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206 Cards in this Set
- Front
- Back
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What is a derivative of cocaine? |
Procaine |
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What is the most common LA used in dentistry ? |
Lignocaine |
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Define pain |
An unpleasant sensory and emotional experience associated with actual or potential tissue damage |
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What are the two different types of pain |
Acute (odontogenic, non odontogenic) Chronic (more than 3 months) |
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What kind of pain do dental clinicians treat? |
Acute odontogenic pain |
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What is the main nerve that provides sensory innervation soft tissues, gingiva mucosa and bone ? |
Greater palatine nerve |
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What can needle trauma damage cause ? |
Haematoma (damage to the artery) |
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What is the greater superficial petrosal nerve a branch of? |
Facial nerve (CN VII) |
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What are examples when to use LA? |
Topically (surface anaesthesia): prior to injections, rubber dam clamp Restorative: into dentine and beyond Sub-gingival scale/curettage Extractions |
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Which cranial nerve is the maxillary nerve a division of? |
Trigeminal nerve division 2 |
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What does the PSA nerve give innervation to? |
Molars except for the mesio buccal root of the 1st molar |
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Which tooth in the primary dentition is innervated by the PSA |
The 2nd deciduous molar (E) |
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Is the MSA found in all people ? |
No, only found in 30% of people |
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In the primary dentition, which teeth does the ASA nerve innervate? |
A B C D |
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Which tooth in the primary dentition is innervated by the PSA |
The 2nd deciduous molar |
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What does the nasopalatine nerve innervate ? |
Anterior 1/3 of the hard palette |
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What does the greater palatine nerve innervate ? |
Posterior 2/3 of the hard palate |
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What cranial nerve is the mandibular nerve part of ? |
Trigeminal nerve division 3 |
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What cranial nerve is the mandibular nerve part of ? |
Trigeminal nerve division 3 |
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What nerves are very important nerves part of the mandibular division ? |
Inferior alveolar nerve (IAN) Lingual nerve Long buccal nerve |
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What is the mental nerve responsible for ? |
Soft tissues |
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What is the mental nerve responsible for ? |
Soft tissues |
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Which teeth does the long buccal nerve innervate ? |
Gingivae of posterior teeth 2nd premolar - permanent dentition 2nd deciduous molar- primary teeth |
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What does the incisive nerve innervate? |
Anterior teeth- attached gingiva through perforating nerve |
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What does the incisive nerve innervate? |
Anterior teeth- attached gingiva through perforating nerve |
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What does the mental nerve innervate? |
1st premolar 1st deciduous molar |
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What does the long buccal nerve provide sensation to? |
Oral mucosa of cheek Parotid duct Buccal fat pad Retromolar trigone Terminal fibres crossover with mental nerve |
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What does the lingual nerve provide sensation to? |
Tongue, FOM, gingiva and lingual nerve |
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Which nerve supplies the anterior 2/3 of the tongue? |
Lingual nerve Anterior 2/3 fibres travel with chorda tympani nerve to the facial nerve (CN VII) Chorda tympani nerve joins the lingual nerve Chorda tympani also carries secretomotor fibres to submandibular and sublingual salivary glands |
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Which nerve supplies the anterior 2/3 of the tongue? |
Lingual nerve Anterior 2/3 fibres travel with chorda tympani nerve to the facial nerve (CN VII) Chorda tympani nerve joins the lingual nerve Chorda tympani also carries secretomotor fibres to submandibular and sublingual salivary glands |
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Which nerve supplies the posterior 1/3 of the tongue ? |
Glossopharyngeal nerve (CN IX) |
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If you attempt to give LA to the mandibular first molar and sensation is still present... what structure could be the cause of this? |
Accessory innervation of the mylohyoid nerve |
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Which artery supplies for all the teeth in the maxilla ? |
Maxillary artery! Supplies all teeth Maxilla, palate, nose Muscles of mastication Middle cranial fossa Part of the ear |
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Which artery supplies for all the teeth in the maxilla ? |
