Upgrade to remove ads
Only $2.99/month

local NERB

Terms in this set (80)

where does the mandibular nerve pass through the skull
foramen oval
where does the NP nerve pass through the skull
incisive foramen
maxillary division of trigeminal nerve is
sensory
nerves associated with maxillary nerve branch V2
pterygopalatine nerves: GP and lesser palatine, NP, zygomatic nerve, PSA , infraobrital nerve MSA and ASA
nerves associated with mandibular nerve branch V3
long buccal, auriculotemporal, lingual, inferior alveolar, mental, incisive, mylohyoid.
PSA inervates
pulps, PDLs, surrouding alveolar bone, buccal gingiva and mucosa of max molars except Mesio buccal root of 1st molar,
what injection needed to anesthetize lingual of max anteriors
nasopalatine (less than 1/4 cart)
what injections needed to anesthetize entire palate on one side
GP and NP (less than 1/2 cart for both)
how far do you insert the needle on an IANB
20-25mm about 2/4th-3/4th a needle (dose: 3/4cart 1.5ml)
what happens during depolarization
sodium in potassium out, rapid influx of sodium ions causes depolarization of nerve membrane from resting level to its firing threshold
when do you aspirate?
right before anesthetic is deposited
which LA is metabolized by pseudocholinesterase
esters: procaine (novacain), benzocaine
topical anesthetics are least effective on?
keratinized tissues
which is true of topical anesthetics
no systemic problems
highest occurance of allergic reactions
benzocaine topical, the ester option
what is the significance of giving an amide anesthetic to a patient with cirohsis
amides are metabolized by the liver
landmark for IANB injection
coronoid notch, pterygomandibular raphe, lingual is 1cm above occlusal plane and 1-1.25cm back from anterior border of ramus
psychogenic pain question
no organic base for pain
max epi dose for healthy patient
0.2mg an appointment
5.5 cart of 1:50,000
11 cart of 1:100,000
22 cart of 1:200,000
max epi does dose for cardiac pt. ASA 3 or 4
0.04 mg an appointment
1 cart of 1:50,000
2 cart of 1:100,000
4 cart of 1:200,000
what is trismus
prolonged, tetantic spasm of jaw muscles, limited opening of the mouth
management of hematoma
pressure at site of bleeding and cold compression
management of trismus
heat therapy, warm saline rinses, analgesics, muscle relaxtants, physiotherapy (jaw exercises)
hematoma can occur if needle penetrates into the pterygoid plexus of veins during which injection
PSA
what needle should be used for infiltration/superperiosteal
27g short
antioxidant
sodium bisulfite
actions of vasopressor (vasoconstrictors)
-increase duraition of LA, hemostiasis, reduce chance of toxicity, decrease blood flow to site of administration, slowed absorption resulting in lower blood levels
what would cause a dry cornea
anesthetizing the facial nerve by not contacting bone during the IANB and anesthetic solution is deposited in parotid gland, temporary bell's palsy would not allow the patients eyelid to blink or close, which would cause dry eye.
amount of epi in a solution
1% solution = 10 X 1.8 (1.7) =18 mg (17mg)
2% solution = 20 X 1.8 (1.7)= 36mg (34mg)
3% solution= 30 X 1.8 (1.7)= 54mg (51mg)
burning upon injection due to....
ph of solution, injection to fast, contaminated cartridges
needle breakage cause
#1 cause: needle fracture occuring at the hub but others include, intentional bending before injection, sudden unexpected movement by pt and forceful contact with bone
electric shock during delivery of anesthesia
needle touched the nerve
ongoing numbess of anterior 2/3 of tongue is caused by which nerve being anesthetized
lingual nerve
benefit of slow deposition
less pain, less complications
location of Long buccal/buccal injection
mucous membrane distal and buccal to most distal molar in arch
why does anestheisa fail to work near an abscessed tooth
infection causes lower pH
innervation of soft palate
lesser palatine nerve
first sign of LA toxicity
CNS excitement
allergic reaction management
epi for immediate, benadryl for deylayed
in a dental practice an injection for LA is
subcutaneous
lingual of #13 for scailing and root planning injection site
apex of tooth
what do beta blockers do
