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Inferior Alveolar Nerve Blocks

M

mbc350

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I didn't see this particular question answered here. Are Inferior Alveolar nerve blocks (mandibular injections) painful or not? I've never had one, but if I were to have one, I feel anxious about it. Can dentists make them comfortable? Thank you.
 
Dr. Daniel

Dr. Daniel

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Hi,
Dentist can make them very comfortable even to the degree you do not feel a thing.
The key thing is to inject very very very slowly and gradually. If the dentist wants to make it quick (thinking it will shorten the anxiety) it will be painful.
Other means that help: using topical gel before, rinsing the mouth with Listerine before, using the WAND technology http://www.dentalfearcentral.org/help/technology/wand/
And again, the most important thing is slow and gradual injection.
 
M

mbc350

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Thank you for your kind reply. :) I haven't had dental work done in many years, and I take very good care of my teeth, but again, I was concerned about the possibility of any injections in the future (e.g., to numb an area of an accidentally-chipped tooth). There was something else I meant to ask, but I didn't want to post too long of a question in my original thread above. I would agree that a slow injection is the most important technique and that's what makes it truly painless, but I guess I'm more worried & anxious about the needle passing thru the tissues, esp. since they're 1 in. or longer and have to be advanced deep into the jaw to reach the nerve area. How badly does that hurt (on a 5-point scale, 5 being the worst), and how long does the pinching sensation last (e.g., a few seconds)? Also, will it lead to jaw-muscle or TMJ soreness after the anesthetic wears off? I know I'd have to look at the cost-benefit analysis of it by getting past any initial mild discomfort from the prick of the needle and focusing on the end result of total pain relief/numbness for a dental procedure, which is definitely preferable than no anesthesia at all! Nevertheless, anything my dentist could do that would minimize the discomfort would be greatly appreciated! Thanks again.
 
biffo1963

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I had an O/S perform one of those blocks on me two or three years ago. From what I can remember it seemed that that particular part of the mouth was only sensitive on the surface - in other words once the needle was in it didn't matter whether it was in one millimetre or two centimetres.
 
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penny_e

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I had tooth number 4 Premolar extracted 7 months ago, the shot in the bone was pretty painful but only for 10 seconds, it was sore after the extraction in the shot spot for about 4 days afterwards, not constant but I remember thinking maybe my dentist wasn't as good as I thought. Now its only a distant memory but I need a crown in tooth number 3 and I have to be honest this is the reason I haven't got the crown I don't want that shot again. My shot was in the bone roof of the mouth, I had all my wisdoms removed and I don't remember a problem with any of the injections at all.
 
M

mbc350

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... I guess I'm more worried & anxious about the needle passing thru the tissues, esp. since they're 1 in. or longer and have to be advanced deep into the jaw to reach the nerve area. How badly does that hurt (on a 5-point scale, 5 being the worst), and how long does the pinching sensation last (e.g., a few seconds)? Also, will it lead to jaw-muscle or TMJ soreness after the anesthetic wears off? ...
Dr. Daniel, what are your thoughts on my other questions in the previous quote above? Sorry I forgot to ask it the first time! (Perhaps I should've been more specific instead of general.) I just want to know what to expect at the outset if I ever have one because again, I've never had one of those. I apologize if I'm asking too many questions and worrying too much, but I just want to have better knowledge and/or experience. Thanks again.
 
Dr. Daniel

Dr. Daniel

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Hi,

Let's divide the injection to two parts: the needle penetration and the releasing of the anesthetics in the desired location in the jaw (in case of the alveolar block it means about 2.5 cm deep). Each step can be and should be painless if preformed slowly and gradually.
Regarding the question: It is very possible to penetrate with the needle without feeling a thing. The technique for that is by penetrating with the needle as shallow as possible (about 1 mm) into the tissue, and very gently release a drop of anesthetics, wait about 5 seconds (while the needle is still in the tissue), proceed 1 mm deeper and release very gently another drop and wait, proceed deeper, release a bit of the solution and wait, proceed deeper.......
The initial needle penetration into the tissue might be noticeable (in some cases a bit painful) but it is very easy to overcome it, for example using topical (there are other extremely useful techniques for that).

There are very clear guidelines how to avoid muscles with the needle. If the dentist accidentally hurts a muscle (the relevant muscle is the medial pterygoid muscle), it will be a bit painful closing the mouth for a 3-4 weeks but it does not happen often because sticking up the guidelines should prevent it.
 
C

comfortdentist

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Hi,

Let's divide the injection to two parts: the needle penetration and the releasing of the anesthetics in the desired location in the jaw (in case of the alveolar block it means about 2.5 cm deep). Each step can be and should be painless if preformed slowly and gradually.
Regarding the question: It is very possible to penetrate with the needle without feeling a thing. The technique for that is by penetrating with the needle as shallow as possible (about 1 mm) into the tissue, and very gently release a drop of anesthetics, wait about 5 seconds (while the needle is still in the tissue), proceed 1 mm deeper and release very gently another drop and wait, proceed deeper, release a bit of the solution and wait, proceed deeper.......
The initial needle penetration into the tissue might be noticeable (in some cases a bit painful) but it is very easy to overcome it, for example using topical (there are other extremely useful techniques for that).

