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Anesthesia Board Review

Terms in this set (601)

An allergy to sulfites would be an absolute contraindication to the use of:
A. Mepivacaine 3%
B. Citanest Plain
C. Lidocaine 2%
D. Lidocaine 3%

C. lidocaine 2%

Which of the following is a name for prilocaine?
A. xylocaine
B. septocaine
C. scandonest
D. citanest
E. marcaine

D. citanest

Prilocaine is biotransformed by the:
A. liver
B. liver and blood
C. liver, kidneys, and lungs
D. liver, lungs, and large intestines

C. liver, kidneys, and lungs

The anatomical landmark for the MSA injection is:
A. Above the maxillary first premolar
B. Above the maxillary second premolar
C. Above the mesiobuccal cusp of the maxillary first molar
D. None of the above

B. above the maxillary second premolar

The long buccal injection anesthetizes which areas?
A. Maxillary tissue to the midline
B. Retromolar area
C. Tissue just buccal to the mandibular molars and premolars
D. Mandibular labial tissue from cuspid to cuspid

C. tissue just buccal to the mandibular molars and premolars

Which of the following agents would be best to administer, if one were to anticipate both severe and prolonged post-operative dental pain?
A. Mepivacaine (Carbocaine)
B. Prilocaine with epinephrine (Citanest Forte)
C. Bupivacaine with epinephrine (Marcaine)
D. Lidocaine with epinephrine (Xylocaine)
E. None of the above

C. Bupivacaine with epinephrine (Marcaine)

Because the patient complains of inadequate "numbing," eight more cartridges of lidocaine 2% with epinephrine 1:100,000 vasoconstrictor are injected. The patient then begins talking incessantly, exhibiting restlessness and fasciculations (twitching) of the extremities, and then becomes sleepy and suffers a convulsion. The blood pressure and heart rate are depressed. These symptoms are most likely caused by:
A. A toxicity reaction to the local anesthetic agent
B. A toxic reaction to the vasoconstrictor
C. A fear reaction
D. The fact that the patient is epileptic
E. None of the above

A. a toxicity reaction to the local anesthetic agent

Local anesthetic dosages should be reduced for which of the following conditions?
A. Frail elderly
B. Very young children
C. Liver disease
D. All of the above
E. None of the above

D. all of the above

What is the primary reason for a burning sensation when the anesthetic agent is injected?
A. pH of the solution
B. Psychogenic
C. Developing hematoma
D. Contaminated solution

A. pH of the solution

Your client is 75 years old and is of average height and weight. His health history includes high blood pressure for which he takes medication, and arthritis for which he takes aspirin daily. He is in the office for restorative treatment on the facial of #27, 28, and 29. Which injection would be indicated?
A. RIA
B. LPSA
C. R Incisive
4. R mental

C. R incisive

Your client is 75 years old and is of average height and weight. His health history includes high blood pressure for which he takes medication, and arthritis for which he takes aspirin daily. He is in the office for restorative treatment on the facial of #27, 28, and 29.What anesthetic will you choose?
A. Mepivacaine 3%
B. Prilocaine 4% w/epi.
C. Lidocaine 2% w/ epi
D. Bupivacaine

C. lidocaine 2% with epi

How many milligrams of mepivacaine is in 3 cartridges of a 3% solution?
A. 30 mg
B. 30 mg
C. 72 mg
D. 108 mg
E. 162 mg

E. 162 mg

[T:F] A rapid rate of injection will increase the rate of absorption at the site of injection, thereby decreasing local anesthetic blood levels

false: increasing the rate increases local anesthetic blood levels

The most common emergency in relation to local anesthesia that will be encountered is:
A. Allergy to the anesthetic
B. Syncope
C. Hyperactivity
D. Shock

B. syncope

What size and gauge needle is used most commonly for the MSA?
A. 30 gauge extra short
B. 27 gauge long
C. 25 gauge short
D. 27 gauge short

27 gauge short

For the MSA injection to be successful, where should the anesthetic solution be deposited?
A. in the mucobuccal fold
B. into the attached gingiva
C. at apex of premolars
D. at the infraorbital foramen

C. apex of the premolars

[T:F] Vasoconstrictors are absolutely contraindicated in a well-controlled cardiovascular patient.

false

The action of epinephrine when combined with a local anesthetic is to:
A. increase the amount of local anesthetic needed for an effect
B. decrease the effective length of action of an anesthetic
C. enhanced circulation and wash the anesthetic from site of action more quickly
D. increase the duration of anesthesia

D. increase the duration of anesthesia

Epinephrine is added to local anesthetic solutions to:
A. Prevent circulatory collapse if the local anesthetic is accidentally injected intravenously
B. Prevent asthmatic attacks if the local anesthetic is accidentally injected intravenously
C. Increase the rate of diffusion and absorption from the injection site
D. Decrease the rate of diffusion and absorption from the injection site

D. Decrease the rate of diffusion and absorption from the injection site

Hematomas are most likely to occur with which of the following injections?
A. PSA
B. MSA
C. ASA
D. All of the above
E. None of the above

A. PSA

To facilitate penetration of the needle, tissues at the site of an injection should typically be:
A. Flaccid
B. Taut
C. Bunched
D. Depressed

b. taut

For a healthy adult male patient of average size, what is the maximum safe dose of mepivicaine 3% without epinephrine?

400 mg

[T:F] The excretion of prilocaine is through the kidney

true

What is the one absolute contradiction for the use of prilocaine?
A. periodontitis
B. anemia
C. allergy
D. asthma

C. allergy

What is one of the symptoms of methemoglobinemia?
A. hyperactivity
B. anxiety
C. cyanotic appearance, usually in the nail beds and lips
D. depression

C. cyanotic appearance, usually in the nail beds and lips

A dental hygienist gives an inferior alveolar nerve block injection on the left side. The left central and lateral incisors remain sensitive. What is the best explanation for this?
A. an insufficient amount of solution was given
B. the needle placement was incorrect
C. the sensitive teeth are receiving innervation from the right side
D. the sensitive teeth are receiving innervation from the cervical plexus

C. the sensitive teeth are receiving innervation from the right side

As a group, ester-type local anesthetics are more likely than amide-type local anesthetics to provoke which of the following adverse drug reactions?
A. allergy
B. overdose
C. idiosyncrasy
D. hypertension
E. syncope

A. allergy

Why don't patients always demonstrate the expected duration of anesthesia?
A. variability of individual response
B. inaccurate deposition of local anesthesia
C. tissue status (vascularity, pH)
D. anatomic variation
E. type of injection (infiltration vs. nerve block)
F. all of the above

F. all of the above

How long does it take a topical anesthetic to reach maximum soft tissue analgesia?
A. 2-3 minutes
B. 45 seconds
C. 15 seconds
D. the effect is immediate

A. 2-3 minutes

You are giving Mepivicaine to a 150lb patient.
1. what is the absolute MRD?
2. What is the weight based MRD?
3. What is the number of cartridges you can give this patient?

1. 400 mg
2. 450 mg
3. 7.4 cartridges

You are giving Lidocaine to a 150 lb patient:
1. What is the absolute MRD?
2. What is the weight based MRD?
3. What is the number of cartridges you can give this patient?

1. 500 mg
2. 480 mg
3. 13.33 cartridges

You are giving Bupivicaine to a 150lb patient.
1. What is the absolute MRD?
2. what is the weight based MRD?
3. what is the number of cartridges you can give this patient?

1. 90 mg
2. there is no weight based MRD
3. 10 cartridges

What is the absolute MRD for bupivacaine?
A. 25 mg
B. 35 mg
C. 45 mg
D. 90 mg

D. 90 mg

Which of the following local anesthetic drugs is available in a 0.5% concentration?
A. prilocaine
B. mepivacaine
C. articaine
D. bupivacaine

D. bupivacaine

You are giving Articaine to a 150lb patient.
1. What is the absolute MRD?
2. What is the weight based MRD?
3. What is the number of cartridges you can give this patient?

1. there is no absolute MRD
2. 480 mg
3. 6.6 cartridges

Which of the following local anesthetic nerve blocks anesthetizes the buccal gingival tissue of the maxillary first molar?
A. Inferior alveolar nerve block
B. Anterior superior alveolar nerve block
C. Buccal nerve block
D. Posterior superior alveolar nerve block

D. posterior superior alveolar nerve block

A patient is missing the mandibular right molars, and surgery is to be performed on the remaining mandibular teeth across the arch. Which combination of local anesthetic nerve blocks would most likely be administered and still be successful?
A. Right mental and left inferior alveolar nerve blocks
B. Left inferior alveolar and right incisive nerve blocks
C. Right posterior superior alveolar and left inferior alveolar nerve blocks
D. Right mental and left incisive nerve blocks
E. Bilateral inferior alveolar nerve blocks

B. left inferior alveolar and right incisive nerve blocks

A 9-year-old child is having a restoration placed on the occlusal surface of the mandibular left first molar. Which of the following heights of the inferior alveolar local anesthetic nerve block sites should be followed during the pain control procedure?
A. Only 6 to 10 mm superior to the occlusal plane of the mandibular molars
B. Slightly inferior to the occlusal plane of the mandibular molars
C. At the same height as the occlusal plane of the mandibular molars
D. More than 10 mm superior to the occlusal plane of the mandibular molars

C. At the same height as the occlusal plane of the mandibular molar

A restoration will be placed on the distal surface of the maxillary first premolar. Which of the following local anesthetic nerve blocks must be administered?
A. Anterior superior alveolar nerve block
B. Middle superior alveolar nerve block
C. Nasopalatine nerve block
D. Inferior alveolar nerve block

B. middle superior alveolar nerve block

As a result of a bicycle accident, a patient has suffered trauma to the upper lip and maxillary central incisors. Which of the following local anesthetic blocks may be used when treating the injured tissue?
A. Anterior superior alveolar, infraorbital, and incisive nerve blocks
B. Anterior superior alveolar, infraorbital, and nasopalatine nerve blocks
C. Anterior superior alveolar, middle superior alveolar, and greater palatine nerve blocks
D. Infraorbital, greater palatine, and Gow-Gates mandibular nerve blocks

B. Anterior superior alveolar, infraorbital, and nasopalatine nerve blocks

From the following list of complications involving the eyelid, nose, and upper lip, select the two most common ones associated with the infraorbital nerve block.
a. Hematoma
b. Stimulation of the gag reflex
c. Tingling
d. Numbness

c. tingling
d. numbness

From the following list of descriptions all can be commonly used when describing paresthesia and its progression except:
A. Abnormal area sensation
B. Burning or prickling
C. Can occur after local anesthesia
D. Can occur with infections
E. Can occur with nonsurgical procedures

E. Can occur with nonsurgical procedures

From the following list of landmarks, select those which are noted by dental professionals when administering the inferior alveolar nerve block.
A. Occlusal plane
B. Maxillary tuberosity
C. Pterygomandibular fold
D. Coronoid notch
E. Mandibular notch

A, C, and D

From the following list of landmarks, select those which are noted when administering the posterior superior alveolar nerve block by dental professionals.
A. Mucobuccal fold
B. Coronoid notch
C. Maxillary first molar
D. Maxillary tuberosity

A and D

[T:F] The dental professional must know the location of certain adjacent soft tissue structures, such as major blood vessels and glandular tissue. This is to make sure to allow for injecting these structures.

first statement true
second statement false: one should not inject in these areas

[T:F] there is only one type of local anesthetic injection used commonly in dentistry, the nerve block. The type of injection used for a given dental procedure is determined by the type and length of the procedure.

first statement false: there is also the infiltration and field block injections
second statement is true

[T:F] When administering the inferior alveolar local anesthetic nerve block, it is important to contact bone because this will decrease the risk of depositing a local anesthetic agent into the parotid salivary gland.

both statements are true

Which local anesthetic nerve block would be necessary for a patient undergoing surgery on an edentulous mandibular left alveolar process in the area of extracted molars?
A. Left buccal nerve block
B. Right buccal nerve block
C. Left mental nerve block
D. Right infraorbital nerve block

A. left buccal nerve block

Which of the following local anesthesia nerve blocks is usually not used bilaterally due to possible complications associated with swallowing and speech?
A. Incisive nerve block
B. Inferior alveolar nerve block
C. Posterior superior alveolar nerve block
D. Greater palatine nerve block

B. inferior alveolar nerve block

Which of the following local anesthetic nerve blocks uses the apex of the maxillary canine for a landmark during administration?
A. Infraorbital nerve block
B. Anterior superior alveolar nerve block
C. Middle superior alveolar nerve block
D. Posterior superior alveolar nerve block

B. anterior superior alveolar nerve block

Which of the following angulations of the needle MUST be followed during the administration of the posterior superior local anesthetic nerve block?
A. Superiorly at 45 degrees and medially at 90 degrees to the occlusal plane
B. Superiorly at 90 degrees and medially at 45 degrees to the occlusal plane
C. Superiorly at 45 degrees and medially parallel to the occlusal plane
D. Superiorly at 45 degrees and medially at 45 degrees to the occlusal plane

D. Superiorly at 45 degrees and medially at 45 degrees to the occlusal plane

Which of the following locations is the injection site for the inferior alveolar local anesthetic nerve block?
A. the pterygomandibular fold
B. Lateral to the pterygomandibular fold
C. Superior to the pterygomandibular fold
D. Inferior to the pterygomandibular fold

B. lateral to the pterygomandibular fold

Which of the following complications can occur during the administration of the inferior alveolar local anesthetic nerve block, resulting in inability to close the eyelid?
A. Motor function of the abducens nerve
B. Motor function of the facial nerve
C. Motor function of the oculomotor nerve
d. Sensory function of the facial nerve

B. motor function of the facial nerve

A client develops paralysis of a half of his face and inability to close his eye on the side of an attempted inferior alveolar nerve block. The most logical explanation is that the injection was given into the:
A. Parotid gland
B. Masseter muscle
C. Maxillary artery
D. Posterior facial vein
E. Pterygo-mandibular ligament

A. parotid gland

All of the following statements about intraoral injections are false except:
A. IANB does not block the mylohyoid nerve
B. Periodontal ligament (PDL) injections are only administered using a specialized syringe
C. Infraorbital injections block the entire maxillary nerve
D. The success rate of the IANB is 80% to 85%

D. The success rate of the IANB is 80% to 85%

All of the following statements about intraoral injections are false except:
A. The incisive nerve block provides lingual soft tissue anesthesia
B. An initial negative aspiration ensures no risk for intravascular injection, and additional aspiration is unnecessary during solution deposition
C. The site of needle insertion for a posterior superior alveolar nerve block is the height of the mucobuccal fold above the maxillary second molar
D. The recommended amount of time to inject a 1.8-mL cartridge with regard to client safety and comfort is 30 seconds

C. The site of needle insertion for a posterior superior alveolar nerve block is the height of the mucobuccal fold above the maxillary second molar

All of the following statements about local anesthesia are true except:
A. Hemostasis is only achieved when the vasoconstrictor is deposited into the area of bleeding
B. Maximum dosages of all drugs administered by injection should be calculated by body weight
C. Children can tolerate adult doses of local anesthetics because of their faster metabolism, and overdose is of little concern
D. The possible causes of decreased anesthetic effect include edema, pH, and vascularity
E. Overdose reactions are dose related; allergic reactions are not dose related

C. Children can tolerate adult doses of local anesthetics because of their faster metabolism, and overdose is of little concern

All of the statements concerning local anesthetic cartridges are true except:
A. The glass dental cartridge should not be autoclaved
B. No alcohol should be present around the cartridges when they are stored outside the packaging container
C. The rubber plunger is treated with silicone to decrease the incidence of "sticky stoppers"
D. Cartridges exposed to extended periods of direct sunlight may have their contents undergo accelerated destruction
E. Manufacturers recommend freezing cartridges so that they may be used beyond the posted expiration date

E. Manufacturers recommend freezing cartridges so that they may be used beyond the posted expiration date

All of the statements concerning local anesthetic needles are true except:
A. The term gauge refers to the diameter of the lumen of the needle
B. The weakest portion of the needle is at its hub
C. Larger needles provide more reliable aspirations
D. Disposable needles will not normally become dull for at least 10 insertions
E. Larger needles should be employed when a greater risk of positive aspiration exists

D. Disposable needles will not normally become dull for at least 10 insertions

Complete the sentence with the most accurate phrase. Local anesthetics______________________.
A. Combine lipid-soluble acids and basic esters
B. Form water-soluble salts with strong acids, which are unionized
C. Dissociate in the tissues, liberating free base, which can diffuse through the nerve membrane
D. Form amides, which transform to esters in tissues
Are synthetic and do not contain amino groups

C. Dissociate in the tissues, liberating free base, which can diffuse through the nerve membrane

How many milligrams of epinephrine are in a cartridge of local anesthetic with 1:200,000?

