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LOCAL AND REGIONAL ANESTHESIA 277
cess of local anesthesia is based on a working knowledge of the oral
anatomy, scrupulous asepsis, fresh drugs and a correct technic in
their use.
Anatomy. The knowledge of anatomy should embrace a clear
understanding of the muscular attachments, the position of the
foramen and a knowledge of the position of the trigeminal nerve
Avith its complete ramifications.
Cocaine. For many years cocaine has been almost universally
used by the dental profession as the principal local anesthetic.
Its

Fi^. 146.—Drawing representing the positions of needles in local anesthesia. A, position
for sub-periosteal injection for surgical anesthesia; B, intra-alveolus injection. This will re-
sult in surgical and sometimes dental anesthesia. This injection is subject to very severe
criticism due to the liability of the introduction of infection. C, intra-alveolar injection. This
will result in dental anesthesia and quite frequently surgical anesthesia on the side toward
which the injection is made.
toxicity was not clearly understood at the beginning and thus oc-
curred overdosing particularly with stale solutions. It has been
fully demonstrated that some individuals could stand heavy doses
without showing systemic ill effects, while death would result in
other cases where only a small dose had been used. For these rea-
sons the profession has been hunting a substitute. That substitute
seems to have been found in novocain.
Novocain is equal to cocaine in anesthesia producing power. It