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115 Cards in this Set
- Front
- Back
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Which statement best describes pain as a protective response? a. Pain is a physiological, conscious reaction. b. Pain is a psychological reaction based on blood flow to the injured site. c. Pain is a rapid, reflexive, subconscious reaction. d. Pain is a slow, deliberate reaction to avoid further tissue injury. |
C - Pain is a rapid, reflexive, subconscious reaction. |
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Which of these groups of variables does not affect the experience of pain? a. Sex, genetics, mental health b. Personality, age, hormones c. Attitudes, learned responses d. Body weight, height |
D - All of these affect individual pain experiences except body weight and height. |
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Which one of the following statements regarding nociception is true? a. Nociception is polymodal. b. Nociceptive receptors can distinguish between chemical and thermal stimuli. c. Nociception is a physiological and psychological process. d. Nociceptive pain is identical in somatic and visceral structures |
A - Nociception is polymodal. This means that it can detect injury from chemical, mechanical, and thermal stimuli even though all are registered as pain. |
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Which one of the following is an example of neuropathic pain? a. Fractured bone b. Psychological disorder c. Postsurgery pain d. Trigeminal neuralgia |
D - Neuropathic pain is caused by nerve tissue injury or dysfunction of the sensory nerves in the central or peripheral nervous systems. Trigeminal neuralgia is the only example of this. |
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Which one of the following will help patients cope with anxiety and fear? a. Avoid discussions about anxiety and fear. b. Only the dentist should ask about anxiety and fear to avoid patient embarrassment. c. Assure the patient that difficulties during past dental visits could not have been avoided. d. Prepare, rehearse, empower, and praise patients to reduce anxiety and fear. |
D - Prepare, rehearse, empower, and praise patients to reduce anxiety and fear. The PREP strategy can build trust and provide reassurance. Clinicians may find the use of these stress-reducing techniques helpful for themselves as well. |
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In the process of debriefing, which one of the following is not useful when managing fearful patients? a. Patient and clinician discussion period at the end of each appointment. b. Patient gives input on the duration and plan for the next appointment. c. Future appoints are modified based on the insights from the patient/clinician discussion. d. Clinicians select strategies for the patient for his or her next appointment. |
D - This response does not include patient participation in decision making. |
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Which of the following statements most accurately describe(s) the major differences between sensory and motor neurons? 1. Sensory neurons are afferent and conduct impulses toward the CNS. 2. Motor neurons are efferent and conduct impulses to effector tissues and organs. 3. Sensory neuronal cell bodies do not participate in impulse conduction and they are located away from the axon. 4. Motor neuronal cell bodies participate in impulse conduction and are located along the length of the neuron at their terminal arborizations. a. 3 only b. 1 and 2 c. 1, 3, and 4 d. All of the above |
D - All of the above accurately describe the differences between sensory and motor neurons. |
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Which of the following sequences best describes the events in a successful impulse generation? a. Stimulation, slow depolarization, firing threshold, rapid depolarization, recovery b. Stimulation, firing threshold, rapid depolarization, slow repolarization, resting state c. Resting state, stimulation, slow depolarization, rapid depolarization, firing threshold d. Resting state, stimulation, slow depolarization, rapid depolarization, slow depolarization |
A - Stimulation slowly depolarizes. In a successful impulse generation, the firing threshold is reached and rapid depolarization occurs followed by recovery to the resting state. |
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How are Schwann cells and nodes of Ranvier related? a. Schwann cells are nodes of Ranvier. b. At the nodes of Ranvier, Schwann cells are one layer thick. c. Gaps between Schwann cells are called nodes of Ranvier. d. They are not related. |
C - Gaps between cells on nerve membranes are called nodes of Ranvier. |
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Which fiber types are responsible for providing sensory information from dental and periodontal tissues? a. C and B fibers b. B and A delta fibers c. Gamma and C fibers d. A delta and C fibers |
D - “A delta" and “C” fibers. |
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Which of the fibers responsible for providing sensory information from dental and periodontal tissues are myelinated? a. Both A delta and C fibers b. Both B fibers and C fibers c. A fibers d. None of the above |
C - “A delta” fibers are lightly myelinated; “C” fibers are nonmyelinated. |
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What are three divisions of the dental plexus? a. Interdental, interradicular, and periodontal b. Inner dental, interradicular, and dental c. Interdental, interradicular, and dental d. Inner dental, interradicular, and periodontal |
c - Interdental, interradicular, and dental. |
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Elimination half-life refers to which one of the following? a. The time it takes for a drug to be half-metabolized b. The time it takes for half of a drug to be out of the system c. The time it takes for half of a drug to be out of the circulation d. The time it takes for a drug to be out of half of the circulation |
C - Half-life refers to the time it takes for 50% of a drug to be removed from the systemic circulation. |
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Ester local anesthetics are metabolized in which one of the following pathways? a. In the liver b. In the blood c. In the kidneys d. In the brain |
B - Esters are metabolized in the blood via plasma cholinesterase. |
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CNS toxicity occurs because of: a. The expected response of neurons in the CNS to the drug dose. b. Frank neural tissue damage due to the excessive dose. c. Compromised vascular supply in the CNS due to vasoconstrictor doses. d. None of the above. |
A - CNS toxicity is due to conduction blockade of vital functions within the CNS due to the normal functioning of nerve cells in response to local anesthetic. |
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CVS toxicity occurs because of: a. Compromised vascular supply. b. Frank tissue damage. c. Decreased myocardial contractility, vasodilation and hypotension. d. Decreased myocardial contractility, vasoconstriction, and hypertension. |
C - Decreased myocardial contractility and hypotension due to vasodilation, if they occur, will further worsen an already developing CNS depression. Some initial heart rate elevation and hypertension may occur, however, in early overdose. |
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Which portion of the anesthetic molecule is responsible for binding to the receptor site inside the nerve membrane, thereby preventing depolarization? a. Calcium ion b. Anesthetic free base c. Anesthetic anion d. Anesthetic cation |
D - Only the cation can bind to the specific receptor sites in nerve membranes to prevent impulse generation and conduction. |