0.009 mg

Inadvertent rapid intravenous injection of a local anesthetic containing a vasoconstrictor may cause:
A. Convulsions
B. Palpitations
C. Unconsciousness
D. Depressed respiration
E. All of the above

E. all of the above

Terminal deposition for the inferior alveolar nerve block is:
A. Mental foramen
B. Mandibular foramen
C. Cingulum
D. Infraorbital foramen

B. mandibular foramen

The following injection(s) should be administered when scaling and root debridement of a mandibular second molar:
A. Mental nerve block
B. Buccal nerve block
C. Inferior alveolar nerve block
D. B and C
E. None of the above

D. B and C

the gauge of a dental needle most recommended for intraoral injections with high risk of aspiration is:
A. 18 gauge
B. 30 gauge
C. 27 gauge
D. 25 gauge
E. 23 gauge

D. 25 gauge

The maximum safe dose of epinephrine for the healthy adult is 0.2 mg. How many cartridges of 1:100,000 epinephrine can be administered?
A. 2 cartridges
B. 5 cartridges
C. 9 cartridges
D. 10 cartridges
E. 11 cartridges

E. 11 cartridges

The problem(s) with topical anesthesia is(are):
A. Dosage control
B. All are esters except 5% lidocaine
C. Concentrations used exceed concentrations administered by injection
D. Topical anesthetic agents containing benzocaine are, by far, the most common
E. All of the above

E. all of the above

The purpose of aspirating before injecting a local anesthetic solution is to prevent:
A. Allergic reactions
B. Intravascular injections
C. Traumatic injections
D. Trismus

B. intravascular injections

Trismus noted in a client the day following an inferior alveolar nerve block most likely results from:
A. Failure to use an aspirating syringe
B. Irritation of the medial pterygoid muscle
C. Accidental injection of the solution near a branch of the facial nerve
D. Allowing the needle tip to rest beneath the periosteum during injection
E. Accidental injection of the solution near a major branch of the trigeminal nerve

B. irritation of the medial pterygoid muscle

What is the average adult depth of penetration for the mental nerve block?
A. 12 mm
B. 6 mm
C. 9 mm
D. Until the bevel is covered
E. Until bone is contacted

B. 6 mm

What is(are) the overdose effect(s) of epinephrine?
A. Palpitation
B. Tachycardia
C. Hypertension
D. Headache
E. All of the above

E. all of the above

Which of the following is not a sign or symptom of an epinephrine overdose reaction?
A. nausea
B. heart racing
C. bronchospasm
D. weakness

C. bronchospasm

Which of the following statements about the metabolism of local anesthetic agents is true?
A. Amides undergo biotransformation by pseudo-cholinesterase
B. Vasoconstrictors are broken down in the liver
C. The rate of metabolism does not have any effect on potential toxicity
D. The location of biotransformation is dependent on drug classification
E. The metabolism of local anesthetic agents occurs in the kidneys

D. The location of biotransformation is dependent on drug classification

Which of the following nerves should be adequately anesthetized to scale and root-debride a maxillary first molar?
A. GP and PSA
B. LP, GP, and NP
C. PSA, MSA, and GP
D. ASA, MSA, and GP
E. PSA, MSA, and LP

C. PSA, MSA, and GP

Which of the following would be the LONGEST lasting for inferior alveolar nerve block (IANB) anesthesia?
A. Prilocaine
B. Lidocaine
C. Mepivacaine
D. Procaine
E. Articaine

A. prilocaine

Within seconds following a posterior superior alveolar injection, a client's face becomes distended and swollen on the injected side. What condition is suspected in this situation?

hematoma

Within seconds following a posterior superior alveolar injection, a client's face becomes distended and swollen on the injected side. The appropriate action by the hygienist would be to:
A. Have the dentist administer an antihistamine
B. Have the dentist administer an antibiotic
C. Have the dentist incise and drain
D. Counsel the client, apply pressure to the site, and ice to the area
E. Ask the client to exhale

D. Counsel the client, apply pressure to the site, and ice to the area

A crown preparation for tooth #19 is planned for a patient who takes a tricyclic antidepressant. Which of the following drugs represents the best choice for this procedure?
A. 4% prilocaine, 1:200:000 epinephrine
B. 4% articaine, 1:100,000 epinephrine
C. 2% mepivacaine, 1:20,000 levonordefrin
D. 0.5% bupivacaine, 1:200,000 epinephrine

A. 4% prilocaine, 1:200,000 epinephrine

[T:F] High blood pressure is always a contraindication to the use of vasoconstrictors in dentistry.

False: Use of a local anesthetic drug without a vasoconstrictor may not provide profound or durable anesthesia. The lack of profound anesthesia can result in unmanageable pain, which, in turn, can lead to a spike in blood pressure due to the release of endogenous epinephrine in response to the pain. This endogenous release may be greater than administered doses of epinephrine.

[T:F] Vasoconstrictors speed the absorption of local anesthetic drugs.

False: Vasoconstrictors slow the absorption of local anesthetic drugs.

Which of the following drugs would be the safest for a patient with cardiovascular disease?
A. 4% articaine, 1:200,000 epinephrine
B. 2% mepivacaine,1:20,000 levonordefrin
C. 2% lidocaine, 1:50,000 epinephrine
D. 4% prilocaine plain

D. 4% prilocaine plain

Which of the following medical conditions does not require precautions when using vasoconstrictors?
A. Liver disease
B. Diabetes with significant cardiovascular disease
C. Radiation therapy of the jaws
D. Cerebrovascular accident/stroke

A. liver disease

Which one of the following patients has a relative contraindication for vasoconstrictor?
A. Heart attack 2 years ago with no current complications
B. Controlled hyperthyroid condition
C. Non-selective beta blocker medication
D. Controlled blood sugar

C. non-selective beta blocker medication

[T:F] Local anesthetic drugs are effective only at the nodes of Ranvier and in order to be effective, multiple nodes must be exposed to the drug to block impulses.

true

Local anesthetic molecules have a greater affinity for protein receptor sites within the nerve membranes compared to which ion(s)?
A. Chlorine and hydrogen
B. Hydrogen and sodium
C. Calcium
D. Sodium

C. calcium

Which statement does not describe the typical onset of anesthesia?
A. Anesthesia will affect smaller nerves before larger nerves.
B. Anesthesia will affect sensory nerves before motor nerves.
C. Mantle bundles will be anesthetized before core bundles.
D. Onset is faster on incisors, soft tissues of chin, and labial tissues

D. onset is faster on incisors, soft tissues of chin, and labial tissues

[T:F] There are more positively charged ions outside the depolarized nerve cell than inside because the nerve membrane is relatively impermeable to sodium.

true

Why do manufacturers alter the pKa of local anesthetic drugs?
A. Increase the duration of anesthesia
B. Decease the duration of anesthesia
C. Provide useful onset time of anesthesia
D. Provide more profound anesthesia

C. provide useful onset time of anesthesia

Which local anesthetic drug can be harmful at higher blood levels however useful in treating cardiac arrhythmias?
A. Bupivacaine and procaine
B. Procaine and prilocaine
C. Lidocaine and procaine
D. Lidocaine and prilocaine

C. lidocaine and procaine

The anesthetic duration of lidocaine plain is:
A. 60 minutes pulpal; 60 to 120 minutes soft tissue
B. 10 to 30 minutes pulpal; 60 to 120 minutes soft tissue
C. 5 to 10 minutes pulpal; 180 to 300 minutes soft tissue
D. 5 to 10 minutes pulpal; 60 to 120 minutes soft tissue

D. 5-10 minutes pulpal; 60-120 minutes soft tissue

A 180-pound patient received 108 mg of 3% mepivicaine. How many cartridges were used?

30 ml/cartridge by ml in one cartridge (30 x 1.8 = 54 mg). Next divide 108 mg received by mg/ml in each cartridge of 3% mepivicaine (108 ÷ 54 = 2). A total of 2 cartridges of 3% mepivicaine were received.

A patient has received four cartridges of 4% articaine, 1:200,000 epinephrine. How many milligrams of vasoconstrictor has the patient received?
A. 0.018
B. 0.036
C. 0.072
D. 0.36

B. 0.036 * there are .009 mg in one cartridge of 1:200,000. take .009X4=.036

Using Clark's rule, a 12-year old, 90 pound child has received two cartridges of 2% lidocaine. How many more cartridges of lidocaine can this child receive before reaching MRD?
A. 3
B. 6
C. 7
D. 8

B. 6 * take 90 lbs/150 lbs (the average weight for adult patient)= .6 then take .6x500 (MRD for lidocaine)=300 mg is the total MRD for this patient. There are 36 milligrams per cartridge of lidocaine. take 300/36=8.3. The child can receive a total of 8 cartridges. Patient already had cartridges so can have 6 more

Using Clark's rule, calculate the maximum number of milligrams of 3% mepivacaine a 5-year old, 40-pound child can receive before reaching the MRD?
A. 40 mg
B. 80 mg
C. 106 mg
D. 117 mg

C. 106 mg

How is young's rule calculated?

the child's dose is equal to the adult dose by the child's age multiplied by adult MRD. Then divided by the sum of 12 plus the child's age

Using Young's rule, calculate the mg of 2% lidocaine a 10-year old, 60-pound child can receive before reaching the MRD?
A. 125 mg
B. 136 mg
C. 200 mg
D. 227 mg

D. 227 * 500 mgx 10= 5000
5000/(10+12)=227

What is the MRD in cartridges for 4% prilocaine, 1:200,000 epinephrine for a healthy 150 pound patient?
A. 5
B. 6
C. 8
D. 11

C. 8

What is a common preservative in topical anesthetic?

methylparaben

[T:F] The most common concentration of benzocaine topical is 20%, which will provide a 30 second onset of anesthesia with peak effectiveness in approximately 2 minutes.

true

Which of the following is not a benefit of eutectic mixtures of anesthetic drugs for use in dentistry?
A. Greater depth of penetration on mucosa
B.Higher concentrations of base forms of anesthetics
C.Increased therapeutic range
D. Typical pulpal anesthesia

D. typical pulpal anesthesia

Which of the following, when considering patient evaluation, is the least pertinent when obtaining local anesthetic informed consent?
A. Specific risks of procedure in light of medical status
B. Benefits of the procedure
C. Identifying a surrogate to provide health information
D. The timing of appointments and cost

D. the timing of appointments and cost

pain management of the mandibular teeth in a single quad when jaw opening is limited

akinosi nerve block technique

true mandibular blocks

gow-gates nerve block

_______ ______ is the mental nerve block target

mental foramen

medial border of the retromolar triangle?

internal oblique ridge

the _______ _______ is the target for the IA

mandibular foramen

persistent anesthesia

parasthesia

contact made with bone before reaching an optimum deposition site

premature contact

motor disturbance of the trigeminal nerve or more simply, an inability to open the mouth

trismus

[T:F] The deposition site for an IA nerve block is superior to the mandibular foramen on the medial surface of the ramus.

true

[T:F] The three key landmarks for the IA nerve block are the pterygomandibular raphe, the coronoid notch, and the external oblique ridge.

false: it is the internal oblique ridge not the external

Which of the following correctly describes the needle pathway for an IA nerve block?
A. Lateral to the pterygomandibular raphe, into the pterygomandibular space; passing lateral to the medial pterygoid muscle, lingual nerve, and sphenomandibular ligament; and superior to the lingula and mandibular foramen
B. Lateral to the pterygomandibular raphe, into the pterygomandibular space; passing medial to the medial pterygoid muscle; posterior and medial to the lingual nerve, lateral to the sphenomandibular ligament; and superior to the lingula and mandibular foramen
C. Medial to the pterygomandibular raphe, into the infratemporal space; passing lateral to the medial pterygoid muscle, lingual nerve, and sphenomandibular ligament; and superior to the lingula and mandibular foramen
D. Medial to the pterygomandibular raphe, into the pterygomandibular space; passing lateral to the medial pterygoid muscle, lingual nerve, and sphenomandibular ligament; and superior to the lingula and mandibular foramen

A. Lateral to the pterygomandibular raphe, into the pterygomandibular space; passing lateral to the medial pterygoid muscle, lingual nerve, and sphenomandibular ligament; and superior to the lingula and mandibular foramen

What is the recommended volume of local anesthetic solution for an inferior alveolar nerve block for an adult?
A. 0.6 to 1.0 mL
B. 0.9 to 1.5 mL
C. 1.2 mL
D. 1.5 to 1.8 mL

D. 1.5 to 1.8 ml (3/4 cartridge)

What is the position of the lingual nerve in relation to the inferior alveolar nerve?
A. Anterior and lateral
B. Inferior and lateral
C. Anterior and medial
D. Posterior and medial

C. anterior and medial

naturally occurring catecholamine that is both a hormone and a neurotransmitter; It is a direct-acting sympathomimetic drug, and is used in some local anesthetic solutions

epinephrine

How much vasoconstrictor is there in 1 cartridge of Lidocaine 2% w/ 1:50,000 epinephrine?

