Med Emergencies Final

Front 1

Anatomical considerations for Pediatric patients receiving anesthesia

Back 1

-Bone density is less
-Mandibular foramen located more inferiorily

Front 2

Behavior management for pediatric patients

Back 2

-BE HONEST!!
-Use of topical anesthetic
-Distraction
-Counter irritation
-Assistant to hold hands and stabilize
-cradle the head when posible
-use mouth prop when it is essential to have mouth open or with patients you do not know
-young children have a limited ability to inform about anesthesia
DONT STOP

Front 3

What should you do while giving anesthesia to children??

Back 3

DONT STOP

Front 4

Children often become upset over the feeling of numbness....

Back 4

-let them see themselves. they may feel distorted
-tell the child when the feeling of numbness (big, tingly, sparkly etc) will go away. Use terms the child will understand

Front 5

technique tips

Back 5

-slow deposition of solution (not too slow)
-use 27 gauge needle
-maxillary short (1")
-mandibular long (1 5/8") usuallly inferior alveolar block & long buccal injection
- may use mouth prop ('tooth pillow")
-reflect lip and pull tissue tight
-finger rests
-DONT STOP

Front 6

complications of local anesthesia

Back 6

-biting of lip, cheek, tongue or excessive rubbing
-Hematoma
-Over dose

Front 7

Dosage of Local anesthetic

Back 7

2 year old = 20 lb = 1 carpule 40 mg
4.5 year old = 40 lb = 2 carpule 80 mg
8 year old= 60lb = 3 carpule 120 mg

Front 8

duration of anesthesia

Back 8

-consider shorter duration of anesthesia
-3% mepivacain 20-40 min pulpal anesthesia and 1-3 hr soft tissue anesthesia
-2% lidocaine 1:100,000 epi 1-2.5 hr pulpal anesthesia and 2-5 hr soft tissue anesthesia
-3% mepivacaine = 20 min Maxillary and 40 min mandibular

Front 9

Short acting local anesthetic

Back 9

-consider 3% mepivacaine (carbocaine) when the procedure is
-very short
-expected to have little post op pain
-done for patients who are at high risk to bite their lips or tongue

Front 10

Articaine (Septocaine)

Back 10

-4% articaine
-1:100,000 epinephrine
-be careful about dose-higher concentration of drug
-not approved for use in children under 4 years

Front 11

Local Anesthesia complications: LOCAL

Back 11

-needle breakage
-pain on injection
-persistent anesthesia or parasthesia
-trismus
-hematoma
-edema
-sloughing of tissues
-soft tissue injuries
-facial nerve paralysis
-postanesthesia intraoral lesions

Front 12

Local Anesthesia Complications: SYSTEMIC

Back 12

-overdose
-allergy

Front 13

Needle Breakage

Back 13

-extremely rare with disposable needles
-causes: smaller needles, bent needles, manufacture's defect
-problem: scar tissue, migration (generally posteriorily), infection
-prevention: longer, larger needles, don't insert to hub, don't redirect while needle is deep (more than 1cm into tissues)

Front 14

Needle breakage management

Back 14

-instruct the patient not to move
-keep the mouth open (bite block)
-if you can see it, grab it (hemostat)
-if you can't see it, refer to OMS immediately, inform patient, document incident, keep needle stump
-litigation? call your lawyer

Front 15

Causes of Pain on injection

Back 15

Causes:
-careless technique, callous attitude
-dull needles
-rapid injection
-needles become barbed after contacting bone

Front 16

Problems with pain on injection

Back 16

-pain--> anxiety---> medical emergency
-pain --> sudden movement--> needle breakage

Front 17

Prevention of Pain on injection

Back 17

-proper techniques
-sharp needles
-topical anesthetic
-sterile local anesthetic solution
-inject slowly
-anesthetic solution too hot or too cold (room temperature is good)

Front 18

Burning on injection Causes

Back 18

-solution pH (5,3)
-rapid injection
-contamination (sterilizing solutions)
-carpule warmed to body temp is "too hot"

