One cartridge of anesthetic contains
1.8mL of solution
Two types of vasoconstrictor in the united states
Epinephrine
Levonordefrin
This is a bacteriostatic agent and preservative that was added to local anesthetic agents without vasoconstrictors before 1984 to prevent bacterial growth
Methylparaben
Currently no dental local anesthetic cartridges contain this
Methylparaben
Two main classifications of local anesthetic agents
Ester
Amides
Theses are metabolized in the plasma by plasma cholinesterase
Ester
these metabolized in the liver
Amides
What is the Proprietary name for Lidocaine
Xylocaine
Lignospan
Octocaine
What is the Proprietary name for Mepivacaine
Carbocaine Arestocaine Isocaine Polocaine Scandonest
What is the Proprietary name for Prilocaine
Citanest
Citanest Forte
What is the Proprietary name for Articaine
Septocaine
Zorcaine
Articadent
What is the Proprietary name for Bupivacaine
Marcaine
Vivacaine
Which anesthetic is the longest duration and the most potent
Bupivacaine
This anesthetic has high pKa and therefore slowest onset
Bupivacaine
These anesthetic is quite effective without a vasoconstrictor, both are good alternatives when a vasoconstrictor is contraindicated
Mepivacaine
Prilocaine
Short duration of anesthetic
Mepivacaine
Medium duration
Lidocaine
Articaine
Prilocaine
Means that the administration of the offending drug may be used judiciously
Relative contraindication
Means the offending drug should not be administered to the individual under any circumstances
Absolute contraindication
IS the maximum quantity of drug, a patient can safely tolerate during an appointment based on their physical status
Maximum recommended dose (MRD)
Are one of the top food allergens. They are used in wine to prevent fermentation and oxidation.
Sulfites
People who are allergic to sulfites should not be given
an anesthetic with a vasoconstrictor
Frist amide local anesthetic suitable for nerve blocks in dentistry, common used local anesthetic solution in dentistry in the US
Lidocaine
Offers pulpal anesthesia of 5-10mins, rarely used in dentistry without a vasoconstrictor
Lidocaine
what is a good alternative if the use of a vasoconstrictor is a contraindicated
Mepivacaine
is not effective as a topical anesthetic
Mepivacaine
The primary limiting factor for clinical use of prilocaine is
Methemoglobinemia
this is characterized by the presence of a higher than normal level of methemoglobin in the blood that does not bind to oxygen
Methemoglobinemia
This occurs when prilocaine is methabolized to orthotoluidine
methemoglobinemia
Which anesthetic effects breathing
Prilocaine
Shortest half-life
Articaine
With articaine come clinicians have been concerned about the frequent reports of
Paresthesia
Is an persistent anesthesia beyond the expected duration or altered sensation such as tingling or itching, beyond normal level
Paresthesia
Is the most potent and toxic of all amide anesthetics
Bupivacaine
Concern when selecting Bupivacaine is a patient with
self-mutilation
Means that the anesthetic will be applied to a body surface such as the skin or mucous membrane
Topical
Topical anesthetics do not contain a
vasoconstrictor
Topical agent should remain at the site of penetration for
1 to 2mins
Topical anesthetics should achieved to a depth of approximately __into the tissue
2 to 3 mm
Topical comes in
Gel Ointment
Spray Patch
Liquid Lozenge
Cream
One of the more common and widely used topical anesthetics
Benzocaine
this is spot specific
Topical
What is an essential requirement before providing dental hygiene care
Medical history evaluation using appropriate dental and medical consultations of the pts current health status is an essential requirement
The administration of a ______ agent will further elevate the existing blood pressure of patients and to a greater extent in the anxious patient
Local anesthetic
What is important to provide the dental hygienist with baseline values as comparison standards in the event that an emergency situation should occur
Preanesthetic vital signs
another benefit to obtaining vital signs is to
identify diagnosed or undiagnosed conditions that may require modifications to treatment, drug selection and dosage
Palpate the radial artery on the tumb side on the wrist for 1 min
