5-21
(b) Palatal injection (see Figure 5-4).
(1) Apply firm pressure to palatal injection site with a finger or mirror handle for 3 to 4 seconds.
This helps to minimize needle insertion discomfort.
(2) Insert the needle one-half of an inch above the gingival (gum) margin of the tooth.
(3) Deposit a small amount (< 1⁄4 carpule) of anesthetic solution – DO NOT BALLOON THE
TISSUE.
NOTE: The palatal injection is very painful.
c. Anesthesia for mandibular extraction.
- Block the inferior alveolar nerve as it exits the mandibular foramen on the medial aspect of the ramus
of the mandible. This foramen is located midway between the anterior and posterior borders of the
ramus and approximately one-half inch above the biting surface of the lower molars. Estimate
the width of the ramus at this level by placing the thumb on the anterior surface of the ramus
(intraorally) and the index finger on the posterior surface extraorally. The inferior alveolar and lingual
nerves are anesthetized by a single injection. (see Figure 5-5)
(1) Place the index finger on the biting surface of the lower molars so that the ball of the finger will
contact the anterior border of the ramus. The fingernail will then be parallel to the midline.
(2) Place the barrel of the syringe on the lower bicuspids on the side opposite of the side to be
anesthetized.
(3) Insert the needle into the tissue of the side to be anesthetized in the apex of the V-shaped, soft
tissue depression about one-half of an inch ahead of the tip of the finger on a line horizontally
bisecting the fingernail.
(4) Advance the needle to contact the medial surface of the ramus. A 1-inch soft tissue penetration
will usually suffice to position the needle point in the area of the mandibular foramen.
(5) Slowly deposit approximately two-thirds of the cartridge contents.
(6) Swing the barrel of the syringe to the side of the mouth being injected (leaving the needle in the
position described in (4) above) and inject the rest of the cartridge contents while withdrawing
Figure 5- 3
Facial Injection