.036 mg vaso in a cartridge

DentiPatch provides approximately _____ minutes of soft tissue anesthesia and contains lidocaine and ________

45, benzocaine

What teeth can be anesthetized with tetracaine nasal mist?

#4-13

[T:F] tetracaine nasal mist is easier on the kidneys, liver, and lungs. It doesn't circulate in the body for hours, but takes a long time to wear off

first statement true
second statement false: wears off rapidly

What is the duration of anesthetic action for lidocaine 1:50,000 and 1:100,00 used in dentistry

60 min. pulpal
180-300 soft tissue

What are the two key considerations that determine the duration of action of bupivacaine?
A. biotransformation and elimination
B. distribution and volume
C. receptor binding and vasoactivity
D. receptor binding and biotransformation

C. receptor binding and vasoactivity

Amides are inactivated by the enzyme:
A. plasma cholinesterase
B. protease
C. lipase
D. monoamine oxidase
E. amylase

E. monoamine oxidase

How is lidocaine metabolized?

by hepatic enzymes, oxidases, and amidases.

What percentage of lidocaine is excreted unchanged by the kidneys?

less than 10%

What is the pKa of lidocaine?

7.7

What is the pH of lidocaine plain solution?

6.5

the correct onset of action for lidocaine is:
A. 30 seconds to 1 minute with vasoconstrictor
B. 2 to 3 minutes
C. 5 to 7 minutes
D. 6 to 10 minutes

B. 2 to 3 minutes

How long is the elimination half-life of lidocaine?

1.6 hours (96 minutes)

What is the onset of action of articaine for nerve block anesthesia?

2-3 minutes

What is the duration of anesthetic action of each formulation of mepivacaine used in dentistry?

3% mepivacaine plain (Short duration) 20-40 minutes pulpal; 120-180 minutes soft tissue
2% mepivacaine with 1:20,000 levonordefrin (Intermediate duration) 60 minutes pulpal; 180-300 minutes soft tissue

How is mepivacaine metabolized?

liver primarily by oxidases; amidase activity is insignificant

What is the onset of action for mepivacaine?

1.5-2 minutes

What is the elimination half-life of mepivacaine?

1.9 hours (114)

How is prilocaine metabolized compared to lidocaine and mepivacaine?

Prilocaine has a simpler hepatic metabolism compared with lidocaine and mepivacaine. Much of the drug is cleared before it is able to reach the liver. The lungs and kidneys are alternate sites of breakdown when the liver is not utilized.

What is the onset of action for bupivacaine?

6-10 minutes

What is the maximum dose of levonordefrine for a healthy patient?

1 mg

What is the maximum dose of levonordefrin for a medically compromised patient?

0.2 mg

What is the maximum dose for 4% prilocaine plain for a 120-pound patient?

120x4= 480 mg

Is the 30 gauge or 25 gauge the larger diameter?

About how long is the long needle?

about 32 mm (1 1/2 inches)

About how long is a short needle?

25 mm (1 in.)

Local anesthetic cartridges contain several ingredients. Which is NOT an ingredient found in these cartridges
A. Vasoconstrictor
B. Isotonic sodium chloride
C. Glucose
D. Anesthetic agent

C. glucose *distilled water is another component

What is the volume of solution delivered when two stopper widths are expelled?

0.4 ml *1 stopper width is 0.2 ml

What is the typical shelf life of local anesthetic with vasoconstrictor?

18 months

a technique that deposits solution near larger terminal branches for treatment near site of an injection is called:
A. infiltration technique
B. ligamental technique
C. field block technique
D. nerve block technique

C. field block technique

what are some anatomical variations related to the MSA?

absence of MSA nerve *between 50-72% of people don't have the MSA nerve

mixtures of local anesthetic drugs used as topical that contain higher concentrations of base molecules

eutectic mixture

Benzocaine is available in a range of __________ to __________ % formulations.

6, 20

[T:F] Benzocaine topical can induce methemoglobinemia.

true

[T:F] Benzocaine topical exists nearly 100% in the base form and is poorly absorbed into the systemic circulation.

true

[T:F] Compared to injectable local anesthetic drugs, topical products do not require MRDs because they are potentially less toxic.

False: MRDs do not exist for many topical products. Since they are formulated in concentrations exceeding those approved for use in injectable local anesthetic drugs, topical preparations are potentially more toxic.

Overdose reactions from lidocaine topical are similar to injectable forms with progression to CNS __________ without the initial excitation phase.

depression

Which of the following types of topical anesthetics has a pregnancy category B?
A. benzocaine
B. dyclonine
C. lidocaine
D. both A and C
E. all of the above

C. lidocaine * all other topical anesthetics are pregnancy category C

ester topical anesthetic that exists almost entirely in the base form

benzocaine

[T:F] Precautions for toxicity increase when topical anesthetic is applied to abraded tissue.

true

[T:F] The advantages of Cetacaine are its low risk of allergy, rapid onset, and long duration of anesthesia.

False: The advantages rapid onset and long duration. All three drugs are esters. The potential for allergy to para-aminobenzoic acid (PABA), a metabolite of benzocaine, does exist.

What three anesthetics is cetacaine formulated with?

1) benzocaine 2) tetracaine 3) butamben

The onset of action for benzocaine is __________

30 seconds to 1 minute

Why do topical anesthetics require a higher concentration of drug than the same drug used as an injectable local anesthetic?
A. More base molecules of drug are needed to diffuse through membrane barriers
B. They are less likely to produce toxicity when applied topically
C. Decreased amounts are applied topically than when locally injected
D. They do not contain vasoconstrictors

A. More base molecules of drug are needed to diffuse through membrane barriers

Which of the following is not an indication for topical anesthetic drugs in dentistry?
A. Needle penetration
B. Radiographic film placement
C. Periodontal evaluation
D. Sedation

D. sedation

Eutectic mixtures have which of the following characteristics?
A. they work more rapidly than most other topicals
B. they penetrate more deeply on skin than mucosa
C. their melting points exceed that of their ingredients acting alone
D. their formulations facilitate deeper and more efficient penetrations of tissues compared with their ingrediants acting alone

D. their formulations facilitate deeper and more efficient penetrations of tissues compared with their ingrediants acting alone * eutectic refers to a substance that has a lower melting point than any of its ingredients. Eutectic topicals not only have lower melting points to facilitate penetration through tissue barriers, but they are formulated primarily in the base form so that they can provide anesthesia more rapidly

Which of the following is incorrect regarding MRDs of topical anesthetics?
A. they are sometimes difficult to track
B. MRDs are not always provided
C. spray forms have easy-to-track dosing
D. Oraqix has easy-to-track dosing

C. spray forms have easy-to-track dosing *metered sprays are easy to track but unmetered are not

generous quantities of topical and injected anesthesia have been administered, when the patient begins to shake and appears agitated and anxious. Is there a reason for concern?
A. yes, because these may be early signs of CNS depression
B. No, because this is a very nervous patient
C. No, because the doses of injectable anesthetic were within safe guidelines
D. Yes, because patient is dental phobic

A. yes, because these may be early signs of CNS depression

topical anesthetic mixtures may be of benefit in all but one of the following ways ?
A. combination may increase therapeutic range
B. combinations may increase penetration depths
C. mixtures may allow drugs to be used as topicals that are not suitable when used alone
D. mixtures decrease the potential for adverse reactions

D. mixtures decrease the potential for adverse reactions *they usually increase the potential

Which of the following application methods are considered safest when preventing toxicity?
A. Metered sprays and single dose application systems
B. Patches and metered sprays
C. Gels and liquids
D. Swabs and two-phase applications

B. patches and metered sprays

[T:F] the predominately base form of lidocaine topical anesthetic is safer than the predominately hydrochloride salt

true

Dyclonine hydrochloride is an excellent and very durable topical anesthetic and belongs to which one of the following classes of anesthetic?
A. amide
B. ester
C. ketone
D. none of the above

C. ketone

drugs formulated by compounding pharmacies

compound drug

topical anesthetic with a ketone linkage

dyclonine hydrochloride

Which of the following is not a typical sign of CNS toxicity related to overdoses of topical anesthetic drugs?
A. Shaking and agitation
B. Talkativeness and excitedness
C. Disorientation and drowsiness
D. Loss of consciousness

B. talkativeness and excitedness

[T:F] Local anesthesia allergy is dose related. Re-exposure typically produces increased reaction with allergy

first statement false: allergy is exposure related, overdose is based on the dose
second statement true

what are some examples of relative contraindications to local anesthetic?

1) atypical plasma cholinesterase 2) methemoglobinemia 3) malignant hyperthermia 4) liver dysfunction 5) renal dysfunction

What drugs can have negative interactions with vasoconstrictors?

1) tricyclic antidepressants 2) non-selective beta blockers 3) cocaine 4) methamphetamine

rapid or gradual elevation of the drug level in the blood

overdose

Which of the following is not a sign of overdose reaction?
A. talkativeness, apprehension, increase in vitals, slurred speech
B. tinnitus, disorientation, drowsiness, loss of conscious
C. seizure activity, depressed vitals
D. systemic anaphylaxis

D. systemic anaphylaxis *this is a sign of an allergy

What are the patient factors that can impact overdose?

1) age 2) body weight 3) disease factors 4) genetics 5) mental attitude

[T:F] the greater the body weight of the patient the larger the drug dose can be tolerated. This is why obese individuals can tolerate more drugs.

Both statements false: lean body weight of a patient can tolerate larger drug doses. Obese individuals have a lower lean body weight

What is the most common cause of serious local anesthetic overdose reactions in dentistry?

too large local anesthetic dose in relation to the age and weight of the patient

What are the drug factors that influence overdose?

1) LA have vasodilating properties 2) drug dosage 3) route of administration 4) rate of injection 5) vascularity of site 6) presence of vasoconstrictors

How do you manage an overdose reaction to local anesthesia?

1) position in supine position 2) check airway 3) check breathing 4) circulation 5) administer oxygen

What are tips to prevent overdose?

1) know MRD 2) keep a reserve of anesthetic to allow for failure 3) administer anesthetic as you go, not all at once 4) aspirate 5) inject slowly 6) don't dispose cartridge until complete 7) document amount used

[T:F] informed consent is required for injections

true

The rate of positive aspiration in the inferior alveolar nerve block is the highest of all techniques and approximates which of the following?
A. 2-5%
B. 5-10%
C. 10-15%
D. 15-20%

C. 10-15%

A __________ needle is recommended for an inferior alveolar nerve block.

25-gauge long

why is it difficult to determine the dose of topical anesthetics used?

maximum dose recommendations for many topical products do not exist. Even when manufacturers provide MRD information, clinicians often have difficulty determining how much was dispensed or absorbed.

What is the onset time and duration of lidocaine topical?

onset: 1-2 minutes and peak effects may take up to 5-10 minutes
duration: 15 minutes.

What is the MRD for lidocaine topical?

200 mg

What is the onset and average duration of anesthesia for tetracaine?

onset: slow and variable, with peak effects taking up to 20 minutes
duration: 20-60 minutes

where is the penetration site for the IA nerve block in relation to the three key anatomical landmarks for the IA.

slightly lateral to the pterygomandibular raphe, at a height 2-3 mm superior to the greatest concavity of the coronoid notch, and well medial to the internal oblique ridge

Where is the deposition site for an IA nerve block?

1 mm lateral to the medial aspect of the ramus and above the mandibular foramen.

situations in which local anesthetic or vasoconstrictor drugs or nitrous oxide sedation cannot be administerd safely

absolute contraindications

form of cholinesterase that results from a genetic, autosomal, recessive condition in which there is an impaired ability to metabolize ester local anesthetics

atypical plasma cholinesterase

drug that has been administered while other drugs are still in effect

concomitant

highly addictive stimulant drugs, avoid administration of vasoconstrictors for a minimum of 24 hours after use

methamphetamines

condition induced by drugs and other substances, including prilocaine, benzocaine, and articaine, which can result in a life-threatening depletion of oxygen in the tissues

methemoglobinemia

contraindications to local anesthetic delivery that allow procedures to proceed but only after appropriate modifications

relative contraindications

acute, life-threatening state induced by excessive release of thyroid hormones

thyrotoxic crisis (thyroid storm)

[T:F] ASA III and IV are contraindicated with use of anesthetics

false: ASA III may still be considered for elective dental procedures

blood pressure over _______ dental treatment should be deferred and referred to a physician

180/110

patients that have had an MI within _____ _______ is considered an absolute contraindication to dental treatment

1 month, consultation with doctor is recommended as well to make sure they are at 4 MET level

[T:F] vasoconstrictors should be used at all times while treating a patient with sickle cell anemia

false: plain drugs are preferred

[T:F] epinephrine is an absolute contraindication in patients with uncontrolled hypothyroidism

false: hypothyroidism is okay to treat, epinephrine is not to be used for uncontrolled hyperthyroidism

if a patient had a stroke dental treatment must wait until after _____ months

[T:F] local anesthesia can be administered safely to Alzheimer patients in all stages

false: if in the middle to late stage they may not be good candidates because they don't cooperate

Which one of the following is not one of the six elements of the ASA Medical Components of Care associated with regional anesthesia?
A. pre-anesthetic evaluation of the patient
B. comprehensive tooth charting
C. remain present during the course of the anesthesia
D. providing indicated post-anesthesia care

B. comprehensive tooth charting *Although useful for planning a course of anesthesia, tooth charting is not one of the ASA Medical Components of Care

Which of the following is not considered a main tool for patient assessment when planing for local anesthesia?
A. medical/dental questionnaire
B. clinical exam
C. drug MRD's
D. medical consultation

C. drug MRD's *although important, it is not considered a patient assessment tool

Which of the following drugs is an absolute contraindication for patients with poorly controlled or uncontrolled hyperthyroidism?
A. lidocaine
B. bupivacaine
C. epinephrine
D. felypressin

C. epinephrine

Your patient has identified or you suspect that your patient has used methamphetamines approximately 20 hours ago. Which of the following would be the most appropriate action when considering the use of local anesthetics?
A. continue with procedures because it has been more than 12 hours since the use
B. restrict the dose of vasoconstrictors
C. consider postponing care for a full 24 hours
D. use only bupivacaine as the local anesthesia agent

C. postpone care for a full 24 hours

For which one of the following medical conditions is it unnecessary to obtain a medical consultation from the patient's physician before dental treatment?
A. significant liver disease
B. Myocardial infarction within 3 weeks
C. kidney dialysis patient
D. organ transplant patients

B. MI within 3 weeks *at this time it is an absolute contraindication

What are 4 reasons it is important for a clinician to know what concomitant drugs a patient is taking?

