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136 Cards in this Set

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type of injection that anesthetizes a small area - one or two teeth and associated structures/tissues
Local infiltration
Local infiltration injection is deposited near
apices or terminal nerve endings
Type of injection that anesthetizes a larger area than the local infiltration
Nerve block
the nerve block injection is deposited near
large nerve trunks
Abnormal sensation from an area such as burning or prikcling
Parasthesia
Management of pain requires thorough knowledge of anatomy of
- skull
- Trigeminal Nerve
- and related tissue
the skull bones involved in the local anesthetic administration are the
- maxilla
- palatine bone
- mandible
avoid infection contamination by not injecting into
- abscess
- cellulitis
- osteomyelitis
True or False:
The nerve block has more degrees of success than that of local infiltration
True
the reason for local anesthesia being more successful on the maxilla over the mandible is due to
-the bone over the facial surface of the maxillary teeth is less dense than that of the mandible over similar teeth
- and less variation also exists in the anatomy of the maxillary and palatine bones and associated nerves with respect to local anesthetic landmarks as compared with similar mandibular structures
Maxilla or Mandible
Less bone density, less anatomical variation
Maxilla
Maxilla or Mandible
greater density, greater anatomical variation
Mandible
Maxillary anesthesia is more/less consistent than mandibular anesthesia
more
pulpal anesthesia is achieved through anesthesia of
each tooth's dental branches as they extend into the pulp tissue by way of apical foramen
the hard and soft tissues of the periodontium are anesthetized by way of
interdental and interradicular branches for each tooth
the local anesthetic block that is recommended for anesthesia of the maxillary molar teeth and associated buccal tissues in one quadrant is the
Posterior Superior Alveolar Block (PSA)
The local anesthetic block that is recommended for anesthesia of the maxillary premolars and associated buccal tissues in one quadrant is the
Middle Superior Alveolar Block (MSA)
The local anesthetic block that is recommended for anesthesia of the maxillary canine and incisors and their associated facial tissues in one quadrant is the
Anterior Superior Alveolar Block (ASA)
The local anesthetic block that is recommended for anesthsia of the maxillary anterior and premolar teeth and associated facial tissues in one quadrant is the
Infraorbital block (IO)
_____________ usually involves anesthesia of the soft and hard tissues of the periodontium of the palatal area such as the gingiva, periodontal ligament, and alveolar bone
Palatal Anesthesia
True or False
Palatal Anesthesia usually does not provide any pulpal anesthesia to the maxillary teeth or associated facial or buccal tissues
True
the local anesthetic block that is recommended for anesthesia of the palatal tissues distal to the maxillary canine in one quadrant is the
Greater Palatine Block (GP)
The local anesthetic block that is recommended for anesthesia of the palatal tissues between the right and left maxillary canines is the
Nasopalatine block (NP)
the local anesthetic block that is recommended for anesthesia of most of the maxillary teeth and their associated tissues in one quadrant, except for those innervated by the Posterior superior Alveolar nerve
Anterior Middle Superior Alveolar Block (AMSA)
The posterior superior alveolar block (PSA) is used to provide anesthesia in
- maxillary third, second, & first molar with the exception of the Mesial Buccal root of the maxillary first molar
- buccal periodontium overlying maxillary third, second and first molars including the associated gingiva, periodontal ligament and alveolar bone
the Posterior Superior Alveolar block (PSA) is indicated when procedure involves
2 or more maxillary molars
In some instances, the _______ root of first molar is innervated by the _____ nerve rather than the PSA nerve and therefore the PSA block would require an additional injection to anesthetize.
