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40 Cards in this Set
- Front
- Back
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Failure in local anesthetic refers to what what |
Inability to induce effective conduction blockade |
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Failure of local anesthetic can be classified as what |
Patient-Dependent Clincian dependent |
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What are some factors that can effect anesthetic (6) |
Device related factors Volume considerations Psychological barriers Chemical barriers Physical barriers Antatomic variations |
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What are some device related factors |
Needle Bevel considerations Needle Deflection Considerations Quality of Cartridge Contents Clinician Judgement |
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What are the needle bevel considerations |
Not critical but recommended to place solution closer to nerves |
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What are the needle deflection considerations |
Higher gauge = greater flexibility and deflection |
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What are some quality of cartridge contents |
90% of the vasoconstrictor must be effective and pH should be 3.3 or higher Storage considerations (dark, room temperature locations) |
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What are clincian judgement errors |
Adequate volumes are necessary |
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What are the VOLUME CONSIDERATIONS |
Anatomy Individual responses Length of anticipated treatment |
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What are the anatomy errors that can occur |
Adequate to flood targeted neural membranes Gow Gates= Higher volume Buccal= very low volume |
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What are the individual responses that can cause error |
Previous Experiences |
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What are some psychological Barriers |
Patient reports it is not effective for them Patients report phobias |
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What are some phobias patients might report (4) |
To needles To lack of control To fear of insuffiecient anesthesia To long-lasting residual anesthesia |
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What is a physical barrier |
Dense bony prominences Shallow Vestibules Dilacerations Periodontal Ligaments can block solutions or deflect them from deposition site |
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What are chemical barriers |
Chemicals existing in the tissue prior to injection Ex: Inflammaiton or Injection Vascular injury Tachyphylaxis |
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What is Tachyphylaxis |
The failure of subsequent administrations of local anesthetics (in the same appt) to prolong the duration extent and intensity of the anesthetic effect. |
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What are two type of anatomical variations that can effect local anesthetic |
Accessory Innervations (Expected) Aberrant Innervations (Unexpected) |
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What is accessory Innervations |
Result in incomplete anesthesia Requires alternative techniques |
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What is Aberrant Innervations |
Result in complete lack of anesthesia of targeted tissue Requires alternative techniques to bypass them Most are addressed with PDL injections |
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What are some other considerations that can contribute to failed anesthesia |
Intravascular injections Inflammation |
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MENTAL AND INCISIVE INJECTIONS |
.................... |
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The mental nerve block is indicated for anesthesia during procedures that involve what |
Buccal soft tissues in the mandible anterior to the mental foramen |
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The Mental nerve block will anesthetize structures innervated by what |
Mental Nerve |
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The mental nerve block will anesthetize what |
Buccal soft tissues Buccal periosteum |
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What is the penetration site for the mental nerve block |
Depth of mucobuccal fold superior to the foramen Varies with location of mental foramen |
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What is the needle pathway for the mental nerve block |
Passing through thin mucosal tissues Superficial fascia containing loose connective tissue, small vessels and microvasculature, and nerve endings |
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What is the depostion site for the Mental Nerve Block |
Just superior to the mental foramen |
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What is the needle selection for the Mental Nerve Block |
25 gauge recommended because of high rate of positive aspiration (6%) 27 gauge is most commonl used |
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What is the technique done for the Mental Nerve Block |
Clinician is seated at a posterior position Retract cheek and lip laterally Ask patient to close eyes Align syringe vertically with the patients cheek Penetrate and advance needle at an angle directly vertical to the foramen to a depth just superior of it (4-6mm) |
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How much of the cartridge should be deposited |
minumum of 0.6ml (1/3 cartridge) |
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How do you confirm anesthesia for the mental nerve block |
sense of numbess on injected side Buccal soft tissues of the chin and lower lip Buccal tissues of premolars and incisors |
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What are some notes that should be known for the mental nerve block |
Uncomfortable without adequate topical anesthesia, slow admination or solution, or inadvertent contact with bone HIghly successful Cross innervation should be considered |
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What is an alternate technicque that can be done for the Mental nerve block |
Horizontal approach |
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INCISIVE NERVE BLOCK |
................. |
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The incisive nerve block is indicated for anesthesia during procedures in the what |
Mandible anterior to the mental foramen |
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The Incisive nerve block will anesthetize structures innervated by what |
Incisive nerve |
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The incisive nerve block will anesthetize what |
Buccal mucous membrane Skin of lower lip and chin Pulps and periosteum of teeth anterior to the mental foramen to the midline |
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Describe the Incisive Nerve Blocl |
Travels within the mandibular canal from the mental foramen to the midline Terminal fibers may innervate contralateral incisors |
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Describe the technique for the Incisive nerve block |
Identical to mental nerve block sometimes called Mental- Incisive It is impossible to anestetize the incisive nerve without also doing the mentla nerve Mental nerve block alone cannot reliably anesthetize incisive nerves |
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What is the additional step for the incisive nerve block |
Requires gentle pressure exerted over the bulge of solution in the direction of the mental foramen for at leat 1 minute |