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Which part of a local anesthetic molecule determines the classification of the drug as an ester or amide? a. Lipophilic portion b. Hydrophilic portion c. Intermediate chain d. Caine linkage |
C - Local anesthetic drugs are classified according to their intermediate chains as esters or amides. Except for its largely nonhepatic, ester-like metabolic pathways and its therefore shorter elimination half-life, articaine cannot be mistaken for an easter. |
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Which of the following is not a systemic reaction to an overdose of a local anesthetic agent? a. CNS stimulation b. Depression of myocardium c. Vasodilation of peripheral blood vessels d. Respiratory arres |
A - An overdose of local anesthetic drugs will result in depression of the CNS. The initial excitatory phase is actually due to depression of inhibitory actions of the CNS. |
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The definition of the maximum recommended dose (MRD) of a drug best fits which one of the following definitions? a. A safe dose to administer in all situations b. A dose that a 150-lb individual can have c. A dose that cannot be exceeded under any circumstance d. A safe guideline when administering local anesthetic drugs |
D - The MRD of a drug is an established safe guideline for administration. |
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Which one of the following best describes articaine’s metabolism? a. Articaine is metabolized approximately 25% in the liver. b. Articaine is metabolized primarily via plasma cholinesterase. c. Much of articaine is excreted unchanged. d. Articaine’s metabolism is similar to prilocane’s. |
B - Articaine is primarily metabolized via plasma cholinesterase. Its metabolism is not similar to prilocaine’s. It is metabolized only one about 5% to 10% in the liver. Very little is excreted. |
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You are treating a patient with significant cardiovascular compromise who suffers from significant liver damage. Which one of the following drugs would be most appropriate for this patient when you are anesthetizing the maxillary right quadrant? a. 2% lidocaine, 1:100,000 epinephrine b. 3% mepivacaine plain c. 4% articaine, 1:200,000 epinephrine d. 0.5% bupivacaine, 1:200,000 epinephrine |
C -4% articaine, 1:200,000, addresses both significant CVS and hepatic compromise. The other three drugs are metabolized in the liver, including 3% mepivacaine, which otherwise would be an excellent choice in CVS compromise. At 1:200,000 epinephrine, articaine is the best overall selection. |
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A periodontist requires hemostasis on palatal tissues in the maxillary left quadrant before elevating a surgical flap. Which one of the following drugs would furnish the most vigorous hemostasis? a. 2% mepivacaine, 1:20,000 levonordefrin b. 4% prilocaine, 1:200,000 epinephrine c. 2% lidocaine, 1:50,000 epinephrine d. 4% articaine, 1:100,000 epinephrine |
C - The local anesthetic drugs are irrelevant to hemostasis. Epinephrine provides the most vigorous hemostasis. Its highest concentration is found in the 1:50,000 dilution. |
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Which characteristic of a local anesthetic drug determines how well it works without a vasoconstrictor? a. Potency b. Vasoactivity c. pKa d. Lipophilic ability |
B - Vasoactivity. Drugs that are weak vasodilators will remain in the area of deposition longer. Vigorous vasodilators enhance their own uptake into the systemic circulation, and therefore, vasoconstrictors must accompany their use. |
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If a patient is taking a tricyclic antidepressant and a beta-blocker, which one of the following drugs would be most appropriate to administer? a. 2% lidocaine, 1:100,000 epinephrine b. 2% mepivacaine, 1:20,000 levonordefrin c. 3% mepivacaine plain d. 4% articaine, 1:200,000 epinephrine |
C - Tricyclic antidepressants require care with vasoconstrictors, and levonordefrin, especially, should not be used because of the risk of serious elevations of BP. Levonordefrin is safer to use in the presence of beta-blockers compared with epinephrine. There are no issues with mepivacaine plain because there are no contraindications to the anesthetic drugs themselves. |
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Methemoglobinemia is a life-threatening condition that may be precipitated by which one of the following drugs? a. Lidocaine b. Mepivacaine c. Prilocaine d. Bupivacaine |
C - Prilocaine |
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Arrange the injectable local anesthetic drugs in descending order of overall CNS and CVS toxicity. a. Bupivacaine, mepivacaine, lidocaine, prilocaine, articaine b. Bupivacaine, mepivacaine, lidocaine, articaine, prilocaine c. Bupivacaine, mepivacaine, articaine, lidocaine, prilocaine d. Bupivacaine, lidocaine, mepivacaine, articaine, prilocaine |
B - Considering overall toxicity to the CNS and CVS, prilocaine is the least toxic, approximately seven times less toxic compared with bupivacaine, the most toxic. Articaine is less toxic than lidocaine and mepivacaine overall is more toxic than lidocaine, although it is not thought to be in doses used in dentistry. |
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Which one of the following vasoconstrictors is most useful in providing hemostasis? a. Phenylephrine b. Epinephrine c. Levonordefrin d. Felypressin |
B - Epinephrine provides the most vigorous hemostasis of this group. |
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A patient has significant cardiovascular disease and requires a restorative procedure on tooth #5. Retraction cord and hemostasis are needed in order to keep the restorative site dry. Which one of the following drugs would be most indicated in this situation? a. 4% articaine, 1:200,000 epinephrine b. 2% mepivacaine, 1:20,000 levonordefrin c. 2% lidocaine, 1:50,000 epinephrine d. 4% prilocaine plain |
A - Dilutions of 1:200,000 epinephrine contain the least ‘vasoconstrictor’ and are indicated because they are the safest and yet provide hemostasis. If hemostasis were not needed, plain drugs would work well in shorter treatment times. |
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Which one of the following statements is true? a. Levonordefrin is more potent compared with epinephrine. b. Cardiac stimulation from levonordefrin is greater compared with epinephrine. c. Cardiac stimulation from levonordefrin is less compared with epinephrine.d. Levonordefrin is equal in potency compared with epinephrine. |
C - Levonordefrin provides less cardiac stimulation compared with epinephrine. |
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Epinephrine’s metabolism is relatively rapid after local anesthesia administration. a. True b. False |
A - Compared with the local anesthetic drug’s metabolism, epinephrine’s metabolism is generally much more rapid. |
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Metabolic enzymes for epinephrine include which of the following? a. COMT and MAO b. Hepatic isoenzymes c. Renal isoenzymes d. COMT only |
A -Epinephrine is metabolized by COMT and MAO. |
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A diabetic patient requires periodontal therapy on the upper and lower right quadrants. She is well controlled and otherwise healthy. Which one of the following represents the safest and most effective local anesthesia regime? a. 4 cartridges of 2% lidocaine, 1:100,000 epinephrine b. 2 cartridges of 2% lidocaine, 1:100,000 epinephrine and 2 cartridges of 3% mepivacaine plain c. 2 cartridges of 2% lidocaine, 1:100,000 epinephrine and 2 cartridges of 4% articaine, 1:200,000 epinephrine d. 2 cartridges of 2% lidocaine 1:100,000 epinephrine and 2 cartridges of 2% mepivacaine, 1:20,000 levonordefrin |