Front 19

Problem burning on injection

Back 19

-related to pH: transient
-related to others: possible tissue damage

Front 20

Prevention and Management of Burnign on injection

Back 20

Prevention:
-slow injection (ideally 1cc/min)
-don't store carpules in alcohol or other sterilizing agent
Management:
-follow up
-manage specific problem

Front 21

Persistent Anesthesia or Parasthesia Causes

Back 21

-contaminated anesthetic solution
-needle trauma to nerve ('electric shock")
-hematoma --> pressure

Front 22

Persistent Anesthesia or Parasthesia Problems

Back 22

-self-inflicted injury (biting, heat)
-taste
-hyperesthesia (normal stimuli cause an excessive sensation) or dyesthesia (normal stimuli cause pain)

Front 23

Persistent Anesthesia or Parasthesia Prevention

Back 23

-adherence to injection protocol
-proper care and handling or carpules

Front 24

Persistent Anesthesia or Parasthesia Management

Back 24

-Reassure; follow up; document in chart
-refer to OMS if still present after 2 months

Front 25

Trismus

Back 25

-restricted jaw movement
Causes
-trauma to muscles or blood vessels: hemorrhage, multiple injections, large volume of anesthetic, infection
-contaminated anesthetic solution
-local anesthestics are slightly myotoxic

Front 26

Trismus problem

Back 26

-usually minor
-chronic hypomobility

Front 27

Prevention of Trismus

Back 27

-sharp, sterile, disposable needle
-proper handling of anesthetic carpule
-aseptic technique
-practice atraumatic insertion and injection
-avoid repeated injections; use regional blocks
-use minimum volumes

Front 28

Trismus Management

Back 28

-usually occurs 1-6 days after injections
-record incident and treatment in dental chart
-use heat therapy, warm saline rinses, NSAIDs, muscle relaxants (e.g. Valium)
-physical therapy (gum chewing)
-if trismus/pain continues > 2 days --> add antibiotics
-if problem worsens or if not improving after 7 days refer to OMS

Front 29

Causes of Hematoma

Back 29

-effusion of blood into extravascular space
-usually related to arterial injury
-related to density of tissues surrounding vessel
-PSA (most common site for hematoma, bruise visible on skin)
-IAN bruise visible only intraorally

Front 30

Hematoma Problem

Back 30

-trismus and pain
-swelling and discoloration usully subside in 2-3 weeks: inconvenience to patient, source of embarassment to HCP
-possible source of infection

Front 31

Hematoma Prevention

Back 31

-knowledge of normal anatomy in injection site
-modify injection technique as dictated by patient's anatomy
-use short needle for PSA
-minimize number of needle penetrations into tissue
-don't use a needle as a probe in tissues

Front 32

Hematoma Management

Back 32

-immediate- apply direct pressure for 5 minutes
-IAN-medial ramus
-Infraorbital- directly over foramen
-Mental- directly over foramen
-PSA: Ice/Pressure on face, digital pressure in mucobuccal fold as far posterior as patient will tolerate

Front 33

Hematoma Subsequent

Back 33

-document in patient's record
-advise patient about possible trismus, discomfort, and dicoloration (bruise)
-ice for first 2 hours
-heat after first 24 hours
-OTC meds
-Tincture of time

Front 34

Infection

Back 34

-extremely rare
Causes:
-contaminated needle or solution
-improper technique
-injecting into an area of infection

Front 35

Problem with infection

Back 35

-trismus
-fascial space infection

Front 36

Infection Prevention

Back 36

-use disposable needles
-avoid contamination of needle through contact with nosterile surfaces
-avoid multiple injections with the same needle
-proper care/handling of carpule
-store aseptically in originally ocntainer
-cleanse diaphragm with a sterile disposable alcohol wipe
-properly prepare tissues prior to penetration: dry, topical anesthetic

Front 37

Edema

Back 37

-swelling of tissues
Causes
-trauma during injection
-infection
-allergy: angioedema from topical anesthetic; vasodilation secondary to histamine release
-hemorrhage
-injection of irritating solution (alcohol or cold sterilizing fluid)

Front 38

Edema Problem

Back 38

-usually not significant
-occasionally pain and dysfunction in region
-angioneurotic edema can compromise airway

