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DEN2SKC > WEEK 5 > Flashcards

WEEK 5 Flashcards

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1
Q

What are the indications for maxillary infiltrations?

A

for anaesthetizing one or two teeth.
for soft tissue anaesthesia of buccal and palatal soft tissues

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2
Q

what are the contradictions of maxillary infiltrations?

A

infection or acute inflammation at infection site

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3
Q

what is the anatomical landmark for maxillary infiltrations?

A

mucobuccal fold which is superficial to the apex of the tooth following long axis

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4
Q

where does the bevel face when inserting the needle?

A

towards the bone

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5
Q

what do you retract with when injecting?`

A

hand mirror

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6
Q

what is the depth of insertion for maxillary infiltrations?

A

2-3mm

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7
Q

how much anesthetic do we deposit for maxillary infiltrations?

A

dependent on procedure

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8
Q

what nerves do we anaesthetize with maxillary nerve blocks?

A

anterior superior alveolar, middle superior alveolar, posterior superior alveolar, branches of infraorbital nerve, nasopalatine and greater palatine nerve

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9
Q

what are the indications of the posterior superior nerve block (PSA)?

A

for procedures involving two or more maxillary molars.
If infiltration is contraindicated or unsuccessful due to dense bone

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10
Q

what are the contraindications of posterior superior alveolar?

A

high haemorrhage risk

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11
Q

what are the anaestheized areas of a posterior superior alveolar nerve block?

A

Buccal periodontium and overlying bone of maxillary third/second and first molar.
Pulpal tissue of maxillary third/second and first molar

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12
Q

what is the insertion site of posterior superior alveolar nerve blocks?

A

mucobuccal fold above second molar, it is then angled 45 degrees upward, inward, and backward so the needle ends up behind the maxilla near the tuberosity

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13
Q

What are the indications of a middle superior alveolar nerve block?

A

when anterior superior block fails to anaesthetize posterior to the canine.
for procedures involving maxillary premolars

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14
Q

what are the contraindications of MSA?

A

infection or acute inflammation at injection site

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15
Q

what areas are anaesthesized in an MSA?

A

pulpal tissue and buccal periodontal tissues overlying bone of maxillary premolars and mesiobuccal root of maxillary first molar

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16
Q

what are the indications of anterior superior alveolar nerve blocks?

A

procedures involving multiple teeth, only if adequate anaesthesia can’t be obtained with local infiltration

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17
Q

what are contraindications of anterior superior nerve block?

A

infection or acute inflammation at injection site

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18
Q

what areas are anaesthesized with an ASA/infraorbital?

A

pulpal tissue, buccal periodontium and overlying bone of maxillary central incisor to canine
lower eyelid, lateral aspect of nose and upper lip of injection side.

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19
Q

where is the site of injection for MSA?

A

height of the mucobuccal fold above the maxillary second premolar, parallel to the long axis of the tooth, upward and inward 5-10mm

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20
Q

where is the site of injection for ASA nerve block/infraorbital?

A

height of muccobuccal fold above the canine. angle approximately 10 degrees so it is in line with the first premolar and the pupil.

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21
Q

What are the indications of the greater palatine nerve block?

A

periodontal or surgical procedures involving palatal soft hard tissues.

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22
Q

what are the contraindications of greater palatine nerve block?

A

infection or acute inflammation at injection site
when infiltration would suffice

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23
Q

what areas are anaesthetized with a greater palatine nerve block?

A

posterior region of hard palate and overlying soft tissues that extend from the mesial maxillary first premolar to distal maxillary third molar.
midline of injecting side to palatal region of anaesthesized dentition

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24
Q

what is the injecting site for greater palatine nerve blocks?

A

slightly anterior to greater palatine foramen, between 2nd and 3rd molars, insert perpendicular to palate, 2-4mm til bone is contacted.

