For a 4-year-old with Duchenne muscular dystrophy needing pulp treatment of a lower second primary molar — which anesthesia technique is LEAST appropriate (EXCEPTION)?

Correct answer: D. Intraligamentary (periodontal ligament) injection — produces inadequate depth for pulp treatment in this location

• A. Nitrous oxide is appropriate supplemental anxiolysis for pediatric patients.
• B. IANB is the most reliable technique for mandibular primary molar pulp procedures.
• C. Infiltration can supplement IANB or be used for buccal tissue anesthesia.
• D. Correct. The INTRALIGAMENTARY INJECTION provides limited anesthesia depth for pulpal procedures on primary molars — it may provide temporary, incomplete anesthesia. For pulp treatment (pulpotomy/pulpectomy) requiring profound anesthesia, IANB is the most predictable technique. The intraligamentary injection is the EXCEPTION (least appropriate) for pulpal treatment in this scenario.