Anesthesia · single question
After an IAN block for tooth #30, the patient has profound lip and tongue anesthesia but experiences pain when endodontic treatment begins. What is the BEST next step?
Show answer and explanation
Correct answer: C. Give a supplemental injection (intraosseous or buccal infiltration) with needle bevel toward bone
✓ C) Supplemental injection with bevel toward bone is correct.
Profound lip/tongue anesthesia confirms successful IAN block (the nerve IS anesthetized). Pain during endo on #30 indicates accessory innervation (mylohyoid nerve, long buccal nerve, or cross-innervation) or intradental inflammation (lower pH reduces anesthetic efficacy). Solution: supplemental intraosseous injection, PDL injection, or intrapulpal injection — needle bevel toward bone improves bone penetration. Waiting 90 min is unnecessary. Repeating in the same spot won't help since the block IS working — the issue is accessory supply.
Profound lip/tongue anesthesia confirms successful IAN block (the nerve IS anesthetized). Pain during endo on #30 indicates accessory innervation (mylohyoid nerve, long buccal nerve, or cross-innervation) or intradental inflammation (lower pH reduces anesthetic efficacy). Solution: supplemental intraosseous injection, PDL injection, or intrapulpal injection — needle bevel toward bone improves bone penetration. Waiting 90 min is unnecessary. Repeating in the same spot won't help since the block IS working — the issue is accessory supply.