Review of Long Buccal Nerve Block

 

Buccal Nerve Block Technique  

 What it numbs:

Buccal nerve block also known as the (long buccal) is useful to anesthetize the soft tissues and periosteum buccal to the mandibular molars. The only reason a hygienist would need to administer a buccal nerve block would be to provide anesthetic to the buccal soft tissue adjacent to the mandibular molars.

The buccal nerve block has a high success rate due to the buccal nerve's location just under the soft tissue not within the bone.  

 Needle:

The buccal nerve block can be painful unless given after the Inferior alveolar nerve block. Since this is most often the case, a 25 long needle is recommended. A short needle may also be used. Deposit a few drops of anesthetic just prior to contact to avoid pain for patient. Place topical if inferior alveolar block was not given.  

 Positioning:

Patient position is supine with mouth slightly open.

For the right buccal nerve block and right handed operator, sit at an 8 o'clock position directly facing the patient.

For the left buccal nerve block and right handed operator, sit at an 10 o'clock position directly facing the patient.  

 Landmarks:

The landmarks are the mandibular molars and the mucobuccal fold.  

 Target area:

The Target area and injection site is located distal and buccal to the most distal molar in the arch on the anterior border of the ramus.  

The bevel of the needle should be toward the bone and inserted at a depth of 1-3 mm with the buccal soft tissue lateral and taut. The syringe should be parallel to the occlusal plane.  

Aspirate, if negative, slowly deposit 1/8 of a cartridge over 10 seconds. If the injection site starts to balloon or the solution runs out of the site stop the injection. If the anesthetic is not being retained at the injection site and there is enough in the cartridge to continue insert the needle deeper into the tissue reaspriate and continue the injection.  

Wait about one minute before starting the planned procedure.  

 Document:

Document in patient record, what injection you gave, who gave it, what kind of anesthetic, how much anesthetic, negative aspiration, no complications, ect.  

Remind patients to be careful not to bite their cheeks if they are still numb upon completion of the treatment.  

Although complication are rare a hematoma may occur at the injection site if this occurs apply pressure with gauze directly to the bleeding area for a minimum of two minutes.  

 

For more information and references:

Handbook of Local Anesthesia by Malamed  

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