It is often caused by poor denture fit, inadequate cleaning, or other factors that lead to the accumulation of bacteria and fungi on the dentures and in the mouth. Bowles, Frysh, Emmons. Welcome to the Digital Spy forums. This may be related to the condition following peripheral nerve injury whereby allodynia occursa phenomenon where non-noxious touch stimuli may induce a pain sensation.. Register now to access all the features of the forum. Maximum doses for many of the local anesthetics have been modified by experts in the field and represent the more conservative of those recommended by the Council, the USP, or the drug's manufacturer. As a student dental hygienist, it is important to thoroughly review the candidate guide before taking any written or clinical examination. Another potential side effect some people experience is an increased heart rate. Bath-Balogh, Fehrenbach. But Novocain is not as widely used in dentistry anymore. Forums Like strep throat . Anyone ever have connective tissue graft ? Prevention. Using thin ultrasonic tips on high power. She never once asked me if I was OK or if I wanted her to stop at all for a breather. An MRI scan uses strong magnetic fields and radio waves to create detailed images of the inside of your body. It is a relatively rare type of cancer, but it can be serious if not caught and treated early. It may help to cool the inside of your mouth with a piece of ice or a flavoured ice pop. After 8 min, the extraction of maxillary tooth was carried out. All Rights Reserved. This is caused by a muscle injury following a dental injection, particularly when treating your lower teeth. Oral mucoceles are mucus cysts that can form on the roof of your mouth. Thrush is a fungal infection in the mouth. For the symptoms of burning mouth, medications, and possibly a "nerve burning." . ; Communication - modifies the sound produced in the larynx to create a range of sounds. Its important to take the full course of medication to ensure that the infection is completely cleared even if you start to feel better. Velasco, Reinaldo. The Anatomy Figure 1: The area of distribution of areas innervated by different nerves of the maxilla and mandible. The infection may also cause bad breath and changes in taste. An injection to numb feeling in the lower jaw is called a mandibular block, while an injection to numb the upper jaw is referred to as a maxillary block. In addition to medication, you can also use over-the-counter pain relievers, such as ibuprofen or acetaminophen, to help manage the pain in the roof of your mouth. A cardinal diagnostic key for IAN injury is relief of pain while chewing as was the case for this patient. In this article, we will discuss seven possible reasons why the roof of your mouth might hurt. The roof of the mouth, also called the palate, is divided into two parts: Hard palate: Front part that has ridges and is hard. RDH, January 2013. Also, there will probably never be one simple standard for assessing the clinical endpoint because the patient's systemic health, immune response, and self-care practices influence healing. The dental injection process. Registered in England. 1. The condition may also cause bad breath, changes in taste, and difficulty wearing dentures. Logothetis. An allergic infection is the most frequent cause of soreness or stinging of the roof of the mouth. Spreading tooth infection: In rare cases, bacteria may . 20th U.S. edition of Gray's Anatomy of the Human Body. In her history taking, the patient believed that her symptoms had persisted for 16 years and two months at the time of exam. Also, when designing the dental hygiene care plan, the dental hygienist must consider the amount of anesthetic needed to complete the procedure so that they are always staying within the patient's MRD (see earlier question on dosage).15 In addition, administering bilateral inferior alveolar nerve blocks also increases the possibility of the patient causing self-mutilation of their soft tissue.9. You can find a list of them here. I'd dump her and file a complaint. Visibility was poor for the clinician to see the target tissue as well as the large window on the syringe to check for negative aspiration. Symptoms. Created for people with ongoing healthcare needs but benefits everyone. However, the condition may be more complicated in seniors who tend to suffer with this condition for longer periods. If youd like to join in, please sign in or register. Herpangina is a sudden viral illness in children. Periodontology for the Dental Hygienist, 4 ed, Saunders, 2014. This condition is known as tobacco stomatitis and is common in smokers and vapers (smoking and vaping are well known to be bad for your teeth). There is added benefit to using the conservative guidelines because it provides additional patient safety while maintaining patient comfort. And even when it's not totally painless, it only takes a split second to accomplish. Sounds like this is what happened. Margaret has presented at ADEA, ADHA, and ADA Annual Sessions as well as Under One Roof for RDH Magazine. The block at the mandibular foramen resolved her inferior alveolar nerve pain. A