In a case involving infection in buccal tissues overlying the maxillary teeth, which block is indicated?

• A. ASA nerve block
• B. Inferior alveolar nerve block
• C. Nasopalatine block
• D. Greater palatine nerve block

Answer: (A)

When infection is present in the buccal tissues overlying maxillary teeth, you want to numb the maxillary teeth and their buccal soft tissue without injecting into or through infected tissue. The anterior superior alveolar (ASA) nerve block achieves this by anesthetizing the maxillary anterior teeth (incisors and canines, and often premolars) and the associated buccal gingiva through the infraorbital nerve as it gives off the ASA branches. Depositing anesthesia near the infraorbital foramen places the effect where it’s needed, bypassing the infected buccal tissue.

Nasopalatine and greater palatine blocks mainly affect palatal tissues and don’t provide reliable buccal anesthesia for the maxillary teeth. The inferior alveolar block targets the mandible, not the maxillary teeth. So the ASA nerve block is the best choice in this scenario because it covers the maxillary anterior teeth and their buccal soft tissue from a site away from the infection.