GRADUATE ENDODONTOLOGY
CLASSIC LITERATURE REVIEW SEMINAR
LOCAL ANESTHESIA I
PHARMACOLOGY, ANATOMY & TECHNIQUES
2007

The purpose of these seminars is to familiarize the student with the pharmacology of local anesthetic and vasoconstrictor drugs commonly used in dentistry and to examine various local anesthesia techniques in terms of their efficacy, safety and the pertinent anatomy of the areas involved.

OBJECTIVES: Upon completion of this seminar the student will be able to:
1.  Describe the applied anatomy of the pterygomandibular space as it applies to local anesthesia of the alveolar nerve.
2.  Describe the proper administration technique of the inferior alveolar, Gow-Gates, Akinosi, posterior superior alveolar and maxillary second division nerve blocks.
3.  Describe the pharmacologic action of common local anesthetics, vasoconstrictors and preservatives and know their indications and contraindications in patient treatment.
4. Recognize and treat adverse reactions to local anesthetics, vasoconstrictors and preservatives.
5.  Describe the techniques, physiologic response and postoperative sequelae of intrapulpal, intraseptal and periodontal ligament injections.
REFERENCES:
Reader A, Nusstein JM, Hargreaves KM. Pathways of the Pulp. Cohen and Hargreaves eds. Mosby 2002, 9th ed pgs 691-723.

1968
            *Ward RJ, Benveniste RJ. Nerve conduction and the effect of local anesthesia. J Oral Therapeu Pharmacol 4:292-297. 1968.

1973
            *Gow-Gates GAE. Mandibular conduction anesthesia: a new technique using            extra oral landmarks. Oral Surg 36:321-330. 1973.

1975
            *Birchfield J, Rosenberg PA. Role of the anesthetic solution in intrapulpal anesthesia. J Endodon 1:12-13. 1975.

1976
            *Watson JE, Colman RS. Interpretation of aspiration tests in local anesthetic injections. J Oral Surg 34:1069-1074. 1976.

1981
            *Brown RD. The failure of local anesthesia in acute inflammation. Brit Dent J 151:47-51. 1981.      

            *Covino BG, Giddon DB. Pharmacology of local anesthetic agents. J Dent Res 60:1454-1459. 1981.
           
1982
            *Walton RE, Garnick JJ. The periodontal ligament injection: histologic effects on the periodontium in monkeys. J Endodon 8:22-26. 1982.        
           
1983
            *Jastak JT, Yagiela JA. Vasoconstrictors and local anesthesia: a review and rationale for use. JADA 107:623-630. 1983. 

            *Chernow B, Balestrieri F, Ferguson CD, Terazhalmy G, Fletcher JR, Lake CR. Local dental anesthesia with epinephrine: minimal effects on the sympathetic nervous system or on hemodynamic variables. Arch Int Med 143:2141-2143. 1983.    

            *Smith GN, Pashley DH. Periodontal ligament injection: evaluation of systemic effects. Oral Surg 56:571-574. 1983.   

            *Smith GN, Walton RE. Periodontal ligament injection: distribution of injected solutions. Oral Surg 55:232-238. 1983.   

            *Smith GN, Walton RE, Abbott BJ. Clinical evaluation of periodontal ligament anesthesia using a pressure syringe. JADA 107:953-956. 1983.      

            *Malamed SF, Trieger N. Intraoral maxillary nerve block: an anatomical and clinical study. Anesth Prog 30:44-48. 1983.       
           
1984
            *Montagnese TA, Reader A, Melfi R. A comparative study of the Gow-Gates technique and a standard technique for mandibular anesthesia. J Endodon 10:158-163. 1984.   
           
            *Kim S, Edwall L, Trowbridge H, Chien S. Effects of local anesthetics on pulpal blood flow. J Dent Res 63:650-652. 1984.   

1988  
            *Schleder JR, Reader A, Beck M, Meyers WJ. The Periodontal Ligament Injection: A Comparison of 2% Lidocaine, 3% Mepivacaine, and 1:100,000 Epinephrine to 2% Lidocaine with 1:100,000 Epinephrine in Human Mandibular Premolars. J Endodon 14:397-404. 1988.            

            *White JJ, Reader A, Beck M, Meyers WJ. The periodontal ligament injection: a comparison of the efficacy in human maxillary and mandibular teeth. J Endodon 14:508-514. 1988.                  
           