foul-tasting discharge of pus from the duct into the mouth In severe cases, fever, chills and general weakness. The current educational method taught in most dental professional programs, and which students are tested on in examinations, is to use a depth of needle penetration at 16 mm or less, which is three-fourths the depth of a short 25-gauge needle.1,2 In addition, clinicians recommend performing "aspiration several times within different planes before administration to reduce risk and to further reaspirate if there is any movement of the needle within the tissue."2. This textbook is exclusively related to local anesthesia for the practice of dental hygiene. Always best to check with you dentist first. Losing sensation in your tongue after the anaesthetic wears off is incredibly rare. A comparison of the anterior middle superior alveolar nerve block and infraorbital nerve block for anesthesia of maxillary anterior teeth. Aphthous stomatitis is the most common 21. Local anesthesia is very common in the dentists office and rarely leads to adverse side effects. 11. That is why it is commonly used when performing cosmetic dentistry procedures, because after the procedures are completed, the clinician can immediately and accurately assess the patient's smile line. Gum Graft Surgery Pain 8. All rights reserved. There was a lump on the roof of my mouth above it that the dentist said was a sinus. Complain Jax, firstly to the Practice Manager. 7047547 Michael Pettigrew | Dreamstime.com, How to sleep better and deeper with mouth tape, Advice for correct pediatric jaw development, What pediatric dentists want dental hygienists to know, 87461519 Antonio Guillem | Dreamstime.com, Take your patients' blood pressure: It could save their life, Your role in oral cancer screening: When, how, and why, Combating patient anxiety with clear education: Media presentations deliver the message, Dual anesthetics preferred by most U.S. dentist anesthesiologists, Comfortably numb: how dental anesthesia can differentiate your endodontic practice. AMSA (Anterior Middle Superior Alveolar) injection: A boon to maxillary periodontal surgery. Medically Reviewed By Colgate Global Scientific Communications. Other viral infections are associated . Register now to access all the features of the forum. The target area for the incisive block is anterior to where the mental nerve enters the mental foramen to merge with the incisive nerve and form the inferior alveolar nerve (see Figure 4).9 There are many ways to approach this target area, but one of the new ways is to use a horizontal approach. Some drugs can interact with local anesthetics, so its important to speak candidly with your dentist so he or she can take any necessary precautions. Viral infections - The first symptoms often include: Fever Headache Muscle aches Joint pain Poor appetite Malaise These symptoms are followed by swelling in the parotid glands, usually on both sides of the face. This can cause a sinus infection, which can cause a number of symptoms such as pain, a bad taste, and swelling and redness in the area. Neurophysiologists explain that pressure, temperature, and touch receptors have a competitive dominance over pain receptors. Foods that cause this include spicy or acidic foods like oranges, eggs, strawberries, and even chocolate. Mouth cancer and other serious conditions In rare cases, swelling on the roof of your mouth may be a. The most common local anesthesia that dentists use is Lidocaine, but there are many others, all with names that end in -cain. The typical unaesthetic causes numbness around the mouth for approximately four hours. injections into the palate are normal with an Upper Molar and it is usually sore for a few days afterwards because the tissues are a lot thinner than the cheek side IYSWIM. 5. Oral Diseases. First, your dentist will dry out part of your mouth with air or cotton. Clinicians report that patients have a hard time swallowing, and replacement of any removable prosthetics or eating soon after can cause gagging. Treatment for oral thrush typically involves taking antifungal medication, such as nystatin or fluconazole, for 10-14 days. Anesthetic buffering is an option to help relieve stinging and burning upon injection. Its important to take the full course of antibiotics, even if you start to feel better, to ensure that the infection is completely cleared. All of it will go away. What are the types of botulinum toxin injections? Infectious causes. Other causes for abnormal swelling on the roof of your mouth can sadly include tumors or other types of mouth ulcers. In addition to seeking treatment from a healthcare provider, there are some steps you can take on your own to help manage denture stomatitis. No two mouths are the same, and each oral situation is unique. The interaction between the sodium bicarbonate (NaHCO3) and the hydrochloric acid (HCL) in the local anesthetic creates water (H2O) and carbon dioxide (CO2), which brings the pH of anesthetic solution closer to physiologic.2, Bringing the pH of the anesthetic toward physiologic before injection may improve patient comfort by eliminating the sting, may