Maxillary artery! Supplies all teeth Maxilla, palate, nose Muscles of mastication Middle cranial fossa Part of the ear |
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What does positive aspiration mean? |
You’ve drawn in blood on the syringe which means you’re most likely in the blood vessel |
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Which artery supplies for all the teeth in the maxilla ? |
Maxillary artery! Supplies all teeth Maxilla, palate, nose Muscles of mastication Middle cranial fossa Part of the ear |
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What does positive aspiration mean? |
You’ve drawn in blood on the syringe which means you’re most likely in the blood vessel |
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What is the difference between the outer surface and inner surface of a cell membrane ? |
The outer surface of a resting nerve fibre is positively charged The inner surface of the cell membrane is negatively charged This is the resting membrane potential (-70mV) |
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Which artery supplies for all the teeth in the maxilla ? |
Maxillary artery! Supplies all teeth Maxilla, palate, nose Muscles of mastication Middle cranial fossa Part of the ear |
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What does positive aspiration mean? |
You’ve drawn in blood on the syringe which means you’re most likely in the blood vessel |
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What is the difference between the outer surface and inner surface of a cell membrane ? |
The outer surface of a resting nerve fibre is positively charged The inner surface of the cell membrane is negatively charged This is the resting membrane potential (-70mV) |
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Which structure in the sodium channel does the LA molecules bind to? |
Inner pore |
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Which artery supplies for all the teeth in the maxilla ? |
Maxillary artery! Supplies all teeth Maxilla, palate, nose Muscles of mastication Middle cranial fossa Part of the ear |
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What does positive aspiration mean? |
You’ve drawn in blood on the syringe which means you’re most likely in the blood vessel |
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What is the difference between the outer surface and inner surface of a cell membrane ? |
The outer surface of a resting nerve fibre is positively charged The inner surface of the cell membrane is negatively charged This is the resting membrane potential (-70mV) |
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Which structure in the sodium channel does the LA molecules bind to? |
Inner pore |
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Pain fibres of teeth |
Pulp is innervated by A-delta and C fibres |
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Which artery supplies for all the teeth in the maxilla ? |
Maxillary artery! Supplies all teeth Maxilla, palate, nose Muscles of mastication Middle cranial fossa Part of the ear |
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What does positive aspiration mean? |
You’ve drawn in blood on the syringe which means you’re most likely in the blood vessel |
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What is the difference between the outer surface and inner surface of a cell membrane ? |
The outer surface of a resting nerve fibre is positively charged The inner surface of the cell membrane is negatively charged This is the resting membrane potential (-70mV) |
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Which structure in the sodium channel does the LA molecules bind to? |
Inner pore |
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Pain fibres of teeth |
Pulp is innervated by A-delta and C fibres |
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What is the difference between A-delta and C-fibres? |
A-delta is responsible for dentinal pain -cavity preparation - dentinal sensivity - air drying -sharp pain C fibres are responsible for pulp al pain -heating -pulpal inflammation -dull aching pain |
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Which artery supplies for all the teeth in the maxilla ? |
Maxillary artery! Supplies all teeth Maxilla, palate, nose Muscles of mastication Middle cranial fossa Part of the ear |
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What does positive aspiration mean? |
You’ve drawn in blood on the syringe which means you’re most likely in the blood vessel |
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What is the difference between the outer surface and inner surface of a cell membrane ? |
The outer surface of a resting nerve fibre is positively charged The inner surface of the cell membrane is negatively charged This is the resting membrane potential (-70mV) |
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Which structure in the sodium channel does the LA molecules bind to? |
Inner pore |
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Pain fibres of teeth |
Pulp is innervated by A-delta and C fibres |
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What is the difference between A-delta and C-fibres? |
A-delta is responsible for dentinal pain -cavity preparation - dentinal sensivity - air drying -sharp pain C fibres are responsible for pulpal pain -heating -pulpal inflammation -dull aching pain |
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What does the LA molecule need to be acidified with to become useful? |
Hydrochloric acid to form salts |
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How does LA work? |
By reversely binding to the inner pore of voltage gated sodium channels |
