Local Anesthesia Final

Front 1

What leaves were first discovered to cause the effect of anesthesia?

Back 1

Coca leaves, cocaine was isolated

Front 2

William Stewart Halsted and Richard john hall developed what and when?

Back 2

Inferior dental nerve block in 1884

Front 3

Who is called the father of local anesthesia?

Back 3

Henrich Braun

Front 4

What type of anesthetic is procaine?

Back 4

Ester type

Front 5

Who synthesized lidocaine and when?

Back 5

Nils Lofgren in 1943

Front 6

What type of anesthetic is lidocaine?

Back 6

Amide type

Front 7

What are 3 characteristics of ester type anesthetic?

Back 7

Short acting, increased allergy, slow onset (10-15 mins)

Front 8

What are 3 characteristics of amide anesthetics?

Back 8

Longer duration, short onset (3-5 mins), less allergy

Front 9

What 3 things do damaged cells release and what are they called collectively?

Back 9

K+, H+ and proteolytic enzymes called inflammatory soup

Front 10

Release of what stimulates more bradykinin formation and activates mast cells and platelets?

Back 10

Substance P

Front 11

Nociceptor nerve endings project along the processes of _________ that extend into the ____________.

Back 11

Odontoblasts, dentinal tubules

Front 12

What fibers are “fast-pain fibers” and which are “slow-pain fibers?”

Back 12

Fast = A-δ
Slow=C fibers

Front 13

What prevents the charge from leaking out of the axon?

Back 13

Myelin sheath

Front 14

Local anesthetic enters what channel from what side?

Back 14

Sodium channel from axoplasmic side

Front 15

What is the normal (resting potential) of a nerve?

Back 15

-70mV

Front 16

Primary effects of local anesthetics occur during ______ phase of action potential

Back 16

Depolarization

Front 17

What is the site at which LA’s exert their pharmacologic effects?

Back 17

Nerve membrane

Front 18

What theory explaining the actions of LA is most favored today?

Back 18

Specific receptor theory

Front 19

What does the specific receptor theory state?

Back 19

LA acts by binding to specific receptors on the sodium channel

Front 20

What is the only access to the nerve for LA?

Back 20

Nodes of Ranvier

Front 21

Where are sodium channels abundant in the nerves?

Back 21

Nodes of Ranvier

Front 22

How many nodes of ranvier need to be blocked to stop action potential?

Back 22

3 or so

Front 23

What ions are thought to exert a regulatory role on the movement of sodium ions across the nerve membrane?

Back 23

Calcium ions

Front 24

What may be the primary reason for the increased sodium permeability of the nerve membrane?

Back 24

The release of bound calcium ions from the ion channel receptor site

Front 25

The majority of local anesthetics are ____ amines

Back 25

tertiary

Front 26

Which anesthetic was first synthesized and what type is it?

Back 26

Procaine (ester)

Front 27

Once the molecules of LA enter the axoplasm, most become ______ to enter sodium channel

Back 27

protonated

Front 28

What are the 2 factors involved in the action of LA

Back 28

Diffusion of the drug and binding at receptor site

Front 29

What is the most important quality of a LA?

Back 29

Ability to diffuse

Front 30

Do you want a high or low pKa for a more rapid onset of action?

Back 30

LOWER pKa

Front 31

All local anesthetics, except cocaine, act as what?

Back 31

Vasodilators

Front 32

What do all local anesthetics cross?

Back 32

The blood-brain barrier and the placenta, entering into fetal circulation

Front 33

What is the halflife of lidocaine?

Back 33

1.6 hrs

Front 34

What do vasoconstrictors do for the LA?

Back 34

Slow the absorption into cardiovascular system
Results in lower blood levels, lower risk of toxicity
Increased duration of action at site, decreased bleeding

Front 35

What is the mode of action for epinephrine and levonordefrin?

Back 35

Direct-acting. Acts directly on adrenergic receptors

Front 36

What are the 2 types of adrenergic receptors and what do they control

Back 36

Alpha – smooth muscle contrxtion (vasoconstriction)
Beta – smooth muscle relaxation (vasodilation)

Front 37

What dilution do we tend to use for vasoconstrictors (epinephrine)?