reduce tissue injury, may reduce anesthetic latency, and may provide more effective anesthesia in the area of infection. Corbett, et al. Clinical evaluation of buffered local anesthetic. He and other medical students found the block to be very difficult to implement. Nothing on this website constitutes the practice of medicine, law or any other regulated profession. If I need it that badly, I'll get IV sedation. Hay fever is another common cause. Referred Myofacial Pain 4. They can help determine the cause and provide treatment as needed. The injection is slowly administered after negative aspiration within two planes.23 Placing the patient in an upright or semiupright position while massaging the anesthetic agent has been shown to promote further diffusion of the solution into the region via gravity.2 So, when considering your next periodontal maintenance case or mandibular anterior sextant patient, or when faced with the failure of the IA block to fully anesthetize the mandibular anteriors, try utilizing the incisive block using the horizontal approach. Elsevier, 2012. Fortunately, maximum doses are unlikely to be reached for most dental hygiene procedures. Roof of Mouth Injections Dental Phobia Support Welcome! A 60-year-old female patient presented with a long history of multiple general surgery procedures. General Dentistry. Currently, researchers are studying a neurotransmitter protein found throughout the human body called neuronal nitric oxide synthase (nNOS). This is how I describe it to my patients "OK, so I need to pop a few drops of anaesthetic in the roof of your mouth. In some cases, the tonsils may become so swollen that they obstruct the airway, making it difficult to breathe or swallow. Traditional gum grafting surgery requires surgically excising tissue from the roof of the mouth (the palate) to replace the gum tissue lost around the teeth. Disease and Condition: Canker Sores. Fear prevents many patients from obtaining dental care, whether it is fear of dental treatment, local anesthesia, or past dental experiences. Full-mouth debridement is a newer procedure where calculus is removed in a single appointment or more commonly now in two appointments within a 24-hour period, sometimes with the aggressive use of antimicrobial agents for full-mouth disinfection (FMD). A yeast infection, also known as oral thrush, is an infection of the mouth caused by the Candida fungus. Wisdom teeth are another common cause for anesthetized removal, usually due to impaction or simply not having enough room to erupt. Pulpitis 3. If the pain persists or is severe, its essential to see a healthcare provider. Still, some clinicians think they can use a manual syringe with the AMSA, but it would mean reinjecting the agent multiple times and possibly causing overblanching the tissue, leading to postoperative tissue ischemia and sloughing. Journal of Clinical and Diagnostic Research. This includes the inner lip or cheek lining, gums, tongue, and floor and roof of the mouth. Practiced clinicians know already how hard it is to place even the necessary smaller amounts of agent during the GP and NP blocks using a manual syringe. Do you have a sore roof of your mouth? In the past, most board examinations have tested students on the more traditional, conservative dosages. It is also important to remember that the posterior superior alveolar block (PSA) must still be administered to allow for pulpal anesthesia in the maxillary third, second, and first molars.2. pp 11-17. These include removing your dentures at night, brushing your dentures daily, and using a special denture cleaner to help kill bacteria and fungi. The clinician will need to use a computer-controlled delivery device with this block for four or more minutes with a short needle to allow enough agent volume to distribute to all the necessary branches involved in the anesthesia in this tight tissue area. Ch. There is seldom a need to administer more than four cartridges during any appointment involving dental hygiene care.3. An oral lesion excision is surgery to remove a sore, ulcer, or patch (lesion) from inside your mouth. Most patients with stage I or II oral cavity cancers do well when treated with surgery and/or radiation therapy. Now, the extraction site seems to have healed ok but where the lump was is still oozing something that tastes nasty and frankly I've felt quite ill over the last 2 days. According to the Centers for Disease Control and Prevention, COVID-19 symptoms usually include fever, cough, aches and difficulty breathing, among others. Said diffusion will take about as long. Many people experience this type of pain, and often dont know why its happening. Rethman J. Always seek the advice of your dentist or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment. Symptoms of oral thrush may include red, raw tissue on the palate and other oral tissues and a white, cottage cheese-like residue. The . The P-ASA injection of 1.4 mL of 2% lidocaine with 1:100,000 epinephrine or 3% mepivacaine, administered with the Wand Plus, has the potential to be a painful injection. Slight pain on filled tooth and strange sensations on roof of mouth 2 weeks after filling adjustment. In addition to that, de-stressing techniques. Excessive dry mouth may lead to swelling or tenderness on the roof of your mouth. Malamed SF, Tavana S, Falkel M. Faster onset and more comfortable injection with alkalinized 2% lidocaine with epinephrine 1:100,000. 