A Duchenne MD patient also has mucopolysaccharidosis and needs extraction of tooth T (primary second molar). What is the BEST anesthesia technique?

Correct answer: C. Nitrous oxide/oxygen conscious sedation

• A. PDL injection provides supplemental anesthesia but not primary anesthesia for a full extraction.
• B. IAN block is the standard for mandibular molar anesthesia in cooperative patients; however, for a medically complex child with Duchenne MD and mucopolysaccharidosis, airway management risks make IV/nitrous sedation more appropriate.
• C. Correct. Nitrous oxide/oxygen conscious sedation is the most appropriate approach for a medically complex child with Duchenne MD and mucopolysaccharidosis. These patients have increased anesthetic risk (cardiac and respiratory complications), so conscious sedation with careful monitoring is preferred over GA or nerve blocks alone.
• D. Mental nerve block would not provide adequate anesthesia for a primary second molar.