Comprehensive Study Guide Flashcards
(275 cards)
1
Q
Label whether the following ions are intra- or extra-cellular:
- K+
- Na+
- Cl-
- Proteins
- HCO3-
A
- ICF
- ECF
- ECF
- ICF
- ECF
2
Q
Intracellular ions=
A
K+ and proteins (more negative)
3
Q
Extracellular ions=
A
Na+, Cl-, HCO3- (more positive)
4
Q
Where do local anesthetics exert their pharmacological action on the nerve?
A
Nerve membrane
5
Q
How do local anesthetics work?
A
Specific receptor theory- local anesthetic binds to specific receptor on the Na+ channel
6
Q
What does the specific receptor theory state?
A
States that the local anesthetic binds to a specific receptor on the Na+ channel to prevent the channel from opening (therefore no action potential and no pain)
7
Q
Which ion channel does the local anesthetics bind to ?
A
specific receptors of the na+ channel
8
Q
Speed of conduction of a myelinated nerve:
Speed of conduction of an unmyelinated nerve:
A
myelinated: 120 m/sec
unmyelinated: 1.2 m/sec
9
Q
Where do local anesthetics work at the myelinated nerve?
A
local anesthetics work at the nodes of ranvier (an abundance of sodium channels here)
10
Q
In order for local anesthetic to work on a myelinated nerve, it needs to block:
A
2-3 nodes (8-10mm of nerve)
11
Q
Drug: Lidocaine
Onset:
Half-Life:
Mg/Kg of max dose:
A
onset: 2-3 min
half-life: 1.6 hrs
(1hr of pulpal and 3-5 hrs of soft tissue for 2% solution)
Mg/Kg of max dose: 4.4 mg/kg (300mg)
12
Q
Drug: Prilocaine
Onset:
Half-Life:
Mg/Kg of max dose:
A
Drug: Prilocaine
Onset: 2-4 min (slightly slower)
Half-Life: 1.6 hrs
Mg/Kg of max dose: 6 mg/kg (400 mg)
13
Q
Drug: Mepivacaine
Onset:
Half-Life:
Mg/Kg of max dose:
A
Drug: Mepivicaine
Onset: 1.5-2 min (rapid!)
Half-Life: 1.9 hrs
(20-40 minutes of pulpal and 2-3 hrs of soft tissue)
Mg/Kg of max dose: 4.4mg/kg
14
Q
Drug: Bupivacaine
Onset:
Half-Life:
Mg/Kg of max dose:
A
Drug: Bupivacaine
Onset: 6-10 min (longer)
Half-Life: 2.7 hours (long!)
Mg/Kg of max dose: 1.3 mg/kg (90mg)
15
Q
What drug would be used when more than 90 minutes of pulpal anesthesia is needed and is also used to reduce post-op pain?
A
Bupivacaine
16
Q
Drug: Articaine
Onset:
Half-Life:
Mg/Kg of max dose:
A
Drug: Articaine
Onset: 1-2 min (rapid)
Half-Life: 0.5 hours (short!!)
(0.5hrs of pulpal and 3-5 hours of soft tissue for 4%)
Mg/Kg of max dose: 7mg/kg (500mg)
17
Q
Drug: Cocaine
Onset:
Half-life:
A
Drug: Cocaine
Onset: immediate- 1 min
Half-life: 1-1.5 hrs
18
Q
What is the onset of Procaine?
A
6-10 min (a little slower than lidocaine)
19
Q
List the following anesthetics in order of fastest to slowest onset:
- Bupivacaine
- Articaine
- Prilocaine
- Procaine
- Cocaine
- Mepiivocaine
- Lidocaine
A
(Fastest)
1. Cocaine
2. Articaine
3. Mepivacaine
4. Lidocaine
5. Prilocaine
6. Bupivacaine
7. Procaine
(Slowest)
20
Q
List the following anesthetics in order of longest to shortest duration:
- Bupivacaine
- Articaine
- Prilocaine
- Procaine
- Cocaine
- Mepiivocaine
- Lidocaine
A
(Longest)
1. Bupivacaine
2. Mepivacaine
3. Lidocaine & Prilocaine (equal)
4. Cocaine
5. Articaine
21
Q
For maximum recommended dose (MRD) what guidelines do we follow?
A
ADA & USPC guidelines (NOT manufacturer)
22
Q
How does low tissue pH influence local anesthesia?
