Anesthesia for Endodontics Flashcards
What are the factors that affect endodontic anesthesia?
-Apprehension and Anxiety
-Fatigue
-Tissue Inflamation
-Previous Unsucessful Anesthesia.
Root canal is impossible without…
profound anesthesia
What does the psychological approach to initial managment involve? (4 C’s)
- Control
- Communication
- Concern
- Confidence
What is an atraumatic anesthetic injection?
-Dry mucosa - then Topical anesthetic - let it soak in at least 60sec.
-Vigorously shaking or gently squeezing the lip or cheek while injecting is a distraction technique
-Slow and gentle
-Talk to patient constantly
-Keep patient occupied
How fast should you inject anesthesia?
SLOW! 60 seconds
How much anesthesia do you use on a palatal injection?
1/4 carp
What is more effective in reducing pain from palatal injections: refrigerant or topical gel?
refrigerant
Any ______ tooth may present problems in achieving adequate anesthesia
pulp inflamed
What situation is a challenge to get numb using anesthesia?
mandibular molar with acutely inflamed pulpitis
Local anesthesia less effective in what type of inflammation?
acutely inflamed tissues often VERY resistant to LA
“lip signs” do no necessarily indicate ____ anesthesia
PULPAL
-infiltration alone here is useless due to the density of the cortical plates
How to check for pulpal anesthesia?
EPT, cold testing, or percussion (whatever caused pain prior to anesthesia)
Why is anesthesia difficult with mandibular molars?
the inherent inaccuracies of mandibular N. blocks
What are the physiological and psychological challenges with anesthesia?
-Emotional Considerations
-Apprehension-Fear-Anxiety
-Fatigue-Hyperalgesia-Allodynia
-Decreased Pain Threshold
-History of Unsuccessful Anesthesia
-Popularized Fear of RCT
-Lack of Confidence in Provider
-Lack of Confidence by Provider
What can you do to combat local anesthesia problems?
- use an anti-inflammatory drug
- diminish the emotional component
- be certain you have a good block
- learn to effectively use supplemental anesthetic technique after a confirmed block
What level of anti-inflammatory drug should you prescribe?
- IBU 600 mg one hour prior = 78% effective
What do you need to prescribe meds?
Cannot prescribe w/o a DX or w/o examining pt
How to diminish the emotional component of anesthesia?
-establish rapport with the patient; show them you care
-communicate your concern for the patient in a calm, convincing, and confident manner
-inform before you perform
If you do a good IA block what signs should you see?
lip signs
ONLY AFTER YOU ARE POSITIVE that you have a NUMB and FAT LIP, do you use any _______ anesthesia
buccal
What is the process for numbing?
- Do initial IA and wait a few minutes to allow anesthesia in área of IA injection. Then go back and FEEL the BONE and painlessly inject the 2nd carpule where you know you need to be for the IA BLOCK.
- Then wait for “lipsigns” and check tooth with percussion and/or cold to determine if you need to do SUPPLEMENTARY anesthesia
What are the types of supplemental anesthetic after a confirmed block?
- Intra-ligamental (PDL injection)
- Intra-pulpal Injection
- Intra-osseous Injection
What are the 5 basic mandibular techniques to LA?
- Inferior Alveolar Nerve (IAN)
- Lingual Nerve (L)
- Bucal Infiltration
- Gow-Gates
- Incisive Nerve Block/Inflitration at the Mental Foramen
What nerve are you going for with an IAN?
inferior alveolar nerve
What nerve are you going for with an L?
lingual nerve
What branch of the trigeminal nerve are you targeting with IAN and L?
mandibular nerve (V3)
What nerve is just anterior to the IAN (inferior alveolar nerve)?
lingual nerve
What nerve enters the mandibular foramen?
IAN (inferior alveolar nerve)
Where do you inject for an IAN?
superior to the mandibular foramen
Where do you inject for a Lingual nerve block?
-superior to the mandibular foramen for the IAN
- then withdraw needle slightly for lingual
For a IAN or L block what do you do before you deposit?
-Aspirate
-Stabilize
-Distraction
Where is the point of penetrtion intraorally for the IAN or L block?
Just lateral to pterygomandibular raphe at the height of coronoid notch
- 6-10 mm above occlusal plane
What is the insertion path for a IAN or L block?
-Barrel of syringe is over opposite premolars.
-Syringe is parallel with mandibular occlusal plane.
-Advance » 20 – 25 mm (1 inch)
What are examples of IAN failures?
- Deposit below mandibular foramen
- Deposit anterior to mandibular foramen
- Deposit too posteriorly into parotid gland
What is the most common method of mandibular anesthesia?
IA
-more successful in molars and premolars
What method of anesthesia has the greatest number of failures?
IA
Lip numbness usually occurs in ______ minutes for a IAN
5-7 minutes
Pulpal anesthesia occurs in ________ minutes for an IAN
10-15 minutes
What is the duration of the IAN block?
2.5 hours
What is the sucess rate or an infiltration in mandible?
64%
Labial or lingual infiltrations injects are or are not effective for pulpal anesthesia in mandible
alone are not
What is better for the first mandibular molar infiltration: articaine or lidocaine?
articaine