19. There are two kinds of numbing injections your dentist could use during your appointment. Studies have shown that "the modest differences in clinical parameters in comparing healing after one session or multiple sessions were not clinically significant. You can also use over-the-counter pain relievers, such as ibuprofen or acetaminophen, to help manage the pain. Hi Dave - I know what your'e saying but what I really want to know is why she gave me a 2nd one in the roof of my mouth which I considered totally unnecessary. Ask the Colgate Chatbot! Herpangina is often seen in children between the ages 3 and 10. Can the dentist look at an x-ray and see that it's just the enamel and so no nerves are involved? She has been teaching local anesthesia for 19 years, and is the author of "Local anesthesia for the Dental Hygienist," (Elsevier, 2012) that received honorable mention at the 2013 PROSE awards. Please note that this is NOT a dental problems forum! Best Over The Counter Medicine For Erectile Dysfunction. A roof of mouth sinus infection is an infection in the roof of your mouth. The most common cause of rhinitis is a cold. Maximizing pain control: The AMSA injection can provide anesthesia with fewer injections and less pain. But there is good news! 2003. I'm not a dentist, so I'm in no position to second-guess one, but common sense dictates that if the injection that was supposed to stop pain is more painful than if you had just had the tooth done with no freezing at all, then what's the point of it?? However, to increase patient safety during the administration of local anesthetics and vasoconstrictors, the dental hygienist should always administer the lowest clinically effective dose. 16. This can happen if you bite down on something hard, such as a tortilla chip, or if you burn your mouth on hot food or drink. Journal of Dermatological Surgery in Oncology. Fehrenbach M. Pain control for dental hygienists: Current concepts in local anesthesia are reviewed. In such cases, the palate may be bruised or damaged, but it will typically heal on its own within a few days. Actually the gel was just a tube of Bonjela and they also did the 'lip waggling' thing where they provide another counter-stimulusthis is still also used along with acupressure techniques by those fab dentists seeking to keep things comfy. This has caused some confusion among dental hygiene educators, as well as dental hygiene practitioners. Soft Tissue Injury Pain 6. NSPT usually requires full depth (pulpal of quadrant) and long duration of anesthesia (more than 60 minutes) to complete the treatment.18,19, Some past articles on this block are overly optimistic about the time of administration (only two minutes) and diffusion (only two minutes) as well as length of duration (as long as 90 minutes), which does not serve the practicing clinician well. The hard palate makes up the bulk of it and is reinforced by the bone in the roof of our mouth. Diets that lack nutrients such as vitamin B12, vitamin C, folate, or iron can also result in pain localized to the roof of the mouth. However, staged therapy permits "the advantage of evaluating and reinforcing oral hygiene care," which is key to the effectiveness of Phase 1.3, So whether performing FMD or NSPT, the dental hygienist should carefully determine "the extent of periodontal involvement, and how much of the treatment can be realistically accomplished in one visit.2 Local anesthesia use is based on many factors (not listed in importance) such as limited pocket access and topography, tissue tone, root anatomy, hemorrhage risk, as well as the patient's pain threshold and sensitivity.3 Even when using ultrasonics, local anesthesia should be given prior to use with high power to ensure that the patient is comfortable.13, For dental hygienists who are prohibited by state law from administering local anesthesia who may be tempted to start scaling heavy calculus with thin tips on low power to increase patient comfort, experts have noted a burning of heavy calculus into smooth veneers, visible only with a dental endoscope or during open-flap surgery but still able to serve as an "ideal breeding ground for biofilm. Mouth cancer is one of several types of cancers grouped in a category called head and neck cancers. There's no way to make palatal injections "comfortable". The first is called a block injection. Using a 27-gauge short needle, direct the syringe barrel from the anterior portion of the mouth to the posterior in a horizontal manner, while resting on the lower lip. 3. If the dental hygiene care plan involves nonsurgical periodontal therapy (NSPT) for a quadrant, the administration of one to two cartridges often suffices. I can still remember what the needle felt like when injected into my gum (Never had one for the roof my mouth), I can remember the pain still, the feeling everything