            1989  
            *Vreeland DL, Reader A, Beck M, Meyers WJ, Weaver J. An evaluation of volumes and concentrations of lidocaine in human inferior alveolar nerve block. J Endodon 15:6-12. 1989.           

OPTIONAL
Berns JM and Sandove MS. Mandibular block injection: a method of study using       injected radiopaque material. J Am Dent Assoc 65:735. 1962.

Magnes G. Intraosseous anesthesia. Anesth Prog 15:264. 1968.

Galbreath J and Eklund M. Tracing the course of mandibular block injection. Oral Surg Oral Med Oral Pathol 30:571. 1970.

Petersen JK. The mandibular foramen block. Brit J Oral Surg 9:126. November, 1971.

Frommer J, Mele F, Monroe C. The possible role of the mylohyoid nerve in     mandibular posterior tooth sensation. J Am Dent Assoc 85:113. 1972.

Barker BCW and Davies PL. The applied anatomy of the pterygomandibular space. Brit J Oral Surg 10:43. January, 1972.

Allen et al. The cardio respiratory effects of epinephrine in local anesthetics for dentistry. Anesth Prog Nov/Dec. 1973.

Bourke K. Intraosseous anesthesia. Dent Anesth Sed 3:13. 1974.

Cannell H Walters H Beckett AH Saunders A. Circulating levels of lignocaine after peri-oral injections. Brit Dent J 138:87. February, 1975.

Lilienthal B. A clinical appraisal of intraosseous dental anesthesia. Oral Surg Oral Med Oral Pathol 39:692. 1975.

Pearce J. Intraosseous injection for profound anesthesia of the lower molar. J Col Dent Assoc 54:25.1976.

Rood JP. The analgesia and innervation of mandibular teeth. Brit Dent J 140:237. 1976.

*Strichartz G. Molecular mechanisms of nerve block by local anesthetics. Anesth 45:421. 1976.

Akinosi J. A new approach to mandibular nerve block. Br J Oral Surg 15:83. 1977.

*Najjar TA. Why can’t you achieve adequate regional anesthesia in the presence of infection? Oral Surg 44:7-13. 1977.

Petersen JK Luck H Kristensen F Mikkelsen L. A comparison of four commonly used local anesthetics. Int J Oral Surg 6:51. 1977.

Laskin et al. Use of bupivicaine hydrochloride in oral surgery- a clinical study. J Oral Surg 35:25. January, 1977.

Lehtinen Risto Aarnisalo Timo. Aspiration in local anesthesia. Acta Odont Scand 35:9. 1977.

Rood JP Cannell H. Plasma levels of lignocaine after peri-oral injections of two different concentrations. Pharm and Therap in Dent 3:45. 1978.

Babst CR Gilling BN. Bupivacaine: A review. Anesth Prog  :87. May-June, 1978.

Lindorf HH. Investigation of the vascular effect of newer local anesthetics and vasoconstrictors. Oral Surg 48:292. October, 1979.

*Fuller NP, Menke RA, Meyers WJ. Perception of pain to three different   intraoral penetrations of needles. JADA 99:822-824. 1979.

*Giovannitti JA, Bennett CR. Assessment of allergy to local anesthetics. JADA 98:701-706. 1979.

Menke RA, Gowgiel JM. Short needle block anesthesia at the mandibular foramen. JADA 99:27-30. 1979.

*Gustainis JF, Peterson LJ. An alternative method of mandibular nerve block. J Am Dent Assoc 103:33. 1981.

Carroll DP. Local anesthetic dosage in children’s dentistry. J Mich Dent Ass 63:141. February 1981.

Block A Covino BG. Effect of local anesthetic agents on cardiac conduction and contractility. Regional Anesth 6:55. 1981.
           
Agren E and Danielsson K. Conduction block analgesia in the mandible. Swed Dent J 5:81. 1981.
           
Walton R and Abbott B. Periodontal ligament injection: Histologic effects  on the periodontium in monkeys. J Endodon 8:22. 1981.

Strichartz GR. Current concepts of the mechanism of action of local anesthetics, J Dent Res 60:1460. August,1981.

Pashley EL Nelson R Pashley DH. Pressures created by dental injections J Dent Res 60:1742. October, 1981.           

Malmed S. The periodontal ligament (PDL) injection: An alternative to the                   inferior alveolar nerve block. Oral Surg Oral Med Oral Pathol 53:117.1982.

Babajews AV Ivanyi L. The relationship between in vivo and in vitro reactivity of patients with a history of allergy to local anesthetics. Brit Dent J 152:385. 1982.

