anesthesia Flashcards
cornerstone of modern dental
practice and are your greatest
practice builders?
- “Painless” injections and
considerate, caring manner are the
cornerstone of modern dental
practice and are your greatest
practice builders - Learning to achieve profound
anesthesia in all cases and doing
so as comfortably as possible can
MAKE or BREAK your practice.
- RCT is impossible without?
- RCT is impossible without
profound LA *
Patients routinely select
a particular dentist
based solely upon?
Patients routinely select
a particular dentist
based solely upon the
comfort level of
injections given.
steps of atraumatic anesthietic injections
- Dry mucosa - then Topical Anesthetic - let it soak in at least 60sec.
- Vigorously shaking or gently squeezing the lip or cheek while injecting is a distraction technique thought to activate the faster Alpha fibers to “close the gate”*
- Sloooooooooooooow and gentle (Take 60 sec. to inject)
- Talk to patient constantly/ Keep patient occupied *
Palatal injection discomfort
can very painful
reducing pain of palatal injection
Use of a refrigerant as a pre-injection anesthetic was more effective compared with a topical gel in reducing pain by patients receiving a palatal injection*
how much LA should be used on palate, why?
Use small quantity of LA on palatal tissue which is TIGHT and Painful. Too much – more than 1/4carp may
slough tissue.
what tissue state is hard to anesthesize?
inflammed
biggest challenge will probably present as a :
mandibular molar with acutely inflamed pulpitis*.
Anesthesia is difficult here at best due to the inherent inaccuracies of mandibular N. blocks but other problems are also present
lip signs and pulpal anesthesia of mandibular molars
Remember “lip signs” do not necessarily indicate pulpal anesthesia and infiltration alone here is useless due to the density to the cortical plates**
how to check for pulpal anestheisa
testing with endo ice
EPT
usually not warm
essentially use pts cheif complaint
why is inflammed tissue more difficult to anesthesize
- In clinical practice, local anesthesia may be influenced by the local availability of free base, as only the non-ionized portion (free base) can diffuse through the neuronal membrane.
- Thus, local anesthetics are relatively ineffective when injected into tissues with an acid pH (e.g. pyogenic abscess, inflamed pulp) which is presumably due to reduced release of free base *
Teeth with acutely
inflamed tissues are often VERY resistant to:
Teeth with acutely
inflamed tissues are often VERY
resistant to LA.
anesthesia and pain at inflammed tissues
Bottom line: LESS EFFECTIVE
anesthesia is resultant and a
whole lot more PAIN is perceived
pt perception when anesthesia doesnt work with inflammed tissue
fear
may have a physio and psychological challenge
- Emotional Considerations of LA
- Apprehension-Fear-Anxiety
- Fatigue-Hyperalgesia-Allodynia
- Decreased Pain Threshold
- History of Unsuccessful Anesthesia
- Popularized Fear of RCT
- Lack of Confidence in Provider
- Lack of Confidence by Provider
how can we combat inflammed tissue and need for LA
First, use an anti-inflammatory drug in an effort to reduce inflammation, revert the pores to normal & raise the patient’s pain threshold. Such an inexpensive & simple benefit.
* IBU 600 mg one hour prior=78% effective
when should IBU be given?
You must have already seen the patient, taken history, obtained radiographs, clinical testing and made your DX* (Cannot prescribe w/o a DX or w/o examining pt.)
how to diminish the emotional coomponent of LA
– Establish rapport with the patient. Show them you CARE*
– Communicate your concern for the patient in a calm, convincing and confident manner.
– “Inform before you Perform”
– “If you feel discomfort, raise your hand and I will stop at once” (giving the patient - some control) –Jim Dryden, DDS
– Consider pre-op Anti inflammatory &/or Anti-anxiety Drugs (Anxiolytics: another Lecture)
how to ensure you have a good block
- If you do a good IA block, you should have “lip signs”.= fat and thick
waiting for the lip signs
- If you include additional any BUCCAL anesthesia initially (w/o waiting for “lip signs”), you won’t know if the “lip signs” are from the BLOCK or the infiltration.
- Do initial IA and wait a few minutes to allow anesthesia in area of IA injection. Then go back and FEEL the BONE and
painlessly inject the 2nd carpule where you KNOW you need to be for the IA BLOCK. - Then wait for “lip signs” and check the tooth with percussion and/or cold to determine if you may need to do
SUPPLEMENTARY anesthesia.
when to use buccal anesthesia
ONLY AFTER YOU ARE POSITIVE that you have a NUMB and FAT LIP,
do you use ANY buccal anesthesia
when to use supplemental anestheisas
after you have confirmed IA block
approach for IA block
long needle above the plan of coronoid notch/6-10mm above occlusal plane
or from opposite PM to the coronoid notch region
locate lingula and deposit posterior to it
IAN-L – Point of Penetration
Just lateral to pterygomandibular raphe at the height of coronoid notch
potential supplemental injections for RCT
– Intra-ligamental (Periodontal Ligament=PDL ) Injection
– Intra-pulpal Injection
– Intra-osseous Injection
Most LA agents have an onset of action between _______.
Most LA agents have an onset of action between 1-20 minutes. Wait and TEST*
will any LA last a 3hr clinic session?
None of the LA solutions available at UMKC will last for the duration of the typical 3 hr. Clinic Session* Plan on re-injecting in Clinic*
duration of effective pulpal anestheisia
Effective Pulpal Anesthesia will be routinely gone in 30-90 minutes.* Get pulp OUT while numb***
reinjections necessary?
It WILL be necessary to monitor the patient and RE-INJECT during the course of
what if pulp necrotic? still use
LA?
because there is a well developed P/A lesion and both teeth test necrotic (Non-responsive ); don’t begin ANY treatment w/o LA. Always use LA for every case at every appointment*
he most essential element
of patient management:
the confidence of the patient
if any pain encountered during procedure what should you do?
stop and give more LA