Front 39

Edema Prevention

Back 39

-proper care and handling of local anesthetic armamentarium
-atraumatic injection technique
-good medical evaluation of patient before treatment

Front 40

Edema Management

Back 40

-if from trauma or irritating solutions: usually no formal therapy maybe Rx analgesics
-If from hematoma : see hematoma
If from infection: see infection

Front 41

Edema Management if from allergic reaction

Back 41

in buccal tissues:
-no airway involvement
-antihistamines
-consult with allergist
in tongue, FOM, or pharynx
-life threatening
-BLS, EMS (911)
-epinephrine (.3mg q 5 min), antihistamine, corticosteroid
-cricothyrotomy

Front 42

Sloughing of the tissues Causes

Back 42

epithelial desquamation
-prolonged application of topical anesthetic
-heightened sensitivity of tissues to local anesthetic
sterile abscess
-prolonged ischemia
-almost always in the tissues of the hard palate

Front 43

Sloughing of the tissues problem

Back 43

-pain (like an ulcer)
-infection (rare)

Front 44

Sloughing of the tissues prevention

Back 44

-topical anesthetics 1-2 minutes
-avoid concentrated vasoconstrictors
-avoid reinjection of palatal tissues

Front 45

Sloughing of tissues Management

Back 45

-inform/reassure patient
-document in chart
-analgesics

Front 46

Soft tissue injury Cause

Back 46

-child or mentally handicapped adult
-self-inflicted trauma to tongue, lips, or cheeks while tissues are numb

Front 47

Soft tissue injury Prevention

Back 47

-local anesthetic of appropriate duration
-warn the patient and guardian (self adherent warning sticker)
-cotton roll between lip and teeth
-advise patient to avoid chewing foods until numbness wears off

Front 48

Soft tissue injury management

Back 48

-analgesics for pain
-antibiotics if infection results (rare)
-warm NS rinses
-lubricant to cover lip lesion

Front 49

Facial Nerve Paralysis Causes

Back 49

-infraorbital block or maxillary canine infiltration
-anesthetic into deep lobe of parotid gland:
-too far posterior during IAN block or too deep during akinosi block

Front 50

Facial nerve paralysis Problems

Back 50

-transitory: several hours
-unilateral paralysis of involved muscles
-loss of protective lid reflex --> corneal irritation

Front 51

Facial nerve paralysis prevention

Back 51

-adhere to injection protocols
-IAN -contact with bone
-akinosi <25mm

Front 52

Facial Nerve Paralysis Management

Back 52

-reassure patient
-eye patch or manually close eye
-avoid contact lenses
-document in chart

Front 53

Postanesthetic Intraoral Lesions

Back 53

-intense pain and ulcerations at injection site approximately 2 days after intraoral anesthetic injection
-cause: activation of latent form of disease process
-recurent apthous stomatitis (probably autoimmune)
-herpes simplex virus

Front 54

Postanesthetic Intraoral Lesions Problem

Back 54

-pain in ulcerated areas
-secondary infection (rare)

Front 55

Postanesthetic intraoral lesions prevention

Back 55

-no way to prevent
-can use acyclovir in prodromal phase to minimize the acute phase of the disease process

Front 56

Postanesthetic Intraoral Lesions Management

Back 56

Symptomatic
-reassure patient
-analgesics if required
-topical anesthetic preparations (viscous lidocaine, 1-2-3 mouth rinse (lidocaine, benedryl, MOM), orabase ointment, zilactin
-ulcers usually last 7-10 dyas
-document in chart

Front 57

Anatomy of an Aspirating Syringe

Back 57

-Thumb ring
-Finger grip
-Spring
-Guide bearing
-Piston with Harpoon (harpoon most likely to break)
-Barrel
-Adapter

Front 58

Types of Needle

Back 58

- 25 gauge (Red)
-27 gauge (Yellow)
-30 gauge (Blue)

Front 59

Needle Lengths

Back 59

-Short 20mm
-Long 32mm

Front 60

Needle Parts

Back 60

-syringe adaptor
-Hub
-shaft
-bevel (should be towards nerve you are trying to anesthetize)
-cartridge penetration end