- Mesial buccal
- MSA
True or False
the PSA block also provides anethesia to the lingual tissues of the first, second and third molars
FALSE
- if anesthesia of the lingual tissues is desired, the greater palatine block also may be necessary
The target area for the PSA block is the
PSA nerve as it enters the maxilla through the posterior superior alveolar foramina on the maxilla's infratemporal surface
The injection site for the PSA block is
into the tissues at the height of the mucobuccal fold at the apex of the maxillary second molar, distal to the zygomatic process of the maxilla
When administering the PSA block a complication may arise if the needle is overinserted and may penetrate the ____________ possibly causing a hematoma in the infratemporal fossa
pterygoid plexus
If the needle of the PSA block is nonsterile, a possible complication could be spread of infection into the
cavernous sinus
Inadvertent and harmless anesthesia of the _________ may occur with a PSA block due to the close proximity of structures
- lingual nerve (branch of V3)
The Middle Superior Avleolar Block is indicated when the procedure invloves
- maxillary premolars and the Mesial Buccal root of the maxillary 1st molar (if innervated by MSA nerve)
- and assoiciated buccal periodontal tissues including the gingiva, periodontal ligament, and alveolar bone
The symptoms of the PSA block includes
- teeth feel dull during procedure
- lack of pain / discomfort during dental procedure
The symptoms of the Middle Superior Alveolar Block include
- Tingling / numbness of upper lip
- lack of pain/discomfort during dental procedure
Complications from the Middle Superior Alveolar Block include
- overinsertion with hematoma (rare)
Target are for the MSA block is
the MSA nerve at the apex of the maxillary second premolar
The injections site of the MSA is
tissues at the height of the mucobuccal fold at the apex of the maxillary second premolar
The _____ block and the _____ block are commonly used in conjuction with each other instead of using the infraorbital block
- MSA
- ASA
The Anterior Superior Alveolar Nerve Block (ASA) is indicated when the procedure involves
maxillary central incisors, lateral incisors, and canines
The Anterior Superior Alveolar Nerve Block anesthisizes the
- pulp tissue of the maxillary canine and incisor teeth as well as the associated facial periodontal tissues including the gingiva, periodontal ligament, and alveolar bone
- if lingual tissue of these teeth needs to be anesthitized then a Nasopalatine block may be necessary
What anesthetic block would be given in order to anesthetize the lingual tissues of the anterior teeth
Nasopalatine Block
The target area for the Anterior Superior Alveolar Nerve Block (ASA) is the
ASA nerve at the apex of the maxillary canine
The site of injection for the Anterior Superior Alveolar Nerve Block (ASA) is the
tissues at the height of the mucobuccal fold at the apex of the maxillary canine, just anterior to and parrallel with the canine eminence
Symptoms of Anterior Superior Alveolar Nerve Block (ASA) include
- tingling / numbness of upper lip
- Lack of pain / discomfort during dental procedure
Complications of Anterior Superior Alveolar Nerve Block (ASA) include
Overinsertion with complications (hematoma) rare
True or False
many times the ASA nerve crosses over the midline to the opposite side in a patient and should be considered when giving anesthesia in this area
True
The Infraorbital block (IO) is indicated when procedure involves
2 or more maxillary premolars or anterior teeth
The infraorbital block (IO) is a useful nerve block becuase it anesthetizes both the _____ & ______ nerves
- MSA
- ASA
The Infrarobital block (IO) is used for anesthesia of the
- maxillary premolars, maxillary canine, and maxillary incisors
- overlying facial periodontium including the gingiva, periodontal ligament and alveolar bone
Symptoms of the Infraorbital Block (IO) include
- tingling / numbness of eyelid, side of nose, upper lip (due to IO branches)
- Lack of pain / discomfort during dental procedure
Complications of the Infraorbital (IO) block include
- overinsertion with complications (Hematoma) rare
The target are for the Infraorbital block (IO) is the
- ASA and MSA nerves as they ascend to join the IO nerve after it enters the infraorbital foramen
- Branches of the IO nerve to the lower eyelids, side of nose, and upper lip are also inadvertently anesthitized
The injection site for the Infraorbital Block (IO) is the
tissues at the height of the mucobuccal fold at the apex of the maxillary first premolar
The Greater Palatine (GP) block is indicated when procedure involves
2 or mor maxillary posterior teeth or palatal soft tissue distal to maxillary canine
The Greater Palatine (GP) block is used for anesthesia of
the posterior portion of the hard palate, anteriorly as far as the maxillary first premolar and medially to the midline