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25
where is the greater palatine foramen most frequently located?
distal to the maxillary second molar, but it differs.
26
how do you find the greater palatine foramen?
cotton swab is pressed against hard palate at junction of alveolar process and palatal bone until a depression is felt.
27
what are the indications of a nasopalatine nerve block?
periodontal or surgical procedures involving palatal soft and hard tissues.
28
what are the contraindications of nasopalatine nerve block?
infection or acute inflammation at injection site. if infiltration would suffice.
29
what areas are anasthesized with the nasopalatine nerve block?
soft and hard tissues of the anterior portion of hard palate, extending from distal surfaces of maxillary canines
30
what is the area of insertion for nasopalatine nerve blocks?
palatal mucosa lateral to the incisive papilla at a 45 degree angle
31
what are local adverse effects of maxillary LA?
needle breakage, prolonged anasthesia, facial nerve paralysis, trismus, soft tissue injury, haemotoma, pain on injection, post injection pain
32
what are some risk factors of needle breakage?
prebending it, inserting to hub, too big gauge, sudden movement
33
how do you manage a broken needle?
remove with artery forceps if visible. if not visible inform patient and refer to maxillofacial surgeon for immediate removal.
34
how do you prevent needle breakage?
use a larger gauge needle for IANB long needle if inserting greater than 18mm avoid inserting to hub avoid lateral pressure
35
what is the risk of needle fragments remaining in tissue?
can migrate through the soft tissue to nerves and blood vessels
36
what is prolonged anaesthesia/sensitivity disorder
persistant anaesthesia beyond reasonable duration, usually transient
37
what are the increased risks of paraesthesia?
direct nerve trauma (extraction of third molar) nerve sheath trauma, usually described as electric shock contaminated anaesthetic solution (alcohol based disinfectant) haemorrage of nerve sheath
38
how do you manage a paraesthesia case?
should resolve in 8 weeks without treatment, arrange prompt examination with patient, explain duration, offer referral to dental surgeon.
39
how do you prevent paraesthesia?
strictly following rules of LA
40
what is facial nerve paralysis?
transient paralysis of facial nerve, usually after IANB, duration lasts approximately same time as soft tissue
41
how do you manage facial nerve paralysis?
reassure patient, remove contact lenses, review with patient after a few hours, document
42
how do you prevent facial nerve paralysis?
adhere to LA protocols, don't deposit too far posteriorly into parotid gland
43
what is trismus?
prolonged spasm of muscles preventing opening of mouth (lock jaw). often occurs days after treatment, result of trauma usually involves infratemporal fossa, could be caused by haemorrage (blood puts pressure on surrounding tissues limiting mouth opening)
44
what is the management of trismus?
explain to patient, heat for 20 mins every hour, saline rinses, NSAIDS, small controlled opening and closing of jaw for 3-5 mins every 3-4 hours. Refer to oral surgeon if it doesn't resolve.
45
how do you prevent trismus?
avoid keeping anaesthetics in the fridge, don't use too much LA
46
what is a soft tissue injury following anaesthesia?
ulcerations, swelling, pain, lacerations
47
what is the management of soft tissue injuries?
analgesics for pain relief, warm saline rinses, vaseline
48
how do you prevent soft tissue injuries?
least amount of LA, shortest duration, thorough post-op instruction
49
What is a haemotoma?
accumulation of blood into extravascular space if you nick an artery or vein, dark coloured bruise may occur
50
how do you manage a haemotoma?
direct pressure to region for 2 mins warn patient that swelling and bruising could take up to 3 weeks to heal. ice, Do not apply heat for the first 6 hours as this will cause vasodilation. patient can be discharged once feeling better and bleeding stopped.
51
where do you apply pressure for a haemotoma from IANB
medial aspect of mandibular ramus
52
where do you apply pressure for a haemotoma from ASA?
skin overlying infraorbital foramen
53
where do you apply pressure for a haemotoma from mental nerve block?
