Q: The anterior hard palate is anesthetized with:
(A). The PSA nerve block
(B). The MSA nerve block
(C). The GP nerve block
(D). The NP nerve block
- Posterior superior alveolar (PSA) nerve block: anesthetizes the maxillary first/second/third molars, periodontal tissues, buccal soft tissue, and bones of these teeth. The mesiobuccal root of the first molar is anesthetized in only about 72% of the cases. In about 28% of the cases, the posterior superior alveolar nerve is missing branches that reach the mesiobuccal root of the first molar.
- Middle superior alveolar (MSA) nerve block: anesthetizes the maxillary premolars (and in some cases, the mesiobuccal root of the first molar), periodontal tissues, buccal soft tissue, and bones of these teeth. Only present in about 28% of patients. If the MSA is missing, the premolars are innervated by the ASA.
- Nasopalatine (NP) nerve block: anesthetizes the anterior hard palate (canine to canine bilaterally).
- Greater palatine (GP) nerve block: anesthetizes the posterior hard palate on one side (palatal soft tissues and bones from the first premolar to the back). The teeth are not
Among all the answer choices, only the nasopalatine nerve block anesthetizes the anterior hard palate.
Answer: (D). The NP nerve block
It is important to remember that the greater palatine nerve block and the nasopalatine nerve block do not provide anesthesia to teeth (pulp), only to the palatal tissues. For the local anesthesia boards (WREB and CDCA), you MUST know this information. If the patient has very sensitive gingiva on the palatal side, a separate greater palatine nerve block or nasopalatine nerve block is required.
Learn more for the dental hygiene boards
Let’s review the technique for the nasopalatine nerve block, bullet point (StudentRDH-style):
o Apply pressure with a cotton tip against the side of the incisive papilla until it is blanched. Continue applying pressure with cotton tip while injecting.
o Place the needle on the opposite side of the cotton tip (other side of the papilla), on the lateral border and lower third of the incisive papilla at a 45° angle.
o Apply pressure to bow the needle slightly.
o Deposit a small amount of solution.
o Straighten the needle and insert it toward the incisive foramen until the bone is contacted (the needle should not enter the incisive canal).
o Withdraw about 1 mm and aspirate.
o If negative, deposit solution slowly.
o Ischemia (blanching) of the tissues is observed.
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