A
Low tissue pH (high acidity/H+) is HARDER to anesthetize (usually associated with inflamed tissues)
23
Q
How does low anesthetic pH lead influence local anesthesia?
A
Low anesthetic pH leads to higher effective shelf life
24
Q
is the average pH of local anesthetics?
A
5.5-7.0
25
If the pH of the environment does not allow the ___ of the anesthetics to exist, numbing will NOT occur.
free base form
26
In order for the local anesthetic to work, the pH of the environment:
must allow the free base form to exist
27
What is the free base form of the local anesthetic?
What enters the nerve membrane
28
The further the pH Is from the ideal for that specific anesthetic, the:
lower the percentage of that local anesthetic will be present in the free base form
29
Is local anesthetic hydrophilic or hydrophobic?
amphipathic (both hydrophilic and hydrophobic)
30
What is the exception to local anesthetic being amphipathic?
Benzocaine; doesn't have a hydrophilic group so it is good for topical but not for injections
31
_____ determines the ease for nerve blockade
extracellular pH
32
Inflamed or infected tissue is
much more difficult to get adequate anesthesia because:
of increased H+ or lower pH
33
RNH+ Breaks down into:
Rn (free base) and H+
34
The low pH in an anesthetic allows for:
increased shelf life
35
RNH+ ---> RN + H+ describes:
the dissociation of local anesthesia
36
RNH+ ---> RN + H+
What does RN represent?
free base
37
RNH+ ---> RN + H+
What does RNH+ represent?
cation
38
RNH+ ---> RN + H+
In this reaction, if there's excess H+, the equilibrium will shift to the:
left (RNH+ side)
this means that if there is an acidic environment (example- a really infected tooth with lots of bacteria = very acidic) it will be harder to anesthetize because there is less of the free base form RN which is what actually enters the nerve membrane
39
Only the _____ of the anesthetic can enter the nerve, which is important because the sodium channel must be blocked ____
free base form ("ninja"); from the inside
40
Anesthesia is injected as a ___ that ___
ionized cation; that cannot cross the nerve cell membrane (until broken down into free-base form)
41
The anesthesia that is injected must break down from its _____ form into ____ form, which can diffuse into the membrane
ionized cation; non-ionized free-base
42
Once in the nerve, the free base can become the ionized version again and bind to the specific receptor to:
prevent sodium channel from opening
43
Once the free base form of the local anesthetic is diffused, it must _____ in order to bind to the receptor
dissociate back into the cationic form
44
Once the free base form of the local anesthetic is diffused, it must dissociate back into the cation form in order to bind to the receptor- what does this binding t the receptor cause?
prevents sodium channel from opening
45
Describe the relationship of pKa vs. local anesthesia:
high pKA: slow onset (few free bases available)
low pKA: rapid onset
46
Local anesthesia are _______- They combine with acids to form local anesthetic salt (HCl)
weak base compounds
47
pKA influences:
onset; inversely related
48
Describe why a high pKA would have slower onset?
because there are fewer free bases to diffuse (fewer ninjas without their backpacks that can get through, most ninjas have their backpacks on so they can't cross to bind)
49
How does lipid solubility influence local anesthesia?
With increased lipid solubility, the drug is more potent.
With decreased lipid solubility, the drug is less potent.
50
The relationship of pKA to onset is ____.
The relationship of lipid solubility to local anesthesia potency is ___
inverse; direct
51
The nerve membrane is ____% Lipid
90%
52
1. What influences the ONSET of local anesthesia?
2. What influences the POTENCY of the local anesthesia?
3. What influences the DURATION of the local anesthesia?
1. pKA
2. lipid solubility
3. protein binding
53
With increased protein binding, the local anesthetic has:
longer duration
54
With decrease protein binding, the local anesthetic has:
shorter duration
55
The nerve membrane is ____% protein
10%
56
With increased lipid solubility, the drug is:
more potent
57
With decrease lipid solubility, the drug is:
less potent
58
With a high pKA, the onset of the local anesthesia is:
slow (few free bases available)
59
With a low pKA, the onset of the local anesthesia is:
rapid
60
Most local anesthetics have a ____ effect
vasodilation
61
Which local anesthetic has the most profound vasodilation effect?