1) They may influence the choice of local anesthetic drug and quantity administered 2) They may affect the efficacy, metabolism, and elimination of a local anesthetic drug.
3) They may potentiate the action or delay the metabolism of local anesthethic drugs. 4) Their actions may be affected by local anesthetic drugs.

What are some examples of the need for medical consultation prior to the administration of local anesthesia?

1) patient has symptoms of undiagnosed disease 2) pregnant 3) cardiovascular conditions 4) recent surgeries 5) uncontrolled hypertension 6) psychological conditions that may influence oral procedures 7) compromised liver and/or kidney function 8) immune system compromise

[T:F] Typically, most local anesthetic injections through tissue are not considered to be invasive and do not require antibiotic premedication

true

[T:F] Patients with hemophilia and clotting disorders require antibiotic premedication and modification of injection types, drug selection, and doses of local anesthetics.

false: Patients with hemophilia and clotting disorders do not require antibiotic premedication; however, these patients may require modification of injection types, drug selection, and doses

[T:F] In children, anxiety related to the administration of local anesthesia may provoke syncope or hyperventilation. In adults, anxiety more commonly provokes asthmatic episodes.

False: should be reversed

[T:F] The systemic effects of local anesthesia on the respiratory system are typically minimal. Epinephrine acts on β receptors of the smooth muscles of the bronchioles to dilate air passages.

true

[T:F] A patient has taken a large dose of narcotics prior to local anesthetic administration. Local anesthetic drugs can have a profound effect on the central nervous system (CNS) because local anesthetic drugs are CNS stimulants.

False: anesthetic drugs are CNS depressants. This depression is additive to any existing CNS depression.

[T:F] Pregnancy poses a temporary and relative contraindication to local anesthetics, and the second trimester of pregnancy is considered the safest period for both the fetus and the mother.

true

[T:F] Individuals taking nonselective beta-blocking agents for hypertension or other conditions such as migraines should never be given epinephrine

False: Individuals taking nonselective beta-blocking agents should be given epinephrine with caution

adrenergic drugs that are combined with local anesthetic drugs in order to increase their efficacy and safety

vasoconstrictors (vasopressor)

Which of the following is not an indication for the use of a vasoconstrictor?
A. reducing the risk of toxicity of local anesthetic drugs
B. prolonging the duration of local anesthetic drugs
C. providing hemostasis
D. providing vasodilation following treatment

D. providing vasodilation following treatment

[T:F] Epinephrine and Levonordefrin are indirect-acting on the adrenergic receptors

false: they are direct acting

What are the concentrations of epinephrine?

1) 1:50,000 (lidocaine) 2) 1:100,000 (articaine and lidocaine) 3) 1:200,000 (articaine, bupivacaine, prilocaine)

Which of the following are effects of vasoconstrictors?
A. increased contractility in the heart
B. increased heart rate
C. increased cardiac output
D. vasoconstriction
E. all of the above

E. all of the above

Which of the following adrenergic receptors increase blood pressure?
A. alpha-1
B. beta-1
C. beta-2

A. alpha-1

Which of the following adrenergic receptors increase heart rate and force contraction?
A. alpha-1
B. beta-1
C. beta-2

B. beta-1

Which of the following adrenergic receptors causes vasodilation in skeletal muscle?
A. alpha-1
B. beta-1
C. beta-2

C. beta-2

undesired effects that occur in response to the pharmacologic actions of a drug, including the events surrounding the administration of the drug and described in terms of their local or systemic effects or complications

adverse events (adverse drug events or reactions (ADAR))

the maximum dose for epinephrine in healthy individuals is _____ mg. per appointment

0.2

the maximum dose for epinephrine in medically compromised patients is _____ mg. per appointment

0.04

what are the absolute contraindications for epinephrine?

1) recent heart attack 2) recent heart bypass 3) unstable angina 4) uncontrolled hypertension 5) uncontrolled CHF 6) uncontrolled hyperthyroidism 7) uncontrolled diabetes 8) sulfite allergy

epinephrine's effect on the pacemaker cells [increase/decrease] the incidence of dysrhythmias

increase

epinephrine effects blood pressure by [increase/decrease] systole and [increase/decrease] diastole

increase, decrease * diastole BP can increase in higher doses

How many mg per cartridge is there in lidocaine 2%?

there is 1.8 ml cartride, drop the decimals and you get 18.
18x2=36
answer: 36 mg lidoacine/per cartridge

[T:F] Levonordefrin is 1/6 as potent as epinephrine. The concentration of Levo is low

first statement true
second statement false: more concentrated dilutions (1:20,000)

Compare the potency of levonordefrin to the potency of epinephrine
A. levonordefrin is one fourth as potent
B. levonordefrin is one sixth as potent
C. levonordefrin is twice as potent
D. levonordefrin is six times as potent

B. levonordefrin is one sixth as potent * this is why it is found in a higher concentration

[T:F] if a patient is sensitive to epinephrine, a patient may not be sensitive to Levonordefrin

true

how is Levonorderfrin's actions on adrenergic receptors different from epinephrine?

epinephrine is 50% alpha and 50% beta while Levo is primarily 75% alpha

What are the signs and symptoms of vasoconstrictor toxicity?

1) nausea 2) restlessess 3) racing heart 4) severe headaches 5) palpitations 6) tremors 7) shakiness

levonordefrin is biotransformed by:
A. COMT and MOA
B. hepatic enzymes
C. renal 450 isoenzymes
D. COMT primarily

D. COMT primarily

What is the plasma half-life of vasoconstrictors?

1-2 minutes

Norepinephrine has typically vigorous and sustained vasoconstriction and good hemostasis, why can this be a problem?

may induce necrosis, especially on the palate

Which of the following vasoconstrictors is a very weak vasoconstrictor and is not available in the US?
A. phenylephrine
B. Epinephrine
C. Levonordefrin
D. Felypressin

A. phenylephrine

How is Felypressin different than other vasoconstrictors?

more effects on venous rather than arteriole microcirculation, but can be used for patients with dysrhythmias

Which of the following vasoconstrictors is most useful in providing hemostasis?
A. phenylephrine
B. Epinephrine
C. Levonordefrin
D. Felypressin

B. epinephrine

A patient with severe cardiovascular disease needs restorative work on tooth #5. Hemostasis is needed to keep the site dry. What drug would be indicated in this situation?
A. 4% articaine 1:200,000 epinephrine
B. 2% mepivacaine, 1:20,00 levonordefrin
C. 2% lidocaine, 1:50,000 epinephrine
D. 4% prilocaine plain

A. 4% articaine 1:200,000 epinephrine * a 1:200,000 is best because it contains the least vasoconstrictor for this patient but still provides hemostasis

[T:F] epinephrine's metabolism is relatively rapid after local anesthesia administration

true

Metabolic enzymes for epinephrine include which of the following?
A. COMT and MAO
B. hepatic isoenzymes
C. renal isoenzymes
D. COMT only

A. COMT and MAO

A diabetic patient requires periodontal therapy on the upper and lower right quadrants. She is well-controlled and otherwise healthy. Which one of the following represents the safest and most effective local anesthesia regimen?
A. 4 cartridges of 2% lidocaine, 1:100,000 epinephrine
B. 2 cartridges of 2% lidocaine, 1:100,000 epinephrine and 2 cartridges of 3% mepivacine plain
C. 2 cartridges of 2% lidocaine, 1:100,000 epinephrine, and 2 cartridges of 4% Articaine 1:200,000 epinephrine
D. 2 cartridges of 2% lidocaine, 1:100,000 epinephrine and 2 cartridges of 2% mepivacaine 1:20,000 levonordefrin

B. 2 cartridges of 2% lidocaine, 1:100,000 epinephrine and 2 cartridges of 3% mepivacine plain * epinephrine can raise blood sugar levels and this had the least amount of epinephrine

Which local anesthetic is not available in the United States with 1:200,000 epinephrine?
A. Prilocaine
B. Articaine
C. Lidocaine
D. Bupivacaine

C. lidocaine * this comes with 1:50,000 and 1:100,000 epinephrine

Which of the following drugs has the shortest duration of action?
A. Mepivacaine 3% plain
B. Bupivacaine 0.5%, 1:200,000 epinephrine
C. Prilocaine 4%, 1:200,000 epinephrine
D. Lidocaine 2% plain

D. 2% lidocaine plain * vasoconstrictors would prolong duration and lidocaine plain lasts 5-10 minutes in pulp and 60-120 minutes soft tissue

A healthy 160-pound patient has received three cartridges of 2% lidocaine, 1:50,000 epinephrine during an oral surgical procedure. How many more cartridges with the same drug could this patient receive before reaching the MRD?
A. 2
B. 5
C. 8
D. 10

A. 2
1:50,000 epi= 0.036 mg per cartridge
healthy patient MRD= .2 mg
.2/.036= 5.5 cartridges MRD; patient already had 3 cartridges; 5-3=2

Which of the following is not a trade name for lidocaine?
A. Xylocaine
B. Octocaine
C. Lignocaine
D. Carbocaine

D. Carbocaine *this is another name for mepivacaine

A 2% solution of lidocaine contains __________ mg/ml.

What is the composition and function of a neurolemma (nerve membrane)

bilayered phospholipid membranes. The function is to act as a barrier. Lipid membranes are composed of phospholipids having both lipophilic and hydrophilic ends. The membranes are held together by the attraction of the lipophilic ends at their centers.

What is the significance of the nodes of Ranvier in the administration of local anesthesia.

Local anesthetic solutions cannot diffuse through myelinated nerves except in areas where they come into direct contact with the membrane at the nodes of Ranvier.

Which two layers within the fasciculi are the most significant barriers to the diffusion of anesthetic solutions?

1) perilemma 2) perineurium

local anesthetics are readily able to diffuse through the _____ because of its loose consistency
A. perilemma
B. perineurium
C. mesothelial membrane
D. epineurium

D. epineurium

loose connective tissue layer that surrounds the fasciculi, their associated supporting connective tissue including blood vessels and lymphatics, and the perineuria

epineurium

Which ions bind to specific protein receptor sites within the ion channels of the nerve membrane in its resting state?

Ca2+ ions

what other parts of the body are affected by local anesthetic drugs?

1) CVS 2) CNS 3) skeletal muscle

Why can the lack of profound anesthesia result in a spike in blood pressure?

it can result in unmanageable pain, which in turn can lead to a spike in blood pressure due to the release of endogenous epinephrine in response to the pain. This endogenous release may be much greater than doses of exogenous epinephrine typically administered.

What are the possible local and systemic adverse effects of adrenergic vasoconstrictors

Local effects may include 1) ischemia 2) necrosis systemic effects may include 1) changes in arterial blood pressure 2) palpitations 3) dysrhythmias 4) permanent injury or death due to ventricular fibrillation, heart attack, or stroke.

Why are most adverse events related to the use of vasoconstrictors short-lived?

because efficient reuptake in synapses, and the rapid removal and biotransformation of any residual portions that enter the bloodstream.

Which receptors are responsible for smooth muscle contraction in peripheral arterioles and veins?

alpha

What is the maximum dose of cartridges for 1:100,000 epinephrine that can be delivered in a healthy patient at the same appointment

.2/.018= 11 cartridges

Which of the following signs and symptoms are not signs of CVS overdose toxicity?
A. Depression of myocardial conduction rate
B. Vasoconstriction of peripheral vasculature
C. Hypotension
D. Depression of force of myocardial contraction

B. vasoconstriction of peripheral vasculature

What are some characteristics of topical anesthetics?

1) concentration is typically higher 2) most effective on non-keratinized tissue 2-3 mm 3) atraumatic needle penetration 4) poorly absorbed into CVS

which of the following does not contribute to the toxicity risk of topical anesthetic drugs?
A. hydrophilic properties
B. higher concentrations
C. total applied dose
D. application method

A. hydrophilic properties

[T:F] metered topical anesthetic sprays are potentially dangerous and shouldn't be used for routine use

false: this is only true for unmetered sprays

What are the contraindications for using bio-adhesive patches for topical anesthesia?

1) pregnancy 2) under 12 3) allergy

eutectic topical anesthesia mix of lidocaine and prilocaine periodontal gel that is applied directly into the pocket

oraqix

Oraqix is a eutectic mixture of which anesthetic drugs?
A. benzocaine and lidocaine
B. lidocaine and cetacaine
C. prilocaine and lidocaine
D. prilocaine and benzocaine

C. prilocaine and lidocaine

What is the onset of Oraqix

30 seconds

What is the maximum dosage for Oraqix?

5 cartridges

What are the contraindications for using Oraqix

1) methemoglobinemia 2) children

How is Oraqix applied?

apply around the gingival margin and wait 30 seconds then fill in the periodontal pockets for 30 seconds

[T:F] you should use Oraqix on a limited number of teeth

false: use for at least 1 quad or more, Ultradent is used for a limited number of teeth

What type of local anesthetic is used in Ultradent sulcular topica?

20% benzocaine

[T:F] topical anesthetics don't produce adverse events

false

[Levonordefrin/Epinephrine] is available in a 1:20,000 concentration

levonordefrin

Mepivacaine is available in the following formulation:
A. 2% plain
B. 3% plain
C. 1% with 1:20,000 levonordefrin
D. 3% with 1:20,000 levonordefrin

B. 3% plain *can also be seen as 2% with 1:20,000 levonordefrin

[T:F] 2% lidocaine with 1:50,000 epinephrine provides excellent hemostasis for periodontal surgery.

true

[T:F] all amides are metabolized in the liver.

false: true except for Articaine which is metabolized in the blood like esters

What is the maximum recommended dose per appointment for prilocaine?
A. 200 mg
B. 300 mg
C. 400 mg
D. 600 mg

D. 600 mg

Administering more than 600 mg of prilocaine may result in:
A. malignant hyperthermia
B. heart failure
C. allergic reaction
D. methemoglobinemia

D. methemoglobinemia

In the US prilocaine is marketed at what percent solution?
A. 1%
B. 2%
C. 3%
D. 4%
E. 5%

D. 4%

What is the clinical significance of the rapid half-life of articaine?
A. There is half the risk for a lingual paresthesia to occur.
B. There is a low allergy potential.
C. Half of its metabolites are excreted unchanged; therefore, there is less risk of toxicity.
D. It can be reinjected sooner than the other dental injectable drugs due to its rapid half-life.