B - Epinephrine can raise blood sugar levels.The lowest quantity of epinephrine is found in combination “B” where half of the administered volume has no epinephrine. The lowest amount of vasoconstrictor should always be used in all individuals. Because this patient is a well-controlled diabetic and otherwise healthy, no special precautions are necessary and the default principle applies. Use the least amount of drug necessary. |
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All of the following are correct when considering MRDs, except: a. Articaine = (3.2 mg/lb, 7.0 mg/kg) b. Bupivacaine = 90 mg (0.9 mg/lb, 2.0 mg/kg) c. Lidocaine = 600 mg (4.0 mg/lb, 8.0 mg/kg) d. Mepivacaine = 400 mg (3.0 mg/lb, 6.6 mg/kg) |
C - The absolute maximum for lidocaine is 500 mg (3.2 mg/lb, 7.0) |
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Relevant information and mathematical operations required when calculating drug doses for local anesthetics and vasoconstrictors include all but which one of the following? a. Dilution percentages b. Standard cartridge volumes c. Defined MRD for each drug d. Height and weight |
D - Local anesthetic toxicity is weight related, but height is not a relevant. |
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Which one of the following is not related to the MRD for 2% lidocaine, 1:100,000 epinephrine? a. ~11 cartridges absolute maximum b. ~13 cartridges absolute maximum c. 3.2 mg/lb d. 500 mg absolute maximum |
B - This is correct for epinephrine alone but is too much for lidocaine, the limiting drug in this situation. |
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What is the MRD for vasoconstrictors when administering 2% lidocaine, 1:100,000 epinephrine to a healthy individual? a. 0.02 mg b. 0.1 mg c. 0.2 mg d. 1 mg |
C - 0.2 mg is the MRD for epinephrine in a healthy individual. |
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An individual has received 4 cartridges of 2% lidocaine, 1:100,000 epinephrine, and is not profoundly anesthetized. How many cartridges of 4% articaine, 1:200,000 epinephrine, may be administered if the individual weighs 160 lbs? a. 2.5 b. 3.5 c. 4.5 d. 5.5 |
C - 4 cartridges of 2% lidocaine = 144 mg. The absolute maximum is 500 mg for lidocaine or 3.2 mg/lb × 150 or more pounds = 480 mg. 480 mg – 144 mg= 336 mg. 336 mg/72 mg per cartridge of 4% articaine = 4.5 cartridges (rounded down to nearest half cartridge). |
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How many cartridges of 4% articaine, 1:200,000 epinephrine may be administered to an individual with significant cardiovascular compromise? a. 1 b. 2 c. 3 d. 4 |
D - The maximum for epinephrine in significant cardiovascular compromise is 0.04 mg. Each cartridge of a dilution of 1:200,000 epinephrine contains 0.009 mg of epinephrine. 0.04 mg/0.009 mg per cartridge of 4% articaine, 1:200,000 epinephrine = 4 cartridges. |
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Which one of the following accurately describes available formulations? a. 2% lidocaine, 1:100,000 epinephrine; 3% lidocaine,1:200,000 epinephrine b. 2% lidocaine, 1:100,000 epinephrine; 4% lidocaine,1:200,000 epinephrine c. 2% lidocaine, 1:100,000 epinephrine; 2% lidocaine,1:50,000 epinephrine d. 2% lidocaine, 1:200,000 epinephrine; 2% lidocaine,1:20,000 levonordefrin |
C - Available formulations of 2% lidocaine include 1:100,000 epinephrine and 1:50,000 epinephrine. |
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The maximum dose per weight of 4% articaine,1:100,000 epinephrine for children is: a. 2 mg/lb b. 3 mg/lb c. 2.2 mg/lb d. 3.2 mg/lb |
D - The maximum dose per pound of 4% articaine is 3.2 mg/lb for all individuals. |
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0.5% bupivacaine, 1:200,000 epinephrine containes how many milligrams of anesthetic drug per cartridge? a. 9 b. 18 c. 36 d. 54 |
A - By definition, a 1% drug contains 10 mg/mL. There are therefore 18 mg in a 1.8 mL cartridge. 0.5% drugs contain half this amount or 5 mg/mL. In 1.8 mL of a 0.5% drug, there is 5 mg in the first mLand 5 mg × 0.8 = 4 mg in the additional 0.8 mL. 5 mg + 4 mg = 9 mg/cartridge of a 0.5% drug. |
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Eutectic mixtures have which of the following characteristics? a. They work more rapidly than most other topicals. b. They penetrate more deeply on skin than mucosa. c. Their melting points exceed that of their ingredients acting alone. d. Their formulations facilitate deeper and more efficient penetrations of tissues compared with their ingredients acting alone. |
D -The term eutectic refers to a substance that has a lower melting point than any of its ingredients. Eutectic topicals not only have lower melting points to facilitate penetration through tissue barriers but they are formulated primarily in the base form so that they can provide anesthesia more rapidly. |
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Which of the following lists is most accurate when describing topical anesthetic uses? a. Before exposing radiographs, before injections, before placing retraction cord b. Before dental hygiene therapy and in subgingival tissues c. In procedures confined to mucosa and before taking impressions d. All of the above |
D - All of the above. |
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Which one of the following statements is incorrect regarding maximum recommended doses of topical anesthetics? a. They are sometimes difficult to track. b. MRDs are not always provided. c. Spray forms have easy-to-track dosing. d. Oraqix has easy-to-track dosing. |
C - Metered sprays are generally easier to track. Unmetered sprays are not. |
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Generous quantities of topical and injected anesthesia have been administered, when the patient begins to shake and appears agitated and anxious. Is there a reason for concern? a. Yes, because these may be early signs of CNS depression. b. No, because this is a very nervous patient and he or she hates dental appointments. c. No, because the doses of injectable anesthetic were within safe guidelines. d. Yes, because the patient is a dental phobic. |
A - Tremors and agitation may be early signs of CNS depression. They are also reactions that occurin response to the stress of dental appointments. It is important to remain alert to the development of further signs and symptoms of CNS depression. |
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Topical anesthetic mixtures may be of benefit in all but which one of the following ways? a. Combinations may increase therapeutic ranges. b. Combinations may increase penetration depths. c. Mixtures may allow drugs to be used as topicals that are not suitable when used alone. d. Mixtures decrease the potential for adverse reaction. |
D - Adding additional drugs does not decrease the potential for adverse reactions; it generally in-creases the potential. |
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All of the following statements are true regarding compounded drugs, except: a. Compounded drugs are formulated for individuals for whom they are prescribed. b. Compounded drugs may be used on other individuals as long as the use is the same as the original use. c. Compounded drugs may contain much larger quantities of drug compared with multiuse commercial preparations. d. Compounded topicals are dispensed by prescription. |
B - Compounded drugs, including compounded topicals, may be used only by individuals for whom they were prescribed. |
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The predominantly base form of lidocaine topical anesthetic is safer than the predominantly hydrochloride salt. a. True b. False |
A - True. The base form has less ability to be absorbed systemically |
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Dyclonine hydrochloride is an excellent and very durable topical anesthetic and belongs to which one of the following classes of anesthetic? a. Amide b. Ketone c. Ester d. None of the a |