Procaine
62
The only local anesthetic to have a vasoconstrictive effect
cocaine
63
Cocaine is vasoconstrictor (meaning its alpha-1) and works by:
Inhibition of catecholamine re-uptake
64
Alpha 1 =
vasoconstriction
65
Beta 2=
vasodilation
66
What agent has the most potent vasodilation properties?
procaine
67
The most commonly used vasoconstrictor:
epinephrine
68
"I" comes before "Caine" if the agent is:
an amide
69
_____ are readily hydrolyzed in aqueous solutions
esters
70
List examples of esters (6)
1. procaine
2. propoxycaine
3. tetracaine
4. cocaine
5. benzocaine
6. dyclonine
71
_____ resist hydrolysis and get excreted in urine as an unchanged form
Amides
72
List examples of amides (6)
1. lidocaine
2. etidocaine
3. mepivocaine
4. bupivocaine
5. prilocaine
6. articaine
73
What are the two different classes of local anesthesia?
Amides & Esters
74
How do amides metabolize in the body?
The liver is the primary biotransformation site
75
Metabolism of what type of anesthetic can cause cirrhosis/CHF or hypotension?
amides
76
How are esters metabolized in the body?
Hydrolyzed in plasma by pseudocholinesterase into paraaminobenzoic acid (PABA)
77
What is a substance in local anesthetic that individuals commonly have a reaction to? Is this in amide anesthetics or ester anesthetics?
PABA; Esters
78
What is the relationship between cirrhosis patient and metabolism of local anesthetics?
Liver function/hepatic perfusion influence biotransformation
(1) Cirrhosis → Late stage of scarring (fibrosis) of
the liver
79
When is local anesthetics a contraindication for patients with liver issues?
ASA IV to V for patients with liver
dysfunction (or heart failure)
80
How do cirrhosis and/or CHF interfere with the amounts of your local anesthesia injection?
Amide LAs are chemically modified (metabolized) in the body in the liver, so since the liver is not functioning well (does have full metabolic capacity), then less LA should be administered
81
If a patient has cirrhosis and/or liver failure, do you give them more or less local anesthetic when injecting?
LESS
82
Does a patient who has cirrhosis and/or CHF increase the availability of the amide local anesthetic or decrease the availability of the local anesthetic?
Increases the availability because the amide is not being metabolized as quickly and more is left in the body for longer periods of time
83
Which organ in the body (largest mass and tissue in the body) has the greatest concentration of local anesthesia?
skeletal muscle
84
What is tachyphylaxis?
The increase in tolerance to drug after repeated administration
85
Explain how to calculate elimination half-life
Take percentage of leftover, divide that in half, and add it on to what has been eliminated thus far.
86
What does elimination half life describe?
The amount of time needed for 50% reduction in blood level
87
List the percentages of elimination of the following elimination half life:
1st half life: 50% eliminated
2nd half life:
3rd half life:
4th half life:
1st half life: 50% eliminated
2nd half life: 75% eliminated
3rd half life: 87.5% eliminated
4th half life: 94% eliminated
88
DO all local anesthetics readily cost the BBB and placenta?
yes
89
What is the cause for local anesthesia overdose/ toxicity?
over injection or repeated injections into the bloodstream and systemic circulation
90
To prevent local anesthesia overdose/toxicity it is important to:
aspirate
91
What are the initial signs of local anesthesia overdose/toxicity?
Initially: Causes excitatory response (numbness of tongue and circumoral region slurred speech, shivering, AV disturbances, tremor and etc.)
92
If you ignore the initial signs of local anesthesia overdose/toxicity, what may occur?
patient may go into a seizure and if you continue loading them up with more local anesthesia they will stop breathing
93
What are the later signs/stages of local anesthesia overdose/toxicity?
Depressive response on CNS with a lesser CV effect as well as agitation, confusion, dizziness, drowsiness, dysphoria, auditory changes, tinnitus, perioral numbness, metallic taste, etc.)
94
Causes excitatory response (numbness of tongue and circumoral region slurred speech, shivering, AV disturbances, tremor and etc.)
Initial stage of local anesthesia overdose/toxicity
95
Depressive response on CNS with a lesser CV effect as well as agitation, confusion, dizziness, drowsiness, dysphoria, auditory changes, tinnitus, perioral numbness, metallic taste, etc.)