Front 61

How to assemble a syringe

Back 61

-place needle on syringe
-pull back on thumb ring to insert carpule into syringe
-slowly slide carpule forward to penetrate diaphragm
-Use needle puncture guard
-engage harpoon into stopper
-verify flow of local anesthetic

Front 62

Atraumatic Injection Technique Part 1-7

Back 62

1-use a sterilized sharp needle
2-check the flow of local anesthetic solution
3-solution at room temp
4-Position of the patient-supine if tolerated
5-Dry the tissue
6-Apply topical antiseptic (optional)
7-Apply topical anesthetic

Front 63

Atraumatic Injection Technique Part 8-14

Back 63

8-Communicate with the patient-explain superficial numbness, minimize discomfort
9-establish a firm hand rest
10-make the tissue taut
11-keep the syringe out of patient's sight
12-insert the needle into the mucosa-bevel towards bone
13-watch and communicate with patient-never say it wont hurt
14-inject several drops (optional)

Front 64

Atraumatic injection Technique part 15-21

Back 64

-Slowly advance needle towards target
-aspirate
slowly deposit the local anesthetic solution
-communicate with the patient-explain why you are injecting slowly
-slowly withdraw the syringe and cap the needle using safe technique
-observe the patient after the injection
-record the injection in the pt's chart

Front 65

Nerves that can be blocked in maxilla

Back 65

-Posterior Superior Alveolar (PSA)
-Infraorbital
-Maxillary (2nd division block)
-Greater palatine
-nasopalatine

Front 66

Nerve Block Advantages

Back 66

-fewer injections (pain) when anesthetizing several sites
-Less total volume of anesthetic soln and less chance of overdose
-Lasts longer and more profound

Front 67

Distribution of Nerve blocks in Maxilla

Back 67

Front 68

Nerve Block disadvantages

Back 68

-lasts longer
-Greater chance of complication(hematoma, intravascular injection, slightly lower success rate, trismus, anesthesia more wide

Front 69

Structures exiting a foramen

Back 69

-nerves
-arteries
-veins

Front 70

Reasons for the bevel toward the bone

Back 70

-bevel away from bone is more likely to penetrate periosteum and cause pain and bruising
-bevel towards bone prevents this

Front 71

Infiltration

Back 71

-depositing fluid that will diffuse through the periosteal and into the nerve near the end of the root
-canine root is longer and less likely to be anesthetized
-Muscle attachments can effect distribution of anesthesia
can anesthetize molars with a half a carpule

Front 72

Posterior Superior Alveolar Nerve Block (PSA)

Back 72

-anesthetizes maxillary 3rd, 2nd and 1st molars (MB root of 1st molar not anesthetized=28%) and buccal periodontium and facial bone
-Indications: treating >1maxillary molar, infection site, infiltration not effective
-Contraindication: risk of hemorrhage too great
-angled across 2nd molar crown

Front 73

PSA Advantages

Back 73

-atraumatic
-95% success rate
-less injections when treating multiple teeth
-less total volume

Front 74

PSA disadvantages

Back 74

-hematoma
-no bony landmarks
-2nd injection usually required for 1st molar

Front 75

Infraorbital Nerve Block

Back 75

-Anesthetizes ASA nerve and MSA nerve
-ASA nerve: pulps of incisors and canine
-MSA nerve:72% pulp of premolars, MB root of 1st
-Infraorbital Nerve (inferior palpebral, lateral nasal superior labial)
-Facial bone and periodontium of effected teeth

Front 76

Infraorbital Indication and Contraindications

Back 76

-Indications: multiple teeth, infection, infiltrations not effective
-Contraindications: 1 or 2 teeth, bleeding disorders, anticoagulants

Front 77

Infraorbital nerve block advantages and disadvantages

Back 77

-Advantages: simple, minimal volume of solution, minimal punctures
-Disadvantages: lack of confidence in operator-fear of injury to eye, landmarks usually difficult to palpate

Front 78

Infraorbital nerve block landmarks

Back 78

-lower rim of the orbital
-center of the eye

Front 79

Greater Palatine Nerve Block

Back 79

-Anesthetizes posterior portion of hard palate and its overlying soft tissues, anteriorly as far as the 1st premolar and medially to the midline
-indications: pain control during restorative, periodontal, or oral surgical procedures
-contraindications inflammation in site, smaller area of therapy (1 or 2 teeth)

