What part of the syringe indicates it is an aspirating syringe?
What tissue is topical anesthetic least effective on?
C.) Ulcerated areas
What LA is metabolized by pseudocholiesterase?
What antiseptics do you not use with local anesthesia?
What is the landmark for the IANB injection?
Coronoid notch and pterygomandibular raphe
What is a possible cause of pain upon removal of the needle?
How does a self-aspirating syringe work?
When you let off the pressure it aspirates
An organic base is used for psychogenic pain. True or False
What is the max. dose of epi for a normal patient?
.2mg (11 carpules)
What is the max. dose of epi for a cardiac patient?
.04mg (2 carpules)
Superior Orbital Fissure is classified as what division? And Sensory or Motor?
VI Ophthalmic Division (Trigeminal) and Sensory
Rotundum is classified into what division? Sensory or Motor?
V2 Maxillary Division, Sensory
Ovale is part of what division? Sensory or Motor?
V3 Mandibular Division, Sensory AND Motor
Mandibular Foramen is part of what nerve(s)?
IAN and Incisive
Mental Foramen is part of what nerves?
Mental and incisive nerve
Topical anesthetic benzocaine is not absorbed systemically. T or F
What injection would numb the lower lip?
Mental/Incisive Nerve Block
What cause would you expect if a patient had a lesion on the lower lip?
Bit their lip
This injection anesthetizes the anterior portion of the hard palate (soft and hard tissues) from the mesial of the right first premolar to the mesial of the left premolar.
Nasopalatine (Incisive papilla)
How far is the needle inserted for an IA injection?
Bone must be contacted, average is 20-25mm, or 2/3-3/4 the length of the long needle
What happens during depolarization?
Reverse polarity, sodium in, potassium out
How does LA decrease depolarization phase of the action potential?
It blocks the sodium channel.
This dendrite is the most distal segment of sensory neuron. It responds to stimulation and provokes an impulse transmitted centrally along the axon.
Free Nerve Ending
Myelinated nerves help local currents travel ____ than an unmyelinated nerve. It occurs by current leaps from node to node called _______ conduction.
What is the least preferable way to re-cap a needle?
2 handed method
Re-capping needle is safer by using what technique?
How is bevel of needle to be oriented during injection?
Bevel should be towards the bone
What is the Trade Name for Lidocaine?
What is the Trade Name for Mepivacaine?
Trade name for Prilocaine?
Trade name for Articaine?
Bupivacaine (Generic Name)-Trade name is?
Marcaine (Trade Name)
Which LA is an amide and an ester?
Which LA should be used for short appointments? Good for children and produces pulpal anesthesia.
Which LA is used for short appointments and methemoglobinemia occurs most often with this?
This LA biotransforms in the liver, kidney, and lung. Less toxic than other amides. Good for EPI Sensitive Patients requiring prolonged pulpal anesthesia (greater than 60 mins)
Prilocaine Plain or Prilocaine w/epi
1.5xs more potent than Lidocaine. Biotransforms in plasma and liver. Reports of paresthesia. Not used on children under 4 or for blocks.
For long dental procedues where pulpal anesthesia is necessary of 90 minutes and for management of post op. pain. Rarely used on children or mentally handicapped.
Name a topical anesthetic
What is the max dose for Oraqix?
When do you aspirate?
Just before deposition of LA
Beta Blocker increase or decrease blood pressure?
A response to the act of drug administration not the drugs is called _____. Two most common types are?
Vasodepressor syncope and hyperventilation
This can occur when an infraorbital nerve block is administrated or when maxillary canines are infiltrated.
Facial Nerve Paralysis
Muscle droop can occur when LA is administered into the deep lobe of the _____ where the terminal branches of the facial nerve extend. (IANB or VaziraniAkinosi NB)
For what injections are long needles used?
For all injection techniques with significant thickness of soft tissue- IA, Gow-Gates mandibular, Akinosi mandibular, infraorbital, sometimes Buccal
What causes a hematoma and where is it most common?
Arterial or venous puncture after PSA or IANB. Common in the pterygoid plexus following PSA.
What is the volume of a single cartridge of LA? How much is in two?
What is the needle gauge and which lumen is smallest?
The gauge is the diameter of the lumen of the needle. The smaller the number the greater the diameter of the lumen. 30 gauge has a smaller lumen than a 25-gauge needle.
What sensation is lost after an injection?
What function does sodium chloride provide to LA solutions?
It makes the solution isotonic with the tissues of the body.