Later stage of local anesthesia overdose/toxicity
96
The initial signs/symptoms of CNS toxicity are:
excitatory
97
Higher levels of initial toxicity from local anesthetic may result in:
tonic-clonic convulsion (seizure)
98
In later stages of toxicity or where their is further increases in anesthetic beyond the initial symptoms, there will be:
cessation of seizure activity --> respiratory depression ---> respiratory arrest
99
Catecholamines include:
epinephrine, norepinephrine and dopamine
100
Non-catecholamines include:
amphetamine, ephedrine, and methanphetamine
101
Epinephrine, Norepinephrine and dopamine are ____ catecholamines
natural
102
Isoproterenol and levonordefrin are ____ catecholamines
synthetic
103
Contain hydroxyl group on benzene ring and work directly on adrenergic receptors (alpha 1, 2 and beta 1, 2)
Catecholamines
104
Do not contain hydroxyl group on benzene ring
non-catecholamines
105
Catecholamines work directly on:
adrenergic receptors (alpha 1 & 2 and beta 1 & 2)
106
What is more concentrated
1:100,000 or 1:200,000
1:100,000 because this is equal to 1G or 1000mg/100,000ml of solution
versus
1:200,000 is equal to 1G or 1000mg/200,000ml of solution
107
Calculate the mg/ml of solution for a 1:300,000 dilution:
1G = 1,000 mg
1000mg/300,000ml = 0.0033mg/ml
108
The maximum dose of epinephrine in a healthy patient is:
0.20mg (200mcg)
109
The maximum dose of epinephrine in an unhealthy/cardiac patient is:
0.04mg (40mcg)
110
If you have a 1.7ml solution of the 1:100,000 dilution of epinephrine, how much epi is present per ml?
1.7 x.01 = .017mg/ml
111
Which agent (catecholamine) lacks significant b2 actions thus produces intense peripheral vasoconstriction with possible dramatic elevation of BP and is associated with a side effect ratio 9x higher than that of epinephrine? (a big reason that this agent is NOT available in the US)
Norepinephrine (EXCESSIVE vasoconstriction)
112
Closely resembles norepinephrine:
Levonodefrin
113
Contraindications for vasoconstrictor administration includes: (6)
1. Blood pressure in excess of 200mmHg systolic or 115mmHg diastolic
2. Uncontrolled hyperthyroidism
3. Severe cardiovascular disease
4. Undergoing general anesthesia with halogenated agents
5. Patients receiving nonspecific B-blocker, MAOi, tricyclic antidepressants
6. Patients in categories 1 to 3a through 3d are classified as ASA4 risks and NOT normally considered candidates for elective or emergency dental treatment in the office
114
Contraindications for vasoconstrictor administration includes patients with severe cardiovascular disease such as: (6)
1. Acute MI within past 6 months
2. Cerebrovascular accident within past 6 months
3. Cardiac dysrhythmias despite appropriate therapy
4. Daily exposure of angina pectoris or unstable angina
5. Post-coronary artery bypass surgery within last 6 months
115
Do patient OD if you exceed MRD?
No- remember bell-shaped curve.
Multiple factors to consider, but exceeding MRD does increase chances of overdose
116
What are contributing factors to local anesthetic overdose:
1. accuracy of deposition
2. tissue status
3. anatomical variation
4. type of injection
117
Can a patient overdose if given under MRD?
YES
118
What categories of patient might you want to decrease the MRD on? Why?
medically compromised, debilitated, and elderly patients; these disadvantaged patients are slower in metabolizing these drugs
119
Do we need to decrease the MRD on medically compromised, debilitated, and elderly patients? Why or why not?
Yes because they are unable to metabolize anesthetic as efficiently
120
What is the most common cause of failure to achieve adequate anesthesia?
anatomic variation and faulty technique
121
Articaine is ____% concentration
4%
122
What are contraindications for articaine use?
1. patient allergic to amide anesthesias
2. Sulfite sensitivity
3. Hepatic disease
4. Patient with impairments in cardiovascular function
5. Children under age of 4
123
Why should you not use articaine on children under 4 years old?
due to insufficient data
124
Has the potential for neurotoxicity, resulting in more non-surgical paresthesia's than all of local anesthetics (despite fewer injections given):
Articaine
125
The smaller the gauge;
the bigger the diameter
126
Which has a greater internal diameter? A 25 gauge or a 30 gauge?
25 gauge
127
A ____ gauge needle results in less deflection, and greater accuracy in injection as well as less chance for the needle to break and easier aspiration
30 gauge
128
Name four positive qualities of a 30 gauge needle:
1. Less deflection
2. Greater accuracy
3. Less chance of needle break
4. Easier aspiration
129
A total of 4ml of 3% Mepivacaine without epinephrine has been used. What is the total mg used in this case?
