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LA all Flashcards

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1
Q

what all needs to be in place/checked before local anesthetic can be carried out?

A
  • must be enrolled on GDC register
  • signed treatment plan from dentist
  • PMH checked
  • dentist must be on site if doing an IDB
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2
Q

what position should pts be in for LA and why?

A

semi recumbant

reduce chance of vaso vagal attack

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3
Q

apply topical for how long?

A

2 mins

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4
Q

why are infiltrations possible in maxillary teeth and mandibular incisors?

A

bone is thinner

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5
Q

maxillary incisors and canines/buccal gingivae supplied by?

palatla gingivae?

A

anterior superior alveolar nerve

nasopalatine nerve

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6
Q

maxillary premolars and buccal gingivae supplied by?

palatal gingivae?

A

superior plexus

nasopalatine and greater palatine nerve

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7
Q

maxillary molars and buccal gingivae supplied by?

palatal gingivae?

A

posterior superior alveolar nerve

greater palatine nerve

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8
Q

what problems might there be with LIA at the maxillary molars?

A

zygomatic arch

mesial and distal infiltrations overcome

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9
Q

where do you give a palatal injection?

A

equidistant between median raphe and gingival margin above tooth requiring anaesthetic

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10
Q

how do you know a palatal injection achieved?

A

blanching

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11
Q

where to avoid when giving a palatal injection?

A

rugae and foramen

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12
Q

why do the lower molars and premolars require an IDB?

A

thick lamina dura - LIA doesnt work

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13
Q

when giving LIA at the lower incisor/canine region where should you ensure the needle is?

A

in contact with bone to prevent escape of agent into the tissues

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14
Q

how to anaesthatise the lingual nerve?

A

LIA below attached gingivae lingually

interpapillary

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15
Q

how to give an interpapillary injection?

A

insert needle at centre of papilla near crest of bone/perio pocket level
small and slow injection
blanching indicates anaesthesia

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16
Q

how quick should LIA anesthesia be established?

A

2 mins

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17
Q

lidocaine and ep gives pulpal anaesthesia of how long?

A

approx 1 hour

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18
Q

do the soft tissues or the hard tissues stay anesthatised for longer?

A

soft tissues

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19
Q

what are some reasons for LA failure?

A 
pts are different - some la might not last as long
IV - syncope
IM
too little LA
infection and injection site
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20
Q

why can an injection stop LA working?

A

infection sites tend to be acidic and LA works best in alkaline conditions

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21
Q

what is LA?

A

the loss of sensation in a specific area by depressing excitation of nerve endings or inhibititng conduction processes

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22
Q

what is the main aim of LA in dentistry?

A

loss of pain

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23
Q

what channels does LA block?

A

ion channels

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24
Q

where does inferior alveolar nerve pass through?

A

passes through the foramen ovale into the infratemporal fossa, between the lateral and medial pterygoids

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25
where is the needle entered into?
the pterygomandibular space
26
what are some contra indications to an IDB?
haemophilliacs co agulation tx co operation
27
what anatomy is identified prior to IDB?
external oblique ridge at anterior aspect of ascending ramus | and V shape of pterygomandibular raphe
28
where does the thumb palpate when doing an IDB? | and where is the needle advanced from?
palpate the ramus, needle advanced from opposite premolars in line with lower occlusal plane enters soft tissues at mid point of thum above last standing molar
29
why might an IDB fail?
``` too little LA not enough time inaccurate placement different anatomy inflammed tissues ```
30
what complications can an IDB cause?
``` facial palsy nerve damage ST damage haematoma IV ```
31
what systemic effects might an IDB cause?
fainting allergy drug interactions toxic reaction
32
6 contents of LA?
``` local anaesthetic agent vasoconstrictor reducing agent preservative fungicide carrier solution ```
33
details of lidocaine?
commonly in 2% solution dissolved in sol as hydrochloride salt with ep gives longer anaesthesia
34
details of prilocaine?
citanest 3% with octapressin 4% plain less effective at haemostasis and vasoconstriction
35
mepivicaine comes as?
2% with epinephring 1:100000 | 3% plain
36
articiane details?
4% 1:100/200000 | metabolised faster so is useful for repeat injections
37
advantages of epinephrine?
more profound anaesthesia longer lasting hameostasis
38
details of felypressin?
less effective at haemorrhage control | not as good a vasoconstrictor
39
what trauma can LA cause?
IV IM needle trauma to mouth while numb
40
why is an IV injection dangerous?
enough LA agent to be of a toxic dose to the CNS of children and young adults heart and brain susceptible to effects
41
why may you think twice about LA and a pt with liver disease on PMH?
liver disease = impaired metabolism, could cause toxic effects
42
what heart problems can contraindicate use of LA?
arrhythmia, unstable angina
43
alternate LA for cardiac pts?
use felypressin max 3 cartridges and avoid epinephrine
44
max lidocaine? | prilocaine?
lido plain - 11 max, ep - 6.8 | prilo plain - 9, fely - 4
45
be careful with use of LA agent and what drugs?
beta blockers - max of two with ep | calcium channel blockers
46
be careful of what drugs and vasoconstrictors?
diuretics antiparkinsons calcium channel blockers beta blockers
47
what are some systemic diseases that are contra indicated in LA?
``` leukaemia anticoag tx steroid tx liver dysfunction renal disease rheumatic fever uncontrolled diabetes haemophilia pregnancy ```
48
what is gate control theory?
melzack and wall 1965 | pain is modulated at the spinal cord and influenced by socio cultural factors/physiological and psychological factors
49
what is the adult pain rating scale? | children?
mcGill | wong and baker
50
what are some ways of distracting the pt?
shift attention mental task audio analgesia visual distraction
51
what component of LA gives haemostasis?
the vasoconstrictor
52
what is the aim of analgesia?
haemostasis and elimination of pain
53
what part of a nerve cell contributes to nerve conduction?
nodes of ranvier | end feet synapses
54
how does analgesia work r.e nerve anatomy?
gains access to nerve at nodes of ranvier and blocks conduction
55
what conditions can give rise to pain?
inflammation trauma necrosis ischaemia
56
what substances give rise to pain?
potassium chlorine sodium calcium
57
what is polarisation?
no pain | potassium in cytoplasm and sodium outwith
58
what is depolarisation?
destruction of polarity ionic exchange sodium in cytoplasm and potassium outwith
59
what is action potential?
change in membrane potential permeability transfer or ions potassium exchanges with sodium
60
what is repolarisation?
sodium potassium pumo | reverts to polarised state

Clinical Practice (22 decks)

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