Tips for a perfect AMSA injection

Sept. 22, 2023
Shelley Brown of Hygiene Edge has a solution for patients who don't want anyone to know they had dental work done. Find out why she likes the anterior middle superior alveolar (AMSA) nerve block.

Who’s heard this from a patient? “I have an in-person meeting after this appointment, and I don’t want them to see that I’m numb in this upper area. Is there anything you can do?” No patient wants to reveal that they’ve just had dental work done.  

From topicals and numbing reversals to alternative injections, we have options for these patients. One alternative injection is the anterior middle superior alveolar (AMSA) injection. This injection will not affect that upper smile line but will, at the midline, anesthetize the central, lateral, canine, premolars, and mesial buccal root of the first molar. 

In the soft tissue, it will work at the midline on the greater palatal tissues and buccal periodontium of the listed teeth. This leaves just one more injection to be done—the posterior superior alveolar block (PSA).  

Essentially, it’s a combined nasopalatine (NP), anterior superior alveolar (ASA) (without the lip), median superior alveolar (MSA), and it oftentimes gets the greater palatine (GP) area. It reduces the injections from five to two. 

Watch the video to see it in use

The insertion point is on the palate near the apices of the premolars of the quadrant you’re working on. You’ll insert about the length of the bevel, aspirate, and deposit .9 mL to a full 1.8 mL cartridge. As this is on the palate, the injection rate needs to be slow—0.5 mL per minute. This equates to three to four minutes if delivering the entire cartridge. A solution with a higher concentration of epinephrine (1:50,000) is contraindicated, as it causes more vasoconstriction in this palatial tissue now full of solution, which could cause necrosis and ischemia. 

So, next time you’d like to use fewer maxillary injections and keep the patient’s smile line intact, try out the AMSA injection technique.

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Hygiene Edge was created by three dental hygiene educators who love both dentistry and education. With over 40 years of experience both in the education space and in the dental field, Melia Lewis, Jessica Atkinson, and Shelley Brown love sharing their knowledge through helpful, short videos online, speaking, and working with amazing companies. You can find more information at Hygiene Edge, on YouTube, and Instagram  @hygieneedge. Have a question or a tricky area? Let us know! We'd love to help.

About the Author

Shelley Brown, MEd, BSDH, RDH

Shelley Brown, MEd, BSDH, RDH, has worked in a variety of dental settings and has been in academia for 13 years and in dentistry for 21 years. She’s an educator for baccalaureate-level students at the Utah College of Dental Hygiene.

Shelley coruns Hygiene Edge, whose goal is to inspire students to be their best, promote industry best practices, and help educators navigate the clinic and classroom. Their Youtube channel has over 17 million views on their helpful videos. Through Hygiene Edge she creates videos, blogs and professionally speaks on topics such as anesthesia, oral hygiene education, clinical updates, and AAP classifications. Shelley is a recipient of the 2021 Today’s RDH Honor Awards and has served as the secretary of the Utah Dental Hygienists’ Association.