Front 80

Advantages and Disadvantages of Greater Palatine Nerve Block

Back 80

-Advantages: minimizes needle penetrations and volume of solution
-Disadvantages: no hemostasis except at site of injection, potentially traumatic/painful
-Alternatives: infiltration, V2 block

Front 81

Target of Greater Palatine Nerve Block

Back 81

-Anterior 1/2 2nd : 0%
-Posterior 1/2 2nd: 40%
-Anterior 1/2 3rd: 50%
-Posterior 1/2 3rd: 10%

Front 82

Nasopalatine Nerve Block

Back 82

-Anesthetizes nasopalatine nerves bilaterally anterior portion of hard palate (soft and hard tissues) from mesial of right 1st premolar to the mesial of the left 1st premolar
-Indications: restorative, periodontal, or oral surgery procedures on multiple teeth
-Contraindications: inflammation or infection in area, smaller area of therapy

Front 83

Nasopalatine Nerve Block Advantages and Disadvantages

Back 83

-Advantages: Fewer needle penetrations, less volume of soln
-Disadvantages: hemostasis only in area of injection, potentially the most painful intraoral injection
-Alternatives: local infiltrations, maxillary nerve (V2) block

Front 84

Maxillary Nerve (V2) Block

Back 84

-Anesthetizes: pulpal anesthesia in hemimaxilla, soft tissue and bone and hemimaxilla, skin of lower eyelid, side of nose, cheek, upper lip
-Indications: extensive restorative, periodontal or oral surgery procedures, inflammation or infection precluding other blocks, diagnosis or treatment of neuralias or tics of V2 nerve

Front 85

Maxillary Nerve (V2) Block Contraindications

Back 85

-inexperienced operator
-pediatric patient
-uncooperative patient
-inflammation or infection at injection site
-when hemorrhage is risky
-bony obstructions in canal (5-15%)

Front 86

Maxillary Nerve (V2) Block Advantages and disadvantages

Back 86

-Advantages: high success rate-95%
-minimizes needle penetrations (1 vs 4) and volume of anesthetic (1 vs 2 carpules)
-usually atraumatic
-Disadvantage: risk of hematoma, lack of hemostasis at surgery site, discomfort, arbitrary landmarks
-Alternatives - other blocks, infiltrations

Front 87

V2 block methods

Back 87

-Greater palatine canal approach to V2 block
-high tuberosity approach to V2

Front 88

Inferior Alveolar nerve block general

Back 88

-aka mandibular nerve block
-most commonly used
-highest rate of failure (15-20%)
-Try and avoid bilateral mandibular blocks (uncomfortable to pt)
-most difficult to master

Front 89

Inferior Alveolar Nerve block

Back 89

-nerves anesthetized: inferior alveolar, mental, incisive, lingual (usually)
-indications: procedures on multiple teeth in one quadrant, buccal and lingual soft tissue required
-contraindications: infection or acute inflammation, tongue or lip biters (children, mentally handicapped)
-Advantages: one injection provides a wide area of anesthesia

Front 90

Inferior alveolar nerve block Disadvantages

Back 90

-sometimes not necessary for localized areas/procedures
-high block failure rate
-intra-oral landmarks not consistent
-high rate of positive aspiration (10-15%)
-lingual and lip anesthesia (biters/hot beverages)

Front 91

Inferior Alveolar Nerve Block Insertion and Target

Back 91

-insertion: mucosa on medial aspect of mandibular ramus
-target: inferior alveolar nerve before it enters the foramen

Front 92

Inferior Alveolar Nerve Block Landmarks

Back 92

-coronoid notch (greatest concavity on the anterior border of the ramus)
-pterygomandibular raphe
-occlusal plane of mandibular posterior teeth (6-10 mm above occlusal plane )

Front 93

Inferior Alveolar Nerve Block Failures

Back 93

-deposition of anesthetic below mandibular foramen
-deposition of anesthetic too far anteriorly
-accessory innervation of mandibular teeth (mylohyoid nerve posteriorly and mylohyoid/overlapping fibers of contralateral IAN)
-bifid inferior alveolar nerve (lower indicidence)