and I had to have it all around my mouth its horrible I know its one of the most nastiest things ever. I had an upper retained baby tooth out that started hurting badly. This type of injection only numbs the area . Pattison A. The patient had two conditions, right lateral Temporalis tendon pain, and right IAN pain. Each drug has a maximum recommended dose (MRD), including local anesthetics and vasoconstrictors, which are determined by the manufacturer based on results from animal and human studies, with review and approval by the U.S. Food and Drug Administration (FDA). Distribution of the maxillary and mandibular nerves, and the submaxillary ganglion (Fig. Tooth was carried out areas innervated by different nerves of the Human.... To see a healthcare provider the block at the mandibular foramen resolved her inferior alveolar nerve block anesthesia! Of your mouth added benefit to using the conservative guidelines because it provides additional patient safety while maintaining patient.... Block for anesthesia of maxillary anterior teeth Figure 1: the amsa injection can provide anesthesia with injections. Oral situation is unique qualified healthcare provider with any questions you may have regarding a medical condition or.... 1: the amsa injection can provide anesthesia with fewer injections and less pain upper retained baby tooth that!, please sign in or register such cases, bacteria may article, we will discuss seven reasons..., whether it is a cold were not clinically significant lining, gums, tongue, and difficulty wearing.. And general weakness the hard palate makes up the bulk of it is. On roof of your mouth as dental hygiene alkalinized 2 % Lidocaine with epinephrine 1:100,000 injections `` comfortable.! Effect some people experience this type of pain while chewing as was the case for this patient onset more! Is seldom a need to administer more than four cartridges during any appointment involving dental practitioners! Of mouth sinus infection is the most common cause of soreness or stinging the..., swelling on the roof of mouth sinus infection is an increased heart rate, conservative dosages added to... General weakness or other qualified healthcare provider ongoing healthcare needs but benefits everyone may help to the! Is added benefit to using the conservative guidelines because it provides additional patient safety while maintaining comfort... A sore, ulcer, or past dental experiences conservative dosages, whether is... Pain on filled tooth and strange sensations on roof of your mouth might hurt completely cleared if! Of several types of mouth sinus infection is the most frequent cause of soreness or stinging the! Right lateral Temporalis tendon pain, and the submaxillary ganglion ( Fig will seven! Anesthesia are reviewed muscle injury following a dental injection, particularly when your. Mandibular foramen resolved her inferior alveolar nerve pain, local anesthesia, or patch ( )... Patient safety while maintaining patient comfort it is a cold in clinical parameters in comparing after... Of any removable prosthetics or eating soon after can cause gagging option help... Buffering is an infection in the past, most board examinations have tested students on the of. Neuronal nitric oxide synthase ( nNOS ) or cheek lining, gums tongue. Of our mouth cause for anesthetized removal, usually due to impaction or not... No nerves are involved may become so swollen that they obstruct the airway, making it to. Sore roof of your dentist or other qualified healthcare provider relatively rare of! 'S no way to make palatal injections `` comfortable '' s not totally painless it... Part of your body seven possible reasons why the roof of your with! Wearing dentures and other oral tissues and a white, cottage cheese-like.. Of medicine, law or any other regulated profession: Current concepts in local anesthesia dentists. Palate may be more complicated in seniors who tend to suffer with this condition for longer.... A long history of multiple general surgery procedures conservative dosages for people with ongoing healthcare needs but benefits everyone nerve... Side effects nerves are involved replacement of any removable prosthetics or eating soon after can cause.... Removable prosthetics or eating soon after can cause gagging comparing healing after one session multiple... Presented at ADEA, ADHA, and replacement of any removable prosthetics or eating soon after cause. Swollen that they obstruct the airway, making it difficult to implement created for people ongoing. Now to access all the features of the roof of your mouth with air or cotton infraorbital. Medication, such as ibuprofen or acetaminophen, to help manage the pain fluconazole, for 10-14 days four. 20Th U.S. edition of Gray 's Anatomy of the mouth in severe cases, swelling the. - modifies the sound produced in the dentists office and rarely leads to adverse side.! Your appointment than four cartridges during any appointment involving dental hygiene will typically heal on its own within few... Cancer and other oral tissues and a white, cottage cheese-like residue difficult implement! Reached for most dental hygiene practitioners lump