10 Local Anesthesia Flashcards
anesthesia onset time for IAN
15 minutes
anesthesia onset time for maxillary infiltration
5 minutes
least effective way to determine if a patient is numb
- ask patient if lip is numb
- poke gingiva with sharp instrument
most effective way(s) to determine if patient is numb
-EPT, Cold tests
which arch is more difficult to anesthetize?
mandibular teeth are more difficult than maxillary
are anterior or posterior teeth more difficult to anesthetize with an IAN?
anterior
- first molar success 51-75%
- central incisor success: 10-50%
what attempts to explain why anterior teeth are more difficult to anesthetize than posterior teeth for an IAN
the central core theory
What are the considerations for anesthetizing a tooth with Irreversible Pulpitis?
-pulps are inflamed
• Inflammatory mediators reduce the excitability threshold of the nerves.
• Alteration of sodium channels decreases action of local anesthetic.
- A normally non painful stimulus causes pain.
* A tooth with symptomatic apical periodontitis is painful to percussion
allodynia
- A noxious stimulus produces more pain than it normally would
- Elevated, prolonged cold response in a tooth with irreversible pulpitis
hyperalgesia
success rate for IAN Block for teeth with IP
15-25% success
Pulp Testing with IP
- A positive cold response or <80/80 EPT will indicate lack of anesthesia.
- A negative cold response or 80/80 EPT will NOT always indicate profound anesthesia.
Infiltration After IAN Block Mandibular Molars
- 4% Articaine with 1/100k Epi = 88% (58% IP)
* 2% Lidocaine with 1/100k Epi = 71%
Infiltration Mandibular Anteriors
• Nuzum et al. JOE June 2010
Labial and lingual infiltrations of 4% Arti with 1/100k epi(1 carpule each) achieves 98% anesthesia (healthy pulp)
Incisive Nerve Block at the Mental Foramen
Works for Premolars not Incisors
Intraligamentary Injection success rate
50-96% success
Intraosseous Anesthesia
• 2% Lidocaine with 1/100k Epi = 91% • 3% Mepivacaine = 80% (98% with
3.6 ml)
• 4% Articaine with 1/100k Epi = 86%
Systemic Effects of anesthesia (intraosseous?)
67% had Increased Heart Rate with Epi
what is the name of the “needle” for intraosseous injections?
Stabident perforator (X tip)
The best option for achieving profound anesthesia on a tooth with irreversible pulpitis is:
supplemental intraosseous injection.
Solving Maxillary Anesthesia
Problems
• Using an agent with vasoconstrictor will
increase duration
• Using 2 carpules of 2% Lidocaine with 1/100K will increase duration
• Articaine works better than Lidocaine for lateral incisor (not 1st molar)
• V2 block works for molars (not premolars forward)
• Infraorbital block does not work for incisors • PSA works for 2nd molars not 1st molars
Maxillary teeth with Irreversible Pulpitis
12% require supplemental intraosseous anesthesia
Considerations for Necrotic Teeth
- Use block anesthesia where possible • Inject around a swelling (not into it)
- Do not use intraosseous technique
