Yoga Class Sparks Mandibular Block Discovery

I would like to share with JCDA readers what I have found to be a very useful clinical technique—to have a patient relax his or her shoulders (and thus the pharyngeal and facial muscles) to make the inferior alveolar block a more comfortable and effective injection.

Every dentist has probably noticed that at times this injection can be effortless and painless. At other times, however, it can feel like you’re trying to push the needle through a brick wall, the patient is suffering, and you’re more likely to miss the block for lack of anatomical feedback while injecting.

Several years ago I was sitting in a yoga class and suddenly realized that it is difficult to relax your shoulders and maintain muscle tone in the neck and pharyngeal regions. Although people aren’t used to relaxing their neck on demand, they are used to noticing shoulder tension and letting that go temporarily. By asking a patient to relax the shoulders, the buccinator muscle relaxes as well and the needle passes through that curtain of buccinator where it attaches to the pterygomandibular raphe with relative ease and comfort.

I included this suggestion about relaxing the shoulders in a previous JCDA article.¹ However, it was listed among many points and consequently, may have been missed by some readers.

I’m a part-time instructor at Dalhousie University and last fall I brought this technique to the attention of 2 other instructors who teach anesthesia methods to second-year dental students. The instructors tried this technique themselves and they both found the results to be profoundly different. They vowed to include this suggestion in their future lessons on the mandibular block technique.

If more instructors and clinical dentists adopt this simple modification as routine, I believe we will have happier patients, less stressed dentists and a significantly higher rate of success in achieving a profound mandibular block.