title: Palatal Injection for the Removal of Maxillary Teeth: Current Practice Among Oral and Maxillofacial Surgeons.
abstract: OBJECTIVE
  Conventional teaching regarding palatal injection for the removal of maxillary teeth dictates the administration of buccal and palatal injections. Recently, some investigators have questioned the necessity of the palatal injection, suggesting that contemporary local anesthetics might diffuse sufficiently across the buccopalatal cortical bone distance. It has been suggested that because the buccopalatal cortical bone distance increases anteriorly to posteriorly in the maxilla, the success of maxillary extractions with buccal injection only might be related to the anteroposterior position of the tooth. Evidence from clinical trials has only recently become available. Since 2006, 15 clinical trials that examined outcomes of maxillary tooth extractions performed with buccal injection of local anesthetic only have been published. However, there are limited data available on the clinical practice of surgeons.
  
  
  METHODS
  An online survey was sent to 276 full members of the Canadian Association of Oral and Maxillofacial Surgeons. Respondents were asked about their use of palatal injection for the removal of maxillary teeth under local anesthesia, including how often they administer a palatal injection for maxillary extractions in each region of the maxilla.
  
  
  RESULTS
  Ninety-two responses were received (33%). Most practitioners deliver a palatal injection for every maxillary tooth extraction under local anesthesia. However, there is a substantial number who do not always administer a palatal injection (ie, they give it "most of the time," "occasionally," or "never"). This number decreased in a linear fashion anteriorly to posteriorly in the maxilla (incisors, 17 of 89; canines, 16 of 88; premolars, 13 of 88; first and second molars, 10 of 89; third molars, 10 of 88).
  
  
  CONCLUSIONS
  Some surgeons who do not always administer a palatal injection for extraction of maxillary teeth under local anesthesia. The number is larger for anterior compared with posterior teeth.
authors.affiliation: General Dentist and Resident, Royal Brisbane and Women's Hospital, The University of Queensland, School of Medicine, Brisbane, QLD, Australia. Electronic address: emma.badenochjones@uqconnect.edu.au.
authors.forename: Emma K
authors.initials: EK
authors.lastname: Badenoch-Jones
authors.affiliation: Statistical Consultant and Lecturer in Biostatistics, The University of Queensland, School of Public Health, Brisbane, QLD, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: David
authors.affiliation: Final-Year Advanced Trainee in Oral and Maxillofacial Surgery and Associate Lecturer, The University of Queensland, Maxillofacial Department, Princess Alexandra Hospital, Brisbane, QLD, Australia.
authors.forename: Trent
authors.initials: T
authors.lastname: Lincoln
mesh_terms: D000779:Anesthetics, Local / Q000008:administration & dosage*; D006801:Humans; D007267:Injections; D008437:Maxilla; D019647:Oral Surgical Procedures; D010159:Palate; D010818:Practice Patterns, Physicians'; D013515:Surgery, Oral; D014081:Tooth Extraction
chemical_list: D000779:Anesthetics, Local