Lec 8

Question 1

root canal possible without profound local anesthesia

Answer 1

FALSE

Question 2

need more LA for endo vs operative or fixed

Answer 2

TRUE

Question 3

endo ice can be more effective than topical for palatal injection

Answer 3

TRUE

Question 4

give no more than 1/4 carp on palatal injections

Answer 4

TRUE
could slough tissue off

Question 5

mandibular nerve block more difficult than infiltration

Answer 5

TRUE

Question 6

biggest challenge to numb: mandibular molar w/ acutely inflamed pulpitis (Hot IP)

Answer 6

TRUE

Question 7

use endo ice to check for pulpal anesthesia

Answer 7

TRUE

Question 8

why are LA less effective on infected teeth

Answer 8

infected teeth have acidic environments, LA free base not released as much, less effective

Question 9

the closer you place LA to the nerve

Answer 9

the more profound the anesthesia is, and the faster it kicks in

Question 10

one way to combat LA problems?

Answer 10

have Pt take 600 mg Ibuprofen 1 hour before (78% effective)
cannot do this before diagnostic tests

Question 11

always let block sit for a few minutes and check before doing any more auxiliary injection

Answer 11

TRUE

Question 12

what is the pterygomandibular raphe

Answer 12

bundle of tissue from maxillary tuberosity to retromolar pad, inject mesial to it

Question 13

how long does pulpal anesthesia last

Answer 13

30-90 minutes
take pulp out while numb
most lost in 45 min

Question 14

even if tooth is necrotic, still have to do LA

Answer 14

TRUE

Question 15

what allows articane to penetrate cortical bone plates

Answer 15

thiophene ring
-articaine better than lido for bone penetration

Question 16

for buccal infiltration, where should needle be placed

Answer 16

at about the level of the apices for tooth being treated

Question 17

get physician consult for patients with what ASA classification

Answer 17

ASA III or IV need consult before LA, get it in writing

Question 18

when should you attempt a Gow-Gates injection

Answer 18

When IA block might not be effective for mandibular molars with HOT IP

Question 19

3 types of supplemental injections

Answer 19

PDL injection
Intra-pulpal injection
intra-osseus injection

Question 20

for how long should you inject LA?

Answer 20

very slowly, 60 sec
slow injections allow pH to balance when entering tissue

Question 21

how to check for pulpal anesthesia?

Answer 21

use endo ice or EPT on tooth
(dont use hot gutta percha)

Question 22

how does LA work in a non-inflamed tissue

Answer 22

a gate channel or pore in the nerve cell will be blocked by LA resulting in no action potential and therefore no pain

Question 23

only the non-ionized portion (free base) of LA can diffuse thru neuron membranes

Answer 23

TRUE

Question 24

how long is the onset of action for LA

Answer 24

most have 1-20 min onset of action

Question 25

two types of LA agents are:

Answer 25

1. esters (novacaine, procaine) (no longer used)
2. amides (all the rest) (preferred)

Question 26

short duration amides are (2)

Answer 26

less than 1 hour
-mepivacaine, carbocaine

Question 27

medium duration amides (2)

Answer 27

60-120 min
-lidocaine, articaine

Question 28

long duration amides (2)

Answer 28

over 120 min
-bupivacaine, marcaine

Question 29

mandibular molar injections
(hot IP)

Answer 29

start w/ 2 carps
GG may be better than IA
make sure Pt is numb before any supplemental injections or buccal infiltrations

Question 30

mandibular anteriors require what injections?

Answer 30

IA or GG too, not just a Mental nerve block

Question 31

what supplemental injection is first choice

Answer 31

PDL injection
-inject into PDL space, bevel towards bone
-2% lido w/ 1:100,000 epi
-lasts 1-30 min
-must have back pressure, blanching
-inject at all 4 line angles

Question 32

2nd choice supplemental injection?

Answer 32

Intra-pulpal injection
-most painful and short acting but immediate relief
-use 30 gauge needle in canal
-duration only minutes, pulp out fast
-do not repeat
-do distal canal first

Question 33

what is the intra-osseus injection?

Answer 33

-use a perforator to create hole in cortical bone for LA to pass thru to medullary space
-radiograph w/ cannula in place
-be very careful w/ cannula, drill, infection of bone after perforation

Question 34

issues w/ cellulitis and LA injection

Answer 34

do not inject into swollen tissue
-sensitive to palpation and percussion
-localized swelling can be numbed
-generalized swelling may need ABX first

Question 35

considerations w/ cellulitis

Answer 35

do block away from inflamed area
increase LA dose
supplemental injections
consider referral (Ludwigs Angina)

Question 36

ludwigs angina involves what

Answer 36

sublingual, submental, submandibular spaces
-spread of infection
-life threatening
-refer to OS or MD ASAP

Question 37

if lip tingles, the Pt is numb

Answer 37

FALSE
lip is thick and fat, not tingly

Question 38

most commonly used LA agent

Answer 38

2% Lido w/ 1:100,000 Epi
-detox by liver (beware liver disease)
-no contraindications for heart problems or pregnant women
-dont use w/ MAO inhibitors or tricyclic antidepressants

Question 39

how much anesthetic is in a carp of lido

Answer 39

34 mg
8 carps is max adult dose

Question 40

how much is in a carp of septocaine (articaine)

Answer 40

68 mg
4 carps is max adult dose

Question 41

Articaine (Septocaine) controversy

Answer 41

may cause neuropathies
-5x as likely to cause paresthesias compared to lido
-lawyers know this

Question 42

what does Epi do in LA

Answer 42

delays absorption
increases duration and effectiveness
stops bleeding
-can affect Pt w/ high BP tho