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DOH 210 > W4 Local Anaesthesia > Flashcards

W4 Local Anaesthesia Flashcards

(113 cards)

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1
Q

Describe what local anaesthetics are in dentistry?

A

Local anaesthetic is a loss of sensation to a circumscribed area of the body. Used in dentistry to create reversible blockage of pain/sensation signals in peripheral nerves. Natural vasodilators.

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2
Q

Does LA stimulate or depress CNS?

A

Both

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3
Q

What can LA cause on the heart?

A

Antidysrythmias

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4
Q

Do smooth muscles; relax or constrict during LA?

A

Relax; inhibition of neuromuscular transmission in skeletal muscle.

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5
Q

What is added to LA to stabalise the solution?

A

Salt (hydrochlorides) this makes the molecules stable and sobuable in water.

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6
Q

What is the pH base of LA?

A

pka 8-9. In ECF 7.4pH, it is positively charged and called a CATION.

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7
Q

What is pka?

A

Strength of acid.

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8
Q

What determines speed of onset? (pKa)

A

Determeined by pKa of the solution and the pH of the surrounding fluids.

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9
Q

What does it mean if an anaesthetic has a high lipid solubility?

A

HIGH lipid solubility is more potent as they produce more affection conduction blockade at lower concentration that less sol anaesthetics.

LOWER percentage sol, smaller amount required.

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10
Q

Describe binding affinity on LA and how it works in onset of action

A

Drugs with ↑ protein binding affinity will bind to plasma proteins for longer, resulting in an additional reservoir once the unbound drug has diffused away from site/metabolized.

Also will bind to Na+ channel receptor for longer.

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11
Q

How is local anesthetic carried away from site?

A

Vasodilator action increases perfusion of LA in local area with blood,.
Anesthetic agent is carried away from site more rapidly for metabolisim.

Potential for ↑ bleeding at sit of infection

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12
Q

What affects the mode of action of LA of ↓ tissue pH?

A

Low tissue pH. eg. Inflammation which affects the speed of onset. This has ↓ pH outside of the nerve, this means more LA solution present in cation (+). Less free base avail to penetrate nerbe membrane to action on Na receptor

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13
Q

What affects the mode of action of LA of ↑ tissue vascularity?

A

Inflammation affects th duration of action. More blood vessels present in local area, therefor greater opportunity for LA to be removed from injection sit. & spread.

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14
Q

Define speed and mechanism of absorption of LA

A

Speed can be influced by the chemical nature of the drug. Site of injection
- Local blood flow
- Vasoconstriction.
Greater th absoprtion the greater potential for systemic effects.

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15
Q

How does metabolism make LA less lipophillic?

A

Alters the chemical properties of drugs to make them less lipophillic (disolvable) to enable excretion.

Occurs in the liver, blood, plasma and lungs.

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16
Q

How does metabolisim enable LA excretion?

A

Alters the chemical properties of drugs to make them less lipophillic to enable excretion.

Occurs in the liver, blood, plasma and lungs.

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17
Q

Describe Esters as functional groups

A

Procain/Novocaine, Tetracaine.
Metabolisim: rapidly hydrolyzed in plasma by pseudocholinesterease. It is excreted in urine - can be related to allergic reactions. It can ↑ potential for toxicity. Can be hereditry.

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18
Q

What anaesthetics are Amides groups?
Where are they metabolised?
What may affect metabolisim?

A

Lignocaine/Lidocaine. Prilocaine, Articaine, Bupivacaine, Mepivcaine.
Metabolised in the liver.

  • Rate of breakdown is dependent on hepatic flow.
  • Secondary metabolism in lungs.

Things that may affect metabolism are hypotension, congestive hart failure, cirrhosis.

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19
Q

What is the onset of topical anaesthetics?

A

2-5min

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20
Q

What is the duration of topical duration?

A

15-20 min

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21
Q

What are the indication for topical anesthetics?

A

Prior to anesthetic injection on mucous membranes.

Contraindicated: allergy, eating, drinking

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22
Q

What are the constituants of LA?

A

ADD MORE INFO!

