Bleeding diatheses
Injection into deep tissues should be avoided in patients with bleeding diatheses such
as haemophilia. Inferior alveolar nerve block techniques should not be used unless
appropriate prophylaxis has been provided (e.g. Factor VIII for those with
haemophilia). This can be overcome by the use of intraligamentary injections in the
mandible in such patients for restorative dentistry.
Susceptibility to endocarditis
Intraligamentary anaesthesia will produce a bacteraemia. In patients susceptible to
endocarditis this method should not be used for procedures in which gingival
manipulation would not normally be involved. This is because it is unreasonable to
provide antibiotic prophylaxis for the anaesthetic when other methods of local
anaesthesia can be employed. When antibiotic prophylaxis has been provided to cover
the operative procedure then intraligamental injections can be employed.
Incomplete root formation
The use of intraligamental techniques for restorative procedures on permanent teeth
with poorly formed roots could lead to avulsion of the tooth if inappropriate force is
applied during the injection.
Trismus
Trismus will preclude the usual direct approach to the inferior alveolar nerve block.
Epilepsy
As seizure disorders can be triggered by pulsing stimuli (such as pulses of light) it is
perhaps unwise to use electroanalgesia in children with epilepsy.
5.9 SUMMARY
- Surface anaesthesia is best achieved with a topical agent on a cotton bud applied to
dry mucosa for 5 min. - Buccal infiltration anaesthesia is successful in the maxilla.
- Regional block anaesthesia is successful in the mandible.
- Intraligamentary anaesthesia is successful in children. This method may be the first
choice in the posterior mandible and as a supplementary technique in the maxilla. - Pain-free local anaesthesia in the maxilla is possible with buccal infiltration and by
anaesthetizing the palate via the buccal papillae. - In the mandible, intraligamental techniques may be used to avoid the discomfort of
regional block injections.