Dental syringe: Specifically designed for delivering local anesthetics in dental procedures.
Needles
Long dental needles: Typically 25 to 27 gauge, used for deeper penetrations to reach the nerve.
Local Anesthetics
Lidocaine (2% with 1:100,000 epinephrine): Standard choice, offering a balance between duration and onset, with a medium duration of anesthesia.
Articaine (4% with 1:100,000 epinephrine): Known for better bone penetration, used commonly in the US and Europe for dental blocks.
Mepivacaine (2% or 3%, available with or without epinephrine): Offers a faster onset and is useful for shorter procedures; less vasodilation compared to lidocaine.
Bupivacaine (0.5% with 1:200,000 epinephrine): Long-lasting anesthetic, suitable for procedures requiring extended pain control.
Prilocaine (4% with 1:200,000 epinephrine): Less potent and toxic, suitable for patients where methemoglobinemia isn't a concern.
Topical Anesthetic
Benzocaine gel or Lidocaine gel: To numb the surface before injection and reduce patient discomfort.
Protective Equipment
Sterile disposable gloves: For hygiene and protection.
Eye protection: To safeguard against possible splashes or contact during the procedure.
Other Supplies
Cotton swabs: For applying topical anesthetics.
Gauze pads: To assist in drying the injection area before topical application and managing any minor bleeding post-injection.
Sharps container: For the disposal of needles and other sharp instruments safely.
Recapping device: Helps in safely recapping needles, reducing the risk of needle-stick injuries.
Dental mirror: To aid in visualizing the mouth and ensuring accurate needle placement.
Technique
Preparation:
Assemble all necessary materials: syringe, needle, and local anesthetic.
Choose an appropriate anesthetic solution (e.g., lidocaine with epinephrine).
Ensure the patient's medical history is reviewed to avoid any contraindications.
Positioning the Patient:
Have the patient seated in an upright or semi-reclined position.
Ensure the patient is comfortable and relaxed.
Identifying Landmarks:
Ask the patient to open their mouth wide.
Identify the pterygomandibular raphe and the coronoid notch.
Glove and Prepare:
Put on sterile gloves.
Prepare the anesthetic in the syringe and ensure there are no air bubbles.
Surface Anesthesia:
Apply a topical anesthetic to the mucosa overlying the injection site to minimize discomfort upon needle insertion.
Approach:
Approach the patient from the contralateral side (opposite side of the mouth).
Position the syringe at the corner of the mouth, aiming the needle towards the pterygomandibular raphe.
Needle Insertion:
Insert the needle gently but firmly, aiming slightly upwards and backwards. The insertion point is usually beside the pterygomandibular raphe, slightly above the occlusal plane of the lower molars.
The depth of insertion typically ranges from 20 to 25 mm, depending on the patient’s anatomy.
Aspirate:
Once the needle is in place, pull back the plunger slightly to aspirate, ensuring that the needle is not within a blood vessel.
Inject the Anesthetic:
If no blood is aspirated, slowly inject approximately 1.5 to 1.8 mL of anesthetic solution.
The injection should be slow, over approximately 60 seconds, to reduce discomfort.
Withdraw and Observe:
Slowly withdraw the needle.
Observe the patient for any immediate reactions or complications.
Test for Anesthesia:
After a few minutes, test the area to ensure it is numb.
Use a dental explorer to check for loss of sensation in the lower teeth, lip, and chin area.
Performing an IAN block requires precision and a good understanding of dental anatomy. Always make sure to maintain clear communication with the patient throughout the procedure to manage any anxiety and ensure their comfort.
Postoperative Considerations
Immediate:
Patient Instructions:
Advise the patient that their lip and tongue will be numb and to be careful not to bite them.
Inform them about the duration of the anesthesia and any post-procedure care needed.
Aftercare
Monitor the patient briefly to ensure there are no adverse reactions.
Provide post-operative instructions, particularly if further dental procedures are performed that might cause pain after the anesthetic wears off.