  1. Anaesthetic agent
  2. Stabilisers
  3. Vasoconstrictors
  4. Antioxidants
  5. Preeservativees
  6. Water
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23
Q

What effect does adrenaline have on the body in LA?

A

Naturally occurs in the body. Binds to adrenreceptors.

SYMPATHOMIMETIC.
Heart: 
↑ HR, 
↑ Co2 
coronary artery dilation
 ↑ BP

Blood vessels:
Acts on: lungs (bronchiolar muscle relaxation)
GI tract (↓ gut contractiability)
metabolisim (inhibits insulin release)

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24
Q

Dfine Felypression

A

It causes vasoconstriction by acting on smooth muscle of the muscular beds, with greater effects on the venous sude of the peripheral circulation.

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25
What is the formula for maxium LA?
``` #mg/kg (absolute max) x weight = 000mg 000mg / % (00) = 00.00ml 00.00ml / 2.2ml = 0.0 cartridge ```
26
Describe functional group esters
Metabolisim: rapidly hydrolyzed in plasma by pseudocholinesterase. A metabolite of this para-aminobenzoic acid is excreted in urine. - Contra: unable to metabolise ester → prolonged higher levels of LA in blood, increasing potential for toxicity.
27
Describe the functional group of amindes
Metabolisim in the liver - biotransformation in the liver. - Rate of breakdown in dependant on hepatic blood flow. - May undergo secondary diffusion metabolisim in the lungs.
28
What are conditions that may affect hepatic blood flow of amide LA's?
1. Hypotension 2. Congestive heart failure 3. Liver function (cirrhosis Unable to metabolise amide la, thus increasing potention for toxicity.
29
Is the maxilla bone cortical or cancellous bone?
thin cortical bone. This permit diffusion of anaesthetic to n.
30
What types of maxilla inflitrations are there?
Buccal infiltration & Palatal infiltration
31
What are the indications for buccal infiltration?
Pulpal anaesthesia of 1 or 2 teeth.
32
What nerve is targeted in buccal infiltration?
Dependant on the tooth you want to numb. PSA, MSA, ASA.
33
What areas are anaesthetised in buccal infiltrations?
Local pulp, root, buccal periosteum, CT, buccal gingiva & mucous membrane
34
Where is the target bony site for a buccal infiltration?
Slightly distal and superior to apex of target tooth
35
What is the soft tissue landmark of a buccal infiltration?
Height of muccobuccal fold of vestibule adjacent to target tooth.
36
What should the orientation of the syringe be for a buccal infiltration?
Parallel to long axis of tooth in anterior teeth, more oblique as moves posteiorly
37
What needle length should be used for buccal infiltrations?
Short
38
What is the insertion & amount depositied for a buccal infiltration?
3-5mm. | 0.5-1ml... 1/4 - 1/2 of a cartridge
39
What is a consideraton for buccal infiltrations?
Flared deciduous roots. Do distal injections first. You can inject interproximally between apices of 2 teeth to target both
40
When is a palatal infiltration indicated?
Anaestheises palatal gingiva of corresponding tooth only.
41
What nerve is targeted for a palatal infiltration?
Dependant on tooth you are anaethesising. - Nasopalantine - Greater palatine
42
What areas are anaesthetised for palatal injection?
Terminal branches on innervating nerves resulting in anaesthesia of local pulp.
43
What is the target bony site for palatal infiltration?
Greatest angle of palate. (Junction of the palatine process of maxilla and alveolar process of maxilla).
44
What is the soft tissue landmark of palatal infiltration?
maximum tissue thickness of the palate. (curvature of palate).
45
What is the orientation of needle for palatal infiltration?
Insert needle at 45 degree angle.
46
What needle is used for a palatal infiltration? Insertion? & how much do you deposit?
Short: insert 1-2mm. | Deposit 0.-0.3mls
47
How many times do you aspirtate for a block techniqe?
2 aspirations in different planes. Except for nasopalatine
48
How many block techniques are there for maxilla? Name them?
``` 5! Anterior Superior Alveolar: Middle Superior Alveolar: Posterior Superior Alveolar: Greater palatine block: Nasopalatine block: ```
49
What is the indications for PSA?
