Anesthetization of the Maxillary Primary Molars and Premolars

The areas anesthetized are the pulps of the maxillary first primary molars (primary and early mixed dentition) and the first and second premolars and mesiobuccal root of the first permanent molar in the permanent dentition, as well as the buccal periodontal tissues and bone over these teeth. The injection is contraindicated if infection or inflammation is present in the area of administration.


  • A 25 or 27 gauge, short needle is acceptable.
  • The area of insertion for the first primary molar is in between the apices of the roots of the tooth at the height of the mucobuccal fold. The area of insertion for the premolars is in an area between the two teeth.
  • Retract the cheek so the tissue of the mucobuccal fold is taut.
  • Apply topical anesthetic.
  • Orient the needle bevel toward the bone.
  • Penetrate the mucous membrane and slowly advance the needle until its tip is above the area between the apices of the first molar or above the apex of the second premolar.
anesthetization of the Maxillary Primary Molars and Premolars
  • Aspirate.
  • Slowly deposit ½-⅔ of a cartridge of solution.
  • The needle is withdrawn and recapped.
  • Wait 3-5 minutes before commencing dental treatment. If the patient complains of pain it may be necessary to supplement anesthesia with a posterior superior alveolar nerve block.
  • A rare complication is formation of a hematoma at the injection site. If this occurs apply pressure with gauze over the site of swelling for a minimum of 60 seconds.