the conduction of nerves
 Vasoconstrictor;
• Increase the duration and depth of LA
• Reducing agent (sodium metabisulphite) ;
• To prevent the oxidation reaction of vasoconstrictors which
are unstable in solution
 Antifungal (thymol);
• In the past some solutions tended to become cloudy due to
proliferation of minute fungi
 Preservative (methylparaben, capryl);
• To increase the shelf life
.
 Vehicle (ringer lactate, distlled water, NaCl);
• The anesthetic agent and the addititves are dissolved. This
isotonic solution minimizes discomfort during injection
LOCAL ANESTHESIA COMPLICATION
 Needle breakage
 Pain on injection
 Burning on injection
 Persistent anesthesia paresthesia
 Trismus
 Hematoma
 Infection
 Edema
 Tissue sloughing
 Facial nerve paralysis
 Toxicity
 Allergic reactions
 INFERIOR ALVEOLAR NERVE
BLOCK
 Commonly referred to as the mandibular nerve block
 A supplemental block is needed only to anesthetize the buccal soft
tissue of posterior region
 NERVE ANESTHETIZED;
 Inferior alveolar nerve
 Incisive nerve
 Mental nerve
 Lingual nerve
AREA ANESTHETIZED
 Mandibular teeth to the midline
 Body of the mandible, inferior portion of the ramus
 Buccal mucoperiosteum, mucus membrane anterior to
mental foramen (mental nerve)
 Anterior two third of the tongue and the floor of the oral
cavity ( lingual nerve)
 Lingual soft tissue and periosteum
INDICATION
 Procedure on multiple mandibular teeth in one quadrant.
 When buccal soft tissue anesthesia is necessary.
 When lingual soft tissue anesthesia is necessary.
 CONTRAINDICATION
 Infection or acute inflammation in the area of injection
 Patient who are more likely to bite their lips or tongue like
children or physically and mentally handicapped.
TECHNIQUE
 Target area: mandibular foramen
Anatomical landmarks:
• coronoid notch
• Pterygoandibular raphe
• Occlusal plane for mandibular posteriors
 Direct technique:
 Palpate and identify injection site
 Advance needle from contralateral side premolars
horizontally 1cm above the occlual plane
 Needle goes in 2-2.5cm, hit bone, retract needle 1mm,
aspirate, inject slowly.
Subjective sign
 Tingling or numbness of lower lip (anesthesia of mental
nerve)
 Tingling or numbness of tongue( anesthesia of lingual nerve)
 OBJECTIVE SIGN
 No pain on inserting the dental probe
 SAFETY FEATURE
 Preventing over insertion of needle
 PRECAUTIONS
 Donot deposit local anesthesia if bone is not contacted
 Avoid pain by not contacting the bone too forecfully
ADVANTAGES
 One injection provides wide area of anesthesia useful for
quadrant dentistry
 DISADVANTAGES
 Wide area of anesthesia may not indicated for localised
procedures
 Increased chances of failure
 Intraoral landmarks nor consistently reliable
 Lingual and lower lip anesthesia may sometimes lead to self
inflicted soft tissue trauma
Failure of Anesthesia
 The most common causes are;
 Deposition of anesthetic agent too low below the mandibular
foramen
 Deposition of anesthesia too far anteriorly (laterally) on the
ramus
 Accessory innervation to the mandibular teeth mainly
mylohyoid nerve act as the prime candidate
 Incomplete anesthesia of central and lateral incisors due to
overlapping of the contralateral inferior alveolar nerve fibers
Thank you