Inferior dental block technique
The inferior dental block is recommended for all procedures in mandibular primary molars requiring pulpal analgesia in children of 6 years or older. A 27-gauge needle is recommended for more reliable aspiration.
Figure 1: The child’s mandibular foramen lies relatively lower and deeper along the internal surface of the ascending ramus when compared with that in an adult.
Figure 2 : Topical analgesia is most reliably achieved by placing topical gel on the outer aspect of a bent cotton roll.
Figure 3 :The gel is placed in contact with the tissues overlying the injection site.
Figure 4 :The patient is asked to occlude, holding the cotton wool roll in situ.
Figure 5 : The patient is instructed to open the mouth as wide as possible. The thumb palpates the external oblique ridge and tautens the mucosa between the pterygomandibular raphe and the external oblique ridge.
Figure 6 : The needle is inserted from the opposite side of the mouth, the barrel lying over the first primary molar. The needle enters the tissues at a point midway between the external oblique ridge and the pterygomandibular raphe at the level of the occlusal plane. Once the mucosa has been penetrated a small amount of analgesic solution is immediately deposited; the needle is then gently advanced, with slow injection and aspiration until the resistance of the bone of the internal surface of the ramus is felt. The periosteum at this site is sensitive, and so great care should be exercised. The needle is withdrawn 1 mm and the remainder of the solution slowly deposited.
Figure 7 : In young children a two-stage technique may be preferred for inferior dental block administration. This involves first giving a small submucosal infiltration at the injection site.
Figure 8 : After 1–2 minutes, an inferior dental block can be administered, injecting through the already anaesthetized tissues.