Local Anesthesia Disadvantages

Effective local anesthesia is the foundation of pain control in dentistry. It increases the patient comfort, cooperation and faith in the operator and also reduces stress on the dentist’s mind. The fear of pain during a dental procedure has been observed as a major reason for patients not seeking dental care. Some investigators have reported that the opinion of patients on their dental treatment is related to their experience with local anesthesia. In fact, most of the patients select their dentist based on their previous ability to provide pain free dental treatments.

Anesthetizing mandibular teeth is sometimes challenging especially when they have inflamed pulps. It has been reported that teeth having inflamed pulps are eight times more likely

As this technique depends on the presence and detection of anatomic landmarks like teeth and pterygomandibular raphe. Variations in these landmarks like mandibular ramus and mandibular foramen can occur; hence, there are more chances of failure to anesthetize the inferior alveolar nerve. Improper technique by the dentist is the other main reason of IANB failure. Due to the proximity of injection site to the neuromuscular bundle, there is high positive aspiration rate and intravascular injection (10% to 15%). Pain, trismus and needle breakage, facial paralysis, hematoma, ptosis, self-inflicted trauma and pterygomandibular space infection are the other major complications of this

Robertson and Gow gates studies showed higher anesthetic success rates of Gow gates technique (92-98%) in comparison with IANB (71-76%). Similarly Kohler et al had shown high anesthetic efficacy with Gow gates technique (82%). Another study conducted by Aggarwal et al had shown high anesthetic efficacy of Gow gates technique (52%) as compared to inferior alveolar nerve block (36%).However study conducted by Hung at el failed to show higher effectiveness and success rates of Gow gates technique (first premolar, 54%; first molar, 88%) in comparison to conventional inferior alveolar nerve block (first premolar, 54.8%; first molar, 83.9%). Goldberg, Reader, Drum et al study had shown anesthetic success rate of Gow gates technique to be inferior (First molar, 38%; First premolar, 44%) than inferior alveolar nerve block (First molar, 53%; First premolar, 62%). Similarly studies conducted by Ågren and Danielsson, Montagnese et al had found that the two techniques were