Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
68 Cards in this Set
- Front
- Back
|
Local Infiltration
|
Penetration Site: mucofacial fold; midline of tooth
Insert Depth: 1-5 mm Deposition Site: at root apex Amt: 1/2 - 3/4 cartrigde Max Teeth: from MB of 1st Molar to midline Mand Teeth: incisors only Bone, facial periosteum, gingiva and mucosa |
|
|
PSA
|
Penetration Site: posterior to zygomatic buttress in muccobuccal fold
Insert Depth: 12-18 mm Deposition Site: vicinity of foramen for PSA nerve Amt: 3/4 cartridge Max 3rd & 2nd molars DF & P roots of 1st molar Bone, facial periosteum, gingiva and mucosa |
|
|
Nasopalatine - Step 1: Infiltration
|
Penetration Site: Midline of each maxillary central incisor
|
|
|
Nasopalatine - Step 2: Modified Interdental
|
Penetration Site: Midline interdental papilla, #2 mm apical to papilla crest
Depth: 2-4 mm (1 mm at a time) Deposition Site: continuous along path of insertion Amt: 1/2 - 1 stopper Area: Interdental papilla to incisive papilla |
|
|
Anterior Palatine (Greater Palatine) Nerve Block
|
Penetration Site: 2 mm anterior to soft palate junction & mediolaterally where tissue compresses
Depth: 2-4 mm Deposition Site: vicinity of greater palatine foramen Amt: 1 - 1.5 stopper Area: Post. of hard palate; from palatal FGM near teeth to midline of palate on side injected; tissue, NOT tooth |
|
|
Inferior Alveolar (IA) Nerve Block
|
Penetration Site: superio inferiorly at least 1/2 way sup. from post. mand. molar occ. surface to post. mas. occ. surface
Depth: 25-30 mm Deposition Site: above foramen of mandibular canal Amt: 3/4 cartridge Area: mand quadrant of teeth & bone; anteriorly from foramen to midline |
|
|
Inferior Alveolar (IA) Nerve Block
|
Other Penetration Site:
Medial to internal oblique ridge of ramus Just lateral to Pterygomandibular ligament of ramus All other criteria same as other flashcard |
|
|
Lingual Nerve Block
|
Penetration Site: same as IA
Depth of Insertion: 12-15 mm Deposition Site: vicinity of desc. lingual n. (b/c there's no lingual foramen Amt: 1/4 cartridge Area: lingual gingiva; mucous membrane of floor of mouth; ant. 2/3 of tongue |
|
|
Buccal Nerve Block
|
Penetration Site: height of mand. occlusal plane, higher for extracting 3rd molars, or vestibule due to trauma
Depth: 2-3 mm Deposition Site: vicinity of path of buccal nerve Amt: 1/3 cartridge Area: facial gingiva & mucosa from site of injection to mental foramen |
|
|
Nasopalatine - Step 3
|
Penetration Site: Lateral to incisive papilla
Depth of Insertion: 2-3 mm (1 mm at a time) Deposition Site: Midline over incisive canal Amt: 1 stopper Area: ant 1/3 of hard palate & overlying structures if injected at midline; tissue, NOT tooth structure |
|
|
1. What must be done before placing topical?
|
Gently wipe tissue of any potential barrier with 2x2 gauze
|
|
|
2. Is more topical necessarily better?
|
No, it will cause extra salivation and go down the throat
|
|
|
3. How long should the topical be left in place before needle penetration?
|
Minimum of 1-2 minutes
|
|
|
4. How long is the short needle used at Pacific S.F. main clinic?
|
20 mm
|
|
|
5.How far should the needle penetrate in giving PSA injection?
|
12-18 mm (2-8 mm from the hub of the needle which visually is 1-3 gradations of Pacific's periodontal probe
|
|
|
6. What is the range in length of short needles?
|
Short needles come in different sizes; give any outrageous number; (20-25 mm is standard); 25 mm at Stockton clinic
|
|
|
7. How long is the long needle used at Pacific S.F. main clinic?
|
32 mm (most commonly used for mandibular blocks)
|
|
|
8. How far should the needle penetrate in giving a Gow-Gates or Inferior Alveolar injections?
|
25-30 mm (thus 2-7 mm from hub of needle);