D. it can be reinjected sooner because of the rapid half life

What is the FDA pregnancy category for mepivacaine?
A. A
B. B
C. C
D. A, if minimal doses are administered

C. C

The maximum recommended dose for lidocaine is:
A. 5 mg/lb
B. 500 mg per appointment
C. 4.4 mg/lb
D. 2.0 mg/kg

B. 500 mg per appintment

Which of the following drugs is most appropriate for a patient with significant liver and cardiovascular compromise for a root planing procedure in the lower right quadrant?
A. 4% articaine, 1:200,000 epinephrine
B. 3% mepivacaine, 1, 20, 000 levonordefrin
C. 3% mepivacaine plain
D. 4% articaine, 1:100,000 epinephrine

A. 4% articaine; 1:200,000 epinephrine *since articaine isn't metabolized in the liver like other amides it would work better. The 1:200,000 concentration would be better for a cardiovascular compromised patient

A one hour root planing appointment is planned for a patient with significant cardiovascular compromise. Which of the following drugs would be safest and still have adequate duration?
A. 3% mepivacaine plain
B. 4% prilocaine, 1:200,000
C. 2% lidocaine 1:50,000
D. 2% mepivacaine, 1:20,000

B. 4% prilocaine, 1:200,000

A patient with cardiovascular disease has received one cartridge of 2% lidocaine, 1:100:000 epinephrine. How many milligrams of vasoconstrictor has this patient received? How many additional milligrams of vasoconstrictor can the patient receive before reaching MRD?
A. 0.018 mg received; 0.022 mg additional
B. 0.009 mg received; 0.391 mg additional
C. 0.36 mg received; 0.4 mg additional
D. 0.18 mg received; 0.22 mg additional

A. 0.018 mg received; 0.022 mg additional

[T:F] Clark's rule for determining pediatric drug doses is based on a child's weight divided by 150 to get the approximate fraction of the adult dose.

true

How would you calculate the vasoconstrictor of Lidocaine 2% w/ 1:100,000 epinephrine in one cartridge?

1,000/100,000 ml solution = 0.01 mg/ml vaso
0.01 mg/ml vaso x 1.8 ml cartridge = 0.018 mg vaso in a cartrdige

Which of the following local anesthetic drugs has a sulfur atom within the ring structure?
A. articaine
B. bupvacaine
C. lidocaine
D. mepivacaine
E. procaine

A. articaine *this makes the drug more lipophilic

drug that determines the maximum amount that may be administered when considering more than one type of local anesthetic drug during an appointment

limiting drug

young's rule is based on the child's [age/weight]

age

A periodontist requires hemostasis on palatal tissues in the maxillary left quadrant before elevating a surgical flap. Which one of the following drugs would furnish the most vigorous hemostasis?
A. 2% mepivacaine, 1:20,000 Levonordefrin
B. 4% prilocaine, 1:200,000 epinephrine
C. 2% lidocaine, 1:50,000 epinephrine
D. 4% articaine, 1:100,000 epinephrine

C. 2% lidocaine, 1:50,000 epinephrine

If a patient is taking tricyclic antidepressant and a beta-blocker, which of the following drugs would be most appropriate to administer?
A. 2% lidocaine, 1:100,000 epinephrine
B. 2% mepivacaine, 1:20,000 levonordefrin
C. 3% mepivacaine plain
D. 4% articaine, 1:200,000 epinephrine

C. 3% mepivacaine plain

arrange the injectable local anesthetic drugs in descending order of overall CNS and CVS toxicity?
A. Bupivacaine, mepivacaine, lidocaine, prilocaine, articaine
B. Bupivacaine, mepivacaine, lidocaine, articaine, prilocaine
C. Bupivacaine, mepivacaine, articaine, lidocaine, prilocaine
D. Bupivacaine, lidocaine, mepivacaine, articaine, prilocaine

B. Bupivacaine, mepivacaine, lidocaine, articaine, prilocaine *bupivacaine is the most toxic and prilocaine is the least toxic. Mepivacaine is just barely more toxic than lidocaine

Which of the following drugs used in dentistry is the least toxic to the CNS and CVS?
A. lidocaine
B. mepivacaine
C. prilocaine
D. bupivacaine

C. prilocaine

How many mg of 2% lidocaine plain are in two cartridges?

Answer: 72 mg
2x18=36 mg per cartridge
36x2=72

What is the maximum dose for 2% lidocaine plain for a 100-pound patient.

multiply the maximum dose for 2% lidocaine plain (3.2 mg/lb) by the patient weight (100).
3.2 mg/lb x 100 lbs = 320 mg
The maximum dose for 2% lidocaine plain for this patient is 320 mg.

What is the maximum dose for 3% mepivacaine for a 195-pound patient.

400 mg
*if you multiply 3x195=585 mg, which exceeds the MRD for Mepivacaine

A 150-pound patient has received 128 mg of 2% lidocaine plain. How much additional 2% lidocaine plain can this patient safely receive at the same appointment?

MRD for lidocaine =500mg
500-128=372 mg

3.5 cartridges of 2% lidocaine plain have been delivered to a 150-pound patient and an additional 372 mg of the same drug may be delivered. Compute the number of additional cartridges that may be administered.

To convert this number (372 mg) into number of cartridges, divide the 372 mg by the mg per cartridge.
372 mg ÷ 36 mg/cartridge = 10.3 cartridges
An additional 10 cartridges may be delivered

A 150-pound patient can receive 372 mg of 4% prilocaine in addition to the 128 mg of 2% lidocaine. How many cartridges of 4% prilocaine can be delivered?

4x18=72 mg/per cartridge
372 mg/72 = 5.1
5 cartridges of prilocaine can be delivered

All of the following are correct when considering MRDs except:
A. articaine =(3.2 mg/lb, 7.0 mg)
B. bupivacaine = 90 mg (0.9 mg/lb)
C. lidocaine = 600 mg (4.0 mg/lb)
D. mepivacaine = 400 mg (3.0 mg/lb)

C. lidocaine 600 mg (4.0 mg/lb) *this would be true for prilocaine
lidocaine = 500 mg (3.2 mg/lb)

Which of the following is not related to the MRD for 2% lidocaine, 1:100,000 epinephrie?
A. ~11 cartridges
B. ~13 cartridges
C. 3.2 mg/lb
D. 500 mg

B. ~13 cartridges *this would be true if it was lidocaine plain, but epinephrine is the limitinig drug so ~11 cartridges would be true

What are the considerations in selection of local anesthetic?

1) medical/physical status 2) length of time that pain control is required 3) potential for post-operative pain 4) requirement for hemostasis 5) potential for self-mutilation

Which of the following would be an absolute contraindication to giving local anesthetic?
A. heart problems
B. liver dysfunction
C. allergy
D. renal dysfunction

C. allergy *all others would be considered a relative contraindication

What are the considerations of giving local anesthetics for relative contraindications?

1) consider risk/benefit for patient 2) give least possible amount 3) choose a different drug if possible

[T:F] if a patient is allergic to an amide, then they are allergic to all amides. This is referred to as cross-allergenicity

first statement false: this is true for esters not amides
second statement is true

Which of the following local anesthetic solution is the best choice for a patient with a documented sensitivity to sulfites?
A. 2% lidocaine with 1:100,000 epinephrine
B. 1.5 etidocaine with 1:200,000 epinephrine
C. 2% mepivacaine with 1:20,000 levonordefrin
D. 4% prilocaine plain

D. 4% prilocaine plain *sulfites are aused as preservatives with vasoconstrictors, so vasoconstrictors should be avoided

What are some medical conditions that are relative contraindication to local anesthetics?

1) atypical plasma cholinesterase 2) methemoblobinemia 3) malignant hyperthermia 4) liver dysfunction 5) renal dysfunction

What type of drugs have interactions with vasoconstrictors?

1) tricyclic antidepressants (avoid Levonordefrin) 2) non-selective beta blockers 3) cocaine 4) methamphetamine

What is the best choice of drug for a patient taking a beta blocker for hypertension that will provide the longest duration of action?
A. 2% lidocaine
B. 2% mepivacaine, 1:20,000
C. 3% mepivacaine
D. 4% articaine, 1:200,000

C. 3% mepivacaine

What is the maximum recommended dose of mepivacaine?
A. 3.0 mg/lb
B. 0.5 mg/lb
C. 1.8 mg/lb
D. 600 mg per appointment

A. 3.0 mg/lb

Mepivacaine 2% Levo has a _______ duration and the MRD is __ mg/lb or ____ mg

medium, 3, 400

What is the absolute contraindication for Mepivacaine 2% with Levo?

tricyclics

Lidocaine 2% Epi has a ______ duration and an MRD of ___ mg/lb or _____ mg

medium, 3.2, 500

What vasoconstrictor concentrations can be found in Lidocaine?

1:100,000 or 1:50,000 of epinephrine

What is the epinephrine concentration for Prilocaine 4%?

1:200,000

The risk of methemoglobinemia may be precipitated by which one of the following drugs?
A. mepivacaine
B. lidocaine
C. bupivacaine
D. prilocaine

D. prilocaine

Bupivacaine .05% has a ______ duration and the MRD is ____ mg/lb or _____mg

long, .9, 90

Protein binding affects duration of anesthesia. Which of the following has the highest degree of protein binding?
A. bupivacaine
B. lidocaine
C. mepivacaine
D. prilocaine

A. bupivacaine

local anesthetic possessing the greatest degree of protein binding appear to ______ because of this characteristic.
A. penetrate the nerve membrane more easily
B. lack equilibrium between their base and cationic forms
C. have a longer duration of clinical activity
D. provide shortened duration of anesthetic

C. have a longer duration of clinical activity

What type of procedures would Bupivacaine be used?

1) surgeries 2) extractions 3) long post-op pain control

What is the epinephrine concentration for Bupivacine .05%?

1:200,000

Articaine 4% has a [short/long] half-life and is highly [hydrophilic/lipophilic]

short, lipophilic

The correct maximum recommended dose for articaine is:
A. 3.2 mg/lb
B. 4 mg/lb
C. 7 mg/lb
D. 400 mg per appointment

A. 3.2 mg/lb

Which formulation of articaine is correct?
A. 2% articaine with 1:50,000 epinephrine
B. 2% articaine with 1:100,000 epinephrine
C. 4% articaine with 1:100,000 epinephrine
D. 4% articaine plain

C. 4% articaine with 1:100,000 epinephrine *also comes in 1:200,000 epinephrine

What is the duration of action of articaine with 1:200,000 epinephrine?
A. 30 to 45 minutes pulpal anesthesia
B. 45 to 60 minutes pulpal anesthesia
C. 60 to 90 minutes pulpal anesthesia
D. 120 to 300 minutes of pulpal anesthesia

B. 45 to 60 minutes pulpal anesthesia

[T:F] lidocaine with epinephrine is safe to use while nursing

false: lidocaine is safe but not epinephrine

What is the best local anesthetic for a nursing mother?

Articaine because of the short half-life and will take only 4 hours after treatment for it to removed from breast compared to 8-9 hours in Lidocaine and Mepivacaine

How many mg is there in lidocaine 2%?

there is 1.8 ml cartride, drop the decimals and you get 18.
18x2=36
answer: 36 mg lidoacine/per cartridge

How many mg is there in Bupivcaine 0.5%?

18x.5=9 mg Bupivacaine/per cartridge

How much is the total drug with Mepivacine 3% of 1.5 cartridges?

3x18=54 mg mepivacine percartridge x 1.5 cartridges is 81 mg total Mepivacaine

a 1:100,000 vasoconstrictor ratio equals _______ mg/ml vaso

0.01

How would you calculate the vasoconstrictor of Lidocaine 2% w/ 1:100,000 epineprine?

1,000/100,000 ml solution = 0.01 mg/ml vaso
0.01 mg/ml vaso x 1.8 ml cartridge = 0.018 mg vaso in a cartrdige

How would you calculate the vasoconstrictor of Lidocaine 2% w/ 1:50,000 epinephrine?

1,000 mg vaso / 50,000 ml solution = 0.02 mg/ml vaso
0.02 x 1.8 ml cartridge = .036 mg vaso in a cartridge

What is the maximum dose for Mepivacaine HCL 2% w/ 1:20,000 levonordefrin?
maximum dose = 3 mg/lb
patient weight = 100 lb

100 lb x 3 = 300
maximum dose = 300 mg drug based on weight
2% = (20 mg/ml x1.8 =36 mg drug/cartridge)
300 mg / 36 mg percartridge = 8.3 cartridges max

What would you record if you gave multiple injections?

total amount of the anesthetic given the patient

Which statement best describes pain as a protective response?
A. pain is a physiological, conscious reaction
B. pain is a psychological reaction based on blood flow to the injured site
C. pain is rapid, reflexive, subconscious reaction
D. pain is slow, deliberate reaction to avoid further tissue injury

C. pain is rapid, reflexive, subconscious reaction

What are the three types of pain?

1) nociceptive pain 2) neuropathic pain 3) pain disorders associated with psychogenic factors

aspects not attributable to specific injuries or pathology when discussing pain disorders

psychogenic factors

Which of the following statements about nociception is true?
A. nociception is polymodal
B. nociception receptors can distinguish between chemical and thermal stimuli
C. nociception is a physiological and psychological process
D. nocicpetion pain is identical in somatic and visceral structures

A. nociception is polymodal *This means that it can detect injury from chemical, mechanical, and thermal stimuli even though all are registered as pain.

neurotransmitter-mediated mechanism resulting in increased heart rate and BP, dilation of the pupils and of the bronchial and skeletal muscle vasculature, and constriction of mesenteric vessels

fight or flight response

Which of the following is an example of neuropathic pain?
A. fractured bone
B. psychological disorder
C. post-surgery pain
D. trigeminal neuralgia

D. trigeminal neuralgia * Neuropathic pain is caused by nerve tissue injury or dysfunction of the sensory nerves in the central or peripheral nervous systems.

Which of the following will help patients cope with anxiety and fear?
A. avoid discussions about anxiety and fear
B. only the dentist should ask about fear and anxiety
C. assure the patient that difficulties during past dental visits could not have been avoided
D. prepare, rehearse, empower, and praise patients to reduce anxiety and fear

D. prepare, rehearse, empower, and praise patients to reduce anxiety and fear (PREP)

in the process of debriefing, which of the following is not useful when managing fearful patients?
A. patient and clinician discussion period at the end of each appointment
B. patient gives input on the duration and plan for the next appointment
C. future appointments are based on insights from patient/clinician discussion
D. clinicians select strategies for the patient for his or her next appointment

D. clinicians select strategies for the patient for his or her next appointment

What is the mechanism of action for local anesthesia?

it prevents opening of voltage-gated Na channels which prevents depolarization so there are no impulses

Which of the following sequences best describes the events in a successful impulse generation?
A. stimulation, slow depolarization, firing threshold, rapid depolarization, recovery
B. stimulation, firing threshold, rapid depolarization, slow repolarization, resting state
C. resting state, stimulation, slow depolarization, rapid depolarization, firing threshold
D. resting state, stimulation, slow depolarization, rapid depolarization, slow depolarization

A. stimulation, slow depolarization, firing threshold, rapid depolarization, recovery

The resting state of the axoplasm (intracellular environment) is around _______ mv

-70 mV

What is the significance of the core and mantle bundles on local anesthesia?

the mantle (outer) bundles innervate structures in close proximity and a lot easier while the core (inner) bundles innervate structures a distance away from them and the anesthetic takes longer

[T:F] local anesthetic works both on motor and sensory nerves

true

what is the specific protein receptor theory of how LA works?