treat high BP and treatment of congestive heart failure, they work by blocking the effects of epinephrine and slowing the heart's rate, thereby decreasing the heart's demand for oxygen
impulses travel faster on...
myelinated nerves
possible cause of pain upon removal of needle
needle barb
needle gauge and which lumen is smallest
smaller the number larger the lumen
what sensation is lost first
pain (skelatal last and recovers in reverse order)
what function of sodium chloride is LA
makes solution isotonic
sodium bisulfite
antioxidant preventing biodegration of LA
what injection numbs lower lip
IANB
why infilatration works better on maxilla than mandible
mandible is more dense
where is epi naturally found in the body
endocrine system: adrenal gland
amides
biotransformed in liver by by hepatic microsomal enzymes
lidocaine,mepivicaine,prilocaine,articaine,bupivicaine
anesthetic deposition rate
2 min a cartrigde or 1min a 1ml
a patients BP drops and they have immediate allergic reaction
administer epi
local anestetic that would be used for pt methemoglobinema
avoid prilocaine and articaine because of increased risk of producing methehemglobinema, relative contrainindication to prilocaine
what part of syringe indicates it is an aspirating syringe
harpoon
what would you not use as an antiseptic
alcohol
how does a self aspirating syringe work
when you let off pressure it aspirates
procaine (novacain)
ester
MRD: 1000mg
lidocaine
amide
topical
MRD 3.2mg/lb 500 max
mepivicane
amide
MRD: 3.0mg 400 max
prilocaine (Citanest HCl Plain)
amide
EMLA
MRD: 3.6mg/lb 600 max
articaine
amide
MRD 3.2 mg/lb
bupivicaine
amide
MRD= 90mg
management for post op pain
ASA
27 short
dose: 1/3rd-1/2 0.6-0.9ml
depth: 1/4 inch
injection site: MB of canine
area anesthetized: max canine to midline, teeth and facial tissues
MSA
27 short
dose: 1/3rd-1/2 0.6-0.9ml
depth: 1/4 inch
injection site: MB of 2nd PM
area anesthetized: max PMs and facial tissues and MB root of 1st molar
PSA
27 short
dose: 1/2 to full 0.9-1.8ml
depth: 3/4 of needle
injection site: MB of 2nd molar, distobucccal root, 45 degree angle, pterygoid plexus
area anesthetized: max molars and facial tissues except MB root of 1st molar
greater palatine
25/27 short
dose: 1/3rd 0.4 - 0.6ml
depth: 2mm cover bevel
injection site: anterior to foramen lingual to 2nd molar, cotton tip
area anesthetized: PM to molar palatal tissues
nasopalatine
25/27 short
dose: 1/4th .45ml
depth: 2mm cover bevel
injection site: posterior and lateral to the incisive papilla, cotton tip
area anesthetized: canine to canine, palatal tissues
inferior alveolar nerve block
25 long
dose: 3/4th 1.5ml
depth: 2/3 of needle
injection site: coronoid notch, pterygomandibular raphe, lingual is 1cm above occ. plane and 1-1.25cm back from anterior border of ramus
area anesthetized: 1 side of mandible except for buccal tissues of molars, anterior 2/3 of tongue, floor of mouth
buccal
25/27 short
dose: 1/6th 0.3ml
depth: 2mm cover bevel
injection site: MB fold DB to last molar, inject parallel and inferior to occlusal plane
area anesthetized: buccal tissues of mand. molars
lingual
25 long
dose: < 1.4th cart
depth: 1/2 needle
injection site: withdraw needle from IA until 1/2, reaspirate and inject
area anesthetized: 1 side of mand. lingual tissues
mental/incisive
25/27 short
dose: 1/3rd 0.6ml
depth: 5-6mm
injection site: MB fold anterior to mental foramen
area anesthetized: soft tissues and teeth PM to midline, chin, lower lip
patient with hyperthyroidism
if uncontrolled avoid vasoconstrictor, okay to use normal anesthesia if controlled
pt with impaired liver or kidney function
only severe impairment is clinically relevant
pt with malignant hyperthermia
amides are concidered safe
pt with heart failure, heart attacks, recent heart surgery or hypertension
concern vasoconstrictor (limit use or totally eliminate use depending on the case)
hemophilia
avoid injecting highly vascular areas
pregnancy
safe to administer, avoid 1st trimester, use lidocaine or prilocaine
drug interactions with vasoconstrictors
cimetidine, non selective beta blockers, tricyclic antidperessants, cocaine
THIS SET IS OFTEN IN FOLDERS WITH...