The MRD for mepivicaine is 4.4mg/kg
4ml x 0.03% = 0.12
0.12x 1000= 120mg
3% is equal to 30mg/ml
130
Billy Jean is going through a special diet and after 2 months she only ways 20kg. She is at UMKC for some dental work. You pick 2% lidocaine with epinephrine 1:100,000 as your anesthetic agent (because it has red label on it). What is the maximum mg that you can give for her.
- We know that MRD for lidocaine is 4.4mg/kg
4.4mg/kg x 20kg= 88 mg
131
Can a needle be used on more than one patient?
No
132
When not in use, the needle should be:
covered with protective sheath
133
T/F: You should use both hands to recap the needle:
FALSE! use scoop technique
134
What technique should be used to recap the needle?
scoop technique
135
T/F: The needle should be bent for difficulty access blocks due to curves and different contours of the facial skeleton
False- absolutely no
136
Where should you dispose the needle after use?
sharps and biohazard containers
137
Which agent is bacteriostatic and was removed from local anesthesia cartridge in 1984 due to reported allergic reactions?
methylparaben
138
______ was replaced by lidocaine (back in the day)
novocaine
139
When discussing the "care & handling of the cartridge", there is no manufacture claim:
sterility of exterior surface of cartridge
(bacterial culture test failed to produce growth)
140
When discussing the "care & handling of the cartridge", it cannot:
withstand extreme temps
141
Due to a cartridge being unable to withstand extreme temps, No _____ especially with plastic cartridge.
autoclaving
142
Due to a cartridge being unable to withstand extreme temps, when heated, ____ are ____
vasopressors are destroyed
143
How should you store cartridges?
store at room temp in a dark space
144
T/F: A study showed benefits of using a cartridge warmer
False- study showed NO BENEFITS
145
In regard to cartridges, DO NOT soak in:
alcohol or "cold sterilizing solution"
146
Why should you NEVER soak cartridges in alcohol or "cold sterilizing solution"?
The semipermeable diaphragm permits diffusion of these solutions
147
What should you read in regard to cartridges?
drug insert
148
The rubber diaphragm of a cartridge can be wiped with:
alcohol wipes moistened with undiluted 91% isopropyl alcohol or 70% ethyl alcohol- BUT DO NOT SOAK
149
What are some problems that can occur with cartridges? (6)
1. bubble in cartridge
2. corroded cap
3. rust on cap
4. leakage during injection
5. broken cartridge
6. burning on injection
150
What is the size considered a "small bubble" in a cartridge and what is the cause?
Small bubble= 1-2 mm
Usually just nitrogen gas
151
What is the size considered a "large bubble" in a cartridge and what is the cause?
large bubble = greater than 2 mm
Occurs due to extruded stopper or frozen cartridge
152
When might a cap of a cartridge become corroded?
If immersed in disinfection solution
153
The only sterilization needed for a cartridge is to rub the cap only (rubber diaphragm) with:
91% isopropyl alcohol or 70% ethyl acohol
154
Why night the cap of a cartridge rust?
From "tin" container
155
Leakage from the cartridge during injection may occur with:
eccentric needle puncture of diaphragm
156
What should you do with a broken cartridge?
return damaged box upon receiving
157
When might a cartridge shatter?
occurs due to improper loading & bent harpoons
158
Why might burning on injection occur?
due to mishandled or defective cartridges (1. pH, 2. alcohol, 3. heat, 4, expired)
159
What are the most common psychogenicallly induced reactions people have upon local anesthetic injection?
Most common: vasodepressor syncope & hyperventilation
Others (less common) include: tonic clonic convulsions, brochospasms, and angina pectoris
160
What does relative contraindication to local anesthetic mean?
means that caution should be used when two drugs or procedures are used together (its acceptable if the benefits outweigh the risk)
161
What does absolute contraindication to local anesthetic mean?
means that event or substance can cause a life-threatening situation
162
List the RELATIVE contraindications to local anesthetic administration: (5)
1. pregnant women (in first trimester)
2. malignant hyperthermia
3. Cimetidine + ASA III CHF patient
4. ASA III or IV with CHF
5. Methemoglobinemia to prilocaine
163
Why is an ASA III patient with CHF taking Cimetidine a relative contraindication to local anesthetic?
Because Cimetidine increases the half-life of circulating LA
164
Why is an ASA III or IV patient with CHF considered a relative contraindication to local anesthetic?