B -Dyclonine has a ketone linkage as opposed to amide or ester. |
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Which one of the following statements is correct? a. The standard aspirating syringe is designed to provide negative pressure on aspiration, unlike the self-aspirating syringe. b. The standard aspirating syringe is designed to provide positive pressure on aspiration, unlike the self-aspirating syringe. c. Neither the standard nor the self-aspirating syringes provide negative pressure on aspiration. d. The standard aspirating syringe is designed to provide negative pressure on aspiration similar to the self-aspirating syringe . |
D - Negative pressure is developed in both syringes although the mechanism for creating the pressure is different for each. |
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Which one of the following is correct when addressing OSHA requirements for medical device safety in dentistry? a. Two hands are allowed as long as one hand only secures the needle cap. b. Contaminated needles may be bent as long as the bend is accomplished with cotton pliers or a hemostat. c. Two hands are never allowed to recap needles even when one hand is holding a hemostat or locking pliers to secure the protective caps. d. Uncontaminated needles may be bent. |
D - It is permissible to bend uncontaminated needles according to OSHA. Two hands are never allowed unless one is holding a hemostat or cotton pliers to hold the cap. Contaminated needles may never be bent. |
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In comparing a 25-gauge needle with a 30-gauge needle, the 25-gauge needle: 1. Has better aspiration. 2. Breaks more easily. 3. Is less comfortable than the 30 gauge. 4. Has a smaller diameter. 5. Can be used in highly vascular areas. a. 2,4,5 b. 2,4 c. 1,3,5 d. 1,5 |
D - 25-gauge needles have larger lumens and are thought to have greater ease of aspiration; 30-gauge needles have the greatest risk for breakage; studies demonstrate that patients cannot perceive the difference between the various needle gauges; and because of the ease of aspiration, 25-gauge needles are beneficial in highly vascular areas. |
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long needles are approximately _________ long. a. ~12 to 22 mm b. ~32 to 36 mm c. ~40 to 42 mm |
B - Long needles average ~32 mm (1½ inches), with some noted to be as long as 40 mm. |
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When a stopper is extruded, what has likely caused the problem? a. The cartridge was overfilled during manufacturing. b. Freezing occurred during shipping or handling. c. Overheating has caused pressure in the cartridge. d. Oxidation of sodium bisulfate has created gas in the cartridge. |
B - Freezing during shipping or handling causes expansion of the solution that dislodges the stopper. |
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During an infiltration injection you give the patient three stopper-widths of local anesthetic. How muchsolution have you injected into the patient? a. 0.2 mL b. 0.9 mL c. 1.8 mL d. 0.6 mL |
D - Each stopper’s width displaces 0.2 mL of solutions; therefore, three stoppers would displace 0.6 mL. |
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What substance is used as the preservative for epinephrine in local anesthetic cartridges? a. Sodium bisulfite b. Sodium hypochlorite c. Methylparaben d. Nitrogen |
A - Sodium bisulfite and methylparaben are preservatives; however, because of the high incidence of allergy to methylparaben, it is no longer used in local anesthetic agents. |
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The delivery of local anesthesia requires both medical and technical skills. Which one of the following is not one of the six elements of the ASA Medical Components of Care associated with regional anesthesia? a. Pre‐anesthetic evaluation of the patient b. Comprehensive tooth charting c. Remain present during the course of the anesthesia d. Providing indicated post‐anesthesia care |
B - Although useful for planning a course of anesthesia, tooth charting is not one of the ASA Medical Components of Care. |
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The ASA (American Society of Anesthesiologists) Physical Status Classification System categorizes patients based on their overall health. Classification P3 describes which one of the following? a. Normal Healthy patient b. Severe Systemic Disease c. Moribund Patient d. Severe Systemic Disease (constant threat to life) |
B - ASA Classification P3 is defined as “Severe Systemic Disease.” |
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Which of the following is not considered a main tool for patient assessment when planning for local anesthesia? a. The medical/dental questionnaire b. The clinical examination c. Drug MRDs d. Medical consultation |
C - Although important when monitoring total doses of drug delivered, this is not considered a main tool for patient assessment. |
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Which one of the following drugs is an absolute contraindication for patients with poorly controlled or uncontrolled hyperthyroidism? a. Lidocaine b. Bupivacaine c. Epinephrine d. Felypressin |
C - Epinephrine and Felypressin are both vasoconstrictors; however, Felypressin has no adrenergic effects and is therefore safe to use for patients with hyperthyroidism. |
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Your patient has identified or you suspect that your patient has used methamphetamines approximately 20 hours ago. Which of the following would be the most appropriate action when considering the use of local anesthetics? a. Continue with procedures, as it has been more than 12 hours since the use. b. Restrict the dose of vasoconstrictors to 20%of standard dose. c. Consider postponing care for a full 24 hours. d. Use only bupivacaine as the local anesthetic agent. |
C - Administration of vasoconstrictors may result in hypertensive crisis, stroke, or myocardial infarction. It is recommended that you not administer local anesthetics with vasoconstrictors for a minimum of 24 hours after methamphetamine use. |
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For which one of the following medical conditions is it unnecessary to obtain a medical consultation from the patient’s physician before dental treatment? a. Significant liver disease b. Myocardial infarction within 3 weeks c. Kidney dialysis patients d. Organ transplant patients |
B - Myocardial infarction within 3 weeks is an absolute contraindication to care. |
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A technique that deposits anesthetic solution near larger terminal nerve branches for treatment near the site of an injection is called: a. An infiltration injection. b. A ligamental injection. c. A field block injection. d. A nerve block injection. |
C - A field block injection deposits local anesthetic solution near larger terminal nerve branches for treatment near the site of injection. |
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Which one of the following describes the target site for local anesthetic solutions? a. Needle pathway b. Deposition site c. Penetration site d. Aspiration site |
B - The deposition site is the anatomical location where drugs are deposited. |
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The first step in the administration of local anesthetic solutions is to: a. Assemble the armamentarium. b. Obtain informed consent. c. Assess the patient before proceeding. d. Make sure that solution is able to exit the needle. |
C - Thorough patient assessment is critical to safe local anesthetic administration. Patient assessment must precede all other steps. |
