Effectiveness of the Greater Palatine Nerve Block for Anaesthetising Anterior Palate: A Prospective Study

Abstract

Introduction: Local Anaesthesia (LA) is the mainstay of any routine dental extraction. Accomplishing optimum anaesthesia with least pain and anxiety to patients is a challenge. Hence, modification of technique and application of routine dental LA to enhance patient comfort is the need of the hour. In this pursuit, a prospective cohort study was carried out to evaluate the effectiveness of greater palatine nerve block as an alternative to nasopalatine nerve block in anaesthetising the anterior palatal mucosa and to achieve optimum palatal anaesthesia. Aim: The primary outcome variable is to assess the extent of the anaesthetic effect of greater palatine nerve block in maxillary anterior palatal region. Materials and Methods: A total of 100 patients scheduled for the extraction of ipsilateral anterior and posterior maxillary teeth were included in this prospective study between June 2017 to June 2019. Palatal anaesthesia for all the extractions done was achieved only with greater palatine nerve block. After an interval of five minutes, the extent of palatal anaesthesia from the posterior palatal tissue to the anterior region was evaluated for both subjective and objective symptoms. Pain on the palatal mucosa was assessed using Numerical rating scale of 0-10. Post-evaluation, depending on the proposed tooth of extraction, buccal anaesthesia was achieved with Posterior superior alveolar nerve block for posterior teeth and infraorbital nerve block for anterior teeth. Results: Of the 100 patients administered with greater palatine nerve block, it was observed that in 36 patients (36%) had effectiveness in anaesthesia till central incisor, 28 (28%) patients had effectiveness in anaesthesia till lateral incisor, 20 (20%) patients had effective in anaesthesia till the canine and 16 (16%) patients anaesthetic effects were limited to posterior teeth. Overall, 84% had varied degree of positive anterior anaesthesia with greater palatine nerve block alone. Conclusion: Greater palatine nerve block was effective in providing anaesthesia to the posterior region till the premolars, with the extended complete anaesthesia in the anterior region with similar action as the nasopalatine nerve block administered to anaesthetise the anterior palate for extraction of the anterior teeth.