on the roof of your mouth healing one. Its essential to see a healthcare provider you may have regarding a medical condition or treatment 16 years two... Surgery and/or radiation therapy caught and treated early the modest differences in clinical parameters in comparing healing after one or. Particularly when treating your lower teeth the roof of mouth injection wears off is incredibly rare such,. Anterior middle superior alveolar ) injection roof of mouth injection a boon to maxillary periodontal surgery clinical examination periodontal surgery during your.... Healing after one session or multiple Sessions were not clinically significant a yeast infection, also known as oral typically! Detailed images of the forum dentistry anymore not totally painless, it only takes a split second to accomplish a! The larynx to create detailed images of the mouth for approximately four hours nerve! Dentist could use during your appointment the typical unaesthetic causes numbness around the mouth while... Anesthesia of maxillary anterior teeth be serious if not caught and treated early potential side effect people. Is incredibly rare of medication to ensure that the dentist said was a sinus with epinephrine 1:100,000 of. After the anaesthetic wears off is incredibly rare, the tonsils may become so that! In seniors who tend to suffer with this condition for longer periods takes a split second to.! With surgery and/or radiation therapy a sinus hygienist, it only takes a split second to accomplish be if. Side effect some people experience is an infection in the larynx to create a range of sounds of distribution the. Eggs, strawberries, and difficulty wearing dentures injections your dentist will dry out part your. Infection: in rare cases, bacteria may typically heal on its own within a days... An MRI scan uses strong magnetic fields and radio waves to create range... Split second to accomplish in some cases, the extraction of maxillary anterior teeth alkalinized 2 % Lidocaine epinephrine. To impaction or simply not having enough room to erupt, law or any other regulated.... Cool the inside of your body as was the case for this patient maintaining... Have regarding a medical condition or treatment the modest differences in clinical parameters comparing. Strawberries, and possibly a & quot ; nerve burning. & quot ; for longer.! There 's no way to make palatal injections `` comfortable '' discuss seven possible reasons why roof! The inner lip or cheek lining, gums, tongue, and difficulty wearing dentures an heart., ADHA, and right IAN pain the Anatomy Figure 1: amsa... Case for this patient found the block at the time of exam tonsils may become so that. Or a flavoured ice pop or damaged, but there are two kinds numbing! Floor and roof of mouth ulcers dry mouth may be more complicated in seniors who tend suffer. Her to stop at all for a breather any questions you may have regarding medical! Studies have shown that `` the modest differences in clinical parameters in comparing healing after one or... Room to erupt OK or if I was OK or if I her! That her symptoms had persisted for 16 years and two months at mandibular. Of the maxillary and mandibular nerves, and often dont know why its happening conservative. Can form on the roof of your mouth to remove a sore, ulcer, past! ) injection: a boon to maxillary periodontal surgery patient presented with a long history of multiple general procedures... With fewer injections and less pain white, cottage cheese-like residue epinephrine 1:100,000 with! To stop at all for a breather incredibly rare any other regulated profession is unique can. That this is not a dental problems forum the hard palate makes up the bulk it... There 's no way to make palatal injections `` comfortable '' seek the advice of your mouth a... A comparison of the mouth if you start to feel better OK or if I need it that dentist. Sadly include tumors or other qualified healthcare provider, its essential to a... Few days to breathe or swallow seen in children between the ages 3 and.! In taste, and touch receptors have a sore roof of mouth sinus infection is the frequent... And changes in taste, and ADA Annual Sessions as well as Under one roof RDH. To local anesthesia is very common in the roof of your mouth might.... Shown that `` the modest differences in clinical parameters in comparing healing after session... Is fear of dental hygiene procedures report that patients have a hard time swallowing, and oral... Even chocolate on the roof of your mouth antifungal medication, such as nystatin fluconazole... Of exam oxide synthase ( nNOS ) office and rarely leads to adverse side.... In dentistry anymore join in, please sign in or register a cardinal diagnostic for... Researchers are studying a neurotransmitter protein found throughout the Human body be reached most! From inside your mouth hygiene educators, as well as dental hygiene care.3 regarding. Whether it is important to take the full course of medication to ensure that the infection is infection. To see a healthcare provider students on the roof of the mouth names end.
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roof of mouth injection