Because the Greater palatine (GP) block does not provide pulpal anesthesia of the area teeth the use of the ____, _____, and _____ blocks or the _____ block may also be indicated
- ASA
- PSA
- MSA
- IO
Soft tissue anethesia in the palatal area of the maxillary first premolar may prove inadequate because of overlappping nerve fibers from the nasopalatine nerve, so this lack of anesthesia may be corrected by additional administration of the
Nasopaltine Block (NP)
Because the overlying palatal tissues are dense and adhere firmly to the underlying palatal bone, what is used to help reduce patient discomfort
pressure anesthesia posterior to the injection site before and during the injection to blanch the tissues
What does pressure anesthesia of the tissues do
produces a dull ache that blocks pain impulses that aries from needle penetration
In addition to pressure anesthesia, what will also help reduce patient discomfort
slow deposition of the local anesthetic agent
The target site for the Greater Palatine (GP) block is
anterior to where the GP nerve enters the greater palatine foramen from its location between the mucoperiosteum and bone of the hard palate
The site of injection of the Greater Palatine (GP) block is
in the palatal tissues anterior to the depression created by the greater palatine foramen
Symptoms of the Greater Palatine (GP) block include
- Numbness in posterior portion of palate
- patient may indicate gagging / discomfort during injection or after if the soft palate inadvertently gets anesthitized due to close proximity
- lack of pain / discomfort during dental procedure
Complications of Greater Palatine (GP) block includes
Hematoma (rare)
The Nasopalatine (NP) block is indicated when procedure involves
palatal soft tissue of 2 or more maxillary anterior teeth
The Nasopalatine (NP) block is used for anesthesia of
- bilateral anterior portion of hard palate (Mesial of right PM1 to Mesial of left PM1)
- no pulpal anesthesia
The Nasopalatine (NP) block does not provide pulpal anesthesia of teeth, so additional anesthesia such as ______ & _______ or _______ may be indicated
- MSA block
- ASA block
- IO block
Because the dense overlying palatal tissues adhere firmly to the underlying maxillary bone, the use of _______ on the _________ side of the injection site of the incisive papilla before and during the injection to blanch the tissues will reduce patient discomfort
- pressure anesthesia
- contralateral
The target area for the Nasopalatine (NP) block is
both the right and left NP nerves as they enter the incisive foramen from the mucosa of the anterior hard palate beneath the incisive papilla
The injection site of the Nasopalatine (NP) block is
the palatal tissues lateral to the incisive papilla which is located at the midline about 10 mm lingual to the maxillary central incisor teeth
Symptoms of the Nasopalatine (NP) block include
- Numbness in anterior portion of palate
- lack of pain / discomfort during dental procedure
Complications of the Nasapalatine (NP) block include
Hematoma (rare)
The Anterior Middle Superior Alveolar (AMSA) Block is indicated when procedure invloves
palatal soft tissue of 2 or more maxillary anterior teeth
The Anterior Middle Superior Alveolar (AMSA) block is use for anesthesia for
soft tissue and pulpal anesthesia of the large area covered by the ASA, MSA, GP, and NP blocks in the maxillary arch
True or False
The single-site palatal injection of the AMSA can anesthetize multiple teeth, without causing usual collateral anesthesia to the soft tissues of the patients lips and face
True
_________ is commonly used in aesthetic / cosmetic dentistry because after the procedures are completed the clinician can immediately and accurately assess the patient's smile line
Anterior Middle Superior Alveolar Block (AMSA)
The AMSA block together with the ______ block will anesthetize a maxillary quadrant for other dental procedures
PSA
True of False
The AMSA injection is best accomplished with a computer controlled delivery device because it regulates the pressure and volume ratio of agent delivered which is not readily attained with a manual syringe
True
Target site of the Anterior Middle Superior Alveolar (AMSA) Block is the
tissues of the hard palate
The injection site of the Anterior Middle Superior Alveolar (AMSA) block is
an area bisecting the apex of the maxillary premolars, as well as being midway between the lingual gingival margin and the median palatal suture
The symptoms of the Anterior Middle superior Alveolar (AMSA) block include
- Numbness
- lack of pain / discomfort during dental procedures
The complications of the Anterior Middle Superior Alveolar (AMSA) block include
- Blanching on palatal and buccal tissues after AMSA block, if excessive may lead to ischemia/sloughing
- hematoma (rare)
True or False
There is only one technique used to anestheszie the Mandibular nerve and its branches
False
- there are many different techniques used
True or False
