Paediatric Local Anaesthesia — ORE Part 1 MCQ
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Correct answer: B — Buccal infiltration
Explanation lettering: D = shown as A · A = shown as B · E = shown as D · B = shown as E
For extraction of primary mandibular molars in children up to 5 years, buccal infiltration (particularly with 4% articaine) is the preferred technique. In this age group, the apices of primary teeth are located at the mucobuccal fold, and buccal infiltration provides adequate anesthesia of both pulp and surrounding tissues without the need for deeper nerve blocks. Although inferior alveolar nerve block (IANB) is effective, it has important limitations: 15–30% of cases show inadequate anesthesia of the buccal mucosa, requiring supplementary long buccal nerve block. Buccal infiltration avoids this, reduces injection trauma and risk of intravascular injection, minimizes child anxiety, and eliminates the complication of accidental self-injury to lingual tissues. Mental nerve block (C) is not indicated for molars. Lingual infiltration alone (D) is insufficient, and intraligamentary injection (E), while effective, is typically supplementary rather than first-line for this procedure in young children.
Reference: Yu J, Liu S, Zhang X. Can buccal infiltration of articaine replace traditional inferior alveolar nerve block for the treatment of mandibular molars in pediatric patients?: A systematic review and meta-analysis. Med Oral Patol Oral Cir Bucal. 2021;26(5):e604-e613. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8601637/