Local Anesthesia in Pediatric Dentistry
Local Infiltration of the Palate

Local infiltration of the palate provides anesthesia of the terminal branches of the nasopalatine and greater palatine nerves. The soft tissues in the immediate area of the injection site are anesthetized.

The indications for local infiltration are for achieving hemostasis during surgical procedures and when pain control of localized areas is necessary such as application of rubber dam or subgingival placement of matrix bands on no more than two teeth. It may supplement inadequate areas of anesthesia from nasopalatine and greater palatine alveolar blocks. It is contraindicated when there is infection or inflammation in the injection area. It can be a traumatic injection for the patient.

Technique:

• A 25 or 27 gauge short or ultra-short needle may be used.
• The area of insertion is the attached gingiva, 5-10mm from the free gingival margin in the estimated center of the treatment area.
• Approach the injection site at a 45-degree angle with the orientation of the needle bevel toward the palatal soft tissues.
• Clean and dry the injection area with sterile gauze.
• Apply topical anesthetic for two minutes with a cotton applicator.
• Move the cotton applicator adjacent to the injection site and apply sufficient pressure to blanch the tissue for 30 seconds.
• Place the bevel of the needle against the blanched soft tissue and apply enough pressure to slightly bow the needle.
• Inject a small amount of anesthesia and allow the needle to straighten and permit the bevel to penetrate mucosa.
• Continue to apply pressure with the cotton applicator while injecting small amounts of anesthetic.
• Advance the needle until bone is contacted (3-5mm) and inject 0.2-0.3ml of anesthetic solution.
• Withdraw and recap the needle.
• If a larger area needs to be anesthetized, reinsert the needle at the periphery of the previously anesthetized tissue and repeat the procedure.
• Treatment may be commenced immediately.

A multiple penetration technique may be used. Following the steps as described previously, after buccal or labial anesthesia is achieved, interpapillary injection is performed to attain palatal tissue anesthesia observed by blanching of the mucosa (Figure 15). It is to be noted that palatal infiltration is the most painful injection technique due to close approximation of palatal mucosa to the periosteum of the bone.