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A primary benefit of orienting needle bevels toward bone during injections is that it: a. Reduces trauma to the periosteum when bone is contacted. b. Deflects the needle away from the bone during penetration. c. Prevents false negative aspirations within a vessel. d. Reduces discomfort from the advancing needle. |
A - Orienting the bevel toward bone reduces discomfort and trauma to periosteum when bone is contacted. In the event of inadvertent contact, the needle tends to glance off the bone rather than pierce the periosteum. Although reducing discomfort is important (Answer D), many other aspects of injections which decrease discomfort have nothing to do with bevel orientation. Option A is the better answer because bevel orientation specifically reduces trauma to the periosteum in addition to providing for more comfort. |
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Which one of the following is the most appropriate local anesthesia patient record entry? a. 10/21/2015: Review Health History. BP 120/80. 2 car-tridges 2% lidocaine, 1:100,000 epi, no complications b. Review Health History. BP 120/80. 2 cartridges 2% lidocaine, 1:100,000 epi, Rt IA, LB, (+) aspiration c. Review Health History. BP 120/80. 72 mg of 2% li-docaine, 0.036 mg 1:100,000 epi, IA, LB d. 10/21/2015: Review Health History. BP 120/80. 2 cartridges (3.6 mL) 2% lidocaine (72 mg), 1:100,000 epi (0.036 mg), Rt IA, LB, (–) aspiration. No adverse reactions. |
D - This is the only sample that has all components: date, drug(s), total drug volume(s), injection(s) or sites, results of aspiration test(s), a notation on adverse events, and clinician signature. |
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When is it safe to deposit local anesthetic solution? a. After a negative aspiration, where no blood is drawn into the cartridge. b. After a negative aspiration, following a positive aspiration where blood was visible in the cartridge only as a small trickle of blood or “worm like” thread. c. Following a positive aspiration that obscures the results of subsequent aspirations. d. A & B. |
D - It is safe to deposit the anesthetic solution once a negative aspiration is confirmed, including when there is no preceding positive aspiration;when previous positive aspiration does not obscure subsequent aspirations; and only when the clinician essentially starts fresh with a new cartridge and new aspiration, not after a positive aspiration that obscuresthe results. |
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The most important safety step(s) during a local anesthetic injection is/are: a. To aspirate before depositing. b. To administer local anesthetics slowly. c. To direct the bevel away from bone. d. To aspirate before depositing and to administer drugs slowly. |
D - It is not only critical to determine if a needle lumen lies within a vessel before deposition but also critical to administer drugs slowly in case the needle lumen lies within the vessel despite negative aspiration test results. |
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Upon completion of an injection, the most important subsequent step is to: a. Rinse the patient’s mouth. b. Calculate the volume of drug delivered. c. Make the needle safe with a one-handed technique. d. Determine if the patient experienced discomfort. |
C - Make the needle safe with a one-handed technique. This optimizes safety for all personnel. Once this has been done, attend to the patient. |
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Which one of the following statements best describes the needle pathway for an infiltration injection technique? a. The needle is parallel to the long axis of the tooth, passing through thin mucosal tissues to superficial fascia containing loose connective tissue, and past small vessels and microvasculature, and nerve endings. b. The needle is distal to the long access of the tooth, passing through thin mucosal tissue to deep fascia of connective tissues, and past small vessels, alveolar bone, and nerve endings. c. The needle is parallel to the long axis of the tooth, passing through thin mucosal tissues to superficial tissue, and past small vessels, nerves, and bone. d. The needle is perpendicular to the long axis of the tooth, passing through thick mucosal tissue, dense connective tissues, muscle, and vessels, and past microvasculature and nerve endings. |
A - A is the correct choice. B is incorrect because the needle is not oriented distal to the long axis of the tooth. C is incorrect because the needle does not pass through bone. D is incorrect because the mucosa and connective tissue in this area are not typically thickened. |
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When infiltration injections are unsuccessful, it maybe helpful to: a. Change the length of the needle and repeat the injection. b. Visualize, palpate, check radiographs, and reassess the technique. c. Establish contact with bone before administering one cartridge of anesthetic solution. d. Repeat the same injection and deposit more solution. |
B - This is the correct answer. Visualization, palpation, and reassessment of available landmarks are most useful. A is incorrect in most instances unlessthe wrong size was used in the first place, such as anultrashort needle. C is incorrect because contact with bone results in pain and trauma, not increased success. D is incorrect because the patient is not the one responsible for the injection parameters. |
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The middle superior alveolar nerve is absent in approximately 28% – 50% of individuals. a. True b. False |
B - The MSA nerve is present in somewhere between 28% and 50% of individuals. |
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In a typical adult patient, the infraorbital foramen is approximately 8 to 10 mm below the infraorbital ridge. a. True b. False |
A - This range is considered normal for the average adult. |
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Which one of the following provides the most accurate description of the field of anesthesia in a PSA injection? a. Pulps of the maxillary premolars and molars, and their facial gingiva, periodontal ligament, and alveolar bone on the side injected b. Pulps of the maxillary and mandibular molars on the side injected c. Pulps of the maxillary teeth to the midline, and their facial gingiva, periodontal ligament, and alveolar bone on the side injected d. Pulps of the maxillary molars, except sometimes the mesiobuccal root of the first molar, and their facial gingiva, periodontal ligament, and alveolar bone on the injected side |
D - This is the only accurate description. A, B, and C are incorrect. The premolars are not anesthetized by a PSA injection nor are the mandibular molars or the maxillary teeth to the midline. |
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Which one of the following is most likely to increase the risk of hematoma following a PSA nerve block? a. The needle is inserted too deep or too posterior to the deposition site on the posterior surface of the maxilla. b. The needle is inserted too inferior to the posterior surface of the maxilla. c. The porous bony surface of the maxilla allows the needle to penetrate the maxilla - piercing blood vessels. d. A long needle is inserted, contacting the bony periosteum on the surface of the maxilla. |
A - Overinsertion of needles increases the risk of hematoma formation in PSA blocks. This can occur both by deeper insertion into the pterygopalatine fossa or by location too posteriorly initially. |
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Which one of the following statements best describes the deposition site for a nasopalatine nerve block? a. The deposition site is within the nasopalatine canal. b. The deposition site is near the wall of the incisive canal. c. The deposition site is anterior to the opening of the anterior palatine foramen. d. The deposition site is near the junction between the vertical alveolar process and the horizontal palatal process. |
