Local Anesthesia-- Quiz 2 Maxillary & Mandibular Injections

Front 1

Osteology of maxilla

Back 1

right & left maxillae, more porous/ cancellous

Front 2

why is there a greater chance of correctly anesthetizing when working on the maxilla

Back 2

the bone is more porous/ cancellous then the mandible

Front 3

what are the techniques we learned for maxillary anesthesia

Back 3

local infiltration, field block, nerve block, PSA, MSA, ASA, GP, NP

Front 4

what type of needle do we use for local infiltration?

Back 4

short need;e

Front 5

define local infiltration

Back 5

area of treatment is flooded with local anesthetic, incision is made into the same area

Front 6

what term is often misused when talking about a local infiltration

Back 6

dentists often use the term local infiltration to describe a field block

Front 7

is local infiltration soft tissue anesthesia or pulpal anesthesia

Back 7

soft tissue

Front 8

what type of needle do we use for a field block

Back 8

short needle

Front 9

is a field block soft tissue anesthesia or pulpal anesthesia

Back 9

pulpal anesthesia

Front 10

define a field block anesthesia

Back 10

solution deposited near the larger terminal nerve branches, anesthetized area circumscribes (prevents impulses from traveling from the tooth to the CNS)---larger area anesthetized

Front 11

where do you insert the needle for a field block injection

Back 11

administered above the apex of the tooth

Front 12

define a nerve block

Back 12

2-3 injections, deposited close to a main nerve trunk

EX. PSA, inferior alveolar, NP

Front 13

what soft tissue areas will be anesthetized with a PSA injection?

Back 13

maxillary molars except for the mesiobuccal root of the 1st molar

Front 14

is there bone contact with a PSA?

Back 14

no bone contact

Front 15

is a PSA injection pulpal or soft tissue anesthesia

Back 15

pulpal

Front 16

what are some contraindications for the PSA

Back 16

blood disorders, Warfarin

Front 17

what is an advantage & disadvantage with the PSA injection

Back 17

advantage= atraumatic (no pain), disadvantage= hematoma

Front 18

what are some alternative injections to the PSA

Back 18

supraperiosteal or PDL injections (shallow, no risk of hitting BV)

Front 19

what type of needle is used for the PSA and why do we use this type of needle

Back 19

short needle, 27 gauge... due to risk of hematoma

Front 20

what is the target area for the PSA injection

Back 20

PSA nerve, above the 2nd molar

Front 21

what is the insertion for the PSA injection

Back 21

height of mucobuccal fold above 2nd molar

Front 22

what is the depth of insertion for the PSA

Back 22

16mm

Front 23

what is the technique used for the PSA injection

Back 23

retract tissue (looks like a "V"), orient needle inward-upward-backward, use zygoma as tool, aspirate in 2 planes

Front 24

is the MSA block pulpal or soft tissue anesthesia

Back 24

pulpal anesthesia

Front 25

what areas are anesthetized with the MSA

Back 25

premolars & mesiobuccal root of 1st molar

Front 26

is there bone contact with the MSA injection

Back 26

no bone contact

Front 27

what type of needle is used for the MSA

Back 27

short or long needle, 27 gauge

Front 28

what is the injection site for the MSA block

Back 28

height of mucobuccal fold above 2nd premolar

Front 29

what is the target area for the MSA block

Back 29

above the apex of 2nd premolar

Front 30

what is another name for the ASA nerve block

Back 30

infraorbital nerve block

Front 31

what nerves are anesthetized with the ASA block

Back 31

anterior superior alveolar & infraorbital nerve

Front 32

what areas are anesthetized with the ASA block

Back 32

maxillary central incisors to the canine

Front 33

does the ASA nerve block contact bone?

Back 33

yes it does, face the bevel of the needle toward the bone

Front 34

what are some disadvantages with the ASA

Back 34

operator may have a fear of injuring patients eye (intraoral techniques rarely a problem)

Front 35

what type of needle do we use with the ASA block

Back 35

long needle 25- or 27- gauge (a short needle may be used but for Boards we must know long needle)

Front 36

where do we insert the needle for an ASA block

Back 36

height of mucobuccal fold directly over the 1st premolar (may insert over the canine)

Front 37

what is the target area for the ASA block

Back 37

infraorbital foramen (over the canine)

Front 38

what happens when you contact bone with the ASA block?