Pulse
(>100 bpm) is an abnormally elevated heart rate and may be sign of a cardiovascular disease or influenced by stress and anxiety
Tachycardia
(<60 bpm) slow heart rate
Bradycardia
local anesthetic containing epinephrine are contraindicated in pts with
uncontrolled cardiac dysrhythmias
breathing that is deeper and more rapid than normal, is common occurrence in apprehensive pts, especially before the administration of a local anesthetic injection
Hyperventilation
The weight of a patient is used before the administration of a local anesthetic to determine the patients
Maximum recommended dose (MRD)
Is any objectively unfounded fear or morbid dread of dental treatment
Dental phobia
Clinical signs of moderate anxiety
Unnaturally stiff posture Nervous play White knuckle syndrome Perspiration on forehead and hands over willingness to cooperate with clinician Nervous conversation Quick answers
cardiovascularly involved patients may receive vasoconstrictors in limited doses called
cardiac dose
The administration of the offending drug increases the possibility of a life-threatening situation and should not be administered to the individual under any circumstances
Absolute contraindication
The administration of the offending drug is preferably avoided because of the increased possibility of an adverse reaction to the drug. If an acceptable alternative drug is not available, the drug may be used judiciously
Relative contraindication
An antihypertensive drug used to lower systolic and diastolic blood pressure
Nonselective B blocker
The bodys response to fear provoked the stress response referred to as
Fight-or-flight
What can recognized by increase in vital signs and visual observation of the pts body movements, skin color (paleness), cold sweats, posture, trembling, and verbal communication
Anxiety and fear
These drugs are used for the treatment of congestive heart failure
Digitalis glycosides (digoxin)
The combination of digitalis glycosides and epinephrine increases what
the potential for cardiac arrhythmias
What should not be administered to a patient who is suspected of using what? on the day of dental treatment, it may lead to a hypertensive crisis, stroke or myocardial infarction
cocaine or methamphetamine
Is a condition that occurs due to excessive production of thyroid hormone by thyroid gland
Hyperthyroidism
Patient may develop this with hyperthyroidism if vasoconstrictors are used
Thyrotoxicosis
What is thyrotoxicosis more commonly known as
thyroid storm
Absolute contraindications to the use of vasoconstrictors
- Blood pressure greater than 180/110 mmHG
- Within 6mo. after heart attack or stroke
- Serve cardiovascular disease
- Daily episodes of angina pectoris or unstable (preinfarction) angina
- Cardiac dysrhythmias despite appropriate therapy
- Whithin 6mo of coronary artery bypass surgery
uncontrolled hyperthyroidism is an absolute contraindication to vasoconstrictors because of the possibility of causing
thyroid crisis
allergy to what should not receive a local anesthetic agent containing vasoconstrictors
Sulfites
Inherited syndrome triggered by exposure to certain drugs used for general anesthesia and the neuromuscular blocking agent succinylcholine
Malignant hyperthermia
what are clinical signs of methemoglobinemia
cyanosis of the lips and mucous membranes
the dental hygienist must determine the maximum dose of injectable local anesthetic based on
the treatment to be delivered and the health status of the patient
Why do you aspirate
To prevent intravenous injection IV
The most common and efficient method of obtaining a medical/dental history in the dental office is by
Printed questionnaire filled out by pt followed by a dialogue history
Two or more drug given at the same time or in the same day
Concomitant
What is an adults respiratory rate per min
12-20
What is an adult normal pulse rate
60-100
What usually causes dental phobia
Traumatic
, difficult, and/or painful dental experience
Esther Wilkins
American dental hygienist and dentist and author of the first comprehensive book of dental hygiene
What instrument was named after Esther Wilkins
Wilkins/tufts explorer
Considered the most potent of the topical anesthesia
Tetracaine hydrochloride