There are very clear guidelines how to avoid muscles with the needle. If the dentist accidentally hurts a muscle (the relevant muscle is the medial pterygoid muscle), it will be a bit painful closing the mouth for a 3-4 weeks but it does not happen often because sticking up the guidelines should prevent it.
I agree but would like to add that in order for a caring gentle dentist to be exceptionally gentle with their injection technique the patient must hold still and follow directions even if they are scared and for that we have to have trust first. Trust gives us cooperation thus allowing for a highly controlled injection without significant pain.
 
M

mbc350

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Thank you all for your kind & thoughtful replies. I want to let you know, biffo1963, that I also found your response to be very helpful, so please don't think I was ignoring or disregarding it. I just wanted to find out from dental experts first since they have more technical knowledge, but as a patient w/ experience, your thoughts were very insightful & comforting.

As far as the Wand, my dentist doesn't use it. As far as I know, I don't think there are many (if at all) dentists in my area that use it, but rather they use the conventional syringe. From what I've read online, electronic devices don't look scary like normal syringes, and they deliver the anesthetic at a preset controlled rate. However, if a skilled dentist can achieve the same results manually, I wonder if computerized inventions are effective in causing only a placebo effect as far as patient perception of pain. Honestly, I don't know b/c I've never had one used on me, but I'd like to try it out to find out what it's like.

As far as Dr. Daniel's comments about the slow advancement of the needle (w/ intermittent drops of anesthetic), I also don't know how many dentists practice that technique (and I doubt my dentist does either). My guess is that, to save time, they go ahead and slowly advance the needle to the necessary length and then start to inject very slowly. I think it would be nice if dentists did IA nerve blocks the way Dr. Daniel described (which I think is a great idea b/c it would seem to be more comfortable), but if the needle doesn't pinch that much, I would assume they don't see the need to utilize that method.

Ultimately, I guess I will have to experience an IA injection personally to know exactly what it feels like, although reading about them here & elsewhere is still educational & informative. It probably sounds odd to say this, but maybe I should ask my dentist to humor me and
give me a sample IA injection! Even if I don't actually need it, perhaps it would help me overcome my fears in an experiential way. Nevertheless, I will continue to take very good care of my teeth to avoid dental work (which thankfully I haven't had in many yrs.). Again, I appreciate you all for helping me out in this endeavor. Feel free to add any additional comments or advice, and I invite anyone else to contribute as well. God bless.
 
Dr. Daniel

Dr. Daniel

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I agree but would like to add that in order for a caring gentle dentist to be exceptionally gentle with their injection technique the patient must hold still and follow directions even if they are scared and for that we have to have trust first. Trust gives us cooperation thus allowing for a highly controlled injection without significant pain.
Trust is indeed the key word in this situation. Sometimes the anxiety is so dominant, even when trust is given.
What I found to be helpful is to emphasize the "here and now" (also known as "mindfullness") concept. I do two things: first explain the patient that he/she has to give me a chance and open up for a (possible) new experience (painless injection) by paying attention to what they really feel during it and not by thinking what they fear might happen. Secondly, I present it as a test for me: if they feel anything they can stop the injection immediately and and they may choose not to continue with the treatment.
I also mention that there is a chance that they might feel something, not pain but something light and easy to cope with. Many times, when the patient is expecting pain, even a light sensation can startle and cause panic, that's why this concept of mindfulness is so needed.
 
M

mbc350

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I agree that trust is very important. As a patient, I would need to establish that trust & cooperation with my dentist for him to complete treatment effectively. Even though I’m voluntarily submitting to him temporarily, I still have control over the situation and can choose to end it at anytime, albeit with consequences (e.g., unfinished dental work), although I’ve never actually done that before. I also agree that anxiety can heighten pain perception and make it seem worse than it is, when injections aren’t bad at all. Mentally, I have to get past any quick & minor discomfort at the beginning and look to the end result of an injection: complete anesthesia (in a controlled area) and no pain during dental work (e.g., fillings), which is definitely more preferable than no anesthesia at all! Also, I think it's beneficial to think of the syringe (even though it looks scary) as an instrument of healing, which is what it actually is. The needle (which is hollowed) is nothing more than a method of delivery for the anesthetic, even thought it causes a brief pinching sensation only because it has to enter the tissue to the target nerve area. I've read that sharp, thin needles easily penetrate the gums and are necessary for relatively painless & comfortable injections. Therefore, the issue I've confronted is more psychological, so practicing positive thinking techniques will reduce or perhaps eliminate unnecessary worry, and taking a prescription drug like Ativan can lower anxiety on a physiological level. I just wish my dentist offered nitrous oxide, but he's still a great & caring professional and takes things slowly for apprehensive patients.
 
J

jennifersmith

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Hi,

Inferior Alveolar Nerve Blocks (mandibular injections) can be considered as mildly painful, with pain only a few seconds. And dentist has a degree , so it can make them very comfortable. :)
 
Last edited:
M

mbc350

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Feb 26, 2014
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Location
USA
Hi,

Inferior Alveolar Nerve Blocks (mandibular injections) can be considered as mildly painful, with pain only a few seconds. And dentist has a degree , so it can make them very comfortable. :)

Thank you. It's such a relief to know that! I doubt I'll ever need one (or any injection for that matter) because I take very good care of my teeth, including the use of fluoride each night. However, chances are if I need dental work, it will be minor (even at an old age, God willing
:)), so the injection process won't be bad at all. By the way, if I may ask, do you work at/for Dentistry Adelaide or go there? I visited their website, and it sounds like a good dental practice, even though I live in the US; and my dentist is a great & caring professional who's been practicing since 1982, so he may retire soon!
 
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