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I am going to go back to the 2-minute IA block and discuss a few issues related to this very common block. Commonly, the IA block is indicated for placement of a local anesthetic agent into the anterior region of the mouth for procedures requiring anesthesia of the teeth, for example, dental hygiene, teeth cleaning, periodontal surgery, minor restorative procedures and orthodontic procedures.3,5 However, it is my personal preference to use this block for injections of any medication into the anterior oral cavity for which patients are anesthetized (not just teeth). I use this block for injections of gingival crevicular fluid, antidepressants, anti-seizure medications, anxiolytics, anti-anxiety medications, and skin creams. We can also use this block for injections of botulinum toxin for procedures such as a dermal filler to soften the jaw line or treat a smile line. In addition, we can use this block for injections of various medications into the soft tissues of the neck for procedures such as the Botox® Cosmetic toxin for the reduction of dynamic wrinkles or the so-called lymphatic lifting. In the head and neck area, injecting above the mandible is often called the V-A block, and injecting below the mandible is often called the G-G block. However, in the anterior oral cavity region, the injection point is more often beneath the mandible. In other words, we do not always choose the safest injection point.
When we use this block, we will generally find that the Anesthesthesia Incisor: Mandibular Molar Anesthesia (AI: MMA) is the preferred site for the drug injection, but it is not always the safest injection point.
Needle-free liquid jet injectors have had a significant impact on drug and vaccine delivery. They hold a prominent place in history as an important component of mass immunization programmes and as the first large-scale needle-free method for macromolecule delivery.7
In a recent study, Miller et al. found that, in general, patients preferred a needle-free approach to local anesthesia. Many patients with no prior experience with local anesthesia did not like the needle-free approach. They preferred the conventional approach with a needle. The same patients preferred needle-free injection of local anesthesia for dental hygiene care.5
The V-A block is a needle-free, two-step method of delivering local anesthetic to the masseteric space and the cervical region of the masseteric nerve. It is performed in two steps. The first is a lip block that allows for the injection of a 1% lignocaine hydrochloride solution into the buccal space. The second step is an injection of a 1% lignocaine hydrochloride solution into the masseteric region and the cervical region of the masseteric nerve.
The V-A block is considered to be a superior alternative to the IA block. Several studies have shown the V-A block to be more effective for pain control than a G-G block for patients with the following conditions: anterior and posterior teeth, mandibular teeth, local anesthesia for dental hygiene, and for patients with symptoms of temporomandibular disorders (TMD) who are not necessarily candidates for the IA block.5,6,61,74,75 827ec27edc