LA diffuses across the cell membrane and binds to a specific protein receptor at the opening of the voltage-gated sodium channel. Thus blocking Na+ ions from entering the gate and exciting the nerve

local anesthetics are amphipathic, what does this mean?

they are both lipophilic and hydrophilic

the [non-ionized RN/Ionized-cation] is lipid soluble and diffuses through the nerve sheath as the free base form of the LA

non-ionized RN

the more non-ionized molecules present the [faster/slower] the onset of action

faster

what does the ionized-cation RNH+ of LA do?

binds at the receptor site

concentration of cationic and neutral base molecules in a solution

pKa

the [higher/lower] pKa the more rapid onset of action

lower

how does pH influence the effectiveness of local anesthetics?

a decrease in pH shifts equilibrium toward the ionized form, delaying the onset of action. There aren't as many base molecules available to cross the membrane into the axoplasm

how can an infection effect effectiveness of LA?

a tissue infection has a lower pH which reduces the number of available non-ionized base molecules

lipid solubility is related to:
A. onset
B. potency
C. duration
D. all of the above

B. potency * more soluble molecules improves membrane passage which gives it higher potency

The degree of lipid solubility of the anesthetic is reponsible for the ___________ of anesthesia.
A. onset
B. duration
C. potency
D. diffusion

C. potency *more soluble molecules improves membrane passage which gives it higher potency

protein-binding is related to:
A. onset
B. potency
C. duration
D. all of the above

C. duration

pKa is related to:
A. onset
B. potency
C. tissue diffusability
D. both A and C

D. both A and C

What are the 5 desirable properties of local anesthetic drugs?

1) high level of biocompatibilty with no systemic effects 2) rapid onset 3) no toxicity to tissues 4) therapeutic duration 5) potency without inducing hypersensitivity or unconsciousness

Because all injectable and most topical anesthetics are absorbed from the administration site into the cardiovascular system, _________ is of parmount importance
A. the duration of action
B. loss of consciousness
C. low system toxicity
D. a slow onset of action

C. a low system toxicity

elimination half-life refers to which of the following?
A. time it takes for a drug to be half-metabolized
B. time it takes for half of a drug to be out of the system
C. time it takes for half of the drug to be out of circulation
D. time it takes for a drug to be out of half of circulation

C. time it takes for half of the drug to be out of circulation

What is the biotransformation of amides?

through the liver by the hepatic enzyme p450 isoenzyme system

What is the biotransformation of lidocaine?
A. kidney
B. liver
C. lungs
D. blood

B. liver

Ester local anesthetic drugs are metabolized in which of the following pathways?
A. liver
B. blood
C. kidneys
D. brain

B. blood

Which portion of the anesthetic molecule is responsible for binding to the receptor site inside the nerve membrane to prevent depolarization?
A. calcium ion
B. anesthetic free base
C. anesthetic anion
D. anesthetic cation

D. anesthetic cation

Why is vasoactivity of LA significant in the clinical setting?

1) determines if there will be rapid uptake which can lead to overdose 2) vasoconstrictors can have adverse effects on patients with cardiovascular problems

What factors can precipitate an overdose reaction to local anesthetics?

1) excessive doses 2) intravascular administration 3) rapid delivery 4) slower than normal biotransformation 5) age 6) weight 7) health status 8) route of administration

What are the signs and symptoms of CNS toxicity?

1) apprehension 2) bilateral numbness of the tongue 3) disorientation 4) drowsiness 5) elevated vitals 6) headache 7) lightheadedness 8) loss of conscious 9) muscle twitching 10) perioral numbness 11) shivering 12) slurred speech 13) visual disturbances 14) warm feeling of the skin

In severe cases, what conditions may occur if a patient is experiencing severe CNS depression?

1) toni-clonic seizures 2) coma 3) respiratory arrest

what are the physiological effects of LA on the CVS?

1) depression of the mycardium 2) vasodilation of the peripheral vasculature 3) hypotension with increasing doses

What conditions may occur with severe CVS toxicity?

1) cardiovascular collapse 2) when combined with CNS seizures, cardiac and respiratory arrest

How can higher drug levels of LA be both beneficial and harmful to the patient?

sometimes a toxic overdose can cause a cardiovascular collapse. At the same time, lidocaine and procaine can treat cardiac arrhythmias. This is all dependent on the state of the host and their excitability

CNS toxicity occurs because of:
A. the expected response of neurons in the CNS to the drug dose
B. frank neural tissue damage due to excessive dose
C. compromised vascular supply in the CNS due to vasoconstrictor doses
D. none of the above

A. the expected response of neurons in the CNS to the drug dose *CNS toxicity is due to conduction blockade of vital functions within the CNS due to the normal functioning of nerve cells in response to local anesthetic drugs.

CVS toxicity occurs because:
A. compromised vascular supply
B. frank tissue damage
C. decreased in myocardial contractility, vasodilation, and hypotension
D. decreased myocardial contractility, vasoconstriction, and hypertension

C. decreased in myocardial contractility, vasodilation, and hypotension

[T:F] pain threshold and pain tolerance can be used synonymosly

false: pain threshold is the point at which a stimulus first produces a sensation of pain, while pain tolerance is an individual's reaction to painful stimuli

pathways within nerve membranes through which charged atoms can pass

ion channels

to transform an area of nerve membrane from an excitable to a less excitable or nonexcitable state

depolarize

point at which a sufficient change in electrical potential has occurred to generate a nerve impulse

firing threshold

reversal of ion concentrations in the recovery phase when the nerve has attained a potential of about +40 mV

repolarization

state following a nerve impulse generation in which a subsequent impulse generation is either temporarily impossible or more difficult

refractory state

potential across a nerve membrane whenever it is not at 0 mV

polarized

local anesthetic agents achieve their effect by:
A. raising pain thresholds
B. blocking nerve conduction
C. depolarizing nerve fibers
D. decreasing porosity of the myelin sheath

B. blocking nerve conduction

How do local anesthetics stop working?
A. diffusion of the local anesthetic molecules out of the neuron
B. metabolism of the local anesthetic itself in the liver
C. reactivation of the chloride channels in the neuronal cell nucleus

A. diffusion of the local anesthetic molecules out of the neuron

process whereby local anesthetic drugs are broken down to less toxic or nontoxic metabolites before being excreted

biotransformation (metabolism)

hydrocarbon linkage between the working ends of local anesthetic molecules, which also determines the pathway of metabolism of the drugs

intermediate chains

part of the pharmacology of a drug that refers to the actions of the drug on the body

pharmacodynamics

part of the pharmacology of a drug that refers to the management and disposition of the drug by the body

pharmacokinetics

passage of a drug from its site of administration to the bloodstream

absorption

transfer of drugs from circulation to the tissues and organs in the body

distribution

process through which drugs or fractions of drugs and metabolites are removed from the body, primarily via the kidneys

elimination

any positively charged ion; specifically the positively charged local anesthetic ionic molecule that exists in aqueous solutions of local anesthetic drugs

cation

form of local anesthetic molecule in which there is no ionic charge

neutral base

equilibrium constant of local anesthetic drugs in solution, described by the Henderson-Hasselbalch equation, and optimized by adjustments to the pH of a solution

dissociation constant

[T:F] vasodilation is a desirable characteristic of local anesthetic drugs

false: this limits their duration and efficacy while increasing toxicity

Which of the following do not need vasoconstrictors because the are naturally weak vasodilators
A. mepivacaine
B. lidocaine
C. prilocaine
D. all of the above
E. both A and C

E. both A and C

Which of the following explains why mepivacaine is effective for short durations without a vasoconstrictor?
A. strong vasodilator property
B. strong protein binding capacity
C. weak vasodilator property
D. equal in potency to lidocaine

C. weak vasodilator property

enzyme responsible for the metabolism of ester local anesthetic drugs

pseudocholinesterase

The field of anesthesia for an AMSA nerve block includes:
A. Pulps of central and lateral incisors, canine, premolars, and molars on the anesthetized side
B. Pulps of central and lateral incisors, canine, and premolars, and upper lip and facial gingival tissues on the anesthetized side
C. Pulps and lingual gingival of the central and lateral incisors, canine, premolars, and molars bilaterally
D. Pulps of the central and lateral incisors, canine, and premolars, and palatal tissues from the central incisors through the second molar on the side of injection on the anesthetized side

D. Pulps of the central and lateral incisors, canine, and premolars, and palatal tissues from the central incisors through the second molar on the side of injection on the anesthetized side

Complications of the anterior middle superior alveolar (AMSA) nerve block include ___________
A. postoperative numbness of the upper lip
B. excessive ischemia, if solution is administered too slowly
C. a possible postoperative palatal ulcer at the injection site
D. profound soft-tissue anesthesia

C. a possible postoperative palatal ulcer at the injection site

What is a typical minimum volume of anesthetic solution deposited for an AMSA nerve block?
A. 0.2 to 0.6 ml
B. 0.6 to 1.8 ml
C. 0.9 to 1.2 ml
D. 1.2 to 1.8 ml

C. 0.9 to 1.2 ml

The most common cause of failure of palatal nerve blocks is:
A. Solution deposited too far from deposition site
B. Solution deposited too rapidly and it backflows into the mouth
C. Vasoconstrictor constricts the vessels preventing the flow of solution to the nerve
D. Inadequate topical and pressure anesthesia prevent adequate penetration depth

A. solution is deposited too far from deposition site

What is a typical minimum dose of anesthetic solution deposited for GP nerve blocks?
A. 1 stopper width (0.2 mL)
B. 2 to 3 stopper widths (0.4 - 0.6 mL)
C. 0.9 to 1.2 mL
D. One-half of a cartridge

B. 2 to 3 stopper widths (0.4 - 0.6 mL)

What is the approximate depth of penetration for a GP nerve block?
A. 2 mm
B. 2 to 6 mm
C. 6 to 10 mm
D. 9 to 12 mm

C. 6 to 10 mm

Which location represents the correct penetration site for a nasopalatine nerve block?
A. Palatal mucosa lateral to the widest anteroposterior dimension of the incisive papilla
B. Palatal mucosa at the base of the incisive papilla on the right or left side of the incisive papilla
C. Midline in the incisive papilla at the widest anteroposterior dimension of the incisive papilla
D. Perpendicular to the incisive papilla at the widest dimension

A. Palatal mucosa lateral to the widest anteroposterior dimension of the incisive papilla

Which of the following represents the correct penetration depth for a nasopalatine nerve block?
A. 2 to 3 mm
B. 4 to 7 mm
C. 6 to 12 mm
D. 10 to 16 mm

B. 4 to 7 mm

Which of the following statements is true of the NP nerve block?
A. Provides highest rate of positive aspiration of palatal injections
B. Provides more durable anesthesia than other palatal injections
C. Provides bilateral anesthesia
D. Contact with bone should be avoided

C. provides bilateral anesthesia

A 10% solution contains one tenth of a milligram per milliliter or __________ mg/ml.

100

A 100-pound patient received 72 mg of 2% lidocaine. How many cartridges of 4% prilocaine can this patient receive?

3.4 cartridges

A bony ridge or __________ can be palpated overlying the facial roots of maxillary teeth.

eminence

A minimum volume (in milliliters) of anesthetic solution needed to achieve anesthesia with an ASA injection is typically __________ mL.

0.9

An anatomical variation that can complicate an MSA injection is the presence of a large __________

zygomaticoalveolar crest

What tissues are anesthetized with the P-ASA injection?

the central, lateral, and canine teeth and the periodontium facial and palatal to the affected teeth

What letter indicates the structures inervated by the Greater palatine nerve block?

What letter indicates the structures inervated by the nasopalatine nerve block?

What letter indicates the structures inervated by the ASA nerve block?

What letter(s) indicates the structures inervated by the AMSA nerve block

B, C (excluding the the mesiobuccal root of first molar), D (to the side of injection) , and E

What letter indicates the structures inervated by the IO nerve block

What letter indicates the structures inervated by the MSA nerve block?

Soft tissue retraction for a PSA injection is both __________ to allow for good visibility.

upward and outward

The ASA nerve is a branch of the __________ division of the trigeminal nerve.

maxillary

The PSA injection is indicated for pain management of __________ in one quadrant

multiple molar teeth

The PSA nerve branches from the maxillary nerve in the __________ fossa prior to entering the infraorbital canal.

pterygopalatine

The angle of insertion for the PSA injection is __________ degrees to the maxillary occlusal table and the midsagittal planes.

The __________ nerve block is indicated for pain management of anterior and premolar teeth in one quadrant.

infraorbital

The __________ theory explains why pressure anesthesia is effective in palatal nerve blocks.

gate control

The correct depth of penetration for a V2 injection is __________ mm.

The deposition site for an infiltration injection is at the __________ of the tooth.

apex

The depth of penetration for an ASA injection ranges from __________ mm.

3-6

The group of nerves innervating the pulp of the tooth, facial areas of the gingiva, periodontal ligament, and alveolus is called the _________

dental plexus

The nasopalatine nerve is the longest branch of the posterior superior nasal branch of the __________ nerve.

maxillary

The needle pathway for an IO injection has been described as oriented along a line parallel to the __________

pupil of the eye

The needle pathway of an MSA injection parallels the long axis of the __________ .

second premolar

The optimal site of penetration for an ASA injection is at the height of the mucobuccal fold __________ to the canine eminence.

The optimum depth of insertion for a PSA injection is __________ mm.

The optimum site of penetration for infiltration injections is at the __________ .

height of muccobuccal fold

The pathway of the needle __________ the long axis of the tooth in an infiltration injection.

parallels

What is the most common cause(s) for failure of anesthesia following a GP injection?

deposition of solution that is too shallow, too lateral, or too medial to the foramen as well inadequate volumes of solution

The two-step method for pre-anesthesia for palatal injections includes a one-minute application of topical anesthesia and _________

pressure

local infiltration of the palate is used primarily for _______
A. achieving hemostasis during surgical procedures
B. anesthetizing inflamed sites
C. pain control during surgical procedures involving palatal tissues
D. anesthetizing large areas of palatal soft tissue

A. achieving hemostasis during surgical procedures

When using 4% solutions on the palate how much should be delivered?

total volume should be half

Topical anesthetic patches may provide a __________ depth of anesthetic penetration.

4-6 mm

A Vazirani-Akinosi nerve block is also called the __________ technique.

closed-mouth

[T:F] The Vazironi-Akinosi nerve block provides a wider field of anesthesia than the IA nerve block. It provides a narrower field of anesthesia than the Gow-Gates nerve block

both statements true: VA is slightly limited compared to the GG

A typical minimum recommended volume of anesthetic solution for a mental nerve block is __________ mL.

