Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Clinical
  • Published:

Problems associated with the traditional Inferior Alveolar Nerve Block and alternative approaches

BDJ Student volume 30, pages 28–29 (2023)Cite this article

'Identify the coronoid notch on the anterior border of the mandibular ramus to obtain the height of your injection, approach from the occlusal plane of the contralateral premolars and penetrate your needle up to 2/3 into the pterygotemporal depression until you encounter bony resistance, aspirate and finally dispense the LA solution' - are all words that are familiar amongst dental practitioners when undertaking anaesthesia training.

Despite the inferior alveolar nerve block (IANB) being taught as the mainstay technique for mandibular anaesthesia in undergraduate clinics, risks associated with this method must be acknowledged to enable the clinician to make informed decisions when treating patients with this approach. Whilst this method may prove useful in providing quadrant anaesthesia via the administration of a single injection,1 the most significant risk, that is, of LA induced post traumatic neuropathy should be at the forefront of the practitioner's mind. The IANB has also shown to have higher failure rates when used for anaesthesia of the anterior mandible, due to potential dual nerve supply from the contralateral IAN2 and accessory supply to the pulp from lingual and mylohyoid nerves.3 Additional considerations, such as the temporary loss of lingual sensation which may predispose self-inflicted trauma and the higher positive aspiration rate (ranging from 10 to 15%)1 which may increase the risk of systemic complications, must also be accounted for during the provision of the IANB. Thus, alternative methods of anaesthesia should be explored when administering LA to optimise pain control and minimise adverse outcomes.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. Malamed S F. Handbook of local anesthesia. 7th ed. Mosby, 2019.

  2. Meechan J, Ledvinka J. Pulpal anaesthesia for mandibular central incisor teeth: a comparison of infiltration and intraligamentary injections. Int Endod J 2002; 35: 629-634.

  3. Wilson S, Johns P, Fuller P. The inferior alveolar and mylohyoid nerves: an anatomic study and relationship to local anesthesia of the anterior mandibular teeth. J Am Dent Assoc 1984; 108: 350-352.

  4. Atkinson M E. Anatomy for dental students. 4th ed. Oxford, 2013.

  5. Ahmad M. The Anatomical Nature of Dental Paresthesia: A Quick Review. Open Dent J 2018; 12: 155-159.

  6. Renton T. Trigeminal nerve injuries related to restorative treatment. 2019. Available online at: www.dentalprotection.org/new-zealand/home/publications/articles/articles-display/trigeminal-nerve-injuries-related-to-restorative-treatment-new-zealand (accessed November 2022).

  7. Smith M H, Lung K E. Nerve injuries after dental injection: a review of the literature. J Can Dent Assoc 2006; 72: 559-564.

  8. Renton T. Inferior dental blocks versus infiltration dentistry: is it time for change?. Dent Update 2019; 46: 204-218.

  9. Pogrel M, Schmidt B, Sambajon V, Jordan R. Lingual nerve damage due to inferior alveolar nerve blocks: a possible explanation. J Am Dent Assoc 2003; 134: 195-199.

  10. Renton T, Adey-Viscuso D, Meechan J, Yilmaz Z. Trigeminal nerve injuries in relation to the local anaesthesia in mandibular injections. Br Dent J 2010; 209: E15.

  11. Jaber A, Whitworth J, Corbett I, Al-Baqshi B, Kanaa M, Meechan J. The efficacy of infiltration anaesthesia for adult mandibular incisors: a randomised double-blind cross-over trial comparing articaine and lidocaine buccal and buccal plus lingual infiltrations. Br Dent J 2010; 209: E16.

  12. Zhang I L, Kratunova E, Marion I, da Fonseca M A, Han M. Articaine Infiltration Versus Lidocaine Inferior Alveolar Nerve Block for Anesthetizing Primary Mandibular Molars: A Randomised, Controlled, Double-Blind Pilot Study. Pediatr Dent 2021; 43: 344-348.

  13. Bataineh A, Alwarafi M. Patient's pain perception during mandibular molar extraction with articaine: a comparison study between infiltration and inferior alveolar nerve block. Clin Oral Investig 2016; 20: 2241-2250.

  14. Awal D, Yilmaz Z, Osailan S, Renton T. Articaine-only buccal infiltrations for mandibular molar extractions: an alternative to inferior dental nerve blocks. Dent Update 2017; 44: 838-845.

  15. Olley R, Renton T, Frost P. Intraligamentary Local Anaesthesia for Posterior Mandibular Extractions. Dent Update 2020; 47: 213-216.

  16. Oghabi N, Renton T. Optimising Local Anaesthetic Practice: Addressing Misconceptions and Minimising Anaesthetic Failures. Dent Update 2022; 49: 32-38.

  17. Foot N. A sensible protocol. Br Dent J 2012; 213: 433-434.

  18. Etoz O, Er N, Demirbas A. Is supraperiosteal infiltration anaesthesia safe enough to prevent inferior alveolar nerve during posterior mandibular implant surgery?. Medicina Oral Patología Oral y Cirugia Bucal 2011; e386-e389.

Download references

Author information

Authors and Affiliations

  1. Peninsula Dental School, Plymouth, United Kingdom

    Kouthar Salih

Authors
  1. Kouthar Salih
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kouthar Salih.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Salih, K. Problems associated with the traditional Inferior Alveolar Nerve Block and alternative approaches. BDJ Student 30, 28–29 (2023). https://doi.org/10.1038/s41406-022-0919-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41406-022-0919-1

Search

Advanced search

Quick links