Suitable if required pulpal/gingival anaesthesia of more than one molar tooth >>>.
50
What nerve is targeted for PSA?
Posterior Superior Alveolar n.
51
What areas are anaeshetised in PSA?
Pulpal tissue, alveolar bone, CT, PDL, buccal gingiva corresponding to maxillary 1st, 2nd, 3rd molar. Except MB root ipsilateral side of injection
52
What is the target bony site for PSA?
Lower infratemporal surface of maxilla
53
What is the soft tissue landmark?
Height of mucobuccal fold over the second molar
54
What is the orientation of syringe for PSA?
45 degree angle directed superiority, medially and slightly posterior (one continuous movement)
55
For PSA injection chose a needle length, amount deposited, and length of time
Short: insertion 15mm. Amount deposited 3/4 - 1/2 Deposit over 30-60 seconds.
56
What is a consideration of PSA?
Injecting near pterygopalatine space - haematoma formation if unctures maxillary artery or pterygoid plexus. Aspirate in 2 planes
57
What are the indications for the MSA?
Suitable if requie pulpal/gingival anaesthesia of both premolars.
58
What n. is targeted for MSA?
Middle Superior Alveolar n,
59
What area is anaesthetised with a MSA injection?
Pulp tissue, alveolar bone, CT, PDL and buccal gingiva corresponding to the premolars and MB root of macillary 1st molar on ipsilateral side of injection
60
What is the target bony site for MSA?
Superior and slightly distal to the apex of second premolar
61
What is the orientation for the MSA injection?
Parallel to long axis of tooth in anterior teeth, more oblique as moves posteiorly
62
What needle length should be used & what is the insertion and amount for MSA?
Short. Insertion: ensure tip depth is above apex of 2nd premolar 1/2 cartridge
63
How much do you deposit for a MSA injection?
App. 0.9-1.2mls | 1/2 cartridge
64
What are some considerations for MSA injection?
Lateral aspect of maxilla slight concave, may need to angle slightly medially.
65
What are the indications for ASA?
Suitable if require pulpal/gingival anaesthesia of more than one anterior tooth.
66
What n. is targeted for ASA?
Anterior Superior Alveolar never
67
What area is anaesthetised for ASA?
Pulpal tissue, alveolar bone, CT, PDL, buccal gingival corresponding to the canine, lateral incisor and central incisor on ipsilateral side of injection
68
What is the target area for the ASA?
Distal to lateral incisor close to the apex of the canine.
69
What are the soft tissue landmarks for ASA?
Height of mucobuccal fold in the area of lateral incisor and cainine.
70
What would the orientation for the syringe be for an ASA injection?
Same as buccal infiltration - parrelle with long axis of tooth
71
What needle length should be used, how far do yo insert and amount deposited ASA?
Short needle. Insertion 10-15ml Amount deposited 1/2
72
When is a greater palatine block indicated?
Suitable if require gingival anaesthesia of molar/premolar region of hard palate
73
What n. is targeted with the greater palatine block?
Greater palatine n.
74
What is the target bony site for greater palatine block?
Greater palatine foramen
75
What are the soft tissue landmarks for greater palatine block?
Junction of soft and hard palate, slightly distal 1cm medial to 2nd premolar.
76
What is the orientation of the syringe for a Greater Palatine block?
Advance syringe from opposite side, approx 45 degrees.
77
What needle length and insertion is required for a Greater Palantine block?
Short: Insertion: 2-3mm. Amount deposited 0.25-0.5mls.
78
What is a main consideration for Greater palatine block?
Aspiritaion as greater palatine artery is close.
79
When is a Nasopalatine block indicated?
Suitable if require gingival anaesthesia of anterior region of hard palate.
80
What n. is targeted with a Nasopalatine block?
Nasopalatine
81
What area is anaethetised with a Nasopalatine block?
Palatal gingiva and mucosa of anterior 1/3 of hard palate, ipsilateral to site of injection
82
What is the target bony site for a nasopalatine block?
Incisive foramen
83
What is the soft tissue landmarks for a Nasopalatine block?
Incisive papilla, located posterior to central incisors, in the midline.
84
What is the orientation of the syringe for a Nasopalatine block?
