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100 Cards in this Set
- Front
- Back
Osteology of maxilla |
right & left maxillae, more porous/ cancellous |
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why is there a greater chance of correctly anesthetizing when working on the maxilla |
the bone is more porous/ cancellous then the mandible |
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what are the techniques we learned for maxillary anesthesia |
local infiltration, field block, nerve block, PSA, MSA, ASA, GP, NP |
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what type of needle do we use for local infiltration? |
short need;e |
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define local infiltration |
area of treatment is flooded with local anesthetic, incision is made into the same area |
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what term is often misused when talking about a local infiltration |
dentists often use the term local infiltration to describe a field block |
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is local infiltration soft tissue anesthesia or pulpal anesthesia |
soft tissue |
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what type of needle do we use for a field block |
short needle |
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is a field block soft tissue anesthesia or pulpal anesthesia |
pulpal anesthesia |
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define a field block anesthesia |
solution deposited near the larger terminal nerve branches, anesthetized area circumscribes (prevents impulses from traveling from the tooth to the CNS)---larger area anesthetized |
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where do you insert the needle for a field block injection |
administered above the apex of the tooth |
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define a nerve block |
2-3 injections, deposited close to a main nerve trunk EX. PSA, inferior alveolar, NP |
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what soft tissue areas will be anesthetized with a PSA injection? |
maxillary molars except for the mesiobuccal root of the 1st molar |
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is there bone contact with a PSA? |
no bone contact |
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is a PSA injection pulpal or soft tissue anesthesia |
pulpal |
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what are some contraindications for the PSA |
blood disorders, Warfarin |
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what is an advantage & disadvantage with the PSA injection |
advantage= atraumatic (no pain), disadvantage= hematoma |
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what are some alternative injections to the PSA |
supraperiosteal or PDL injections (shallow, no risk of hitting BV) |
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what type of needle is used for the PSA and why do we use this type of needle |
short needle, 27 gauge... due to risk of hematoma |
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what is the target area for the PSA injection |
PSA nerve, above the 2nd molar |
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what is the insertion for the PSA injection |
height of mucobuccal fold above 2nd molar |
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what is the depth of insertion for the PSA |
16mm |
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what is the technique used for the PSA injection |
retract tissue (looks like a "V"), orient needle inward-upward-backward, use zygoma as tool, aspirate in 2 planes |
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is the MSA block pulpal or soft tissue anesthesia |
pulpal anesthesia |
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what areas are anesthetized with the MSA |
premolars & mesiobuccal root of 1st molar |
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is there bone contact with the MSA injection |
no bone contact |
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what type of needle is used for the MSA |
short or long needle, 27 gauge |
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what is the injection site for the MSA block |
height of mucobuccal fold above 2nd premolar |
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what is the target area for the MSA block |
above the apex of 2nd premolar |
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what is another name for the ASA nerve block |
infraorbital nerve block |
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what nerves are anesthetized with the ASA block |
anterior superior alveolar & infraorbital nerve |
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what areas are anesthetized with the ASA block |
maxillary central incisors to the canine |
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does the ASA nerve block contact bone? |
yes it does, face the bevel of the needle toward the bone |
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what are some disadvantages with the ASA |
operator may have a fear of injuring patients eye (intraoral techniques rarely a problem) |
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what type of needle do we use with the ASA block |
long needle 25- or 27- gauge (a short needle may be used but for Boards we must know long needle) |
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where do we insert the needle for an ASA block |
height of mucobuccal fold directly over the 1st premolar (may insert over the canine) |
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what is the target area for the ASA block |
infraorbital foramen (over the canine) |
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what happens when you contact bone with the ASA block? |
the patient will feel it, pull back 1mm and inject |
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what are some landmarks for the ASA injection |
mucobuccal fold, infraorbital notch, infraorbital foramen |
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what type of needle is recommended for palatal anesthesia |
27 gauge, short needle |
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what are the benefits of palatal anesthesia (GP & NP) |
they numb the side of the palate, before we used to inject each tooth separately) |
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What is another name for the greater palatine nerve block |
anterior palatine nerve block |
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what areas are anesthetized with the GP block |
posterior portion of the hard palate, soft tissues from 1st premolar and medially to the midline |
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what type of needle do we use for the greater palatine nerve block |
short needle, 27 gauge |
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where is the area of insertion for the GP nerve block |
soft tissue, slightly anterior to the greater palatine foramen |
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what is the target site for the GP block |
greater palatine nerve as it passes anteriorly between soft tissue & bone of the hard palate |
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what are the landmarks for the GP block |
GREATER PALATINE FORAMEN & junction of the maxillary alveolar process & palatine bone, IN LINE WITH 2ND MOLAR DISTALLY |
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can we inject into the greater palatine foramen when giving a GP nerve block |
NO! never inject into the foramen, keep cotton swab on foramen, inject anterior to foramen |
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what is the pre puncture technique and what injections should it be used for? |
hover over injection site, use pressure with cotton swap, drop a little solution onto area being anesthetized before entering the needle-- Use for GP & NP |
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what is another name for the nasopalatine nerve block |
incisive nerve block |
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true/ false The nasopalatine nerve block is a bilateral block |
false, it is unilateral (only one injection is performed for right & left maxillae) |
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what areas are anesthetized with the NP block |
anterior portion of the hard palate (soft & head tissues), bilaterally from the mesial of the right 1st premolar to the mesial of the left 1st premolar |
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what type of needle is used for the NP block |
short needle, 27 gauge |
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what area of insertion is used for the NP block |
