By: Michael Eid
Your first mandibular block probably won’t work — and that’s part of the process. Learning local anesthesia in the clinic is less about perfection and more about troubleshooting, patience, and confidence.
Here’s what I learned when I first started anesthetizing.
1. Landmarks Are Everything
Diagrams make it look easy. Real anatomy isn’t a textbook. Slow down, palpate, and visualize before you insert. Hit the landmark or you won’t get numb.
2. Re-Injection Isn’t Failure
Even seasoned dentists have to adjust. If your IAN misses, supplement with infiltration or PDL. The mistake is letting the patient feel pain because you didn’t try again.
Each patient has a different anatomy. To “hit” an IAN, you may need to go higher or lower than your landmark. Learn to adjust and adapt.
3. Hot Teeth Change the Rules
Infected tissue lowers anesthetic effectiveness. One carpule won’t cut it. Be ready with articaine infiltrations, intraosseous injections, or extra volume.
You may need to prescribe antibiotics to reduce an infection before starting treatment if the patient cannot get numb.
4. Communication Makes or Breaks You
Set expectations. Tell patients they’ll feel pressure or vibration, not sharp pain. Clear communication keeps them calm and keeps you in control.
5. Confidence Comes With Reps
The first dozen shots feel shaky. By your fiftieth, it’s second nature. Every injection teaches you something — technique, anatomy, or patience.
Infiltration can most likely work for a crown on #30, but practice giving an IAN when you’re in a clinic where you have preceptors giving you tips. Practice what you’re not good at as if you love it. It’ll become second nature.
Final Thought
Local anesthesia isn’t about never missing. It’s about knowing how to adjust, keeping patients comfortable, and building confidence through repetition. Patients don’t care how many tries it takes — only that they’re numb when it matters.
