pulps) by this approach is not as reliable as an inferior alveolar nerve block.
The pulps of lower incisor teeth may not be satisfactorily anaesthetized by inferior
alveolar nerve or mental and incisive nerve block injections as a result of cross-over
supply from the contralateral inferior alveolar nerve. A buccal infiltration adjacent to
the tooth of interest is sufficient to deal with this supply. The method of choice for
pulpal anaesthesia in the permanent lower incisors is a combination of buccal and
lingual infiltrations.
Maxillary block techniques
Regional block techniques are seldom required in a child's maxilla. Greater palatine
and nasopalatine nerve blocks are avoided by infiltrating local anaesthetic solution
through already anaesthetized buccal papillae and 'chasing' the anaesthetic through to
the palatal mucosa (see further). This technique is equally effective in anaesthetizing
lingual gingivae in the lower jaw if infiltration or mental block techniques have been
used (it is obviously not needed if a lingual block has been administered with an
inferior alveolar nerve block injection). The effects of an infraorbital block are often
achieved by infiltration anaesthesia in the canine/maxillary first primary molar region
in young children.
172H
Fig. 5.3 The mandibular foramen is
below the occlusal plane in children.
(By kind permission of Dental Update.)173H
Fig. 5.4 The mental foramen faces
anteriorly in children (left) compared
with posteriorly in adults. (By kind
permission of Dental Update.)5.5.3 Intraligamentary anaesthesia
Intraligamentary or periodontal ligament (pdl) anaesthesia is a very effective
technique in children (174HFig. 5.5). This is a method of intraosseous injection with local
anaesthetic reaching the cancellous space in the bone via the periodontal ligament.
This method allows the use of small amounts of local anaesthetic solution. The