BACKGROUND: The authors review four techniques for producing block and topical anesthesia that have been advocated as alternatives to conventional methods. The objective of this review is to examine the basis for each method's application in dentistry, including scientific studies where available. TYPES OF STUDIES REVIEWED: The authors reviewed both historical (1912 and 1923) and more recent (1977 to present) reports relating to specific local anesthetic delivery systems. While this article is not a comprehensive literature review, the clinical reports and double-blind scientific reports from peer-reviewed publications are specific to the various attributes of the delivery systems being described. In addition, the authors identify any claims lacking scientific validity. RESULTS: Several alternative local anesthetic delivery systems are clinically effective in producing local anesthesia. Potential adverse effects and complications do, however, differ from one technology to another, depending on the mechanical characteristics of the particular system. Finally, all of the alternative local anesthetic delivery systems represent additional costs when compared with those of conventional applications, and cost-effectiveness is an important factor to be considered when implementing these systems in a dental practice. CLINICAL IMPLICATIONS: Alternative local anesthetic delivery systems may offer some advantages over conventional techniques in certain situations, although the costs may outweigh the advantages in certain cases.

Administration, Topical↗

PubMed2003

The key to profound local anesthesia: neuroanatomy.

BACKGROUND: To achieve profound dental local anesthesia, it is necessary for the dentist to have a thorough knowledge of the details of sensory innervation to the maxilla and mandible. Since the early 1970s, dentistry has experienced a resurgence of interest in the neuroanatomical basis of local anesthesia, resulting in numerous scientific reports on the subject. OVERVIEW: Current studies afford a more detailed knowledge of the branching of various divisions of the trigeminal nerve, the great sensory nerve of the head region. In this article, the authors provide an update of the peripheral distribution of the trigeminal nerve to enhance induction of safe and effective dental local anesthesia. CONCLUSIONS AND PRACTICAL IMPLICATIONS: An understanding of the potential variations in innervation should help the dentist improve his or her ability to induce profound local anesthesia.

Anesthesia, Dental↗

PubMed2003

Avoiding complications in local anesthesia induction: anatomical considerations.

BACKGROUND: Dentists administer thousands of local anesthetic injections every day with few reports of serious complications. However, misjudging the anatomy involved during local anesthetic administration can result not only in inadequate or incomplete anesthesia, but in other complications such as paresthesia, bleeding or hematoma formation, or in serious systemic complications. OVERVIEW: The authors discuss anatomical considerations that dentists should keep in mind when administering local anesthetic injections. In particular, they discuss ways in which dentists can minimize the risk of nerve or vascular injury, as well as systemic complications. CONCLUSIONS AND CLINICAL IMPLICATIONS: Even the most experienced practitioner can benefit from a periodic review of the anatomy associated with local anesthesia. This article offers dentists the opportunity to consider needle placement with regard to location of nerves, blood vessels and glands, and to review injection protocols that can minimize the risk of complications.

Anesthesia, Dental↗

PubMed2003

Looking back.

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History, 20th Century↗

PubMed2002

Misconceptions involving dental local anesthesia. Part 1: Anatomy.

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Anesthesia, Dental↗

PubMed2002

Misconceptions involving dental local anesthesia. Part 2: Pharmacology.

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Anesthesia, Dental↗