What antioxidant prevents biodegrading of LA?
All of the following are true regarding actions of vasopressors except:
A.) Constrict blood vessels, decreasing blood flow to site of administration
B.) Absorption of LA into cardiovascular system is decreased
C.)LA blood levels are lowered, minimizing risk of LA toxicity
D.)Decrease bleeding at site of administration
E.)Increased amount of LA remain around nerve for longer periods increasing duration of action of most LA.
F.) LA blood levels are increased
Maxillary nerves are Sensory or Motor?
Mandibular Nerves are?
Sensory and Motor
Prolonged tetanic spasm of the jaw muscles by which normal opening of the mouth is restricted. Caused by muscles, blood vessels in infratemporal fossa, hemorrhage, or infection after injection
How do you treat trismus?
Heat therapy, warm saline rinses, analgesics and if needed, muscle relaxants. Patients should initiate physiotherapy of opening and closing the mouth and lateral excursions of the mandible. In severe cases, referral to oral surgeon.
What would cause a dry cornea?
Anesthetizing the facial nerve. If bone is not contacted during the IANB and the solution is deposited into the parotid gland. Temporary bell's palsy would not allow the patients eyelid to close or blink.
An injection that is deposited close to a main nerve trunk is called ____. Also, name 3 of the injections pertaining to this.
Nerve Block (IA, PSA, Nasopalatine)
An injection where small terminal nerve ends are flooded with LA solution is called?
What would you do for a patient with post op infection?
immediate treatment of heat and analgesics, muscle relaxant if needed and physiotherapy. If infection persists, patient should get on a 7-10 day course of antibiotics like penicillin V or erythromycin if allergic to penicillin.
Name the injection site for MSA
mucobuccal fold of 2nd premolar
Name injection site for PSA
mucobuccal fold of 2nd molar, DB root, 45 degree angles, *Pterygoid plexus
Name injection site for Greater palatine
Ant. to foramen lingual to 2nd molar *cotton tip
Posterior and lateral to the incisive papilla *cotton tip
Name injection site for Long Buccal injection
mucobuccal fold, DB to last molar, inject parallel and inferior to occlusal plane
Injection site for Lingual
withdraw needle from IA until 1/2, reaspirate and inject
Injection site for mental/incisive
mucobuccal fold anterior to the mental foramen
How much epi is in a cartridge of 2% lidocaine with 1:100,000?
20mg x 1.8ml=36mg lidocaine/cartridge
.01 x 1.8= .018mg epi/cartridge
Acute inflammation of the laryngeal mucosa due to infection, allergy or inhalation of irritant materials, causes obstruction of airflow
What is the cause of needle breakage?
Sudden movement by the patient
Patient receives electric shock during delivery of LA. What happened?
It touched the nerve sheath.
Why does filtration work better in the maxilla than in the mandible?
Bone is less dense in the maxilla.
How much epi is in one cartridge of 1:100,000?
.018ml in one cartridge
How much epi is in 2 cartridges?
Where is epi naturally found in the body?
Found in the medulla of the adrenal glands located in the kidneys. The endocrine system/urinary system
Ongoing numbness of the anterior part of the tongue is caused by which nerve being anesthetized?
What anesthetic is not an amide?
How long can you safely leave on a lidocaine patch?
15 minutes for a concentration of 20%
What is the most common LA without Epi?
What needle gauge is used for infiltration? 27 or 30?
If a patient has liver disease, you would use caution with an amide because....
Amides are metabolized/biotransformed in the liver
What is the benefit of slow deposit rate?
Less pain and less complications
After the infraorbital injection, the patient's cheek turns white. What happened?
Blanching or vasoconstriction of the blood vessels in that area.
Why does LA fail to work near an abscessed tooth?
infection causes lower pH
If asked about allergic reaction to LA, choose the ester option
Innervation of the soft palate is what palatine nerve?
What causes a droopy eyelid?
Anesthesia of the facial nerve
Which root is not anesthetized with the PSA injections?
Mesialbuccal root of the maxillary first molar
Where do you dispose of the used needles?
In a contaminated or sharps container
Burning on injection could be due to:
injecting too fast or a
*lower pH from a vasoconstrictor
What is the injection site for lingual infiltration of maxillary molars?
The attached gingiva 5-10mm from the free gingival margin
If you want hemostasis, what is the infiltration procedure of choice?
2% Lidocaine with 1:50,000 EPI injected directly into surgical site to stop bleeding.