|
|
|
9. What is the range in length of long needles?
|
29-41 mm; give outrageous numbers
|
|
|
10. List 3 reasons why the needle must be replaced for the same patient.
|
1. After 3rd penetration
2. After an injection, if bone was contacted 3. Before the anterior palatine (greater palatine) injection |
|
|
11. What is the maximum number of cartridges that can be given without instructor guidance and/or approval?
|
2 cartridges of local anesthetic
|
|
|
12a. Function of Local Anesthetic Component of a cartridge
|
Block neural pain message transmission to brain
|
|
|
12b. Function of Hydrochloric Acid anesthetic component of a cartridge
|
1. Lowers pH
2. Makes LA soluble in water (for diffusion) 3. Makes LA more stable (longer shelf-life) 4. More is added in cartridge with vasoconstrictor ot inhibit oxidation of vasoconstrictor |
|
|
12c. Function of Vasoconstrictor anesthetic component of a cartridge
|
Lengthens duration of anesthesia by allowing local anesthetic to remain in longer via peripheral vasoconstriction
|
|
|
12d. Sodium bisulfate or metabisulfate (only in anesthetics with vasoconstrictor)
|
Preserve vasoconstrictor from oxidation (antioxidant)
|
|
|
12e. Sodium Chloride
|
To control osmotic balance so that it is the same as the tissue (isotonic)
|
|
|
12f. Distilled Water
|
Mixer or dilutent
|
|
|
13. Convert the following:
a. 0.5% LA = __ mg/mL b. 2.0% LA = __ mg/mL c. 4.0% LA = __ mg/mL d. 10% LA = __ mg/mL |
a. 5 mg/mL
b. 20 mg/mL c. 40 mg/mL d. 100 mg/mL |
|
|
14. How much LA solution is in a cartridge?
|
1.8 mL
|
|
|
16. How much time should you take in administering a cartridge of LA?
|
30-60 sec/mL (approx. 1-2 min/cartridge)
|
|
|
The amount of Epi in a LA having 1:100,000 Epi is how many mg/mL?
|
0.01 mg/mL
|
|
|
How many mg of Epi are in a cartridge of LA?
|
1.8 mL x 0.01 mg/mL = 0.018 mg/cartridge
|
|
|
18. How many mg of vasoconstrictor are in 2 cartridges of 1:200,000 LA?
|
2 x 1/2 x 0.01 = 0.018 mg for 2 cartridges
|
|
|
19. What is the usual time for onset of anesthesia?
|
3-5 minutes
|
|
|
20. What must be done prior to placing clamp on a tooth?
|
Tooth: mirror handle to percussion test the tooth and contralateral tooth
Tissue: use curve of #2 explorer to pressure test any tissue that may be impacted by the clamp |
|
|
21. What must be done before using a handpiece on a tooth?
|
Tooth: mirro handle to percussion test the tooth and contralateral tooth
|
|
|
22. What is a good way to make sure the patient understands what area of the lip you are asking aobut to determine if the mandibular block injection was successful?
|
Tap on area of lower lip near midline and ask how area feels: regular, tingling, or swollen/fat? Tap the other side if in doubt
|
|
|
23. Does the patient with subjective tingling sensation to the midline of the lower lip have anesthesia to the quadrant of teeth on that side?
|
No.
|
|
|
24. Will the patient with subjective tingling sensation to the midline of the lower lip later have profound anesthesia?
|
Many times they will not. There may not be enough LA solution at the nerve to surround it and diffuse to all the nerve fibers withing the neurovascular bundle
|
|
|
25. Does the patient with subjective swollen sensation to the midlien of the lower lip have profound anesthesia to the quadrant of teeth on that side?
|
Yes, in the majority of cases
|
|
|
26. What 3 nerves must be anesthetized before a tooth can be extracted?
|
a. Nerve innervating tooth and bone
b. Nerve to Lingual/Palatal gingival attachment c. Nerve to buccal soft tissue |
|
|
27. What nerves must be anesthetized before a segment/area/quadrant of root planing?
|
a. Nerve innervating tooth since area below CEJ is sensitive to instrumentation
b. Nerve innervating lingual/palatal soft tissue since tissue will be impacted during instrumentation c. Nerve innervating buccal soft tissue since tissue will be impacted during instrumentation |
|
|
28. Does the tissue site sometimes look swollen after an injection due to the quantity of local anesthetic injected?
|
Yes
|
|
|
Will the penetration site sometimes bleed after the injection?