Brannstrom M, Nordenvall K, Hedstrom K. Periodontal tissues changes after intraligamentary anesthesia. J Dent Child 12:417.1982.

Simon D, Jacobs L, Senia S, Walker W. Intraligamentary anesthesia as an aid in endodontic diagnosis. Oral Surg Oral Med Oral Pathol 54:77. 1982.

Littner MM, Tamse A, Kaffe I. A new technique of selective anesthesia for diagnosing acute pulpitis in the mandible. J Endodon 9:116-119. 1983.

Moore P and Dunsky J. Bupivacaine anesthesia - a clinical trial for endodontic therapy. Oral Surg Oral Med Oral Pathol 55:176. 1983.

Fuhs Q, Walker W, Gough R, Schwindler W, Hartman K. The periodontal ligament injection: Histologic effects on the periodontium in dogs. Endodon 9:411. 1983.

Dreyer W, van Heerden J, Joubert J. The route of the periodontal ligament      injection of local anesthetic solution. J Endodon 9:471. 1983.

Kaufman E, Galili D, Garfunkel A. Intraligamentary anesthesia: A clinical study. J Prosth Dent 49:337. 1983.

Faulkner R. The high-pressure periodontal ligament injection. Brit Dent J 154:103. 1983.

Smith G and Smith S. Intrapulpal injection: Distribution of an injected solution. J Endodon 9:167. 1983.

Kruetz RW Kinni ME. Life threatening toxic methemoglobinemia induced by prilocaine. Oral Surg 56: 480. November, 1983.
Kaufman E, Weinstein P, Milgram P. Difficulties in achieving local anesthesia. J Am Dent Assoc 108:205. 1984.

*Laskin DM. Diagnosis and treatment of complications associated with local anesthesia. Int Dent J 34:232-237. 1984.

Davis W, Oakley J, Smith E. Comparison of the effectiveness of etidocaine and lidocaine as local anesthetic agents during oral surgery. Anesth Prog 31:159. 1984.

Dunsky J and Moore P. Long-acting local anesthetics: A comparison of bupivacaine and etidocaine in endodontics.  J Endodon 10:6. 1984.

Kaufman E, LeResche L, Sommers E, Dworkin S, Trulove E. Intraligamentary anesthesia: A double blind comparative study. J Am Dent Assoc 108:175. 1984.

Wilson S, Johns P, Fuller P. The inferior and mylohyoid nerves: An anatomic study and relationship to local anesthesia of the anterior mandibualar teeth. J Am Dent Assoc 108:350. 1984.

Galili D, Kaufman E, Garfunkel A, Michaeli Y. Intraligamental anesthesia-histologic study. Int J Oral Surg 13:511. 1984.
           
Brannstrom M, Lindskog S, Nordenvall K. Enamel hypoplasia in permanent teeth induced by periodontal ligament anesthesia of primary teeth. J Am Dent Assoc 109:735. 1984.

Milles M. The missed inferior alveolar block: a new look at an old problem. Anesth Prog Mar/Apr. 1984.

Jeske AH Boshart BF. Deflection of conventional versus non deflecting dental needles in vitro. Anesth Prog Mar/Apr. 1985.

Kuster CG Udin RD. Frequency of accidental intravasucular injection of local anesthetics in children. J Dent for Child  :183. May-June 1985.

Yagiela JA Duffin SR Hunt LM. Drug interactions and vasoconstrictors used in local anesthetic solutions. Oral Surg Oral Med Oral Path 59:565. June, 1985.

Saadoun AP Malamed S. Intraseptal anesthesia in periodontal surgery. J Am Dent Ass 111:249. August, 1985.

Wallace J, Michanowicz A, Mundell R, Wilson E. A pilot study of the clinical  problems of regionally anesthetizing the pulp of an acutely inflamed mandibular molar. Oral Surg Oral Med Oral Pathol 59:517. 1985.

Rawson R and Orr D. Vascular penetration following intraligamental injection. J Oral Maxillofac Surg 43:600. 1985.

Johnson G, Hlava G, Kalkwarf K. A comparison of periodontal intraligamental anesthesia using etidocaine HCL and lidocaine HCL. Anesth Prog 32:202. 1985.

Lin l, Lapeyrollerie M, Skribner J, Shovlin F. Periodontal ligament injection:     effects on pulp tissue. J Endodon 11:529. 1985.

Peurach J. Pulpal response to intraligamentary injection in Cynomologus                    monkeys. Anesth Prog 32:73. 1985.