Because this patient may demonstrate decreased liver perfusion and increase half-life
165
List the ABSOLUTE contraindications to administrations to local anesthesia: (3)
1. ASA IV cardiovascular risk patient
2. Tricyclic antidepressant (TCAs)
3. Cocaine abuser
166
Why is an ASA IV cardiovascular risk patient an ABSOLUTE contraindication to local anesthetic?
Because an ASA IV Cardiovascular risk patient is not a candidate for vasopressors or elective dental care.
Specifically recent MI (less than 6 months ago) or repeated MIs increase risk during dental care or local injection
167
Specifically what classifies someone as an ASA IV cardiovascular risk patient? (making them an ABSOLUTE contraindication to local anesthetic)
Specifically recent MI (less than 6 months ago) or repeated MIs increase risk during dental care or local injection
168
Why are patients taking Tricyclic antidepressants (TCAs) and ABSOLUTE contraindication to local anesthetic?
TCAs enhance cardiovascular action to exogenously administered vasopressors
169
List the statistical risk associated with TCAs enhancing cardiovascular action to exogenously administered vasopressors: (3)
A) 5-10x increase with levonordefrin and Norepi
B) 2x increase with epinephrine
C) Hypertensive crisis --> death
170
List the reasons a cocaine abuser is an ABSOLUTE contraindication for local anesthetic:
1. Cocaine stimulates norepinephrine please and inhibits re-uptake
2. 72hrs is needed for cocaine clearance
3. Epinephrine impregnated gingival retraction cord is absolutely contraindicated
171
What should you do if you suspect cocaine usage within 24hrs of dental treatment?
postpone
172
Since cocaine stimulates norepinephrine release and inhibits uptake, what may occur?
Tachycardia/Hypertension leading to increased myocardial oxygen requirement leading to cardiac ischemia and eventually myocardial infarction
173
What is ABSOLUTELY contraindicated for a cocaine user?
epinephrine-impregnated gingival retraction cord
174
How long do you need to leave topical in the mouth for it to be effective?
apply topical for 2 minutes
175
Where should the bevel of a needle be placed during and LA injection?
place the bevel of the needle on tissue in the direction you want to go (towards bone)
176
When MUST you aspirate when giving local anesthetic injections?
for PSA and Inferior Alveolar Nerve blocks
177
What does aspirating when giving an injection do?
makes sure you are not in a blood vessel
178
When giving an LA injection, you should: (technique)
twist the needle as you insert it to keep the needle from deflection in one direction
179
How do you avoid deflection in one direction when giving LA injections?
twist the needle as you insert
180
Finger rest or chest/body rest?
finger rest
181
What are the three branches of the trigeminal nerve?
V1- ophthalmic
V2- maxillary
V3- mandibular
182
Where do the following branches of the trigeminal nerve enter/exit the cranium?
1. V1- ophthalmic:
2. V2- maxillary:
3. V3- mandibular:
1. superior orbital fissure
2. forman rotundum
3. foramen ovale
183
Name whether each branch is sensory or motor of the trigeminal nerve:
1. V1- ophthalmic:
2. V2- maxillary:
3. V3- mandibular
1. sensory
2. sensory
3. motor & sensory
184
One of the branches of the V2 (trigeminal nerve) upon exiting cranial base makes a quick 180 degree turn back into the cranium. This nerve provides sensory innervations to the dura mater.
Middle meningeal nerve
185
Which division of the trigeminal nerve is sensory and motor?
Mandibular branch (V3)
186
Type of injection that numbs one tooth:
local infiltration
187
Type of injection that numbs about two teeth:
field block
188
Type of injection that numbs the entire area as you are injecting the nerve bundle:
Nerve block
189
When you inject a nerve bundle you are performing a:
nerve block
190
What type of LA injection is seen in the photo below?
local infiltration
191
What type of LA injection is seen in the photo below?
field block
192
What type of LA injection is seen in the photo below?
nerve block
193
Infiltration is considered a _____ injection
supraperiosteal
194
Infiltration is performed if you are numbing:
one tooth
195
How is the needled entered when performing an infiltration injection (one tooth)
needle is entered adjacent to bone and apical to apex
196
Describe how infiltration kind of works:
maxillary labial bone is porous, and allows infiltration of anesthetic (anesthetic diffuses into the bone)
197
Infiltration is commonly done with:
premolars
198
List the areas anesthetized by infiltration:
1. single tooth
2. buccal periodontite & bone
3. labial/buccal mucosa
199
PSA:
posterior superior alveolar nerve block
200
What type of LA injection is seen in the following photos?
posterior superior alveolar nerve block (PSA)
201
How is the needed entered for a posterior superior alveolar nerve block? (PSA)
needle is entered into the height of the vestibule at a 4 degree angle to the occlusal plane
(needle is inserted about 16mm and you MUST aspirate)
202
How far is the needle inserted in a posterior superior alveolar nerve block?
