In case dentist recommends removing wisdom teeth, conventional inferior alveolar nerve block is the most widely used method. But various anesthesia methods are being perfoming. Success rate is not high and it may lead to complications, such as painfulness, aspiration and nerve injury.
To perfom anesthesia, the location of the mandibular foramen (MF) must be determined. It is important to find anatomical landmarks, such as the sigmoid notch, occlusal plane, coronoid notch, and external and internal oblique ridges. MF is positioned at the level of or slightly below the occlusal plane and is situated approximately 3mm above the midpoint of the imaginary line running from the sigmoid notch and the inferior border of the mandible.
This technique involves anesthesia of the inferior alveolar nerve, which enters the mandibular foramen, via the positioning of the needle on the mandibular foramen area. The crucial clinical landmarks of this technique are the coronoid notch and pterygomandibular raphe. The insertion point is located 3/4 down the line drawn from the deepest part of the pterygomandibular raphe to the coronoid notch. The needle must be advanced until the bone is contacted. Aspiration is mandatory prior to administration of the local anesthetics and administration should be done very slowly.
The nerves anesthetized are the inferior alveolar, incisor, mental, and lingual nerves. The mandibular teeth to the midline, the body of the mandible, the lower part of the mandibular ramus, buccal periosteum and mucous membrane to the premolars, anterior 2/3 of the tongue, oral floor, lingual soft tissue, and the periosteum are all anesthetized
Sedation anesthesia achieved by taking an oral medication (anti-anxiety pill) or intravenous sedative agents (midazolame, diazepam, propofol) in small titrated doses.It allows patient to stay awake but feel relaxed and less nervous. Nitrous oxide or “laughing gas” is a mix of nitrous oxide and oxygen that patient breathes through a mask placed over nose.
Local anesthesia is routinely administered to patients undergoing general anesthesia for third molar extractions. Pain control through local anesthetic administration during surgery permits less exposure to general anesthetic agents, allowing a faster postanesthetic recovery and minimizing drug-related complications.
General anesthesia, is a viable short-term alternative to local anesthetic administration in managing the “allergic” patient.