Flashcards in Final Deck (66):
T/F: A second cartridge for an IAN/lingual and buccal injections is useful.
Reinjection after 5 minutes is useful
What are some secondary techniques to numbing the anterior mandible?
1. Anterior infiltration
2. Mental block
3. PDL injection
T/F: Each cartridge contains 1.7 ml of solution.
T/F: Each 1% of LA is 10mg/ml.
1.7 ml solution of 2% lidocaine = 34 mg/cartridge
T/F: A 1:100,000 solution contains 0.01 mg/ml.
1.7 ml of 1:100,000 epi solution = .017mg of epinephrine
What is the adult and pediatric maximum dose of mepivacaine?
Adult - 400 mg
Child - 6.6 mg/kg
What is the adult and child max dose of 2% lidocaine (1:100,000)?
Adult - 500mg
Child - 7mg/kg
T/F: The maximum doses of articaine and lidocaine are the same.
What is different about most articaine local anesthetics vs lidocaine?
Lidocaine is a 2% solution while articaine is a 4% solution
T/F: Mepivacaine has a short acting time.
Which local anesthesia has the longer acting time?
0.5% Bupivacaine (1:200,000)
What is the adult and child maximum dose of bupivacaine?
Adult - 90mg
Child - 2mg/kg
How many cartridges of 2% lidocaine would it be safe to give an adult?
2% solution = 20mg/ml
20mg/ml x 1.7ml/cartridge = 34 mg/cartridge
500 mg/34mg = 14 cartridges
What is the suggested maximum dose of epinephrine for a healthy adult? One with severe hypertension/cardiac disease?
0.2 mg - healthy
0.04mg - unhealthy
What is the safe dose of epinephrine for a healthy 70 kg adult patient with 1:100,000 epinephrine solution?
Maximum = 0.2mg = 20 ml in 1:100,000 solution
20ml/1.7ml cartridge = 11 cartridges
How many ml of a 1:100,000 epinephrine can an unhealthy adult have?
4ml = 2 cartridges
T/F: Articaine is safe to use for a mandibular block.
Possible for mandibular infiltration
What are three methods of intra-Osseous anesthesia?
1. Periodontal ligament injection
2. Intra-septal injection
3. Intra-Osseous injection
Interligamentary injection is another term for _________.
What area is anesthetized during a PDL injection?
Bone, soft tissue, apical and pulpal tissues
T/F: A PDL injection should be given with the long axis of the tooth, with the bevel on the root.
What are two signs that you are in the right spot for a PDL injection?
1. Resistance to deposition
2. Ischemia (blanching) of tissue
How much LA is deposited for a PDL injection?
0.2 ml (one stopper length) in 20 seconds
What are two contraindications for a PDL injections?
1. Infection/inflammation at site
2. Presence of primary teeth
T/F: The PDL injection is used when you only have a partially successful IAN.
What can happen from excessive pressure on the cartridge?
Break the glass
Where is the target area for an intra-septal injection?
Center of interdental papilla equidistant from adjacent teeth
What angle to you hold the needle at for an intra-septal injection?
45 degrees to long axis of tooth
90 degrees to the tissue
How much anesthetic is given for an intra-septal injection?
T/F: Intra-Osseous injections are given into the inter proximal bone between two teeth.
How long does it take for pulpal anesthesia to take place with intra-Osseous injections?
T/F: Intra-Osseous injections involve drilling a whole into the bone.
T/F: Palpitations are a more likely side effect of intra-Osseous injections.
What teeth are indicated for an intra-pulpal injection?
Teeth ready for RCT
T/F: Intra-pulpal injection technique uses pressure as part of the anesthesia technique.
Articaine contains a _________ instead of a benzene ring like other amide LAs?
T/F: Articaine contains an extra ester linkage.
What is a downside about using a 4% solution instead of a 2% solution?
Higher chance of parasthesia
T/F: Soft tissue testing is a good indicator of pulpal anesthesia.
Electric pulp test or Endo-Ice (cold refrigerant)
Electronic pulp testing readings less than _______ resulted in pain during restorative procedures.
Reading must be 80 or above to indicate pulpal anesthesia
T/F: Lip numbness is indicative of pulpal anesthesia.
What is articaine useful for in anesthesia?
T/F: There does seem to be more complications (parasthesia) with articaine.
T/F: The Gow-Gates and Vazirani-Akinosi is superior to IA block.
T/F: Two cartridges in an IA block are preferred due to better pulpal anesthesia.
Better soft tissue, no effect on pulp
What is the effect of buffering anesthetic solutions?
Faster onset and less pain on injection - but probably not
T/F: Injecting more slowly results in better anesthetic results.
T/F: If a patient has profound lip numbness, but no pulpal anesthesia, you should repeat the block.
Move on to supplemental techniques
Which injections are most vulnerable to needle breaking?
IA block and PSA
How do you prevent needle breakage?
Don’t use short or 30 gauge needles, do not bend needle
What should you do if there is a needle breakage?
Refer to OMFS
What are the top 3 causes of parasthesia?
1. Direct nerve injury
2. Contaminated LA
3. LA itself (articaine)
How do you manage a patient with parasthesia?
Record the incident and watch for 2-3 weeks, if no improvement refer to OMFS
How do you avoid facial nerve paralysis when giving IA block?
Ensure bone contact on medial side of ramus
Multiple injections to the muscles can cause _________.
If the patient has trismus for over 48 hours what should be suspected?
T/F: Infection from local anesthesia is extremely rare.
T/F: Local anesthetics exert a single action and are non-toxic.
No drug has these qualities
What is biotransformation?
Esters hydrolyzed by pseudocholinesterase into PABA in plasma/liver
Amides bio-transformed by liver enzymes
Which injection gives the highest percentage of positive aspirates?
IA block (12%)
What are some signs of a LA overdose?
Talkativeness, slurred speech, metallic taste, twitching
What is the first sign of moderate to high LA overdose?
Tonic-clonic seizure activity
What is always the first step when an LA overdose is recognized?
T/F: O2 should be administered if a patient is suspected to have an LA overdose.
T/F: Benadryl can be prescribed for a patient who has a skin reaction to LA.