Back 37

1:100,000

Front 38

How many micrograms of epinephrine are in one cartridge of LA with 1:100,000 dilution?

Back 38

18 micrograms.
1.8ml per cartridge x 10micrograms/ml

Front 39

How long do short, intermediate, and long duration drugs provide pulpal or deep anesthesia for?

Back 39

Short – 30 mins or less
Intermediate – about 60 mins
Long – longer than 90 mins

Front 40

What percent of people are normal responders to anesthesia, pulpal anesthesia for about 60 mins?

Back 40

68%

Front 41

Inflammation, infection, or pain does what to the duration of the LA?

Back 41

decreases

Front 42

What is the maximum recommended dose of lidocaine and mepivacaine?

Back 42

2.0 mg/lb

Front 43

What is the volume of the cartridges we use?

Back 43

1.7ml

Front 44

What is the maximum number of cartridges of 1:100,000 epi for a normal ASA I patient

Back 44

11

Front 45

What is the max # of cartridges of 1:100,000 epi for an ASA III or IV patient?

Back 45

2

Front 46

Which needle is the thickest?
Guage = 25, 27, 30 ?

Back 46

25 gauge
Lower gauge = thicker needle

Front 47

What is the length of the long and short needles?

Back 47

Long = 32 mm , Short = 20mm

Front 48

Does a smaller gauge or larger gauge have less deflection

Back 48

Smaller gauge because it is thicker

Front 49

Needles should be changed after ______ insertions in a single patient

Back 49

3 or 4

Front 50

What is the color of the cartridge band for lidocaine HCl 2% with epinephrine 1:100,000?

Back 50

Red

Front 51

How often should a patient’s medical history be updated?

Back 51

At least every 6 months

Front 52

What ASA classification is a patient with mild to moderate systemic disease?

Back 52

ASA II

Front 53

What ASA classification is a healthy patient with extreme anxiety and fear towards dentistry?

Back 53

ASA II

Front 54

What ASA class if a patient with severe systemic disease that limits activity, but is not incapacitating?

Back 54

ASA III

Front 55

What ASA’s are patients with stable angina pectoris and unstable?

Back 55

Stable = ASA III
Unstable = ASA IV

Front 56

A patient should not receive within __ months of a myocardial infarction.

Back 56

6 months

Front 57

What is normal BP? BP for pre-hypertensive, BP for stage 1 hypertension?

Back 57

Normal = 120/80
Pre-hypertensive = 120-139/80-89
Stage 1 hypertension = 140-159/90-99

Front 58

What is the BP signifying Stage 2 hypertension?

Back 58

160-169/100-109

Front 59

What is BP of Stage 3 hypertension and what does this mean?

Back 59

>180/>110
Stop exam, no treatment, refer for medical consult immediately

Front 60

What are the 6 vital signs?

Back 60

Blood pressure, heart rate, respiratory rate, temperature, height, weight

Front 61

What is the normal heart rate, normal resp rate?

Back 61

60-110 bpm
~12 respirations/min

Front 62

PSA, IA, and NP injections are examples of ____ ______.

Back 62

Nerve blocks

Front 63

What are the 3 branches of the trigeminal nerve?

Back 63

Ophthalmic (V1) , Maxillary (V2), Mandibular (V3)

Front 64

Is V2 sensory, motor, or both?

Back 64

All sensory.

Front 65

What does V2 travel through and exit?

Back 65

The foramen rotundum

Front 66

The PSA provides pulpal anesthesia to what teeth? And what is the exception?

Back 66

Maxillary 3rd, 2nd, and 1st molars.
Exception: in 28% of patients the PSA does not innervate the mesiobuccal root of first molar

Front 67

What makes up the superior dental plexus?

Back 67

PSA, MSA, and ASA

Front 68

The MSA provides sensory innerv. to what?

Back 68

The 2 max. premolars and possibly the mesiobuccal root of first molar

Front 69

The MSA nerve is present in only about __% of the population

Back 69

72%

Front 70

The ASA provides pulpal innervations to what teeth?

Back 70

Central and lateral incisors and canines

Front 71

What is in the area of the PSA that makes the injection slightly more dangerous?

