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An Update and Review of Local Anesthesia Techniques and Pharmacology

DATE: Sunday, November 1, 2020  Daylight Savings Time Ends

TIME:  Lecture: 9:00 a.m. - 4:30 p.m.  Pre-registration is recommended; registrations can be completed the morning of the class.

LOCATION: Online course format via Zoom

TUITION: $195 DDS / $145 AUX

CREDIT: This course meets the Dental Board of California’s requirements for 7 units of continuing education.

AGD Code: 340

Alan W. Budenz, MS, DDS, MBA

Professor, Department of Biomedical Sciences
Vice Chair, Department of Diagnostic Sciences
Arthur A. Dugoni School of Dentistry
University of the Pacific

Who Should Attend

Dentists and dental hygienists will return to their practices with greater confidence in their ability to deliver comfortable and efficient local anesthetic injections. They will gain an increased appreciation for the causes of local anesthesia failures and the knowledge to overcome these failures, and a greater sense of ease in recognizing and managing unexpected side effects and complications of local anesthetic injections. This will reduce the anxiety level of the practitioner and bring the practice another step closer to pain-free dentistry for the patient.


This lecture is designed for dentists and hygienists who wish to expand their understanding of the pharmacologic mechanisms and delivery techniques of local anesthesia and to solve some of the difficulties that arise in obtaining profound anesthesia in the oral cavity. Dr. Budenz presents practical, useful information that can be directly applied to clinical practice in an informal, interactive style.

A wide range of both maxillary and mandibular block techniques will be emphasized, including conventional and alternative techniques. Safe and efficient block techniques for complete quadrant anesthesia of the maxilla and mandible, such as the Gow-Gates mandibular division nerve block and the Greater Palatine Canal maxillary division nerve block techniques, will be emphasized in the context of recognizing and anesthetizing accessory nerve pathways. Use of alternative anesthesia modalities, such as topical anesthetic formulations, anesthetic buffering systems, anesthetic-reversal agent, intraosseous techniques, and computerized delivery systems, to obtain either primary or secondary anesthesia are also presented.

The controversy surrounding the use of articaine and prilocaine for mandibular block anesthesia injections will be addressed, and management of possible complications and injuries related to the delivery of oral local anesthesia agents, such as hematoma, paresthesia, and trismus, will also be discussed.

Course Outline

  • Pharmacology of local anesthetic agents
    • Appropriate usage of the various local anesthetic solutions available
    • Contraindications and toxic reaction concerns with local anesthetics
    • The potential interactions of patient medical conditions with local anesthetics
    • Anesthetic reversal and buffering agents
    • Injection injuries: risk assessment for paresthesia, trismus, hematoma
  • Review of oral anatomy and injection technique landmarks
    • Accessory innnervation pathways and their management
    • Reasons for failure to obtain anesthesia and problem solving these failures
    • Unexpected side effects and their management
  • Review of conventional and alternative local anesthesia injection techniques
    • Infiltration versus block injections: what to use when
    • Mandibular anesthesia injection techniques, including the Gow-Gates and Vazirani-Akinosi quadrant block techniques
    • Maxillary anesthesia injection techniques, including ASA, MSA, PSA, palatal, and complete quadrant block techniques
    • Alternative anesthesia modalities: electronic, intraosseous, and beyond


Upon completion of this lecture the participants will:

  • Have a thorough understanding of the pharmacology of available local anesthetic agents, including their advantages, disadvantages, and safety profiles.
  • Have an appreciation of the anatomical basis of numerous local anesthetic injection techniques, and their advantages and disadvantages in practice.
  • Be knowledgeable about multiple techniques for obtaining profound anesthesia of both maxillary and mandibular teeth.
  • Be better able to assess and manage complications that may occur in the delivery of local anesthesia, and be better able to avoid them when possible.

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