B - This is correct compared with A because, although deposition is at the incisive foramen, the needle is not advanced into the nasopalatine canal. C is incorrect because the nasopalatine nerve block is not performed at the anterior palatine foramen. D does not describe a location at the incisive foramen. |
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The most common cause of failure for palatal injection techniques is: a. Solution is deposited too far from the associated bone or foramen. b. Inadequate volumes of solution are deposited. c. B only. d. Both A and B. |
D - This is the correct answer. Both failure to deposit the solution close to the bone or foramen and insufficient volumes deposited reduce the amount of drug that diffuses through the bone to the nerves. |
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The AMSA technique can provide anesthesia for areas traditionally anesthetized by which one of the following groups of injections? a. ASA, MSA, PSA, NP, and GP b. ASA, MSA, NP, and GP c. PSA and GP d. NP and MSA |
B - This is the best answer. The AMSA technique provides anesthesia for structures traditionally anesthetized by the ASA, MSA, NP, and GP injections. |
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Which one of the following statements is true of NP nerve blocks? a. They have the highest rate of positive aspiration in the palate. b. They have the second-highest rate of positive aspiration in the palate. c. They provide more durable anesthesia compared with other palatal techniques. d. They provide bilateral anesthesia. |
D - This is the best answer. The aspiration rate is similar to other palatal techniques. NP blocks do not provide more durable anesthesia compared with other palatal techniques. When performed as recommended, they provide bilateral anesthesia. |
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Which one of the following is an important consideration in all palatal LA procedures? a. Always apply topical anesthetic for 1 to 2 minutes. b. Always administer solutions slowly. c. Always use patch anesthetics. |
B - This is the best answer. Applying topical for 1–2 minutes is typical of many injections. Using patch topicals in the palate is helpful but not necessary. Slow deposition of solution is important to avoid damage to tissue, which has difficulty accommodating the volumes of solution necessary in many palatal techniques. Pain is reduced with slow administration and safety is enhanced. |
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AMSA nerve blocks provide bilateral anesthesia of palatal tissues at least 20% of the time. a. True b. False |
B - Solution in AMSA blocks does not cross the midline and provides same-side anesthesthesia only. |
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The rate of positive aspiration in the inferior alveolar nerve block is the highest of all techniques and approximates which one of the following? a. 2%–5% b. 5%–10% c. 10%–15% d. 15%–20% |
C - The rate of positive aspiration in alveolar nerve blocks is 10% to 15%. This is the highest rate of all techniques described in this text. In practical terms, this means anticipating a positive aspiration in 1 to 2 out of every 10 inferior alveolar blocks. |
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Which one of the following techniques is an alternative to nearly all mandibular anesthetic techniques? a. Gow-Gates b. Vazirani-Akinosi c. PDL d. Infiltrations |
C - The periodontal ligament injection (PDL), although providing only limited areas of anesthesia, is an alternative to nearly all other techniques, mandibular and maxillary. |
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Which one of the following result(s) in pulpal anesthesia? a. Buccal nerve block b. Mental nerve block c. A and B d. Neither A nor B |
D - Neither the buccal nor the mental nerve blocks provide pulpal anesthesia to the mandibular teeth. |
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When administering a Gow-Gates mandibular nerve block, all of the following are essential, except: a. Performing one or more aspirations b. Meeting bony resistance c. Determining the site, height, and depth of penetration as well as the syringe barrel orientation d. Having the client remove all ear jewelry before administering |
D - Even though there are both extraoral and intraoral landmarks for the Gow-Gates nerve block, it is not necessary to remove jewelry before administering it. |
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Palpating anatomy before all mandibular anesthetic procedures is: a. An unnecessary step in anesthesia techniques b. Helpful in some techniques and useless in others c. The least important aspect of anesthetic assessment d. Critical to the success of these techniques |
B - Palpating anatomy is essential to some techniques and not very helpful in others. While the statement that it is an unnecessary step is obviously false, palpation is not even possible in lingual nerve blocks, for example. |
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Which one of the following is the correct order, from inferior to superior location, of the mandibular techniques listed in relation to the pterygomandibular space? a. IA, Gow-Gates, Akinosi b. IA, Akinosi, Gow-Gates c. Gow-Gates, IA, Akinosi d. Akinosi, IA, Gow-Gates |
B - The correct order from inferior location to superior location in the pterygomandibular space is IA, Akinosi, Gow-Gates. |
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The rate of deposition of local anesthetic drugs in intraosseous, intrapulpal, and PDL injections is best represented by which one of the following? a. 0.1 mL over 20 seconds b. 0.2 mL over 10 seconds c. 0.2 mL over 20 seconds d. 0.1 mL over 30 seconds |
C - The rate of deposition of solution in each of these techniques is slow (0.2 mL over 20 seconds). |
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Which one of the following techniques does not typically provide reliable pulpal anesthesia? a. Intraosseous b. Intrapulpal c. Intraseptal d. PDL |
C - The intraseptal technique does not provide reliable or durable pulpal anesthesia. |
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Which one of the following is not recommended as an anesthetic approach in irreversible pulpitis? a. The Stabident system b. PDL injections c. Higher concentrations of lidocaine d. The IntraFlow system |
C - A 5% concentration of lidocaine may be effective in this situation, but it is also unavailable in dental cartridges and is two-and-one-half times more toxic that 2% lidocaine solutions. |
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What is the approximate success rate of inferior alveolar nerve blocks, according to Wong, in pulpally involved teeth? a. 10% b. 20% c. 30% d. 40% |
C - 30%. |
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Which one of the following statements is true regarding PDL injections? a. Solution diffuses through the periodontal ligament to the dental plexus. b. The orientation of the bevel is critical to success of the procedure. c. The technique is only useful as an initiating technique. d. Solution diffuses through alveolar bone to the dental plexus. |
D - Solution diffuses through the alveolus; therefore, the PDL is an intraosseous technique. The orientation of the bevel is irrelevant to success, and the technique is very useful as a supplementary technique when other techniques have failed to provide profound anesthesia. |
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Inadequate anesthesia may typically be caused by all of the following, except: a. Accessory innervation b. Inflammation c. Poor manufacturing processes d. Freezing of cartridges during shipping |
