Troubleshooting the 'Mandibular Block'

Troubleshooting the 'Mandibular Block'

  • Thu, Nov 11, 2021 | 7:30 AM - Thu, Nov 11, 2021 | 9:00 AM

Stanley Malamed, DDS

Subject: Anesthesia
Primary Audience(s): Dentist
Additional Audience(s): Hygienist, EFDA/Dental Assistant

CE Credits: 1.5

Local anesthesia forms the backbone of pain control techniques in contemporary dental practice. The subject of pain control in dentistry has undergone a recent renewal of interest, a renaissance. In this program, Dr. Malamed will present an in-depth discussion of the problem in achieving mandibular anesthesia.

The traditional ‘mandibular nerve block’ has one of the lowest success rates of major nerve blocks administered in the human body. Is it necessary for the doctor or hygienist to still administer this technique? Newer techniques, such as the Gow-Gates mandibular nerve block, Akinosi-Vazirani closed mouth mandibular nerve block, intraosseous anesthesia, periodontal ligament injection (PDL) and intraseptal techniques have been developed in an attempt to improve success in the mandible. The local anesthetic articaine HCl has been demonstrated to have significant success when administered by mandibular infiltration in adults, while more recently the ability to buffer local anesthetic solutions has demonstrated potential to both increase the rate of onset of anesthesia as well as increasing its depth. These techniques will be reviewed in this program. Is the ‘mandibular block’ passe? Come and hear for yourself!

Learning Objectives

  • Describe the technique for the traditional inferior alveolar nerve block.
  • List four alternative techniques/procedures for achieving mandibular anesthesia.
  • List three advantages of buffering local anesthetic cartridges.


Dr. Malamed is a dentist anesthesiologist and Emeritus Professor of Dentistry at the Herman Ostrow School of Dentistry of USC in Los Angeles. Dr. Malamed is author of 3 textbooks: (1) Handbook of Local Anesthesia; (2) Medical Emergencies in the Dental Office; (3) Sedation: a guide to patient management, as well as author of more than 170 scientific articles.

PACE Approval 2019