Greater palatine nerve block for root debridement

[Charlie W]

Hi i am a 3rd yr dental student from hong kong.
When i do root debridement, I have to give LA to the palate and i always find it difficult to palpate the greater palatine foramen before giving a greater palatine block.

My tutor suggested to me that i deposit the anaesthetic (Xylestesin) at a mid point between the incisive papilla and greater palatine foramen (approx location) until blanching is seen so that i can anaesthetise the whole palate....

my worry is that the amount of anaesthetic would be too large and might cause mucosal necrosis of palate


I am wondering if i can deposit like ~0.5ml somewhere near the greater palatine foramen and let it diffuse to the nerve trunk. (would 0.5 ml be sufficient??) and give then a separate nasopalatine nerve block.

I'd like to know what experienced dentists think about this
THANKS!!!!

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[vellnueve]

People actually palpate for it? I never have and I don't think I've ever missed that block.

 

[Charlie W]

Books and lectures advocate palpation....they say put the needle in until bone contact and needle penetration should be less than 10mm. they are aiming for the foramen. i am not sure whether we have to be that accurate tho.

 

[vellnueve]

The books and lecture don't equal reality. It's hard to miss the GPN.

 

[THS]

My tutor suggested to me that i deposit the anaesthetic (Xylestesin) at a mid point between the incisive papilla and greater palatine foramen (approx location) until blanching is seen so that i can anaesthetise the whole palate....

I think they are describing an AMSA nerve block (), which is very technique sensitive. It is usually done with an electronic syringe (like a CompuDent).

 

[BenignDMD]

Anesthetizing the palate is not technique sensitive

 

[Vapor1122]

I shoot for somewhere between the second and third molars where the alveolar process comes off from the palate. As long as you're in the ballpark, you won't miss it.

 

[armorshell]

My tutor suggested to me that i deposit the anaesthetic (Xylestesin) at a mid point between the incisive papilla and greater palatine foramen (approx location) until blanching is seen so that i can anaesthetise the whole palate....

There is a way to anesthetize the whole palate with a single injection, but that definitely isn't it. I'm not actually sure what the would achieve other than anesthetizing the distal branches of the GP and incisive nerves. You need to look up V2 block techniques.

my worry is that the amount of anaesthetic would be too large and might cause mucosal necrosis of palate

Note that you can literally cut through the nasopalatine and bilateral greater palatine arteries, at the same time, without causing necrosis. As long as you're literally not doing tumescent anesthesia on the palate you should be alright.

 

[vellnueve]

There is a way to anesthetize the whole palate with a single injection, but that definitely isn't it. I'm not actually sure what the would achieve other than anesthetizing the distal branches of the GP and incisive nerves. You need to look up V2 block techniques.



Note that you can literally cut through the nasopalatine and bilateral greater palatine arteries, at the same time, without causing necrosis. As long as you're literally not doing tumescent anesthesia on the palate you should be alright.

You can also cause necrosis with a tiny amount of anesthetic with epi. It's rare and unpredictable...

 

[Charlie W]

Thank you all! I think I know what to do