C - Manufacturing processes are well-regulated and rarely, not typically, may be the cause of inadequate anesthesia. On the contrary, product recalls are more typical when atypical errors occur during manufacturing processes. |
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Infiltration (supraperiosteal) anesthesia over the apex of #9 has failed to achieve adequate anesthesia. Which one of the following is not a likely possibility? a. Cross-over innervation from the contralateral ASA b. Bony obstructions c. Dense bone d. Unseen inflammation |
D - Inflammation with no signs or symptoms is unlikely to inhibit anesthesia. |
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The relative acidity of tissues into which anesthetic drugs are injected is related to the efficacy of a drug in the following manner: a. An excess of hydrogen atoms enhances neutral base molecule formation b. A pH-driven increase in cationic concentrations decreases the rate of success c. A pH-driven increase in cationic concentrations increases the rate of success d. A decrease in pH increases the number of neutral base molecules. |
B - Increases in cationic concentrations decrease the rate of success. |
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Possible successful approaches when an inferior alveolar nerve block fails to provide complete and profound pulpal anesthesia are: a. PDL injections b. Mylohyoid nerve blocks c. Gow-Gates blocks d. All of the above |
D - PDL injections, mylohyoid nerve blocks, and Gow-Gates blocks are all useful supplements when inferior alveolar nerve blocks fail to provide adequate pulpal anesthesia. |
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Two injections of 2% lidocaine, 1:100,000 epinephrine (total lidocaine = 72 mg) have failed to provide adequate anesthesia. Useful supplemental alternatives, regardless of the location or technique, include all of the following, except: a. 3% mepivacaine b. PDL injections c. Mylohyoid blocks d. 2% mepivacaine, 1:20,000 levonordefrin |
C - Mylohyoid blocks are useful only in the mandible. |
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By which of the following mechanisms do intraosseous techniques work? a. They are propelled through tissues to nerves and nerve trunks b. They rapidly diffuse through bony tissue to nerve trunks c. They slowly diffuse through bony tissue to nerve trunks d. They slowly diffuse through bony tissue to dental plexuses |
D - Intraosseously administered solutions slowly diffuse through alveolar bone to dental plexuses. |
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Where is the deposition site for the Gow-Gates nerve block located relative to the inferior alveolar nerve block? a. At the same level in the pterygomandibular space b. At a higher level in the pterygomandibular space c. Below the inferior alveolar nerve block d. Below the Vazirani-Akinosi block but above the IA block |
B - The Gow-Gates is located at a higher level than the Vazirani-Akinosi block which is higher than the IA block. |
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Some nerve blocks require far greater volumes of solution compared with others. a. True b. False |
A - The statement is true. For example, the minimum volume of solution for a Gow-Gates nerve block is 1.8 mL, which is nine times typical volume for one site of a PDL injection, or 0.2 mL. |
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A clinician is administering an IA nerve block before therapy when the patient suddenly jerks and the needle breaks. The embedded portion is not visible.What should the clinician do? a. Attempt removal b. Refer for removal c. Reappoint to remove once the needle has developed a fibrous cocoon around it d. Refer for evaluation |
D - Some embedded needles are retained in tissue after evaluation. Evaluation by an oral surgeon may result in a decision to retain the needle versus the greater damage that might occur with attempted removal. Even though needle fragments are typically removed today, referring for removal may make the patient believe that either the referring clinician or the surgeon is acting inappropriately if the decision is made to retain the embedded fragment. Refer for evaluation. |
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A second cartridge of 2% lidocaine has been administered for an IA nerve block when the 160-lb patient becomes anxious and states that she doesn’t feel well, even a little nauseous. She becomes less anxious as she becomes increasingly fatigued, her speech be-comes slurred, and she reports a numb feeling all around her mouth. Which one of the following statements best describes these observations? a. The patient is likely suffering from severe anxiety and fatigue. b. The patient is likely suffering from a drug overdose due to excessive administered doses. c. The patient is likely suffering from a drug overdose due to intravascular administration. d. The patient is likely suffering from an allergy to lidocaine. |
C - Two cartridges is not an overdose in a healthy 160-lb adult unless intravascularly administered or the patient is a hyper-responder. The progression of signs and symptoms to slurring of speech and perioral numbness is not consistent with anxiety. Assuming the patient has no history of hyper-response, the likely mechanism for overdose is intravascular administration. |
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Allergies to topical anesthetic drugs that cause mucosal signs and symptoms hours to days after exposure are explained best by which one of the following reactions? a. Delayed hypersensitivity b. Anaphylaxis c. Angioedema d. Immunopathology |
A - Reactions with signs and symptoms occurring many hours to days after contact with a drug are characterized as delayed sensitivities. |
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A patient calls several days after an IA block and reports that numbness is still present along with some annoying, occasional sharp pains. Which of the following terms best describes what is occurring? a. Paresthesia, anesthesia b. Paresthesia, hypoesthesia c. Paresthesia, dysesthesia d. Anesthesia, hyperesthesia |
C - These symptoms are consistent with paresthesia (prolonged numbness) and dysesthesia (sharp pains). |
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Which of the following responses is most appropriate after rapid tissue swelling is noticed after a PSA block? a. Get an ice pack and then place pressure on the area with the ice pack. b. Place pressure on the area for 10 minutes and then continue working. c. Place pressure on the area while someone else looks for ice; terminate procedure. d. Reassure the patient and continue with planned therapy once numb. |
C - Place pressure over the area as quickly as possible and then apply ice, when available. Advise the patient regarding the development of discoloration. Instruct the patient to apply ice intermittently for the next 6 hours and to avoid aspirin for pain. Advise the patient to notify you immediately of any change, especially the development of signs and symptoms of infection or limited jaw opening. |
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Of the following possible adverse reactions, which one occurs most frequently? a. Allergy b. Idiosyncratic response c. Overdose |
C - Of the three, overdose is the most frequent systemic complication. |
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Considering all of the following measures for preventing overdose, which one is most important? a. Calculating doses b. Slow administration c. Aspiration d. Reassuring patients |
B - Slow administration is the most important safety factor in local anesthetic drug administration and increases the safety margins of all the other preventive strategies mentioned. Aspiration is critical but not always completely reliable. Calculating appropriate maximum doses is also critical but hyper-responders may react adversely to doses which are carefully calculated and considered to be appropriate. Reassurance does not even address this issue. |