Back 71

Pterygoid plexus

Front 72

Where is the site of the MSA injection?

Back 72

Superficial and between the 2 max premolars

Front 73

Which intraoral injection is potentially the most traumatic?

Back 73

Nasopalatine Nerve block

Front 74

Which division of the trigeminal nerve is the largest?

Back 74

Mandibular division (V3)

Front 75

Is V3 sensory, motor, or both?

Back 75

It has 2 roots, a large sensory, and smaller motor

Front 76

The 2 roots of V3 emerge from the cranium separately through the ___________.

Back 76

Foramen ovale

Front 77

What is the rate of failure for the IA injection?

Back 77

15-20%

Front 78

What is a main complication of the IA injection?

Back 78

Injection into parotid capsule resulting in facial nerve paralysis

Front 79

What does the IA injection anesthetize?

Back 79

All mandibular teeth to midline, lingual soft tissue, anterior 2/3 of tongue, buccal soft tissue ANTERIOR to the mental foramen

Front 80

What nerve usually passes between the 2 heads of the lateral pterygoid?

Back 80

Buccal Nerve

Front 81

What does the buccal nerve innervate?

Back 81

Sensory to buccal gingival of mandibular molars and mucobuccal fold.
It does NOT innervate the buccinators muscle

Front 82

Mental nerve block only gives _______ anesthesia.

Back 82

tissue

Front 83

Gow-Gates injections blocks what?

Back 83

Blocks virtually the entire distribution of V3. True mandibular nerve block

Front 84

What mandibular injection should be used for a patient with limited mandibular opening?

Back 84

Vazirani-Akinosi injection

Front 85

What is the recommended volumes of anesthetic for the IA and the Buccal?

Back 85

IA = 1.5 ml
Buccal = 0.3 ml

Front 86

Paresthesia is defined as…

Back 86

Persistent anesthesia (anesthesia well beyond the expected duration)

Front 87

Which lasts longer… soft tissue anesthesia or pulpal anesthesia?

Back 87

Soft tissue

Front 88

What are the 2 most common postanesthetic intraoral lesions?

Back 88

Recurrent aphthous stomatitis
Herpes simplex

Front 89

On average, a dentist will do approx. ____ injections per year, and have about _____ complications per year.

Back 89

2000 injections
50-100 complications

Front 90

Patients with _____ ______ allergy must not have LA with vasoconstrictor.

Back 90

Sodium bisulfate

Front 91

What are early signs of Vasovagal syncope?

Back 91

Paleness, perspiration, nausea, increased heart rate, feeling of warmth

Front 92

What are late signs of vasovagal syncope?

Back 92

Yawning, dilated pupils, cold extremities, hyptension
Dizziness, loss of consciousness

Front 93

How should you treat a patient who fainted?

Back 93

Position patient supine, head lower than feet if possible (TRENDELENBURG)

Front 94

What are 3 supplemental injection techniques?

Back 94

PDL, Intraosseous, and Intrapulpal Injection

Front 95

Which injection can cause enamel hypoplasia to developing tooth bud if used on primary teeth?

Back 95

PDL injection

Front 96

Which injection is the deposition of anesthetic directly into the bone between 2 teeth?

Back 96

Intraosseous injection

Front 97

What teeth are intrapulpal injections mostly used on?

Back 97

Mandibular molars

Front 98

Which injection may you actually need to bend the needle?

Back 98

Intrapulpal injection

Front 99

Where is the mandibular foramen in children as compared to adults?

Back 99

Children – foramen at occlusal plane
Adults – foramen 1 cm ABOVE occlusal plane

Front 100

What is different in the injections for maxillary teeth in children?

Back 100

Infiltration for all teeth, no PSA needed

Front 101

Depth of penetration for IA injection in kids is about ___mm, whereas it is __-___mm in adults.

Back 101

15mm
20-25mm in adults

Front 102

What 2 anesthetics are used in oraqix (needle-free anesthesia during SRP)

Back 102

Lidocaine and prilocaine gels

Front 103

What does oraVerse do?

Back 103

Reverses the effects of the vasoconstrictors. Sensation returns faster.