1. What Next? What to do if you do not achieve adequate anesthesia

2. After administering a PSA nerve block to your patient, he complains of cold sensitivity when you are scaling around tooth #3. What injection should you administer to eliminate the sensation on tooth #3?

3. Answer: MSA nerve block to innervation to the mesial-buccal root of #14

4. After administering a MSA nerve block to your patient, he complains of pain when scaling around tooth #5. What injection should you administer to eliminate the sensation on tooth #5?

5. 1. Supraperiosteal injection in the mucobuccal fold above tooth #5 2
1. Supraperiosteal injection in the mucobuccal fold above tooth # ASA (Infraorbital) nerve block

6. You administer a PSA nerve block to a 10 year old child for an operative dentistry procedure on tooth #3. The child complains of pain when the dentist begins to excavate decay on the tooth. What injection should you administer next?

7. 1. Re-administer the PSA nerve block inserting the needle more to the distal of tooth # Administer a MSA nerve block above tooth #4 to block innervation to the mesial-buccal root of #3

8. You administer a supraperiosteal injection above tooth #6, but it does not achieve adequate anesthesia. What injection should you administer next?

9. 1. Insert the needle further to insure that the anesthetic is being injected above the root apex of # Administer an ASA (Infraorbital) nerve block.

10. On which tooth in the mandible will a supraperiosteal injection most likely be successful at achieving adequate anesthesia?

11. Lateral incisor

12. Your dentist wants to perform restorative dentistry on teeth #20 and #29 but he does not want bilateral anesthesia of the patient’s tongue. What injection will achieve adequate pulpal anesthesia without anesthetizing the anterior 2/3 of the tongue?

13. Bilateral Mental – Incisive (MI) nerve blocks

14. You do not achieve profound anesthesia with an Inferior Alveolar Nerve Block (IANB). What are your options for achieving adequate anesthesia?

15. 1. Re-inject IANB at a higher site 2. Gow-Gates (GG) nerve block 3
1. Re-inject IANB at a higher site 2. Gow-Gates (GG) nerve block 3. Mylohyoid nerve block administered on the lingual ridge at the level of the root apex of the most distal root of the tooth 4. PDL, Intraosseous injections