palatal mucosa lateral to incisive papilla (almost under papilla) |
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what are the target areas for the NP nerve block |
incisive foramen beneath the incisive papilla |
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what are some landmarks of the NP block |
central incisors & incisive papilla |
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osteology of the mandible |
largest & strongest bone of the face, consists of a curved horizontal portion (the body) & the rami |
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what is another name for the inferior alveolar nerve block |
mandibular block |
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what nerves are anesthetized with the IANB block |
inferior alveolar, incisive, mental and lingual nerves |
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what areas are anesthetized with the IANB |
mandibular teeth to the midline (centrals to the distal of the 2nd premolar-- buccal aspect), body of the mandible, anterior 2/3 of the tongue, lingual soft tissues & periosteum |
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what area is not anesthetized with the IANB |
buccal of mandibular molars |
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True/ false The inferior alveolar nerve block has a high aspiration rate |
true, MAKE SURE TO USE 2 PLANE ASPIRATION |
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what type of needle is used for the IANB |
long needle, 25- or 27- gauge |
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what is the insertion site for the IANB injection |
mucous membrane of the lingual side of the mandibular ramus |
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what is the target area for the IANB injection |
inferior alveolar nerve as it pass downward toward the mandibular foramen (needle tip superior to foramen) |
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what are some landmarks for the IANB |
CORONOID NOTCH (height of injection), mandibular foramen, lingula, between the ptergomandibular raphe & internal oblique ridge, posterior border of the mandibular rap he |
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what happened if the bone is contacted to soon when injecting the IANB |
if less than half the length of the long needle is inserted when bone is hit then the needle tip is too far anteriorly (laterally) on the ramus |
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if the bone is contacted to soon during an IANB injection, what can you do to correct it |
withdrawal needle slightly (don't remove from tissue), move barrel toward front of the mouth (move barrel forward over the canine), redirect needle to a more appropriate depth of insertion |
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what happened during the IANB injection if bone is not contacted |
needle tip located too far posterior (medial) |
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how can you fix your IANB injection if the needle tip is located too far posteriorly |
withdrawal slightly (leave approx. 1/4 needle in tissue), reposition barrel more posteriorly (over molars), continue needle insertion until contact with bone, reinsert in same spot |
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what two things MUST be done during an IANB injection to ensure that you have the correct insertion |
1. must make bony contact (helps to know where you are) 2. must have depth of insertion |
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what is the average depth of insertion to bony contact in the IANB injection |
20-25mm (2/3-3/4 length of needle) |
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what happens if you hit the nerve sheath of the IANB |
it helps to make sure you're in the right spot, the patient will move (causes shock), pull back a little & anesthetize |
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can you anesthetize into the nerve sheath when giving an IANB injection |
NO! slightly pull back and then anesthetize |
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during the IANB injection what can happen is the bone is not contacted and you anesthetize |
the needle tip may be resting within the parotid gland near the facial nerve VII which can cause transient blockade (paralysis) of the facial nerve |
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what are some complications during the IANB |
hematoma (rare), trismus, transient facial paralysis |
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what is another name for the buccal nerve block |
long buccal nerve block |
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what areas are anesthetized with the buccal nerve block |
buccal soft tissues of mandibular molar teeth |
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what are some advantages to the buccal nerve block |
simple injection to give, high success rate, low rate of aspiration |
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what type of needle do we use with a buccal nerve block, why do we use this type of needle |
long needle, 25- or 27- gauge, recommended because of posterior deposition site-- NOT the depth of tissue insertion |
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what is the area of insertion for a buccal nerve block |
distal & byccal to the last molar in the arch, parallel to occlusal plane |
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what is the target area for the buccal nerve block |
buccal nerve as it passes over the anterior border of the ramus |
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what are some landmarks for the buccal nerve block |
mandibular molars & mucobuccal fold |
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what is a good safety feature when injecting the buccal nerve block |
as soon as you get in you'll contact bone, prevents over insertion, minimum positive aspiration rate |
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what areas are anesthetized with the mental nerve block |
buccal mucous membranes anterior to the mental foramen (2nd premolar to the midline) |
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true/false There is no bony contact when injecting the mental nerve block |
true |
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what type of needle do we use for the mental nerve block |
short needle 25 or 27 gauge |
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what is the area of insertion for the mental nerve block |
mucobuccal fold at or just anterior to the mental foramen |
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what is the target area for the mental nerve block |
mental nerve as it exits the mental foramen (between 1st and 2nd premolars) |
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what are some landmarks for the mental nerve block |
mandibular premolars, mucobuccal fold, X-rays of mental foramen |
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true/ false the mental nerve block & the incisive nerve block are 2 injections |
false-- the mental & incisive nerve blocks are performed together during 1 injection |
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if you were able to anesthetized the mental nerve alone what type of anesthesia would it be (pulpal or soft tissue) |
soft tissue |
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what positioning is used for the mental nerve block |
sit at an 8 o'clock position or a 12 o'clock position |
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what is the advantages & disadvantages of sitting at a 12 o'clock position for the mental nerve block |
advantage= increased visibility, goes straight down, injects between premolars disadvantage= the patient can see everything |
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what is another name for the incisive nerve block |
mental nerve block (inappropriate) |
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what areas are anesthetized with the incisive nerve block |
buccal & anterior to the mental foramen |
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if you could anesthetize the incisive nerve block by itself what type of anesthesia would be performed (pulpal or soft tissue) |
pulpal anesthesia |
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what type of needle is used for a PDL injection |
ultra short needle (designed for PDL), if not then a short needle may be used, 27 gauge |
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what is the area of insertion for the PDL injection |
long axis of the tooth to be treated on its mesial or distal root |
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what is the target area for the PDL injection |
depth of gingival sulcus |