45 degree angle. | Lateral to incisive papilla!
85
What needle length should be used, insertion and amount deposited for a Nasopalatine block?
SHORT Incertion 2-3mm Amount: 0.25-0.5mls ↓ quarter of a cartridge
86
When is a mandibular buccal infiltration indicated?
Suitable to anaesthetise the lower anteriors & deciduous molars prior to eruption of 6's.
87
What n. is targeted in a mandibular buccal infiltration?
Incisive n for anteriors | - IAN for deciuous E's D's
88
What areas are anaethestied with a mandibular buccal infiltration?
Terminal branches on innervating nerve of adjacent tooth. | Local pulp, root, buccal periosteum, CT, buccal gingiva and mucous membrane,
89
What is the orientation of syringe for mandibular buccal infiltration?
Parralle with long axis of tooth, towards apex
90
When is a lingual infiltration indicated?
It is a supplementary local infiltration of the lingual n.
91
What would the orientation of lingual infiltration
Parralle with long axis of tooth. Be careful not to insert in FOM! Can create haemotomia
92
When is a IAN indicated?
Pulpal anaesthesia of molar and premolar teeth.
93
What n. is targeted with an IAN block?
Inferior Alveolar Nerve is the pterygoidmandibular space (incisve and mental terminal branches anaesthetised). In the pterygoidmandibular space sol diffuses into lingual n.
94
What areas are anaesthetised with an IAN block?
IAN: all mandibular teeth pulp. Buccal gingiva, periosteum, CT, mucous membrane anterior to first molar. Lingual n.: lingual, gingva, FOM, anterior 2/3 of the tongue. On ipsilateral side of injection
95
What is the target bony site for IAN?
Prior to entry: mandibular foramen... superior to lingula on medial border of ramus. Palpate coronoid notch
96
What is the soft tissue landmarks for the IAN block?
Anterior border of the pterygomandibular space.
97
What is the orientation of the syringe for a IAN block?
1cm above the premolars on the contralateral side.
98
What is the insertion for IAN block?
25mm until hit bone, withdraw slightly then aspirate. | Amount deposited: 1.5-1.8mls over 60 secs.
99
What are the considerations when placing IAN block?
Size of buccal fat pad. Size of ramus. Dental arch and alignment of teeth. If tongue is not number, withdraw slightly and deposit 0.msl to target Lingual n.
100
When is a long buccal block indicated?
If anaesthesia of buccal gingiva of mandibular molars.
101
What nerve is targeted with a long buccal block?
Long buccal nerve.
102
What areas are anaesthesied with a long buccal block
Buccal gingiva of lower posterior teeth and the adjacent mucobuccal fold.
103
What is the target bony site for a long buccal block?
Anterior border of ramus - targeting nerve as it leaves pterygomandibular space, crosses the ramus of the mandible beore it pierces the buccinator.
104
What is the soft tissue landmark for the Long Buccal Block?
Mucous membrane distal and buccal to last molar in the arch,
105
What is the orientation of syringe for IAN block?
Parallel to occlusal plane on the side of injection?
106
What needle length can you chose, insertion and amount deposited for IAN
LONG: 25mm insertion 1/2-3/4 catridge
107
What are the indications for a incisive/mental block?
When tx is limited to mandibular anterior teeth, and full quadrant is not necessary
108
What n. are targeted with an incisive/mental block?
Incisive n. and mental n.
109
What areas are anesthetized with a mental block
Incsive n: Pulp, CT, PDL, buccal gingiva and soft tissue of premolars, canine and incisor teeth ipslateral side to injection. Mental n: lip skin, mucosa and muscles of lower lip ipsilateral side to injection.
110
What is the target bony site for incisive block?
Mental foramen
111
What is the soft tissue landmark for an incisive block?
Between apices of lower premolars
112
What is the orientation of syringe for a mental block?
Parallel to occlusal place of the side of injection OR | Parallel to long acis of tooth for bi.
113
What needle length is needed, insertion and amount for a mental injection?
Short. Insertion 5-6mm. | Amount deposited 0.5-0.6mls 1/4 cartridge

DOH 210 (22 decks)

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