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pKa |
The lower the pka the shorter the onset time The higher the pka the longer the onset time |
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What are some factors that affect the onset time of LA |
Distance of diffusion to nerve fibre Anatomical barriers Adequate concentration and volume of LA |
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What can the duration of the anaesthetic be influenced by ? |
Volume and concentration -need sufficient LA molecules to dock with the inner pore of the sodium channel -especially important for procedures which produce a high pain stimulus |
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What is part of the armamentarium for LA |
Topical anaesthetic Syringe Needle Local anaesthetic solution |
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Does topical anaesthetic work on intact skin? |
No You need to apply it to dry mucosa |
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What does the gauge refer to in the needle? |
Gauge refers to the diameter of the lumen of the needle (how wide the needle is on the inside) |
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How is the patient positioned to give LA? |
Supine or semi-supine |
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pKa |
The lower the pka the shorter the onset time The higher the pka the longer the onset time |
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What are some factors that affect the onset time of LA |
Distance of diffusion to nerve fibre Anatomical barriers Adequate concentration and volume of LA |
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What can the duration of the anaesthetic be influenced by ? |
Volume and concentration -need sufficient LA molecules to dock with the inner pore of the sodium channel -especially important for procedures which produce a high pain stimulus |
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What is part of the armamentarium for LA |
Topical anaesthetic Syringe Needle Local anaesthetic solution |
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Does topical anaesthetic work on intact skin? |
No You need to apply it to dry mucosa |
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What does the gauge refer to in the needle? |
Gauge refers to the diameter of the lumen of the needle (how wide the needle is on the inside) |
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How is the patient positioned to give LA? |
Supine or semi-supine |
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Lignociaine has more than double the potency of articaine.... TRUE OR FALSE |
True |
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Lignociaine has more than double the potency of articaine.... TRUE OR FALSE |
True |
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What is another name for procaine? |
Novocaine |
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Lignociaine has more than double the potency of articaine.... TRUE OR FALSE |
True |
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What is another name for procaine? |
Novocaine |
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Procaine |
Also known as novocaine Slow onset (6-10mins) High pKa Short duration (60mins) Enables higher dose (10mg/kg) Short half- life Vasodilation |
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Is procaine an Ester or amide? |
Ester |
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Is procaine an Ester or amide? |
Ester |
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Is benzocaine an Ester or amide? |
Ester |
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Is procaine an Ester or amide? |
Ester |
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Is benzocaine an Ester or amide? |
Ester |
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What is benzocaine used in ? |
Sore throat lozenges Mouthwash Throat spray Gel, paste |
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Is procaine an Ester or amide? |
Ester |
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Is benzocaine an Ester or amide? |
Ester |
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What is benzocaine used in ? |
Sore throat lozenges Mouthwash Throat spray Gel, paste |
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Lignocaine |
2% plain or with adrenaline (1:80 000) |
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Is procaine an Ester or amide? |
Ester |
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Is benzocaine an Ester or amide? |
Ester |
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What is benzocaine used in ? |
Sore throat lozenges Mouthwash Throat spray Gel, paste |
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Lignocaine |
2% plain or with adrenaline (1:80 000) |
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Articaine |
4% |
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Is procaine an Ester or amide? |
Ester |
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Is benzocaine an Ester or amide? |
Ester |
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What is benzocaine used in ? |
Sore throat lozenges Mouthwash Throat spray Gel, paste |
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Lignocaine |
2% plain or with adrenaline (1:80 000) |
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Articaine |
4% |
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Prilocaine |
3% |
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Mepivacaine |
3% |
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What are some features of lignocaine |
