What tissue is topical anesthetic least effective on?
C.) Ulcerated areas
Superior Orbital Fissure is classified as what division? And Sensory or Motor?
VI Ophthalmic Division (Trigeminal) and Sensory
This injection anesthetizes the anterior portion of the hard palate (soft and hard tissues) from the mesial of the right first premolar to the mesial of the left premolar.
Nasopalatine (Incisive papilla)
How far is the needle inserted for an IA injection?
Bone must be contacted, average is 20-25mm, or 2/3-3/4 the length of the long needle
This dendrite is the most distal segment of sensory neuron. It responds to stimulation and provokes an impulse transmitted centrally along the axon.
Free Nerve Ending
Myelinated nerves help local currents travel ____ than an unmyelinated nerve. It occurs by current leaps from node to node called _______ conduction.
Which LA should be used for short appointments? Good for children and produces pulpal anesthesia.
Which LA is used for short appointments and methemoglobinemia occurs most often with this?
This LA biotransforms in the liver, kidney, and lung. Less toxic than other amides. Good for EPI Sensitive Patients requiring prolonged pulpal anesthesia (greater than 60 mins)
Prilocaine Plain or Prilocaine w/epi
1.5xs more potent than Lidocaine. Biotransforms in plasma and liver. Reports of paresthesia. Not used on children under 4 or for blocks.
For long dental procedues where pulpal anesthesia is necessary of 90 minutes and for management of post op. pain. Rarely used on children or mentally handicapped.
A response to the act of drug administration not the drugs is called _____. Two most common types are?
Vasodepressor syncope and hyperventilation
This can occur when an infraorbital nerve block is administrated or when maxillary canines are infiltrated.
Facial Nerve Paralysis
Muscle droop can occur when LA is administered into the deep lobe of the _____ where the terminal branches of the facial nerve extend. (IANB or VaziraniAkinosi NB)
For what injections are long needles used?
For all injection techniques with significant thickness of soft tissue- IA, Gow-Gates mandibular, Akinosi mandibular, infraorbital, sometimes Buccal
What causes a hematoma and where is it most common?
Arterial or venous puncture after PSA or IANB. Common in the pterygoid plexus following PSA.
What is the needle gauge and which lumen is smallest?
The gauge is the diameter of the lumen of the needle. The smaller the number the greater the diameter of the lumen. 30 gauge has a smaller lumen than a 25-gauge needle.
What function does sodium chloride provide to LA solutions?
It makes the solution isotonic with the tissues of the body.
All of the following are true regarding actions of vasopressors except:
A.) Constrict blood vessels, decreasing blood flow to site of administration
B.) Absorption of LA into cardiovascular system is decreased
C.)LA blood levels are lowered, minimizing risk of LA toxicity
D.)Decrease bleeding at site of administration
E.)Increased amount of LA remain around nerve for longer periods increasing duration of action of most LA.
F.) LA blood levels are increased
Prolonged tetanic spasm of the jaw muscles by which normal opening of the mouth is restricted. Caused by muscles, blood vessels in infratemporal fossa, hemorrhage, or infection after injection
How do you treat trismus?
Heat therapy, warm saline rinses, analgesics and if needed, muscle relaxants. Patients should initiate physiotherapy of opening and closing the mouth and lateral excursions of the mandible. In severe cases, referral to oral surgeon.
What would cause a dry cornea?
Anesthetizing the facial nerve. If bone is not contacted during the IANB and the solution is deposited into the parotid gland. Temporary bell's palsy would not allow the patients eyelid to close or blink.
An injection that is deposited close to a main nerve trunk is called ____. Also, name 3 of the injections pertaining to this.
Nerve Block (IA, PSA, Nasopalatine)
What would you do for a patient with post op infection?
immediate treatment of heat and analgesics, muscle relaxant if needed and physiotherapy. If infection persists, patient should get on a 7-10 day course of antibiotics like penicillin V or erythromycin if allergic to penicillin.
Name injection site for PSA
mucobuccal fold of 2nd molar, DB root, 45 degree angles, *Pterygoid plexus
Name injection site for Long Buccal injection
mucobuccal fold, DB to last molar, inject parallel and inferior to occlusal plane
How much epi is in a cartridge of 2% lidocaine with 1:100,000?