mental foramen
54
where do you apply pressure for a haemotoma from PSA?
as far back distal and superior as patient can tolerate
55
how do you prevent haemotoma?
adhere to LA protocols, short needle for PSA, be aware of unique patient characteristics.
56
how do you prevent pain on injecting?
don't say hurt or pain use topical anaesthetic ensure correct bevel orientation slow controlled advancement of needle and anaesthetic solution.
57
how do you prevent an infection from injection?
don't inject an infected site, use single use sterile needles.
58
what are the three major methods by which drugs produce adverse reactions?
1. toxicity caused by direct extension of the usual pharmacologic effects of the drug (side effects, overdose) 2. toxicity caused by alteration in the recipient (disease, emotion, genetics) 3. toxicity in response to allergy.
59
what are the contributory predisposing factors for overdose?
age, body weight, drug interactions, genetics, presence of disease, pregnancy, vasoactivity, dose, concentration, route of administration, rate of injection, vascularity of injection site, addition of vasoconstriction
60
what drugs interact with LA?
antidysrhythmicscimetidine beta adrenergic blockers CNS Depressants cholinesterase inhibitors
61
how does cimetidine, beta adrenergic blockers (propranolol) interact with LA?
depresses hepatic metabolism of amide LAs (slows livers ability to metablize so don't give too much)
62
how do antidysrhythmics (mexiletine, tocainide) interact with LA?
additive CNS and cardiovascular depression so keep LA dose as low as possible
63
how do CNS depressants interact with LA?
possible additive CNS and respiratory depression so limit LA dose
64
how does cholinasterase inhibitors (antimyasthenics, antiglaucoma drugs) interact with LA?
LAs inhibit neuromuscular transmission, potentially requiring dose ajustments so physicians consultation is recommended.
65
how do dental drugs interact with vasoconstrictors such as epinephrine, levonordefrin, and norepinephrine?
increase the effects so keep dose low and consult with physician.
66
what are some signs of a minimal overdose?
talkative, apprehension, excitability, stutter, sweating, vomit, disorientation, elevated blood pressure, heart and respiratory rate.
67
what are signs of a moderate to high overdose?
seizure activity followed by CNS depression, depressed BP, heart and respiratory rate.
68
what signs warrant a medical emergency?
reduced breathing, seizure, chest pain, concious unresponsive, loss of consiousness.
69
how do you manage an overdose?
discuss, reassure, document, stop procedure, consider a semi-reclined position.
70
what is the most common dental medical emergency?
vasovagal syncope (fainting)
71
what position do you put patients in after a vasovagal syncope episode?
head slightly below feet (trendelenburg position), if they are pregnant then lay on left side.
72
what is a type 1 allergic reaction?
anaphylaxis (IgE)
73
what is a type 2 allergic reaction?
Cytotoxic - Antibodies (IgG, IgM)
74
what is a type 3 allergic reaction?
immune complex (IgG)
75
what is a type 4 allergic reaction?
Cell-mediated (delayed)
76
what are some predisposing factors and common allergens relating to LA?
the LA, vasoconstrictors, sodium metabisulfite, methylparaben, sodium chloride, sterile water, latex, topicals
77
what is the first typical reaction to generalized anaphylaxis?
itching, flushing, hives, nausea
78
whats the second anaphylaxis reaction?
severe abdominal cramps, diarrhea, vomiting
79
whats the third anaphylaxis reaction?
chest pain, cough, wheezing, respiratory symptoms
80
what is the 4th reaction for anaphylaxis
cardiovascular involvement - palpitations, light headed, hypotension, cardiac arrest
81
how do you manage an allergic reaction?
antihistamiens, epipen, call 000
82
what is PCABD?
position, circulation, airway, breathing, definitive care/
83
what is a local infiltration?
small terminal endings of the dental treatment flooded with LA
84
what is a field block?
LA deposited near large terminal branches preventing passage of impulses from tooth to CNS
85
what is a nerve block?
LA deposited close to main nerve trunk at a distance from operative intervention

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