Q: Which injection anesthetizes the maxillary posterior teeth?
(A). Inferior alveolar nerve block
(B). Posterior superior alveolar nerve block
(C). Middle superior alveolar nerve block
(D). Greater palatine nerve block
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- 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 bone of these teeth. Only present in about 28% of patients. If the MSA is missing, the premolars are innervated by the ASA.
- Anterior superior alveolar (ASA) nerve block: anesthetizes the maxillary central/lateral incisors, and canine, periodontal tissues, buccal soft tissue, and bone of these teeth.
- Inferior alveolar (IA) nerve block: anesthetizes the pulp and mucoperiosteum of all mandibular teeth, chin, and lower lip.
- Greater palatine (GP) nerve block: anesthetizes the posterior hard palate on one side (palatal soft tissues and bone from the first premolar to the back). The teeth are not
Among all the answer choices, only the posterior superior alveolar nerve block can anesthetize the maxillary posterior teeth.
Answer: (B). Posterior superior alveolar nerve block
In this question, I selected “teeth” as the keyword. The reason for this is because if the phrase was worded a little differently, for example, “Which injection anesthetizes the palate around the maxillary posterior teeth,” the answer would be the greater palatine (GP) nerve block. It is important to remember that the greater palatine nerve block and nasopalatine nerve block do not provide anesthesia to the teeth (pulp), but only to the palatal tissues. Therefore, if a patient needs “deep cleaning” and is sensitive on the palatal side of the posterior molars, a separate greater palatine nerve block is required. More anesthetics as a PSA block will NOT help anesthetize the palatal tissues.
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