The infiltration anesthesia on the mandible is not as successful as on the maxilla due to the overall denseness of the mandible, especially in the area of the posterior teeth
True
The ________ is generally recommended for anesthesia of the mandibular teeth and their associated lingual tissues to the midline, as well as the facial tissues anterior to the mandibular first molar
Inferior Alveolar (IA) block
the ________is generally recommended for anesthesia of the tissues buccal to the mandibular molars
Buccal Block
The ______ is generally recommended for anesthesia of the facial tissues anterior to the mental foramen (usually the mandibular premolars and anterior teeth)
Mental Block
The ________ is generally recommended for anesthesia of the teeth and associated facial tissues anterior to the mental foramen (usually the mandibular premolars and anterior teeth)
Incisive block
The _______ is the most commonly used injection in dentistry
Inferior alveolar (IA) block
The inferior alveolar (IA) block is indicated when procedure involves
mandibular teeth and pulpal anesthesia (corresponding tissue)
The inferior alveolar (IA) block is used for anesthesia for
lingual periodontium of all mandibular teeth, as well as anesthesia of the facial periodontium of the mandibular anterior and premolar teeth
________ may be used in addition to the inferior alveolar (IA) block if anesthesia of the buccal perodontium of the mandibular molars is necessary
Buccal Nerve block
When troubleshooting the Inferior alveolar (IA) block, if the bone is contacted to soon that means
that the needle tip is too far anterior on the ramus
When troubleshooting the Inferior Alveolar (IA) block, if bone is not contacted, then that means
the needle tip is too far posterior
If the insertion / depostion of the Inferior alveolar (IA) is too shallow and bone is not contacted, then
the medially locted sphenomandibular ligament can become a physical barrier that stops the important diffusion of the local anesthetic agent to the mandibular foramen and IA nerve
Bilateral inferior Alveolar (IA) blocks are usually avoided unless absolutely necessary because
bilateral mandibular injections produce complete anesthesia of the body of the tongue and floor of mouth, which can cause difficulty with swallowing and speech, especially in patients with full or partial removable mandibular dentures
Sometimes there is an overlap of the left and right incisive nerves, in this case an _______ block or local infiltration at the apices of the mandibular teeth that fail to achieve initial pulpal anesthesia of the tissues would be used in addition to the Inferior Alveolar block
Incisive block
True or False
The IA block is the most commonly used dental injection, but it is not always initially succesful. Therefore the patient mus be reinjected to achieve the necessary anesthesia of the tissues
True
The lack of constant success in the inferior alveolar (IA) block is due in part to
anatomical variation in the height of the mandibular foramen on the medial side of the ramus and the great depth of soft tissue penetration required to achieve pulpal anesthesia
Other techniques to achieve mandibular anesthesia and may also be employed with failure of the IA block is the
Gow-Gates mandibular nerve block
It is important not to deposit Inferior alveolar (IA) block if bone is not contacted on intial insertion of the needle because
the needle tip may be too posterior and thus resting within the parotoid salivary gland near the seventh cranial or facial nerve resulting in facial nerve paralysis
If anesthesia is not achieved with the inferior alveolar (IA) block there may be ___________ of the mandibular teeth
- accessory nerve innervation (mylohyoid nerve)
Whenever a bifid IA nerve present (double mandibular canal) then
a second IA block may be necessary and is injected inferiorly to the first one
Symptoms of the Inferior Alveolar (IA) block include
- numbness in lower limb (mental nerve), tongue and floor of mouth (lingual nerve)
- patient may indicate lingual shock during injection
- lack of pain/discomfort during dental procedure
Complications of the Inferior Alveolar (IA) block include
- facial paralysis (facial nerve)
- hematoma - muscle soreness/ limited jaw movement
- lip bitting
- parasthesia - "pins and needles" due to trauma to lingual nerve, lack of adequate fascia, neurotoxicity from local anesthesia
target area for the IA block is
slightly superior to the entry point of the IA nerve into the mandibular foramen, overhung anteriorly by the lingula
The injection site for the IA block is
the mandibular tissues on the medial border of the mandibular ramus at the correct height and anteroposterior direction for injection
The buccal block is indicated when
anesthesia of buccal periodontium of mandibular molars is needed
the buccal block is used for anesthesia for the
buccal periodontium of the mandibular molars including the gingiva, periodontal ligament, and alveolar bone.