Rapid onset, moderate duration Allergies extremely rare Very few contraindications for use 90% metabolised in liver Excreted in urine (90% as metabolites, 10% as free drug) Half life 1.5-1.8 hours |
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What are some features of lignocaine |
Rapid onset, moderate duration Allergies extremely rare Very few contraindications for use 90% metabolised in liver Excreted in urine (90% as metabolites, 10% as free drug) Half life 1.5-1.8 hours |
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Which category drugs are safe to be used during pregnancy ? |
Category A drugs |
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What are some features of lignocaine |
Rapid onset, moderate duration Allergies extremely rare Very few contraindications for use 90% metabolised in liver Excreted in urine (90% as metabolites, 10% as free drug) Half life 1.5-1.8 hours |
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Which category drugs are safe to be used during pregnancy ? |
Category A drugs |
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Can articaine be used for pregnant women? |
No It’s a category B3 drug |
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What are some features of lignocaine |
Rapid onset, moderate duration Allergies extremely rare Very few contraindications for use 90% metabolised in liver Excreted in urine (90% as metabolites, 10% as free drug) Half life 1.5-1.8 hours |
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Which category drugs are safe to be used during pregnancy ? |
Category A drugs |
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Can articaine be used for pregnant women? |
No It’s a category B3 drug |
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From what age can articaine be administered to patients |
Children over the age of 4 |
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What are some features of lignocaine |
Rapid onset, moderate duration Allergies extremely rare Very few contraindications for use 90% metabolised in liver Excreted in urine (90% as metabolites, 10% as free drug) Half life 1.5-1.8 hours |
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Which category drugs are safe to be used during pregnancy ? |
Category A drugs |
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Can articaine be used for pregnant women? |
No It’s a category B3 drug |
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From what age can articaine be administered to patients |
Children over the age of 4 |
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What category is lignocaine ? |
Category A |
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What are some features of lignocaine |
Rapid onset, moderate duration Allergies extremely rare Very few contraindications for use 90% metabolised in liver Excreted in urine (90% as metabolites, 10% as free drug) Half life 1.5-1.8 hours |
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Which category drugs are safe to be used during pregnancy ? |
Category A drugs |
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Can articaine be used for pregnant women? |
No It’s a category B3 drug |
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From what age can articaine be administered to patients |
Children over the age of 4 |
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What category is lignocaine ? |
Category A |
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Where is articaine broken down? |
In plasma |
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What are some features of lignocaine |
Rapid onset, moderate duration Allergies extremely rare Very few contraindications for use 90% metabolised in liver Excreted in urine (90% as metabolites, 10% as free drug) Half life 1.5-1.8 hours |
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Which category drugs are safe to be used during pregnancy ? |
Category A drugs |
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Can articaine be used for pregnant women? |
No It’s a category B3 drug |
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From what age can articaine be administered to patients |
Children over the age of 4 |
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What category is lignocaine ? |
Category A |
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Where is articaine broken down? |
In plasma |
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Is prilocaine safe to use on pregnant women? |
Yes Pregnancy category A drug |
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What are some features of lignocaine |
Rapid onset, moderate duration Allergies extremely rare Very few contraindications for use 90% metabolised in liver Excreted in urine (90% as metabolites, 10% as free drug) Half life 1.5-1.8 hours |
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Which category drugs are safe to be used during pregnancy ? |
Category A drugs |
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Can articaine be used for pregnant women? |
No It’s a category B3 drug |
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From what age can articaine be administered to patients |
Children over the age of 4 |
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What category is lignocaine ? |
Category A |
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Where is articaine broken down? |
In plasma |
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Is prilocaine safe to use on pregnant women? |
Yes Pregnancy category A drug |
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If the drug is “plain” what does this mean? |
It comes without a vasoconstrictor |
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What do all the synthetic local anaesthetics cause to blood vessels ? |
