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Supplementary routes to local anaesthesia

Lookup NU author(s): Dr John Meechan


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The satisfactory provision of many dental treatments, particularly endodontics, relies on achieving excellent pain control. Unfortunately, the administration of a local anaesthetic solution does not always produce satisfactory anaesthesia of the dental pulp. This may be distressing for both patient and operator. Fortunately, failure of local anaesthetic injections can be overcome. This is often achieved by using alternative routes of approach for subsequent injections. Nerves such as the inferior alveolar nerve can be anaesthetized by a variety of block methods. However, techniques of anaesthesia other than the standard infiltration and regional block injections may be employed successfully when these former methods have failed to produce adequate pain control. This paper describes some supplementary local anaesthetic techniques that may be used to achieve pulpal anaesthesia for endodontic procedures when conventional approaches have failed. Although some of these techniques can be used as the primary form of anaesthesia, these are normally employed as 'back-up'. The methods described are intraligamentary (periodontal ligament) injections, intraosseous anaesthesia and the intrapulpal approach. The factors that influence the success of these methods and the advantages and disadvantages of each technique are discussed. The advent of new instrumentation, which permits the slow delivery of local anaesthetic solution has led to the development of novel methods of anaesthesia in dentistry. These new approaches are discussed.

Publication metadata

Author(s): Meechan JG

Publication type: Review

Publication status: Published

Journal: International Endodontic Journal

Year: 2002

Volume: 35

Issue: 11

Pages: 885-896

Print publication date: 01/11/2002

ISSN (print): 0143-2885

ISSN (electronic): 1365-2591


DOI: 10.1046/j.1365-2591.2002.00592.x

PubMed id: 12453016