How would you manage a delayed reaction a patient has to EPI?
Benadryl. Delayed skin reactions are managed by oral histamine blocker such as diphenhydramine or chlorpheniramine. Delayed rxns develops hours to days after exposure.
Immediate skin reactions is managed by:
epi and IM histamine blocker. This reaction develops within seconds to hours of exposure.
This injection is for the lingual of max. anteriors
To inject the entire palate on one side you would do what injections?
Greater Palatine and Nasopalatine
What post op instructions would you give to a patient with a hematoma?
Cold compression's and pressure to bleeding site, common for pterygoid plexus of veins during PSA
What needle size would you use for an infiltration?
What is the first sign of toxicity?
Where do you infiltrate?
near the apex of the tooth
#15 has an abscess. You already gave a PSA. What other injection could you give to numb the lingual?
When scaling #13 and you want to give an injection, where do you infiltrate?
The apex of #13
If the central incisor has a defect on the root, what injection would you give?
What is the shelf-life of LA?
Expiration date on the cartridge. Plain is 36 months and with EPI is 18 months
If you administer LA 1ml per minute, what would happen?
If a patient is allergic to sulfite (sulfa) which LA don't you give?
Articaine w/Epi (Any with epi)
If a patient has an allergy to red wine, what LA should you use?
Mepivacaine 3% plain or Prilocaine 4% Plain NO EPI
Cc, mL, mg.- ml is ______
mg is ______
Place ASA Classification in order from 1-5
A.)Severe systemic disease-BP over 160/95, history of MI, Diabetes 1, heart failure etc.
B.)Normal, healthy, can walk up 2 flights of stairs or 2 city blocks w/o being winded
C.)Moribound-not expected to live 24hrs
D.)Mild systemic disease-BP over 140/90, epilepsy, diabetes II, pregnant, etc.
E.)Incapacitating systemic disease-uncontrolled diabetes, epilepsy or angina, heart failure, shortness of breath at rest etc.
B, D, A, E, C
LA are what type of injection?
Where do you give an injection for Max. incisors?
Mucobuccal fold of supraperiosteal
Pt. experienced no pain until LA was deposited. Why?
Rapid deposition of LA, solution not sterile, or solution too hot or too cold.
Where does the mandibular nerve pass through in the skull?
Where does the nasopalatine nerve pass through?
The incisive papilla
Name a sulfa antibiotic
Some topicals contain preservatives like methylparaben which may cause an allergy to ________.
There is a greater chance of an overdose with this type of LA
What is the mount of epi in a 1%, 2%, and 3% solution?
1.) 10 x 1.8 (or 1.7)= 18mg (or 17mg)
2.) 20 x 1.8= 36mg (or 34mg)
3.) 30 x 1.8= 54mg (or 51mg)
If you want hemostasis, what injection is best?
What best describes topical anesthetics?
A.) works on mucous membranes
B.) limited systemic toxicity
C.) works on keratinized tissue
works on mucous membranes
How many milligrams of
mepivacaine are contained within 2
cartridges of mepivacaine 3%?
3% mepivacaine = 30mg/cc
1 cartridge = 1.8 cc
2 cartridges = 3.6 cc
(30 mg/cc)x(3.6 cc) = 108 mg
Compute the number of cartridges of 2% lidocaine for a 32 year old, healthy male, 175 pounds.
2% x 1.8=36mg
2% x 175= 350mg/lb
350/36=9.7 cartridges (Round down)
Another name for alkalinizing agent is_____.
LA agents work by inhibiting the influx of ___ions by competing with ____ for binding sites.
LA affect small unmyelinated fibers first then large myelinated last.
LA decreases the rate of depolarization and prolong the rate of repolarization. Does NOT prevent the efflux of potassium in nerve cell.
Nerves affected in this order:
autonomic, temperature, pain, touch/pressure, vibration and _____ last!
MOTOR last!!*** Last to be lost, first to be regained.
What anesthetic is safe in pregnancy?
What anesthetic should you not use in patients with oxygen problems?
Put the amides in order from shortest to longest duration.
5-Bupivacaine (longest duration)
All of the following are true regarding vasoconstrictors added to anesthetics except:
a) Prolong anesthetic action
b) Reduce anesthetic toxicity
c) LA blood levels are increased
d) delays absorption
e) decrease bleeding
Max number of carpules containing 1:100,000 epi allowed for a hypertensive patient:
2; EPI is not contraindicated in a CONTROLLED hypertensive patient.