Vasodilation
Cocaine is the only one that causes vasoconstriction |
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What does LA bind to in the body? |
Alpha-1 acid glycoprotein (AAG) |
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Generally where are the drugs metabolised ? |
Liver or plasma |
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What is the common cause of burning sensation experienced by patients ? |
Lower pH Acid burns |
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What is the common cause of burning sensation experienced by patients ? |
Lower pH Acid burns |
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What is added to make the solution more isotonic ? |
Sodium chloride |
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What is the common cause of burning sensation experienced by patients ? |
Lower pH Acid burns |
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What is added to make the solution more isotonic ? |
Sodium chloride |
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What is the main vasoconstrictor added to LA? |
Adrenaline |
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What is felypressin? |
Synthetic analogue of vasopressin Classification A drug (safe on pregnant women) |
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What can LA overdose cause ? |
Methaemoglobinaemia |
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How long does topical anaesthetic take to work ? |
Usually 3-5 mins |
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How long does topical anaesthetic take to work ? |
Usually 3-5 mins |
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What goes on first needle or cartridge? And why |
Needle To prevent bending |
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What is the difference between a block and infiltration ? |
Block- nerve impulses are blocked more proximal (closet to the brain) Infiltration- nerve endings are anaesthetised (adjacent to the site) |
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What is the difference between a block and infiltration ? |
Block- nerve impulses are blocked more proximal (closet to the brain) Infiltration- nerve endings are anaesthetised (adjacent to the site) |
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What nerve does the buccal infiltration anaesthetise? |
Superior alveolar nerve |
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What does the naso palatine nerve block ? |
Anaesthetises palatal tissues to canine |
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With buccal infiltration can you anaesthetise the teeth or any buccal tissue ? |
NO just the palatal side of teeth and palate |
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With buccal infiltration can you anaesthetise the teeth or any buccal tissue ? |
NO just the palatal side of teeth and palate |
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What are the two main intra-oral landmarks for the mandible ? |
Pytergomandibular raphe Pterygotemporal depression |
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With buccal infiltration can you anaesthetise the teeth or any buccal tissue ? |
NO just the palatal side of teeth and palate |
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What are the two main intra-oral landmarks for the mandible ? |
Pytergomandibular raphe Pterygotemporal depression |
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Define aspiration in LA |
Creating a negative pressure in cartridge to check if needle tip is in a blood vessel |
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With buccal infiltration can you anaesthetise the teeth or any buccal tissue ? |
NO just the palatal side of teeth and palate |
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What are the two main intra-oral landmarks for the mandible ? |
Pytergomandibular raphe Pterygotemporal depression |
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Define aspiration in LA |
Creating a negative pressure in cartridge to check if needle tip is in a blood vessel |
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What is the long buccal nerve used for ? |
To anaesthetise buccal tissues of mandibular molars |
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With buccal infiltration can you anaesthetise the teeth or any buccal tissue ? |
NO just the palatal side of teeth and palate |
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What are the two main intra-oral landmarks for the mandible ? |
Pytergomandibular raphe Pterygotemporal depression |
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Define aspiration in LA |
Creating a negative pressure in cartridge to check if needle tip is in a blood vessel |
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What is the long buccal nerve used for ? |
To anaesthetise buccal tissues of mandibular molars |
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What is methaemoglobinaemia? |
The haemaglobin molecules can carry oxygen but can’t release it to the body tissues If left untreated, it can be fatal |
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What is methaemoglobinaemia? |
The haemaglobin molecules can carry oxygen but can’t release it to the body tissues If left untreated, it can be fatal |
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What is Vaso vagal syncope? |
Fainting |
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What is methaemoglobinaemia? |
The haemaglobin molecules can carry oxygen but can’t release it to the body tissues If left untreated, it can be fatal |
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What is Vaso vagal syncope? |
Fainting |