0.6 mL (1/3 cartridge)

Crucial to the success of Gow-Gates nerve blocks, patients must remain in a __________ position throughout the procedure for up to 2 minutes following deposition of anesthetic solution.

wide open

Deposit a minimum of __________ mL of anesthetic solution for a Vazirani-Akinosi nerve block.

1.8 mL

What are some technique related errors that lead to failure of local anesthesia of the IA nerve block?

1) depositing solution too far from foramen 2) shallow deposition 3) deposition medial to soft tissue barriers

The buccal nerve crosses the coronoid notch of the ramus at the level of the __________ .

occlusal plane

The deposition site for a Gow-Gates nerve block is often __________ mm from the inferior alveolar nerve.

5-10

The deposition site for a buccal nerve block is at the buccal aspect of the ramus, lateral to the __________ as the nerve passes over the anterior border of the ramus.

external oblique ridge

The depth of insertion for a mental nerve block is typically __________ mm.

4-6

The field of anesthesia for an incisive nerve block includes the buccal mucous membrane and skin of the lower lip and chin, and the __________ anterior to the mental foramen, to the midline.

pulps of teeth

The largest branch of the mandibular division of the trigeminal nerve is the __________

inferior alveolar

The lingual nerve is usually located __________ to the inferior alveolar nerve.

medial and anterior

The mental nerve typically exits the mandible between the __________

apices of the first and second premolars

The penetration site for an inferior alveolar nerve block is slightly __________ to the pterygomandibular raphe.

lateral

What is the most universal supplemental injections?
A. periodontal ligament (PDL) injection
B. intraosseous
C. mylohyoid
D. all of the above

A. periodontal ligament (PDL) injection *also referred to as intraligamentary or peridental

Which of the following is true regarding PDL injections?
A. the solution diffuses through the periodontal ligament to the dental plexus
B. the solution diffuses through the alveolar bone to the dental plexus
C. the technique is useful only when other techniques have failed
D. the orientation of the bevel is critical to the success of the procedure

B. the solution diffuses through the alveolar bone to the dental plexus

What is an example of failure of anesthesia for an infiltration and would should the clinician do to correct it?

the needle tip lies too far past apex of the tooth or too far from the bone. The clinician should reassess and adjust the depth and redirect closer to bone

What are common anesthetic failures associated with the PSA injection?

1) needle to lateral 2) needle not high enough 3) needle too far posterior

Pre-mature bone contact common for troubleshooting on the IO and it produces anesthesia of the lower eyelid, lateral side of nose, and upper lip, but very little dental anesthesia. What should the clinician do to prevent this problem?

1) keep needle in line with infraorbital foramen during penetration 2) estimate depth of penetration prior to injecting

What are common troubleshooting for the IA injection?

1) deposition too low below the mandibular foramen 2) deposition of anesthetic too far anteriorly (less than half the needle has penetrated) 3) accessory innervation of mandibular teeth 4) cross-over innervation

expected variations in anatomic patterns of innervation

accessory innervation

The most documented of the accessory innervation is the _______ nerve

mylohyoid

What is commonly associated with long buccal failure?

inadequate volume of solution deposited

During the Gow-Gates the clinician can deposit up to ____ ml of additional solution if there was failure

1.2

[T:F] bone should be contacted while giving the GG injection.

true

The Gow-Gates is successful in providing anesthesia of mandibular molars in the presence of accessory innervation from the mylohyoid or lingual nerves because
A. An increased volume of solution is administered and the mouth is maintained in an open position following injection.
B. The deposition site is lower on the inferior nerve; therefore, it is closer to the mylohyoid and lingual nerves.
C. The IA nerve trunk is anesthetized higher on the inferior nerve.
D. A long, 25 gauge needle is used.

C. The IA nerve trunk is anesthetized higher on the inferior nerve.

Mepivacaine plain solutions may be useful for reinjection following the use of lidocaine 2% with epinephrine for all of the following reasons except
A. There is 50% more drug per volume.
B. It raises the pH at the deposition site.
C. Duration is enhanced by the presence of previously injected vasoconstrictor.
D. It is a strong vasodilator.

D. it is a strong vasodilator *mepivacaine is the weakest vasodilator

What are common problems of anesthetic failure associated with the VA technique?

1) insert too medially 2) under/overinsertion 3) needle insertion point too low

What is the depth of penetration for the VA technique?

25 mm

What should the clinician do if their patient experiences anesthetic failure during the VA because their needle point is too low?

insert at height of mucogingival junction of the last maxillary molar and maintain needle parallel to occlusal plane

What are common problems of anesthetic failure associated with the incisive technique?

1) inadequate volume of solution 2) inadequate duration of pressure

After depositing for the incisive technique firm pressure over the injection site needs to be held for a minimum of ____ minutes

Inadequate anesthesia may typically be caused by all of the following, except
A. Volume of solution
B. Presence of inflammation
C. Quality of manufactured solutions
D. Anatomical variations

C. quality of manufactured solutions

Inadequate anesthesia in the maxillary incisors is least likely to be caused by:
A. Crossover innervation from the contralateral ASA nerve
B. Nasopalatine innervation
C. Bony obstructions
D. Facial nerve innervation

D. facial nerve innervation

Infilration (supraperiosteal) anesthesia over the apex of #9 has failed to achieve adequate anesthesia. Which of the following is not a likely possibility?
A. cross-over innervation from the contralateral ASA
B. bony obstruction
C. dense bone
D. unseen inflammation

D. unseen inflammation *inflammation with no signs or symptoms is unlikely

The relative acidity of tissues into which anesthetic drugs are injected is related to the efficacy of a drug in the following manner:
A. an excess of hydrogen atoms enhances neutral base molecule formation
B. a pH-driven increase in cationic concentrations decreases the rate of success
C. a pH-driven increase in cationic concentrations increases the rate of success
D. a decrease in pH increases the number of neutral base molecules

B. a pH-driven increase in cationic concentrations decreases the rate of success

possible successful approaches when an IA nerve block fails to provide complete and profound pulpal anesthesia are:
A. PDL injections
B. mylohyoid nerve blocks
C. Gow-Gates blocks
D. all of the above

D. all of the above

Two injections of 2% lidocaine, 1:100,000 epinephrine have failed to provide adequate anesthesia. Useful supplemental alternatives, regardless of the location or technique, include all of the following except:
A. 3% mepivacaine
B. PDL injections
C. mylohyoid blocks
D. 2% mepivacaine, 1:20,000 levonordefrin

C. mylohyoid blocks *this is only useful in the mandible

What are some examples of patient and clinician-related causes for inadequate anesthesia?

Patient-related: 1)anatomical 2) pathological 3) psychological factors
Clinician factors: 1) technique 2) drug selection.

What factors may influence anesthetic success?

1) Neuroanatomy and its variability 2) bony prominences and dense bone 3) atypical fascial planes 4) highly vascular areas 5) ligamental deflection 6) circadian (diurnal) influences 7) physical and chemical barriers

[T:F] Using 25-gauge needles for injections requiring deep penetration depths creates a high risk for needle deflection and failure of anesthesia.

False:The higher the gauge of needle, the greater its flexibility and deflection in tissues.

[T:F] Acidified solutions of local anesthetics containing vasoconstrictors are less likely to produce profound anesthesia.

True: they are also more likely to produce discomfort during administration.

[T:F] Regardless of the length or type of anticipated treatment, the same volume of anesthesia is required for adequate anesthesia.

False: Volumes administered should take into account the length of anticipated treatment.

What are four examples of physical barriers to successful anesthesia?

1) Dense bony prominences 2) shallow vestibules 3) dilacerations 4) soft tissues such as ligaments

Which of the following factors is most likely to correspond to anesthetic failures?
A. Delivery devices
B. Needle bevel orientation
C. Needle deflection
D. Physical barriers

D. physical barriers

Which of the following does not typically have an effect on the ability to achieve profound anesthesia?
A. Anatomical barriers
B. Choice of anesthetic
C. Volume of anesthetic administered
D. Psychological barriers

B. choice of anesthetic

Adequate blockage of a nerve is more difficult to achieve in infected or inflamed tissues because of the :
A. decreased absorption of remaining anesthetic molecules into dilated blood vessels
B. changes in intracellular pH
C. decreased vascularity in the infected of inflamed area
D. small number of molecules able to cross the nerve sheath

D. small number of molecules able to cross the nerve sheath

What are possible causes of tachyphylaxis in local anesthesia?

localized tissue edema in the area of injection and localized hemorrhage, both of which prevent sufficient concentrations of base molecules near the nerves for anesthesia to develop successfully

synonymous with rapid drug tolerance, the need for increasing doses in order to achieve similar therapeutic effects

tachyphylaxis

unexpected variations in anatomic patterns of innervation

aberrant innervation

Which of the following injections would most likely solve inadequate anesthesia on the palatal root of tooth #3?
A. Facial infiltration
B. MSA
C. Greater palatine
D. PSA

C. greater palatine

Which nerves can provide accessory innervations to the maxillary central incisors, resulting in inadequate anesthesia?

fibers of the nasopalatine nerve may join with the maxillary dental plexus to innervate the central incisors.

Which of the following nerves is often considered the most likely source of accessory innervation of the mandibular first molar?
A. Mylohyoid
B. Buccal
C. Lingual
D. Cervical

A. mylohyoid

What are some examples of injection techniques used to overcome possible accessory innervations of the mandibular teeth?

1) PDL 2) Gow-Gates 3) Vazirani- Akinosi 4) intraosseous injection technique

What is the recommendation to avoid failed anesthesia due to intravascular injection?

Performing multiple aspirations and aspirations in more than one plane

Which of the following is the best option to assure anesthesia in the presence of inflammation?
A. Administer a larger volume of anesthetic in the same location
B. Select an injection that will provide anesthesia of the nerve trunk medial to the area of inflammation
C. Administer infiltrations in several locations around the tooth to provide anesthesia
D. Choose a different anesthetic drug

B. Select an injection that will provide anesthesia of the nerve trunk medial to the area of inflammation

To obtain adequate nerve block anesthesia in the presence of inflammation or infection, dental professionals should deposit solution:
A. away from inflamed area
B. into the infected area
C. in a smaller volume
D. where the tissue pH is 5.5

A. away from inflmated area

What level of sedation does nitrous oxide-oxygen sedation in dentistry fall into?
A. general anesthesia
B. deep sedation
C. moderate sedation
D. minimal sedation

D. minimal sedation

What are the absolute contraindications for nitrous oxide use?

1) COPD 2) active respiratory infection 3) intraocular gas injection within 8-12 weeks 4) latex allergy 5) pregnancy in 1st trimester 6) recent tympanic membrane graft 7) severe psychosis 8) treatment involving injection or pathology that causes pockets of gases into body cavity

What are some relative contraindications to nitrous?

1) dry-air asthma 2) substance abuse or alcoholism 3) claustrophobia 4) PTSD 5) CNS depressant 6) middle ear problems 7) bowel obstruction 8) Alzheimer 9) autism 10) cystic fibrosis

Which of the following patient conditions is not an absolute contraindication for the use of N2O-oxygen sedation?
A. Recovering alcoholic
B. Acute respiratory infection
C. Severe chronic obstructive pulmonary disease
D. Severe psychosis

A. Recovering alcoholic

What color is a N2O tank in the United States?
A. White
B. Blue
C. Green
D. Gray

B. blue

What teeth are anesthetized with the Gow Gates?

all teeth in the mandibular quad

What periodontium and soft tissue is anesthetized with the Gow Gates?

1) all periodontium 2) buccal mucosa premolars to midline 3) floor of mouth 4) 1/2 tongue on quad

What are five condsiderations to think of when your patient isn't numb?

1) poor technique 2) quantity of local anesthetic 3) time allowed following administration for LA to take effect 4) infection/inflammation 5) anatomical reasons

Which of the following is true about the Gow Gates injection compared to the IA?
A. lower success rate
B. higher percentage of positive aspiration
C. slower onset
D. deposited at the occlusal plane

C. slower onset *the IA has a success rate of 65-86% while the GG has a success rate of 90-100%. Positive aspiration in IA is 7-22% while in the GG it is 2%. the IA is deposited at the occlusal plane while the GG is higher

What nerves are anesthetized with the GG injection?

1) inferior alveolar 2) mental 3) incisive 4) lingual 5) mylohyoid 6) auricolotemporal 7) buccal nerve (75% of the time)

Where is the penetration site for the GG?

buccal mucous membrane posterior to the maxillary 2nd molar at the level of the mesiolingual cusp

What are the extraoral landmarks that the clinician needs to know before giving a GG injection?

a line from the intertragic notch to the labial commisure

The target site for the Gow-Gates injection is the:
A. inferior border of the ramus
B. lingula
C. coronoid notch
D. condyle

D. condyle

What needle is recommended with the GG injection?

25 long

What is the depth of penetration for the GG injection?

about 25 mm or about 1/2 to 3/4 length of needle

What is the minimal volume of anesthetic solution recommended for a Gow-Gates nerve block?
A. 0.9 mL
B. 1.5 mL
C. 1.8 mL
D. 3.6 mL

C. 1.8 mL

What nerves are anesthetized with the Vazirani-Akinosi nerve block?

1) IA 2) mental 3) incisive 4) lingual 5) mylohyoid 6) buccal (frequently)

When would the Vazirani-Akinosi technique be used?

limited jaw opening due to 1) physiological 2) pathologic 3) phobic

In which nerve block is where the needle is held at the height of the mucogingival junctiono of the maxillary second or third molar and the bevel of the needle is oriented away from the bone that the needle deflects toward the mandibular ramus as it is advanced through soft tissue ?
A. incisive
B. Gow-Gates
C. Vazirani-Akinosi
D. infraorbital
E. posterior superior alveolar

C. vazirani- Akinosi

Where is the deposition site for the VA injection?

above the mandibular foramen on the medial surface of the ramus in the pterygomandibular space

What is the needle selection for the VA?

both 25 or 27 long needle

What is the angle of insertion for the VA?

parallel to the mandibular molars

What is the average depth of insertion for the VA?

25 mm

how much anesthetic should be used for successful anesthesia with the VA?

1.8 mL (1 cartridge)

What are concerns with using local anesthesia with children?

1) overdose 2) complications related to soft-tissue anesthesia 3) technique variations

What are local anesthetic signs of overdose on the CNS?

1) tremors 2) tonic-clonic convulsion

What are local anesthetic signs of overdose on the CVS?

