Objective signs of inferior alveolar nerve anesthesia in exodontia

Objective determination of the adequacy of inferior alveolar nerve anesthesia is difficult. A dependable objective test based upon clinical observation of hundreds of patients during extraction of mandibular teeth, is presented. Following routine inferior alveolar nerve block anesthesia, time is allowed for subjective signs of "tingling" of the lower lip. Fully aware that the patient may respond to pressure in the absence of pain, the tooth to be extracted is tested. Gradual pressure of increasing intensity is applied with extracting forceps for 3 seconds, then suddenly released, providing a sudden stimulus. If the patient immediately moves or "jumps," this response indicates inadequate anesthesia. If the patient does not respond to the sudden release of pressure, that tooth can be removed painlessly even though the patient may still respond to pressure.