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What’s orthostatic hypotension and which age category is it commonly seen in after administering LA? |
This is low blood pressure and occurs when an individual stands up too quickly Condition seen commonly in elderly patients |
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When does methaemoglobinaemia occur? |
Occurs when red blood cells contain methaemoglobin at levels higher than 1% |
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When does methaemoglobinaemia occur? |
Occurs when red blood cells contain methaemoglobin at levels higher than 1% |
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Which topical anaesthetic can cause methaemoglobinaemia? |
Benzocaine |
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When does methaemoglobinaemia occur? |
Occurs when red blood cells contain methaemoglobin at levels higher than 1% |
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Which topical anaesthetic can cause methaemoglobinaemia? |
Benzocaine |
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Which local anaesthetic can cause methaemoglobinaemia? |
Prilocaine |
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What treatment can be given for methaemoglobinaemia? |
Methylene blue injection It reduces MeHb back to OxyHb |
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What treatment can be given for methaemoglobinaemia? |
Methylene blue injection It reduces MeHb back to OxyHb |
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What are the first effects of overdose on the CNS? |
Inhibitory interneurons are blocked first, with initial excitatory phenomena including -circumoral tingling -visual and auditory disturbances -tremors -dizziness -convulsions/seizures |
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Which type of block or infiltration can commonly result in positive aspiration? |
Inferior alveolar nerve blocks |
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What are systemic effects that occur after injecting LA? |
Increased heart rate Increased blood pressure |
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What are systemic effects that occur after injecting LA? |
Increased heart rate Increased blood pressure |
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What are some causes of slow onset of anaesthesia? |
Problems at injection site: -Proximity to nerve (LA deposited too far away, wrong site) -Physical barriers to diffusion (muscle, bone, fluid) -pH of tissues (infection, inflammation) |
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For IANB is more volume or higher concentration of LA better? |
More volume is better than increasing concentration: -longer sections of the nerve is ‘bathed’ in LA -more nodes of ranvier affected
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For IANB is more volume or higher concentration of LA better? |
More volume is better than increasing concentration: -longer sections of the nerve is ‘bathed’ in LA -more nodes of ranvier affected
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When are increasing concentrations of LA preferred? |
Increasing concentration is better at achieving anaesthesia only when short lengths of the nerve are available |
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What is anaesthetised from an IANB if it is spread throughout the infratemporal fossa? |
Auriculotemporal nerve anaesthesia Long buccal nerve |
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What is anaesthetised from an IANB if it is spread throughout the infratemporal fossa? |
Auriculotemporal nerve anaesthesia Long buccal nerve |
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What causes facial nerve paralysis? |
Zygomatic branch of CNVII are blocked within deep ole of parotid gland LA was deposited too far posteriorly during IANB |
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What is anaesthetised from an IANB if it is spread throughout the infratemporal fossa? |
Auriculotemporal nerve anaesthesia Long buccal nerve |
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What causes facial nerve paralysis? |
Zygomatic branch of CNVII are blocked within deep ole of parotid gland LA was deposited too far posteriorly during IANB |
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What is trismus? |
Reduced or restricted opening |
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What are causes of trismus? |
Trauma to muscles or blood vessels in the infratemporal fossa Haemorrhage Infection Excessive volumes of LA |
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What are causes of trismus? |
Trauma to muscles or blood vessels in the infratemporal fossa Haemorrhage Infection Excessive volumes of LA |
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What is a risk factor for haematoma? |
Advancing a needle through a bony canal or foramen |
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What are the most common sites for haematoma? |
PSA nerve block (visible extraorally) IAN block (visible intraorally) Mental/incisive block (risk of parathesia) |
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What causes pain at the injection site ? |
Blunt needle Injecting into inflamed tissue Using too large a needle Injecting too quickly Solution too cold |
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What causes pain at the injection site ? |
Blunt needle Injecting into inflamed tissue Using too large a needle Injecting too quickly Solution too cold |
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How can you manage pain on injection? |
Use topical Inject into taut tissue Insert needle in a straight path Bevel parallel to bone Inject slowly |
