My dear friends, let us simplify the matter for ourselves and divide the anesthesia in the lower jaw into two parts:
- Anesthesia of the tooth nerve / in the case of a regular filling or a root filling, and includes the following nerves:
A. Inferior alveolar nerve block.
B. Incisive nerve by mental injection. - Anesthesia of the gingival and oral tissues / in the event of tooth extraction or surgical operations, and of course the nerves of the teeth must be anesthetized as well, and it includes the following nerves:
A.Lingual nerve.
B. Long buccal nerve.
C. mental nerve.
- Let us now talk about anesthesia of the dental nerves, which are as follows
A. Inferior alveolar nerve block - If I want to properly anesthetize this nerve, I must keep in mind the following points:
- External oblique bridge.
- Coronoid notch.
- Pterygomandibular raphe.
- Tip of thumb.
- 1st & 2nd premolars on the other side.
- Insert 2/3 of needle and touch bone.
Of course, at the beginning, if I want to anesthetize this nerve, I have to feel the external oblique ridge with the thump of the hand that we do not need the dental syringe with, and continue to feel and move distally for the lower teeth to some extent. The thump is located in a cavity called the coronoid notch, then hold the thump in this position and insert the needle In the middle of the distance between the tip of thump and the pterygomandibular raphe …..now we are done here??? No, no, never… The needle on the other side must be between 4 and 5, and on the thump side, you enter 2/3, and I have a touch bone….
- Brothers, the problem is coming now, which is entering the needle 2/3 and touching the bone…. Here, my loved ones, I will have 3 things without a fourth, which are:
- As for the needle 2/3 entering and I have a touch of bone, and in this case things are fine, and for a while I pull the needle and give a slow injection, why here I pull a little bit of the needle and give a slow injection?? … You can respond with comments and we will see the answers because the topic requires an explanation ….
- Or I have an early touch bone before the needle 2/3 enters, in this case I have to move the needle mesialy or laterally from the side of the 4th and 5th in the opposite side to the point where the needle enters at the same sternal level and I try to insert the needle 2/3 and when it enters 2/3 go back The syringe to its place between the 4th and 5th on the other side and follow the same steps mentioned previously…..
- Or I have no touch bone, meaning the needle has 2/3 or more inside it, but there is no touch bone, in this case I have to move the needle distally or medially from the side of the 4th and 5th in the opposite side to the point of entry of the needle on the same plate level, and start pulling the needle until it happens touch bone and the needle is 2/3 inside and complete the same previous steps.
Summary, my brothers and loved ones, keep this sentence in your mind and memorize it, which is:
(early touch bone move mesially or laterally to get touch bone at 2/3 insertion of needle, no touch bone move distally or medially to get touch bone at 2/3 insertion of needle)
B. Incisive nerve by mental injection.
- Here we are not always drugged in this way and always let us rely on the block …. This method numbs the teeth on one side from the 5th to the 1st by placing the needle in the labial vestibule between the 4th to the 5th and parallel to the longitudinal axis of the teeth, penetrating the tissue and injecting until the anesthesia reaches the mental foramen and the incisive nerve and the mental nerve are numb at the same time but anesthesia The incisive nerve is weak compared to the block method, and this anesthesia can be used if the caries is simple and not deep, and the reviewer has a phobia.
- Now let’s talk about anesthesia of the gum and oral tissues, and here the benefit of anesthesia is if you have a tooth extraction or surgery for the teeth, gums or lip, and we will talk about three nerves, which are:
A.Lingual nerve:
Here, my brothers, anesthesia is very easy. Either it is a block, just that the needle is inside it 2/3 of the previous anesthesia. I pull it out only about 1/3 and slowly inject the remaining amount. This nerve will numb in me and numb the gingival tissue and the tongue itself, and the tongue will play and become numb, or it will be infilteration So that the needle was inserted into the lingual vestibule parallel to the longitudinal axis of the teeth and penetrated, injected and anesthetized the place I wanted from the lingual gums…..
B. Long buccal nerve:
Here, my loved ones, anesthesia is also very easy, either by blocking it by inserting the needle 2mm distally and buccally at the last molar tooth and penetrating and injecting it and it will numb my nerve and numb all the buccal and labial gums, or it will be infilteration by entering the needle vertically into the cheek or labial vestibule parallel to the longitudinal axis To the teeth, penetrate, inject and anesthetize the place I want from the oral or cheek gums.
C.Mental nerve: - Here, my loved ones, anesthesia is very easy by inserting the needle vertically into the labial vestibule parallel to the longitudinal axis of the teeth between the 4th and 5th. It penetrated and injected, and the anesthesia will go to the mental foramen, and the mental nerve will be numb to me, and half of the lower lip will be numb to me from the side of the injection. We can benefit from this anesthesia. If we are going to have lip surgery, block anesthesia can be done as well.
Dr. Atheer Bashir Ahmed
College of Dentistry / Karbala University