Front 94

Inferior Alveolar Complications

Back 94

-hematoma (hold pressure)
-trismus
-facial paralysis (anesthetic in parotid)

Front 95

Inferior Alveolar Technique

Back 95

-place index finger or thumb on the coronoid notch, pull tissue tight
-6-10mm above the occlusal plane of the mandible & middle of thumb determines height of injection
-the anteroposterior point of the injection is 3/4 the distance of the pterygomandibular raphe
-align the barrel of the syringe across the contralateral premolars
-come across contralateral premolars & anterior to the soft tissues
-if you touch bone, redirect around to ipsilateral canine & advance slightly into base of V formed by the pterygomandibular raphe & ramus of mandible
-penetration depth is 20-25mm, 2/3 to 3/4 length of long needle

Front 96

Adjunctive Mylohyoid Block

Back 96

-retract tongue to midline, then inject at the apical area of second molar on the lingual surface of the mandible

Front 97

Adjunctive Contralateral Inferior Alveolar

Back 97

-supraperiosteal injection technique across the midline of the anterior mandibular teeth (buccal surface)

Front 98

Adjunctive Lingual Nerve Block

Back 98

-deposit .1 to .2ml of anesthetic when withdrawing needle from inferior alveolar block

Front 99

Inferior Alveolar Signs and Symptoms

Back 99

-tingling or numbness of lip and chin to midline
-tingling or numbness of the inpsilateral anterior two thirds of the tongue
-anesthesia of teeth and gingiva ipsilaterally (except buccal nerve distribution)

Front 100

Buccal Nerve Block Complications and Technique

Back 100

-AKA long buccal nerve block
-anesthetizes soft tissues and periosteum buccal to the mandibular molars
-indications: buccal soft tissu anesthesia for procedures on the mandibular molars
-Contraindications: infection/inflammation in the area
-Complications: rare (hematoma)
-Technique: penetrate mucosa about 2mm contact bone, aspirate and inject

Front 101

Buccal Nerve Block Advantages/Disadvantages

Back 101

-advantages: easy, high, success rate
-disadvantages: potentially painful if periosteum is torn
-insertion: mucosa distal and buccal to the most posterior mandibular molar
-target: buccal nerve as it passes over the anterior border of the ramus
-landmarks: mandibular molars and mucobuccal fold
-failures: rare

Front 102

Gow-Gates Block

Back 102

-Aka mandibular block
-blocks entire distribution of V3
-Anesthesia of inferior alveolar, lingual, mental, incisive, mylohyoid, buccal and auriculotemporal nerves
-Difficult learning curve
-more successful than inferior alveolar block

Front 103

Gow-Gates Indications/ Contraindications

Back 103

-Indications: procedures on multiple teeth, soft tissue anesthesia , failed inferior alveolar block
-Contraindications: infection/inflammation, lip/tongue biters, pts who are unable to open mouth wide

Front 104

Gow-Gates Block Advantages/disadvantages

Back 104

-Advantages: only one injection
-high success rate (95%)
-minimal complications
-successful anesthesia of bifid -inferior alveolar nerves, -Disadvantages: tongue/lip anesthesia,-longer time to onset of anesthesia, higher learning curve

Front 105

Gow Gates Block Insertion/Target

Back 105

-insertion: mucosa on the mesial of ramus in line of tragus and commissure distal to the maxillary second molar
-Target (lateral surface of condylar neck, below insertion of lateral pterygoid
-landmarks: tragus and commissure, just below mesiopalatal cusp of the maxillary second molar

Front 106

Gow Gates Complications

Back 106

-hematoma (rare)
-trismus (rare)
-paralysis of cranial nerve III, IV, VI (eye paralysis diplopia)

Front 107

Gow-Gates Technique

Back 107

-have pt open wide, point of insertion below mesiopalatal cusp of maxillary second molar aiming to tragus of ear (considerably higher than occlusal plane)
-advance needle 20-25mm until bone is contracted aspirate and injection
-have pt stay open 1-2min after injection

Front 108

Akinosi Block

Back 108

-aka closed mouth block
-useful when dental therapy required in pts with limited mouth opening (trismus)

