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The buccal nerve is a branch of the anterior division of V3 and is not anesthetized during the IA/Li injection.  It provides sensory innervation to the buccal soft tissues adjacent to the mandibular molars only.  More commonly known as the long buccal nerve block, the sole indication for administration of a buccal nerve block is when there is manipulation of the tissue (e.g., with scaling or curettage, the placement of a rubber dam clamp on soft tissues, the removal of subgingival caries, subgingival tooth preparation, placement of gingival retraction cord, or the placement of matrix bands).

The buccal nerve provides sensory innervation to the buccal soft tissues and periosteum adjacent to the mandibular molars only.  It is common for the buccal nerve block to be routinely administered after the inferior alveolar nerve block with a success rate of about 100%.  The reason for this is that the buccal nerve is readily accessible to the local anesthetic as it lies immediately beneath the mucous membrane, not buried within bone.

Proper technique:

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  1. 25 or 27-gauge long or short needle is recommended (the long needle is used most often because the buccal nerve block is usually administered immediately after an inferior alveolar nerve block)

  2. Area of insertion: mucous membrane distal and buccal to the most distal molar tooth in the arch

  3. Target area: buccal nerve as it passes over the anterior border of the ramus

  4. Landmarks

    • Mandibular molars

    • Mucobuccal fold

  5. Orientation of the bevel: toward bone during the injection 

Procedures:

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  1. Correct patient & clinician positioning

    • Right LB, right-handed clinician sit at 8:00 facing patient / left-handed clinician sit at 4:00 facing patient

    • Left LB, right-handed clinician sit at 10:00 facing in the same direction as the patient / left-handed clinician sit at 2:00 facing in the same direction as the patient 

  2. Position the patient supine (recommended) or semisupine

  3. Prepare tissue for penetration distal and buccal to the most posterior molar (because the long buccal nerve block most often immediately follows an IA/Li nerve block, tissue preparation usually is completed before the IA/Li block)

    • Dry with gauze or blow air with air/water syringe​

    • Apply topical anesthetic for 1-2 minutes

  4. With the mirror or your index finger on your non-dominant hand, pull the buccal soft tissues in the area of injection laterally so that visibility will be improved.  Taut tissues permit an atraumatic needle penetration

  5. Direct the syringe toward the injection site with the bevel facing down toward bone and the syringe aligned parallel to the occlusal plan on the side of injection but buccal to the teeth

  6. Penetrate mucous membrane at the injection site, distal and buccal to the last molar 

  7. Advance the needle slowly until bone is gently contacted 

    • To prevent pain when the needle contacts bone, deposit a few drops of local anesthetic just before contact​

    • The depth of penetration is usually about 1-2mm

  8. Aspirate

  9. If negative, slowly deposit 0.3mL of anesthetic solution (about 1/8 cartridge) over 10 seconds 

    • If tissue at the injection site balloons (becomes swollen during injection), stop depositing solution​

    • If solution runs out the injection site (back into the patient's mouth) during deposition:

      • Stop the injection​

      • Advance the needle tip deeper into the tissue

      • Reaspirate

      • Continue the injection

  10. Slowly withdraw needle and safely recap

  11. Wait 3-5 minutes before starting dental procedure​

L O N G   B U C C A L   ( L B ) 

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