Back 38

the patient will feel it, pull back 1mm and inject

Front 39

what are some landmarks for the ASA injection

Back 39

mucobuccal fold, infraorbital notch, infraorbital foramen

Front 40

what type of needle is recommended for palatal anesthesia

Back 40

27 gauge, short needle

Front 41

what are the benefits of palatal anesthesia (GP & NP)

Back 41

they numb the side of the palate, before we used to inject each tooth separately)

Front 42

What is another name for the greater palatine nerve block

Back 42

anterior palatine nerve block

Front 43

what areas are anesthetized with the GP block

Back 43

posterior portion of the hard palate, soft tissues from 1st premolar and medially to the midline

Front 44

what type of needle do we use for the greater palatine nerve block

Back 44

short needle, 27 gauge

Front 45

where is the area of insertion for the GP nerve block

Back 45

soft tissue, slightly anterior to the greater palatine foramen

Front 46

what is the target site for the GP block

Back 46

greater palatine nerve as it passes anteriorly between soft tissue & bone of the hard palate

Front 47

what are the landmarks for the GP block

Back 47

GREATER PALATINE FORAMEN & junction of the maxillary alveolar process & palatine bone, IN LINE WITH 2ND MOLAR DISTALLY

Front 48

can we inject into the greater palatine foramen when giving a GP nerve block

Back 48

NO! never inject into the foramen, keep cotton swab on foramen, inject anterior to foramen

Front 49

what is the pre puncture technique and what injections should it be used for?

Back 49

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

Front 50

what is another name for the nasopalatine nerve block

Back 50

incisive nerve block

Front 51

true/ false

The nasopalatine nerve block is a bilateral block

Back 51

false, it is unilateral (only one injection is performed for right & left maxillae)

Front 52

what areas are anesthetized with the NP block

Back 52

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

Front 53

what type of needle is used for the NP block

Back 53

short needle, 27 gauge

Front 54

what area of insertion is used for the NP block

Back 54

palatal mucosa lateral to incisive papilla (almost under papilla)

Front 55

what are the target areas for the NP nerve block

Back 55

incisive foramen beneath the incisive papilla

Front 56

what are some landmarks of the NP block

Back 56

central incisors & incisive papilla

Front 57

osteology of the mandible

Back 57

largest & strongest bone of the face, consists of a curved horizontal portion (the body) & the rami

Front 58

what is another name for the inferior alveolar nerve block

Back 58

mandibular block

Front 59

what nerves are anesthetized with the IANB block

Back 59

inferior alveolar, incisive, mental and lingual nerves

Front 60

what areas are anesthetized with the IANB

Back 60

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

Front 61

what area is not anesthetized with the IANB

Back 61

buccal of mandibular molars

Front 62

True/ false

The inferior alveolar nerve block has a high aspiration rate

Back 62

true, MAKE SURE TO USE 2 PLANE ASPIRATION

Front 63

what type of needle is used for the IANB

Back 63

long needle, 25- or 27- gauge

Front 64

what is the insertion site for the IANB injection

Back 64

mucous membrane of the lingual side of the mandibular ramus

Front 65

what is the target area for the IANB injection

Back 65

inferior alveolar nerve as it pass downward toward the mandibular foramen (needle tip superior to foramen)

Front 66

what are some landmarks for the IANB

Back 66

CORONOID NOTCH (height of injection), mandibular foramen, lingula, between the ptergomandibular raphe & internal oblique ridge, posterior border of the mandibular rap he

Front 67

what happened if the bone is contacted to soon when injecting the IANB

Back 67

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

Front 68

if the bone is contacted to soon during an IANB injection, what can you do to correct it

Back 68

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

Front 69

what happened during the IANB injection if bone is not contacted

Back 69

needle tip located too far posterior (medial)