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There is a new patient in the chair. During appropriate introductions including handshaking, it is noticed that the patient’s hands are clammy and he has perspiration on his upper lip. He appears very stiff and responds with a brief yes or no to attempts to engage him in conversation. When deciding whether or not he is apprehensive about the dental treatment he is scheduled to receive, the most appropriate strategy would be to: a. Try to distract the patient by offering to let him watch a movie or listen to music. b. Get the nitrous oxide-oxygen sedation ready just in case. c. Check out the observations made by asking the patient about possible concerns regarding dental treatment. d. Avoid saying anything about dental anxiety or fear because it might upset the patient and risk not being able to get the scheduled treatment completed. |
C - Check out and confirm the observations about possible concerns regarding dental treatment by asking a few simple questions: “When was your last dental visit?” “How did it go?” “Do you have any concerns about receiving treatment today?” Patients want to know that their care provider is concerned about them. If the patient is fearful, this may affect their ability to receive an injection and whether or not the anesthetic is effective. Obtaining this information before treatment allows clinicians to develop plans, which address problems methodically and to increase the likelihood of success. This patient is also reassured that he is in the hands of a caring and competent professional. |
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Establishing trust in the patient–clinician relationship is especially important for fearful dental patients because they need to learn: a. How to pay for services provided. b. How to be assertive. c. That clinicians never recommend treatment patients cannot tolerate. d. That clinicians are professionals and know what is best for patients. |
B - Fearful patients need to learn how to be assertive and express their concerns. They need to ask questions about their worries, including comfort during treatment. Good communication empowers fearful patients with a sense of control, whereas poor communication can lead to anger and aggressive behavior rather than helpful assertive behavior. When trust is developed in this manner, it is helpful to both the patient and the clinician. |
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Providing patients with information is an important means of increasing their sense of control in the dental environment. When providing information to a fearful patient about an aversive procedure: a. The clinician should explain how steps taken during the procedure are necessary for the benefit of the clinician’s work. b. The emphasis should be on the scientific rationale for the treatment, procedures, materials, and/or equipment used. c. It is better not to tell the patient what will happen because it might make the patient more fearful. d. The procedure should be described in simple terms, including the sensations the patient will experience so that the patient knows what to expect. |
D - When the procedure is described in simple steps, the fearful patient will not be overwhelmed by the prospect of treatment and will not be startled by each new aspect of the treatment process. It is important not to surprise fearful patients and to let them know what sensations are normal, especially when administering local anesthesia. |
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It is important to have the skills and confidence necessary to teach anxious and fearful patients how to relax in the dental chair. When a patient learns the physical relaxation skills of deep breathing and muscle relaxation: a. The patient benefits by having an active means to relieve the discomfort, both physical and mental, which is experienced as a result of anxiety. b. The clinician benefits because it is easier to achieve pain control in a relaxed patient. c. Neither the clinician nor the patient benefits because these skills are too difficult to teach and to learn in the stressful dental setting. d. Both a and b |
D - The physical relaxation skills of deep breathing and muscle relaxation are easily taught and quickly learned by dental patients. Additionally, the clinician can directly observe whether or not the patient is actively using the skills and whether or not the patient needs coaching. Anxiety leads to muscle tension and shallow breathing, both of which increase the patient’s sense of physical discomfort. Muscle relaxation and deep breathing counteract these, and patients appreciate having a technique that can be used to gain relief from the symptoms of anxiety. These techniques reduce mental stress as it is not possible to be physically relaxed and psychologically anxious at the same time, and the active focus on implementing relaxation techniques displaces the fearful conjectures. The clinician benefits from the patient’s ability to use these skills because a tense and anxious patient has a lower pain threshold, is more easily hurt and startled, and cannot distinguish between anticipated pain and the actual experience of pain both during the administration of local anesthetic and when assessing if the patient is adequately anesthetized to proceed with treatment. |
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Patients who are fearful of dental injections can benefit from having the opportunity to rehearse the procedure before receiving the actual injection. The objective of the rehearsal is to: a. Find out if the patient is sincere about wanting to overcome his dental fears. b. Allow the patient to learn how his role and the clinician’s role are synchronized before proceeding with the injection and treatment. c. Determine the treatment plan for the patient by gaining knowledge about which treatments the patient will be capable of tolerating. d. Test the patient for intolerance and allergies to local anesthetics. |
B - A rehearsal provides the patient with the opportunity to practice the relaxation skills learned while the clinician simulates the steps involved in administering local anesthetic. Patients gain knowledge about their role and what is involved in the actual procedure without the pressure to accomplish treatment. |
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Some patients will report a history of receiving dental care without being adequately anesthetized. They may not be anxious about the injection procedure, but will be reluctant to proceed with treatment after the administration of local anesthetics. Despite soft-tissue signs and symptoms of anesthesia, they do not believe the teeth are numb. The next step for these patients should be to: a. Verify that the tooth is adequately anesthetized by testing, preferably with an electronic pulp tester (EPT), before beginning treatment. b. Reassure the patient that the correct amount and type of anesthetic has been used for the area of the mouth to be treated. c. Reassure the patient that if pain is felt in the tooth, treatment will cease the minute the hand signal to stop is given. d. Give the patient more anesthetic to be on the safe side before attempting to proceed with treatment. |
A - Inform the patient of the technique to verify that the tooth is anesthetized before proceeding with treatment. The EPT is very useful for this purpose, and patients are receptive to the idea of a device that makes the determination objectively rather than relying on subjective responses that have not been reliable in the past. If there is no EPT available, an ultrasonic instrument can be used along with time structuring technique (counting to “1,” then “2,” and “5”) to verify profound anesthesia for the patient. |