|
Yes
|
|
|
30a. 25 Gauge Needle:
Sheat Color Width Deflection Ability to Aspirate |
Sheat Color: Red
Width: Widest Deflection: Least Ability to Aspirate: Best |
|
|
30b. 27 Gauge Needle:
Sheat Color Width Deflection Ability to Aspirate |
Sheat Color: Yellow
Width: Mid Deflection: Mid Ability to Aspirate: Mid |
|
|
30c. 30 Gauge Needle:
Sheat Color Width Deflection Ability to Aspirate |
Sheat Color: Blue
Width: Narrowest Deflection: Most Ability to Aspirate: Least |
|
|
31a. Describe the Hub of the needle
|
The hub is the part immediately attached to the needle. It is metal or plastic. It is threaded or self-threading.
|
|
|
31b. Describe the Tip of the needle
|
The type of bevel, sharpness, and barbs will impact ease of penetration and penetration pain.
|
|
|
32. Does everyone like the same needle?
|
No.
|
|
|
33. List the LAs commonly used in dentistry:
|
Limpa Bet & XOPOCS M.D.
Generic: Brand: Lidocaine Xylocaine,other Mepivacaine Polocaine,other Prilocaine Citanest Articaine Septocaine Bupivacaine Marcaine Etidocaine Duranest |
|
|
Which LAs are longer acting?
|
Generic: Brand:
Bupivacaine Marcaine Etidocaine Duranest |
|
|
What is Paresthesia? Does it improve?
|
Duration of anesthesia well beyond normal. Improvement in degree and extent of symtpoms is good. No improvement over several months may be permanent. Lingual nerve is 2x more likely than IA nerve.
|
|
|
What is Dyesthesia? Does it improve?
|
Pain felt from the area of the nerve innervated though damage is in the nerve trunk. Nerve damage is causing nerve transmission pain. Improvement is good and Lingual nerve is 2x more likely than IA nerve.
|
|
|
35. Which LAs are associated with frequent nerve injuries?
|
4% local anesthetics, especially 4% articaine. (high concentrated LA is neurotoxic to myelin sheaths)
|
|
|
36a. How are ester-derived LAs metabolized?
|
Those such as Procaine-Novocain are metabolized in blood plasma by plasma pseudocholinesterase.
|
|
|
36b. How are amide-derived LAs metabolized?
|
Amides are the modern type. They are metabolized in the liver by microsomal enzymes.
|
|
|
36c. How is Articaine broken down?
|
Ester & Amide linkage is broken down in two steps:
a. ester linkage broken down in plasma b. amide linkage broken down in liver |
|
|
37. What is the half-life of LAs?
|
Articaine: about 30 min due to faster ester bond breakdown in blood
Other amides: about 1.5 hours b/c they must be broken down in liver |
|
|
38. How is the maximum dose determined?
|
Person weighing 154 lbs (70 kg) & in good health: use max in LA chart
Person below 154 lbs (70 kg) & good health: multiply dose by weight Person NOT in good health: usu. has adequate liver function, but impact of vasoconstrictor is a concern. |
|
|
39. Can more than the maximum dose of LA be used by factoring in local anesthetic metabolism?
|
NO. Maximum dose is per appointment/day
|
|
|
40. Can more than one type of LA be used on a patient during an appointment?
|
Yes, but you use the maximum dose for the LA that has the least amount.
|
|
|
41. How should LAs be stored?
|
59-86 F to keep vasoconstrictor from premature breakdown. Hot temp. and intense light will breakdown the vasoconstrictor
|
|
|
42. Signs of vasoconstrictor breakdown?
|
All injections with incomplete anesthesia or shortened duration of anesthesia
|
|
|
43a. What are some issues regarding LAs, duration, & temp. control when using 3% Mepivacaine w/o vasoconstrictor?
|
Will only last about 20 min maxillary and 40 min mandibular block if in a place where LA cannot be protected from high temp.
|
|
|
43b. What are some issues regarding LAs, duration, & temp. control when using 2% Lidocaine w/o vasoconstrictor?
|
Will only last 5 minutes with hard tissue anesthesia: worthless.
|
|
|
44. What is the biggest issue with an unhealthy patient and local anesthetics?
|
How the patient's cardiovascular system will respond to vasoconstrictors such as Epinephrine & Levonordefrin.
|
|
|
45. What do you NEED to do prior to delivering a case presentation to faculty?
|
Be able to know how the patient's medical history impacts local anesthesia and dentistry and theoretical questions on how other medications of health issues would affect LA & patient care.
|