Kim S. Ligamental injection: A physiological explanation of its efficacy. J Endodon 12:486. 1986.

Walton R. Distribution of solutions with the periodontal ligament injection:                    Clinical, anatomical and histologic evidence. J Endodon 12:492. 1986.

Rooney J and Tronstad L. Effect of transcutaneous electrical nerve stimulation on pain perception threshold and pain tolerance level of human teeth subjected to electrical stimulation. Endo Dent Traumatol 2:109. 1986.

Eriksen H, Aamdal H, Kerekes K. Periodontal ligament anesthesia - A clinical evaluation. Endo Dent Traumatol 2:267. 1986.

Pashley D. Systemic effects of intraligamental injections. J Endodon 12:501. 1986.

*  Seng GF, Gay BJ. Dangers of sulfites in dental local anesthetic solutions: warning and recommendations. JADA 113:769-770. 1986.

* Bomberg TJ, Averbach RE. Local anesthesia and the elderly dental patient. Gerodont  2:501-504. 1986.

* Hansson P, Ekblom A, Thomsson M, Lundeberg T. Is acupuncture sufficient as the sole analgesic in oral surgery? Oral Surg 64:283-286. 1987.

* Gallo WJ, Ellis E. Efficacy of diphenhydramine hydrochloride for local anesthesia before oral surgery. JADA 115:263-266. 1987.
* Gray RJM, Lomax AM, Rood JP.  Peridontal ligament injection: with or without a vasoconstrictor? Brit Dent J 162:263-265. 1987.

* Marin MK.  Intraseptal anesthesia in the general dental practice. Comp Cont Educ Dent 8:202-210. 1987.
           
Dreven L, Reader A, Beck M, Meyers W, Weaver J. An evaluation of an electric pulp tester as a measure of analgesia in human vital teeth. J Endodon 13:233. 1987.

Massone JE Goldberg F Barros RE. Histological evaluation of the of intrapulpal anesthesia in pulpotomies. Endod Dent Traumatol 3:259. 1987.

D’Souza J, Walton R, Peterson L. Periodontal ligament injection: An evaluation of extent of anesthesia and post injection discomfort. J Am Dent Assoc 114:341.1987.

Moore K, Reader A, Meyers W, Beck M, Weaver J. A comparison of the periodontal ligament injection using 2% lidocaine with  1:100,000 epinephrine and saline in human mandibular premolars. Anesth Prog 34:181. 1987.

Clark et al. An evaluation of the clinical analgesia/anesthesia efficacy on acute pain using the high frequency neural modulator in various dental settings. Oral Surg Oral Med Oral Path 63:501. 1987.

Hochman R. Neurotransmitter modular (TENS) for control of dental operative pain. J Am Dent Assoc 116:208. 1988.

Conner JP Edelson  JG. Needle tract infection: a case report. Oral Surg 65:401. 1988.

Sillanpaa M Vuori V Lehtinen R. The mylohyoid nerve and mandibular anesthesia. Int J Oral Maxillo Surg 17:  1988.

Salonen M Forssell H Scheinin M. Local anesthesia with lidocaine and adrenaline: effects on plasma catecholamines, heart rate and blood pressure. Int J Oral Maxillofac Surg 17:392.1988.

Loetscher CA Melton DC Walton RE. Injection regimen for anesthesia of the maxillary first molar. J Am Dent Ass 117:337. August, 1988.

*Scott DB. Editorial: maximum recommended doses of local anesthetics. Brit J Anesth 63:373-374. 1989.

Edwards R and Head T. A Clinical trial of intraligamentary anesthesia. J Dent Res 68:1210. 1989.

Malmed S, Quinn C, Torgersen R, Thompson W. Electronic dental anesthesia for restorative dentistry. Anesth Prog 36:195. 1989.

Donaldson D, Quarnstrom F, Jastak J. The combination of nitrous oxide and oxygen and electrical stimulation during restorative dental treatment. J Am Dent Assoc 118:733. 1989.

Fish LR McIntire DN Johnson L. Temporary paralysis of cranial nerves III, IV, and VI after Gow-Gates injection. J Am Dent Ass 119:127. July 1989.

Taylor SE Dorris RL. Modification of local anesthetic toxicity by vaso contrictors. Anesth Prog 36:79. 1989.

Reams GJ Tinkle JS. Supplemental Anesthetic Techniques. J Oregon Dent Ass  :34. 1989.