True or False
The buccal block is a successful injection because the buccal nerve is readily located on the surface of the tissue and not within bone
True
the target area for the buccal block is the
buccal nerve (or long buccal nerve) as it passes over the anterior border of the ramus and through the buccinator muscle before it enters the buccal region
The injection site for the buccal block is
the buccal tissues distal and buccal to the most distal molar tooth in the arch, on the anterior border of the ramus
Symptoms of the buccal block included
- lack of pain / discomfort during dental procedure
- patient rarely feels symptoms
Complications of the buccal block include
- cheek biting
- Hematoma (rare)
the mental block is used to anesthetize the
facial periodontium of the mandibular premolars and anterior teeth on one side, including the gingiva, periodontal ligament, and other alveolar tissues
True or False
The mental block provides anesthesia to the lingual tissue of the teeth involved
FALSE
the mental block DOES NOT provide any lingual tissue anesthesia of the involved teeth
the target area for the mental block is
anterior to where the mental nerve enters the mental foramen to merge with the incisive nerve and form the IA nerve
the insertion site for the mental block is
anterior to the depression created by the mental foramen at the height of the muccobuccal fold
Symptoms of the mental block include
- tingling or numbness of lower lip
- lack of pain/discomfort during dental procedure
Complications of the mental block include
- hematoma (rare)
the incisive block anesthetizes the
pulp tissue and facial tissues of the mandibular teeth anterior to the mental foramen (usually the mandibular premolars and anterior teeth)
If lingual anesthesia is necessary on mandible, an ______ block would be administered instead of incisive block, because the incisive block does not provide lingual anesthesia
IA block
target are for the incisive block is
the same as the mental block; anterior to where the mental nerve enters the mental foramen to merge with the incisive nerve and form the IA nerve
The injection site for the incisive block is
anterior to the depression created by the mental foramen
symptoms of the incisive block include
- tingling or numbness of lower lip
- lack of pain / discomfort during dental procedure
Complications of the incisive block include
hematoma (rare)
The nerves anethetized by the Gow-Gates Mandibular Nerve block include
the inferior alveolar, mental, incisive, lingual, mylohyoid, auriculotemporal, and buccal
The Gow-Gates mandibular nerve block is considered a true nerve block because
it anesthetizes almost the entire V3
A Gow-Gates mandibular nerve block is indicated for use in
quadrant dentistry in which the buccal soft tissue anesthesia from most distal molar to midline and lingual soft tissue is necessary and in some cases when a conventional IA block is unsuccessful
the target area for the Gow-Gates mandibular nerve block is the
anteromedial border of the mandibular condylar neck, just inferior to the insertion of the lateral pterygoid muscle
the injection site of the Gow-Gates mandibular nerve block is
located intraorally on the oral mucosa on the mesial of the mandibular ramus, just distal to the height of the mesiolingual cusp of the maxillary second molar, following a line extraorally from the ipsilateral intertragic notch of the ear to the ipsilateral labial commisure
Symptoms of the Gow-Gates mandibular nerve block include
- Mandibular teeth to midline, buccal mucoperiosteum and mucous membranes and lingual soft tissues and periosteum are anesthetized
- inadvertent anesthesia of anterior 2/3 of tongue, floor of mouth, body of mandible, inferior ramus, skin over zygoma, and posterior cheek and temporal region
- lack of pain/discomfort during dental procedure
Complications of the Gow-Gates mandibular nerve block include
- trismus (rare)
- hematoma (rare)
The Gow-Gates mandibular nerve block is contraindicated in patients with
limited jaw movement