1) decrease in BP 2) decrease in cardiac output 3) cardiac arrest

For small children, the risk of local anesthetic overdose increases because:
A. Higher blood levels of anesthetics are associated with greater blood volumes
B. The safety margin of these drugs is low in such patients
C. such patients have a greater blood volume than adults
D. These drugs are more toxic in children than in adults

B. The safety margin of these drugs is low in such patients

[T:F] the best choice for anesthetic for a child receiving treatment in more than 1 quad is Mepivacaine 3%.

false: mepivacaine 3% should never be used if doing treatment in more than 1 quad

[T:F] articaine is contraindicated in children under the age 4

true

The PowerPoint listed five specific factors that add to increased risk of local anesthetic overdose in children. Which of the following is not one of the five listed?
A. All four quadrants treated using LA in one visit
B. No vasoconstrictor used
C. Rapid injection of solution
D. Full cartridges administered with each injection
E. Exceeding the maximum dosage based on the patient's body weight

C. rapid injection of solution

Among the factors that a clinician can control in regard to a given drug's induction time is/are the ______:
A. diffusion constant of the anesthetic drug
B. concentration of the drug
C. anatomical diffusion barriers of the nerve
D. amount of the drug diluted by interstitial fluid

B. concentration of the drug

What are ways to prevent soft-tissue injury in children that were given anesthetic?

1) select a local anesthetic with a duration of action appropriate to procedure length 2) advise both patient and caregiver of possibility of soft-tissue injury 3) place cotton roll in muccobuccal fold with a ligature

[T:F] nerve block provide the most appropriate anesthesia in children. Infiltrations can only be used for the maxilla

both statements false: since the maxillary and mandibular bone is less dense, infiltrations in both maxilla and mandible usually provide adequate anesthesia

How much solution should be deposited for infiltration in a child?

1/4 - 1/3 cartridge

[T:F] the depth of penetration for an IA on child is about 15 mm. A long needle should be used.

first statement true
second statement false: short needle

What primary teeth surround the mental foramen?

between the two primary molars

[T:F] PDL anesthesia is used for both primary and permanent teeth

false: not recommended for primary teeth because of possibility of enamel hypoplasia on permanent teeth

Which statement describes why aspiration is not required for PDL injections?
A. there is no significant risk of intravascular deposition with this technique
B. special syringes used for PDL injections are self-aspirating
C. it is impossible to aspirate with a bend in a needle
D. the position of the syringe prohibits the ability to aspirate

A. there is no significant risk of intravascular deposition with this technique

What are the most important considerations when treating pediatric patients related to a child's body weight and the immaturity of their organs?

potential for drug toxicity due to the relatively low body weight of small children and the immaturity of their organs.

Which of the following anesthetic drugs is associated with higher number of toxicity reports compared to the others?
A. articaine
B. lidocaine
C. mepivacaine
D. bupivacaine

C. mepivacaine *this is due to: 1) increase systemic absorption 2) Pharmacokinetic evaluation has revealed that anesthetic blood levels of 3% mepivacaine without a vasoconstrictor peak at a more rapid rate than an equivalent amount of 2% lidocaine, 1:100,000 epinephrine 3) surpass plasma levels by a nearly threefold margin, following maxillary infiltration injection

why does dose-dependent toxicity reactions in dentistry occur most frequently in children.

1) disproportion of orofacial anatomy to a child's body weight (larger head compared with body) that may require larger volumes of anesthetic to achieve effect 2) failed anesthesia leading to multiple injection 3) inadequacy of pain assessment scales due to some patients perceiving the numb feeling as pain 4) lack of or improper calculation of maximum recommended dose.

Which of the following is the best management technique for children?
A. cover the mouth and nose to stop a child from screaming
B. use of physical restraint
C. use of vocal distraction and positive feedback
D. explain exactly what the child will feel during the injection

C. use of vocal distraction and positive feedback

What are some special consideration for maximum doses of anesthesia for morbidly obese children.

When a young child has the body weight of an adult, the usual dosing guidelines not only may not apply but likely do not apply. Current medical research, however, has found that it is advisable to use the ideal body weight (IBW) when calculating doses of medicinal agents for patients considered to be obese. Remaining alert to the development of adverse events and dosing below the MRD is paramount whenever local anesthetic drugs are administered to these children.

The presumed safe dose of 2% lidocaine for an obese 10-year-old child weighing 120 pounds is ________ mg.

240 *the MRD for lidocaine for pediatric dose is 2.0 mg/lb and should not exceed 300 mg.

Which of the following is not a special consideration when administering anesthetic drugs to obese children?
A. excess adipose tissue in the oral cavity impedes visibility
B. excess adipose tissue in the oral cavity makes it difficult to identify intraoral anatomical landmarks
C. obesity alters the distribution and elimination of anesthetic drugs
D. obesity may require administration of greater volumes of anesthetic for effectiveness

D. obesity may require administration of greater volumes of anesthetic for effectiveness

What is the treatment for postoperative trauma caused by lip/cheek biting?

1) cold pack over the injured tissue to reduce swelling 2) If notification occurs the day following an appointment, a warm pack can be recommended to stimulate circulation and promote healing. 3) Antibiotics are usually not indicated and are prescribed only in the unlikely event of infection.

Why is 4% articaine used with frequency in pediatric care?
A. less risk of paresthesia
B. ease of biotransformation
C. more effective in its ability to diffuse through bone
D. longer duration than mepivacaine

C. more effective in its ability to diffuse through bone

A technique called ________ allows a dental assistant to minimize unwanted movements by the child during injections.

passive restraint

What is the anatomical reason a short needle is usually adequate length for a maxillary infiltration on a child patient.

the shorter is adequate for reaching the deposition site at the apex of a maxillary tooth because primary teeth roots are typically shorter than the roots of their permanent successors.

What is the advantage of using bilateral mandibular nerve blocks with children?

incidence of postoperative lip-biting actually decreased in children who received bilateral mandibular blocks compared to those who received unilateral blocks

What is the typical position of the mandibular foramen in children compared to its position in adults.

it is more inferior in children compared to adults

Which of the following anatomical variations affects the choice of injection for children?
A. the inferior alveolar foramen is more superior in children than adults
B. the cortical plate is thinner and more porous in children than adults
C. the roots of primary teeth are approximately the same length as permanent teeth roots
D. the maxillary tuberosity is less prominent in children than adults

B. the cortical plate is thinner and more porous in children than adults

Why is it generally more critical to consider toxicity of local anesthetics in pediatric patients than in adults?
A. children react differently to local anesthetic agents
B. local anesthetic doses are based on body weight
C. appropriate anesthetic agents for children are different than for adults
D. crying and screaming may allow more rapid anesthetic uptake

B. local anesthetic doses are based on body weight

What is the most critical risk factor for toxicity of local anesthetics in pediatric patients?
A. children react differently to local anesthetics than adults
B. children are less able to metabolize local anesthetics than adults
C. appropriate anesthetic agents for children are different than for adults
D. children typically weigh less than adults

D. children typically weigh less than adults

How does excellent anesthesia serve as a management tool for children?
A. restorative procedures become tolerable, if not pain-free
B. clamp placement for rubber dam is simplified
C. quadrant (or half-mouth) treatment can be completed in one visit
D. all of the above

D. all of the above

In which of the following ways do anatomical variations affect the choice of injection techniques for children?
A. roots of primary teeth are generally shorter than permanent tooth roots
B. the cortical plate is thicker and less porous in children than in adults
C. the inferior alveolar foramen is often more superior in children than adults
D. all of the above

A. roots of primary teeth are generally shorter than permanent tooth roots

Which of the following describe ways in which an assistant can play a vital role in the successful administration of local anesthetics to children?
A. showing the patient the needle to prepare the child
B. calming the parent during the injection by explaining what is happening
C. placing one hand on the child's forehead and the other on the child's hands for safety
D. none of the above

C. placing one hand on the child's forehead and the other on the child's hands for safety

Which of the following are benefits of using age-appropriate terminology and specific positive feedback during the successful anesthetic administration in pediatric patients?
A. using understandable terms to demystify the child's experiences
B. using specific positive feedback teaches children what is expected and what is going well
C. avoiding frightening (or "trigger") words to reduce the chance of resistance
D. all of the above

D. all of the above

Which of the following is true when considering injection techniques in children?
A. mandibular infiltrations rarely work for children
B. deposition of anesthetic solutions for mandibular blocks are more inferior compared with adults
C. long needle are usually recommended
D. all of the above are true

B. deposition of anesthetic solutions for mandibular blocks are more inferior compared with adults

[T:F] the primary advantage when administering mandibular infiltrations on children is the small volume of anesthetic needed to achieve profound anesthesia

false: the primary advantage of mandibular infiltrations is that it doesn't anesthetize large areas of the tongue and lip and may reduce soft tissue trauma

For pediatric patients, _______ is frequently indicated.:
A. the anterior superior alveolar nerve block
B. supraperiosteal infiltration
C. the posterior superior alveolar nerve block
D. the Vazirani-Akinosi mandibular nerve block

B. supraperiosteal infiltration

When children traumatize soft tissues immediately following injections, what is the best management?
A. place a cold pack immediately
B. place a warm pack immediately
C. always put the child on an antibiotic for infection
D. both A and C

A. place cold pack immediately

Which of the following is an age appropriate explanation for a three year old child?
A. hold real still and you will not feel this
B. your lip will feel fat and sleepy
C. the anesthetic will wear off in just a little while
D. your teeth will feel numb

B. your lip will feel fat and sleepy

The field of anesthesia of an IO nerve block includes the:
A. Pulps of maxillary central incisors through canine, and upper lip, side of nose, and lower eyelid
B. Pulps and periodontium of maxillary central incisors through canine and premolars, mesial buccal root of the first molar, upper lip, side of nose, and lower eyelid
C. Pulps of maxillary incisors, canine and premolars, upper lip, and side of nose
D. Pulps and maxillary periodontium of incisors, canine, premolars

B. Pulps and periodontium of maxillary central incisors through canine and premolars, mesial buccal root of the first molar, upper lip, side of nose, and lower eyelid

In a typical adult, how far below the inferior orbital ridge is the IO deposition site located?
A. 8 to 10 mm
B. 6 to 12 mm
C. 2 to 4 mm
D. 1 to 2 mm

A. 8 to 10 mm

[T:F] the penetration site for the IO is at the height of the muccobuccal fold directly over the first molar.

false: over the 1st premolar

Where is the deposition site for the IO?

anterior to or superficial to the infraorbital foramen

What is the average depth of penetration for the IO injection?

about 16 mm (1/2 of a long needle)

What is the needle selection for the IO injection?

25 or 27 long

What is a minimal volume of anesthetic solution deposited for an IO nerve block?
A. 0.6 mL
B. 0.9 mL
C. 0.9 mL to 1.8 mL
D. 1.2 to 1.6 mL

B. 0.9 mL

What is the importance of applying 1 to 2 minutes of finger pressure over the deposition site following an IO nerve block?

enhances diffusion of the anesthetic solution into the infraorbital canal.

What are some causes of anesthesia failure for the IO?

1) depositing too inferior or too superficial to the foramen 2) inadequate volume of solution 3) inflammation or injection in the area 4) inadequate diffusion

When is the nasopalatine nerve block indicated for pain management?

palatal soft and osseous tissue in the anterior third of the palate, approximately from canine to canine.

Where does the nasopalatine nerve exit the maxilla?

incisive foramen

What teeth are occasionally anesthetized with the NP injection?

central incisors

Which location represents the correct penetration site for a nasopalatine nerve block?
A. palatal mucosa lateral to the widest anteroposterior dimension of the incisive papilla
B. palatal mucosa at the base of the incisive papilla in the right or left side of the incisive papilla
C. midline in the incisive papillae at the widest anteroposterior dimension of the incisive papilla
D. perpendicular to the incisive papilla at the widest dimension

A. palatal mucosa lateral to the widest anteroposterior dimension of the incisive papilla

anesthesia that is already in effect from previous injections in an area, or a two-step topical method that includes an initial 1 minute application of topical followed by 1 minute of pressure anesthesia

pre-anesthesia

technique used to enhance patient comfort during palatal needle penetration through the use of pressure applied with a cotton tip applicator or blunt-ended instrument handle to cause blanching, before penetration

pressure anesthesia

How much anesthetic solution should be deposited for the NP injection?

0.4 ml (little less than 1/4 of a cartridge)

The nasopalatine nerve block is ___________
A. useful for procedures involving palatal soft tissues distal to the canine
B. a potentially high traumatic injection
C. indicated for therapy involving one or two teeth
D. less traumatic with the single-puncture technique

B. a potentially high traumatic injection

What areas are anesthetized with the GP injection?

palatal soft and osseous tissues of the posterior teeth up to the midline of the palate

[T:F] the greater palatine nerve exits the maxilla at the pterygopalatine fossa.

false: at the greater palatine foramen. The nerve travels within the pterygopalatine fossa before traveling inferiorly through the pterygopalatine canal. It exits the canal at the greater palatine foramen

What is the penetration site for the GP nerve block?
A. slightly anterior to the greater palatine foramen
B. greatest depression of the greater palatine foramen
C. junction of the maxillary and palatal bones medial to an imaginary line drawn between the maxillary 1st and 2nd premolars
D. slightly distal to the greater palatine foramen

A. slightly anterior to the greater palatine foramen *the foramen is typically found palatal to the 2nd and 3rd molars

What is the angle of insertion for the GP injection?

perpendicular to the palatal bone at the foramen

How much anesthetic should be delivered for the the GP injection?

0.45 ml (1/4 cartridge)

what is the recommended maximum dose of a 4% anesthetic solution for a GP nerve block?
A. 0.3 ml
B. 0.6 ml
C. 0.9 ml
D. 1.2 ml

A. 0.3 ml *when administering 4% solutions the total volume of anesthetic is reduced

Which one of the following statements best describes the depositions site for a nasopalatine nerve block?
A. within the nasopalatine canal
B. near the wall of the incisive canal
C. anterior to the opening of the anterior palatine foramen
D. near the junction between the vertical alveolar process and the horizontal palatal process.

B. near the wall of the incisive canal

Which of the following statements is true of a NP nerve block?
A. they have the highest rate of positive aspiration in the palate
B. the have the second-highest rate of positive aspiration in the palate
C. they provide more durable anesthesia compared to other palatal techniques
D. they provide bilateral anesthesia

D. they provide bilateral anesthesia

What is the most likely cause of unilateral failure of a nasopalatine nerve block?
A. use of an extra short needle
B. inadequate volume of anesthesia
C. opposite wall of canal is not contacted with needle
D. backflow of solution along the needle pathway

C. opposite wall of canal is not contacted with needle

Which of the following is not anesthetized by a nasopalatine nerve block?
A. soft tissues of the anterior one third of the palate
B. lingual gingiva, canine to canine
C. maxillary incisors and canines
D. incisive papilla

C. maxillary incisors and canines

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THIS SET IS OFTEN IN FOLDERS WITH...

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