Front 70

how can you fix your IANB injection if the needle tip is located too far posteriorly

Back 70

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

Front 71

what two things MUST be done during an IANB injection to ensure that you have the correct insertion

Back 71

1. must make bony contact (helps to know where you are) 2. must have depth of insertion

Front 72

what is the average depth of insertion to bony contact in the IANB injection

Back 72

20-25mm (2/3-3/4 length of needle)

Front 73

what happens if you hit the nerve sheath of the IANB

Back 73

it helps to make sure you're in the right spot, the patient will move (causes shock), pull back a little & anesthetize

Front 74

can you anesthetize into the nerve sheath when giving an IANB injection

Back 74

NO! slightly pull back and then anesthetize

Front 75

during the IANB injection what can happen is the bone is not contacted and you anesthetize

Back 75

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

Front 76

what are some complications during the IANB

Back 76

hematoma (rare), trismus, transient facial paralysis

Front 77

what is another name for the buccal nerve block

Back 77

long buccal nerve block

Front 78

what areas are anesthetized with the buccal nerve block

Back 78

buccal soft tissues of mandibular molar teeth

Front 79

what are some advantages to the buccal nerve block

Back 79

simple injection to give, high success rate, low rate of aspiration

Front 80

what type of needle do we use with a buccal nerve block, why do we use this type of needle

Back 80

long needle, 25- or 27- gauge, recommended because of posterior deposition site-- NOT the depth of tissue insertion

Front 81

what is the area of insertion for a buccal nerve block

Back 81

distal & byccal to the last molar in the arch, parallel to occlusal plane

Front 82

what is the target area for the buccal nerve block

Back 82

buccal nerve as it passes over the anterior border of the ramus

Front 83

what are some landmarks for the buccal nerve block

Back 83

mandibular molars & mucobuccal fold

Front 84

what is a good safety feature when injecting the buccal nerve block

Back 84

as soon as you get in you'll contact bone, prevents over insertion, minimum positive aspiration rate

Front 85

what areas are anesthetized with the mental nerve block

Back 85

buccal mucous membranes anterior to the mental foramen (2nd premolar to the midline)

Front 86

true/false

There is no bony contact when injecting the mental nerve block

Back 86

true

Front 87

what type of needle do we use for the mental nerve block

Back 87

short needle 25 or 27 gauge

Front 88

what is the area of insertion for the mental nerve block

Back 88

mucobuccal fold at or just anterior to the mental foramen

Front 89

what is the target area for the mental nerve block

Back 89

mental nerve as it exits the mental foramen (between 1st and 2nd premolars)

Front 90

what are some landmarks for the mental nerve block

Back 90

mandibular premolars, mucobuccal fold, X-rays of mental foramen

Front 91

true/ false

the mental nerve block & the incisive nerve block are 2 injections

Back 91

false-- the mental & incisive nerve blocks are performed together during 1 injection

Front 92

if you were able to anesthetized the mental nerve alone what type of anesthesia would it be (pulpal or soft tissue)

Back 92

soft tissue

Front 93

what positioning is used for the mental nerve block

Back 93

sit at an 8 o'clock position or a 12 o'clock position

Front 94

what is the advantages & disadvantages of sitting at a 12 o'clock position for the mental nerve block

Back 94

advantage= increased visibility, goes straight down, injects between premolars

disadvantage= the patient can see everything

Front 95

what is another name for the incisive nerve block

Back 95

mental nerve block (inappropriate)

Front 96

what areas are anesthetized with the incisive nerve block

Back 96

buccal & anterior to the mental foramen

Front 97

if you could anesthetize the incisive nerve block by itself what type of anesthesia would be performed (pulpal or soft tissue)

Back 97

pulpal anesthesia

Front 98

what type of needle is used for a PDL injection

Back 98

ultra short needle (designed for PDL), if not then a short needle may be used, 27 gauge

Front 99

what is the area of insertion for the PDL injection

Back 99

long axis of the tooth to be treated on its mesial or distal root

Front 100

what is the target area for the PDL injection

Back 100

depth of gingival sulcus