Front 109

Akinosi Block Indications/contraindications

Back 109

Indications: limited mouth opening,inability to visualize landmarks for conventional block
Contraindications: infection or acute inflammation, lip/tongue biters, inability to gain access to the lingual aspect of ramus

Front 110

Akinosi Block disadvantages and insertion

Back 110

-disadvantages: difficult to visualize path of needle and depth of insertion , no bone contact
-Insertion: soft tissue overlying medial border of ramus adjacent to maxillary tuberosity at the mucogingival junction height

Front 111

Akinosi Target/Landmarks

Back 111

-soft tissue of the medial ramus (below Gow-Gatesand above inferior alveolar block)
-Landmarks: mucoginigval junction of maxillary (second/third molar), maxillary tuberosity/coronoid notch

Front 112

Akinosi Block Failures/complications

Back 112

-must stay in line with flare of the mandible or injection will be too lateral, needle insertion too low, under/overinsertion of the needle
-Complications: hematoma/trismus, facial nerve paralysis (overinsertion into parotid gland)

Front 113

Akinosi Block Technique

Back 113

-bevel of needle away from bone
-advance needle 25mm
-aspirate
-inject

Front 114

Mental/Incisive Block

Back 114

-the mental nerve leaves the mental foramen and provides sensory innervation to the lip and chin area
- incisive nerve continues forward to provide sensory innervation to anterior mandibular teeth
-both have limited usefullness on a routine basis for dental therapy

Front 115

Mental block indications/contraindications

Back 115

-Indications: buccal soft tissue anesthesia for procedures anterior to the mental foramen (biopsy)
-Contraindications: inflammation and infection in the areas

Front 116

Mental Nerve Advantages/Disadvantages/Failures

Back 116

-Advantages: high success rate, easy/atraumatic
-Disadvantages: hematoma (5%)
-Failures: rare, miss the foramen

Front 117

Mental Block Insertion/Target/Landmarks

Back 117

-Insertion: mucobuccal fold anterior to foramen
-Target: mental nerve as it exits the mental foramen
-landmarks: mandibular premolars, mucobuccal fold

Front 118

Mental block Complications

Back 118

-complications: hematoma
-Technique: locate foramen with finger in mucobuccal fold, insert needle anterior to foramen (5mm), aspirate and inject

Front 119

Incisive Nerve Block Indications/contraindications

Back 119

-dental procedures which require pulpal anesthesia of the mandibular anterior teeth, used instead of bilateral inferior alveolar blocks for treatment limited to the anterior mandible
-Contraindications: inflammation or infection

Front 120

Incisive Nerve Block Advantages/Disadvantages

Back 120

-advantages: pulpal anesthesia of the anterior mandibular teeth without lingual anesthesia (uncomfortable), high success rate
-Disadvantages: no lingual anesthesia, cross innervation from contralateral inferior alveolar nerve may require additional supraperiosteal injections for pulpal anesthesia

Front 121

Incisive Nerve Insertion/Target/landmarks

Back 121

-insertion:mucobuccal fold anterior to mucobuccal fold
-target: mental foramen (incisive nerve lies in this)
-Landmarks: mandibular premolars, mucobuccal fold

Front 122

Incisive Nerve Failure/Complications

Back 122

-failure: inadequate volume of anesthetic, inadequate pressure after injection
-Complications: rare, hematoma

Front 123

Incisive Nerve Technique

Back 123

-same as for mental block
-hold pressure for two minutes after injection to force anesthetic into the foramen and reach the incisive nerve

Front 124

Mandibular Infiltration

Back 124

-useful for supplemental anesthesia of anterior mandibular teeth when getting crossover fibers from contralateral inferior alveolar nerve
-thin cortical plate allows for supraperiosteal injection technique to be successful for mandibular incisors only in most pts
-technique exactly the same as for maxillary teeth with deposition of anesthetic at root apex to block dental plexus

Front 125

Injection Pearls

Back 125

-always recap needle after injection
-be confident
-understand the anatomy
-always use a finger rest for stabilization
-if pt complains of an electric shock after the needle is positioned, re-position the needle as you are likely in the nerve itself