16 mm
203
What is the aspiration rate for a posterior superior alveolar nerve block?
3%
204
If there is a positive aspiration with a PSA, what may occur?
hematoma
205
List the areas anesthetized with a PSA:
1. maxillary molar tooth pulps
2. MB root of 1st molar (72%)
3. buccal periodontium and bone (not palatal)
206
During an infiltration injection (supraperiosteal I injection) the syringe is held ______ and the anesthetic is placed ____.
parallel to the long axis of the tooth; apical to apex of tooth
207
Given the anesthetized areas, what type of injection was given?
- tooth
- buccal peridontium and bone
- labial or buccal mucosa
infiltration (supreperiosteal injection)
208
What tooth root has special innervation?
1st molar MB root
209
Which injection is most likely to give you the ugly hematoma?
PSA
210
Given the anesthetized areas, what type of injection was given?
- maxillary molar tooth pulps
- MB root of 1st molar (72%)
- Buccal periodontite and bone
Posterior superior alveolar nerve block (PSA)
211
What type of injection was given if the yellow portion is the area anesthetized?
PSA
212
What type of injection was given if the yellow portion is the area anesthetized?
MSA
213
Describe the position of the needle when injection an middle superior alveolar nerve block:
needle is injected well above premolar apices (bevel facing the bone)
214
List the areas anesthetized during an MSA:
1. maxillary premolars
2. MB root of 1st molar (28%)
3. Buccal periodontium and bone (NOT palatal)
215
According to the image what type of injection is being given?
Middle superior alveolar nerve block (MSA)
216
Given the anesthetized areas, what type of injection was given?
- maxillary premolars
- MB root of 1st molar (28%)
- Buccal periodontium and bone (not palatal)
MSA
217
Describe the needle placement in an anterior superior alveolar nerve block (ASA):
1. Needle contacts roof of infraorbital foramen (which is located about 16mm above vestibule)
2. Insert needle about 1/2 length
3. Orient bevel towards bone and insert until bone is contacting needle
4. Maintain pressure during injection and 1 min aftr
218
In an ASA nerve block, the anesthetic is directed into:
canal
219
List the areas anesthetized during an ASA nerve block:
1. maxillary central incisor through canine
2. premolars
3. MB root of first molar (28%)
4. buccal periodontium and bone
5. lower eyelid, side of nose, and upper lip
220
Given the following anesthetized areas, what type of injection was given?
- maxillary central incisor through canine
- premolars
- MB root of first molar (28%)
- buccal periodontium and bone
- lower eyelid, side of nose, and upper lip
Anterior superior alveolar nerve block (ASA)
221
The following images depict what type of injection?
ASA
222
Am anterior superior alveolar nerve block (ASA) may also be called:
infraorbital nerve block
223
What should be located before an ASA and how?
locate foramen by palpation
224
For a greater palatine injection, where is the needle aiming?
Needle is aiming for greater palatine foramen area and contacts bone (NOT into the foramen)
225
What type of injection is seen in the following images?
greater palatine injection
226
What type of injection is seen in the following image?
nasopalatine injection
227
List the areas anesthetized with an greater palatine injection:
1. posterior portion of hard palate (canine to last molar)
2. overlying soft tissue
(NO anesthesia of teeth)
228
Where its he boundary of anesthetize for greater palatine vs. nasopalatine on the palate?
Greater palatine- distal to the 2nd maxillary molar
229
How can the greater palatine foramen be located?
Can be identified by finding the junction of molars 2 &3 and then moving the needle 1cm medially
230
Can be identified by finding the junction of molars 2 &3 and then moving the needle 1cm medially
greater palatine foramen
231
If the following areas are anesthetized, what type of injection was given?
- posterior portion of hard palate
- overlying soft tissues
- NO teeth anesthetized
greater palatine
232
Where is the injection area of a greater palatine injection?
midway between midline and free gingival border (10mm from palatal midline)
233
Where does the needle need to contact with a nasopalatine injection?
