• Stanley F Malamed.
• Herman Ostrow School of Dentistry of USC, 925 W. 34th St., Los Angeles, Calif. 90089-0641, USA. malamed@usc.edu
• J Am Dent Assoc. 2011 Sep 1;142 Suppl 3:3S-7S.

BackgroundProviding effective pain control is a critical part of dental treatment, yet achieving consistently reliable anesthesia in the mandible has proved elusive. The traditional inferior alveolar nerve block (IANB) has a high failure rate; for example, the failure rate in lateral incisors is 81 percent. As a consequence, new approaches and techniques have been developed. The purpose of this supplement to The Journal of the American Dental Association is to determine whether the mandibular nerve block has become passé.ConclusionsThe high failure rate of the IANB can be frustrating for dentists and lead to discomfort for the patient during treatment. The reasons for this high failure rate include thickness of the cortical plate of bone in adults, thickness of the soft tissue at the injection site leading to increased needle deflection, the difficulty of locating the inferior alveolar nerve and the possibility of accessory innervation. Although the IANB can be unreliable, it is used commonly to provide mandibular anesthesia.Clinical ImplicationsPain control is an essential part of dental treatment. Alternative injection techniques and devices that can help increase the success rate of mandibular anesthesia are available.

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