20mg x 1.8ml=36mg lidocaine/cartridge
.01 x 1.8= .018mg epi/cartridge
Acute inflammation of the laryngeal mucosa due to infection, allergy or inhalation of irritant materials, causes obstruction of airflow
Why does filtration work better in the maxilla than in the mandible?
Bone is less dense in the maxilla.
Where is epi naturally found in the body?
Found in the medulla of the adrenal glands located in the kidneys. The endocrine system/urinary system
Ongoing numbness of the anterior part of the tongue is caused by which nerve being anesthetized?
If a patient has liver disease, you would use caution with an amide because....
Amides are metabolized/biotransformed in the liver
After the infraorbital injection, the patient's cheek turns white. What happened?
Blanching or vasoconstriction of the blood vessels in that area.
Which root is not anesthetized with the PSA injections?
Mesialbuccal root of the maxillary first molar
What is the injection site for lingual infiltration of maxillary molars?
The attached gingiva 5-10mm from the free gingival margin
If you want hemostasis, what is the infiltration procedure of choice?
2% Lidocaine with 1:50,000 EPI injected directly into surgical site to stop bleeding.
How would you manage a delayed reaction a patient has to EPI?
Benadryl. Delayed skin reactions are managed by oral histamine blocker such as diphenhydramine or chlorpheniramine. Delayed rxns develops hours to days after exposure.
Immediate skin reactions is managed by:
epi and IM histamine blocker. This reaction develops within seconds to hours of exposure.
To inject the entire palate on one side you would do what injections?
Greater Palatine and Nasopalatine
What post op instructions would you give to a patient with a hematoma?
Cold compression's and pressure to bleeding site, common for pterygoid plexus of veins during PSA
#15 has an abscess. You already gave a PSA. What other injection could you give to numb the lingual?
What is the shelf-life of LA?
Expiration date on the cartridge. Plain is 36 months and with EPI is 18 months
If a patient has an allergy to red wine, what LA should you use?
Mepivacaine 3% plain or Prilocaine 4% Plain NO EPI
Place ASA Classification in order from 1-5
A.)Severe systemic disease-BP over 160/95, history of MI, Diabetes 1, heart failure etc.
B.)Normal, healthy, can walk up 2 flights of stairs or 2 city blocks w/o being winded
C.)Moribound-not expected to live 24hrs
D.)Mild systemic disease-BP over 140/90, epilepsy, diabetes II, pregnant, etc.
E.)Incapacitating systemic disease-uncontrolled diabetes, epilepsy or angina, heart failure, shortness of breath at rest etc.
B, D, A, E, C
Pt. experienced no pain until LA was deposited. Why?
Rapid deposition of LA, solution not sterile, or solution too hot or too cold.
Some topicals contain preservatives like methylparaben which may cause an allergy to ________.
What is the mount of epi in a 1%, 2%, and 3% solution?
1.) 10 x 1.8 (or 1.7)= 18mg (or 17mg)
2.) 20 x 1.8= 36mg (or 34mg)
3.) 30 x 1.8= 54mg (or 51mg)
What best describes topical anesthetics?
A.) works on mucous membranes
B.) limited systemic toxicity
C.) works on keratinized tissue
works on mucous membranes
How many milligrams of
mepivacaine are contained within 2
cartridges of mepivacaine 3%?
3% mepivacaine = 30mg/cc
1 cartridge = 1.8 cc
2 cartridges = 3.6 cc
(30 mg/cc)x(3.6 cc) = 108 mg
Compute the number of cartridges of 2% lidocaine for a 32 year old, healthy male, 175 pounds.
2% x 1.8=36mg
2% x 175= 350mg/lb
350/36=9.7 cartridges (Round down)
LA agents work by inhibiting the influx of ___ions by competing with ____ for binding sites.
LA affect small unmyelinated fibers first then large myelinated last.
LA decreases the rate of depolarization and prolong the rate of repolarization. Does NOT prevent the efflux of potassium in nerve cell.
Nerves affected in this order:
autonomic, temperature, pain, touch/pressure, vibration and _____ last!
MOTOR last!!*** Last to be lost, first to be regained.
Put the amides in order from shortest to longest duration.
5-Bupivacaine (longest duration)
All of the following are true regarding vasoconstrictors added to anesthetics except:
a) Prolong anesthetic action
b) Reduce anesthetic toxicity
c) LA blood levels are increased
d) delays absorption
e) decrease bleeding