Needle contacts bone lateral to incisive papilla
234
Given the image, what type of injection was given?
greater palatine injection
235
Given the image, what type of injection was given?
nasopalatine injection
236
Describe the steps to giving a nasopalatine injection:
1. needle contact bone lateral to incisive papilla
2. bevel against tissue and bow the needle
3. straighten needle and advance
237
What is alternative approach for a nasopalatine injection?
trans-papillary approach
(insert needle through papilla between 8&9 towards palate)
238
List the areas anesthetized during a nasal palatine injection:
1. anterior portion of hard palate (canine to canine)
2. both hard and soft tissues
(no anesthesia of teeth)
239
The following image depicts what type of injection?
buccal nerve block
240
The following image depicts what type of injection?
mental nerve block
241
The following image depicts what type of injection?
inferior alveolar nerve block
242
The following image depicts what type of injection?
Gow-Gates (true mandibular) nerve block
243
The following image depicts what type of injection?
Vazirani-Akinosi nerve block _closed mouth mandibular nerve block
244
Use a 25 gauge long needle, stretch tissue and contact periosteum.
(large area of nerve coverage, just need to aim in general area)
Buccal nerve block
245
What gauge of needle should be used for a buccal nerve block?
25 gauge
246
What is the only block to anesthetize the buccal mucosa of molars?
buccal nerve block
247
T/F: A lot of anesthesia is needed to anesthetize the buccal mucosa of molars (buccal nerve block)
true
248
List the areas anesthetized with a buccal nerve block:
1. gingival buccal to molars
2. retromolar pad mucosa
3. buccal mucosa in molar areas
(NO hard tissue anesthetized)
249
Given the following image, what type of injection was given?
buccal nerve block
250
The mental nerve (targeted in a mental nerve block) exits out of the:
mental foramen
251
How should you locate the site of injection for a mental nerve block?
palpate the mental foramen near the premolars to determine site of injection and inject into tissue over foramen
252
There is risk of possible _____ with a mental nerve block. What is the aspiration rate?
hematoma; 5.7%
253
List what become anesthetized with a mental nerve block:
1. mucosa anterior to foramen
2. skin of the lower lip
3. chin
254
If the following areas are anesthetized following injection, what injection was given?
- mucosa anterior to foramen
- skin of lower lip
- chin
mental nerve block
255
The largest branch of the posterior division protected by the sphenomandibular ligament:
inferior alveolar nerve
256
The inferior alveolar nerve is protected by:
sphenomandibular ligament
257
What injection is being given in the following scenario:
Syringe directed across the arch (from contralateral side) at level of coronoid notch. Place finger on notch to locate it and determine height of injection.
- Needle penetrated buccinator muscles and is lateral to pterygomnaidbular raphe
- contacts bone
- must aspirate
Inferior alveolar block
258
As what level is a inferior alveolar block given?
level of the coronoid notch
259
With an inferior alveolar block, the needle penetrates _____ and is lateral to ____
buccinator muscle; pterygomandiblar raphe
260
Do you contact bone in an inferior alveolar nerve block?
yes
261
What nerves are anesthetized with an inferior alveolar block?
1. inferior alveolar
2. incisive
3. mental
4. lingual (usually)
262
What areas and nerves are anesthetized with an inferior alveolar block?
1. Nerves- inferior alveolar, incisive, mental and lingual
2. entire unilateral side from midline
3. lingual mucosa
4. tongue
5. teeth
263
According to the following image, what injection was given?
inferior alveolar block
264
" A true mandibular nerve block"
Gow-gates block
265
What injection is being described?
- Needle contacts neck of condyle
- patient opens wide so condyle moves forward
- must aspirate
Gow-gates block
266
What are the extraoral landmarks for a gow-gates block?
1. inter tragic notch
2. corner of mouth
267
When doing a gow-gates block, what should you tell the patient to do?
open wide so condyle moves forward
268
What nerves are anesthetized with a gow-gates block?
1. inferior alveolar
2. lingual
3. mylohyoid
4. auriculotemporal
5. buccal (75%)
269
A closed mouth mandibular nerve block may also be called:
Vazirani-akinosi nerve block
270
The height of injection of a Vazirani-Akinosi nerve block is:
maxillary muco-gingival line
271
How far is the needle inserted in a Vazirani-Akinosi nerve block?
35 mm
272
When giving a Vazirani-Akinosi nerve block the path of insertion is:
parallel to the ramus
273
Should you contact bone with a Vazirani-Akinosi nerve block?
NO
274
What nerves are anesthetized with a Vazirani-Akinosi nerve block?
1. inferior alveolar
2. lingual
3. mylohyoid
275
