Techniques for mandibular block anaesthesia - the practice of Nigerian dentists

Abstract

Objective: To assess the knowledge and practices of Nigerian dentists in the use of alternative techniques for inferior alveolar nerve block.
Method: A survey was conducted using a self administered structured questionnaire distributed among a cross-section of Nigerian dentists. Participants were to distinguish between four alternative methods of mandibular block anaesthesia namely; Gow-Gate block (GGB), Akinosi block (AB), Vazirani block (VB) and Retromolar block (RB). The questionnaire sought demographic information about participants, types of practice, when and how the dentists received formal teaching on these techniques, how often they used the techniques, and the reasons for conventional block failure they have encountered.
Result: There were 273 respondents comprising 165 (60.4%) males and 105 (39.6%) females within the age range of 24-56 years (mean 34.4 + 6.8 years). Two hundred and forty nine (91.2%) respondents were aware of alternative methods of achieving IAN block but 45 (16.5%) employed alternative techniques in less than 5% of cases, 57 (20.9%) in 5-10% of cases and 12 (4.4%) in more than 10% of cases. Akinosi block was the preferred alternative (p = 0.045). Most of the alternative techniques were taught without clinical demonstrations. The relationship between years of experience and encounter with conventional block failure on one hand [p =
0.126] and experience and usage of alternative techniques [p= 0.063] were not statistically significant. The common causes of conventional block failure highlighted were aberrant anatomy (76.9%), local infection (67%), uncooperative patients (64.8%), trismus (59.3%) and poor technique (56%).
Conclusion: There is a deficiency in the undergraduate curriculum of Nigeria Dental Schools with respect to training in dental anaesthesia. Majority use conventional nerve block routinely while alternative techniques are rarely employed.

Keywords: Inferior alveolar nerve block, local anaesthesia, techniques, dental education