Anesthesia in Endo (Archer) Flashcards
What percentage of general dentists have had an anesthesia failure in the previous 5 days of practice?
90%
What percent of the US population experienced a toothache in the last 6 months?
12%
Why correlate anesthesia failure with the percentage of population having toothaches?
It illustrates that toothaches and anesthesia failure are both common
What are 3 pulpal diagnoses to consider when trying to get anesthesia?
- Healthy Vital Pulp
- Vital Pulp with Irreversible Pulpitis
- Necrotic pulp
What is the primary dental injection for the mandible?
IAN block
What is the primary dental injection for the maxilla?
Infiltration
What are pulpal anesthesia onset times for IAN block?
15 minutes
What is the pulpal anesthesia onset time for maxillary infiltration?
5 minutes
Does asking the patient if their lip is numb or poking their gingival give us an indication of their level of pulpal anesthesia?
No
Why is asking if lip is numb or poking with an instrument useful?
Lets us know if we were in the correct area to do our numbing.
What are 2 ways to determine pulpal anesthesia?
- EPT
2. Cold
What are the diagnostic test (EPT and COLD) results for a tooth with a healthy pulp after anesthesia?
- Negative cold response
2. 80/80 EPT
Which arch is harder to anesthetize?
Mandibular
Of the mandibular teeth, which ones are more difficult to anesthetize?
Anteriors
Why is an IAN first molar success rate (51-75%) higher than IAN central incisor success rate (10-50%)?
Central core theory. Posterior teeth served by nerves on the outer mantle. More anterior teeth have innervations from the interior core bundle.
Does the Akinosi or Gow Gates improve IAN success rates?
No
Does the volume of the agent (1.8ml vs 3.6ml) have an effect on IAN success?
No
What is the status of pulps with irreversible pulpitis?
An inflamed pulp with a reduced excitability threshold due to inflammatory mediators.
Why does irreversible pulpits have a lowered response to local anesthetic?
Sodium channels have been altered
What is the success rate of IAN block for teeth with irreversible pulpits?
15 to 25%
What indicates a lack of anesthesia on a tooth with IP that has been anesthetized?
- Positive cold response
2. Less than 80/80 EPT
Does a negative cold response or 80/80 EPT always indicate profound anesthesia on a tooth with irreversible pulpits?
Not always
What can be done to aide in getting profound anesthesia on a tooth with irreversible pulpits?
Supplemental injections
What is the IAN block success rate on mandibular molars?
51%
What is the IAN block success rate on mandibular molars supplemented with local infiltration with 4% articaine with 1:100k eli?
88%
What is the IAN block success rate on mandibular molars with irreversible pulpits supplemented with local infiltration with 4% aticaine with 1:100K epi?
58%
Does IAN supplementation with local infiltration of 4% articaine give predictable results?
No
What is the IAN block success rate on mandibular molars supplemented with local infiltration of 2% Lidocaine with 1:100K eli?
71%
Nuzum found what anesthesia and technique achieved 98% anesthesia success in the healthy pulps of Mandibular anteriors?
Labial and lingual infiltrations of mandibular anteriors with 4% articaine with 1:100K epi
What are the only teeth anesthetized by incisive nerve blocks?
Premolars, not incisors
What is the success rate of intraosseous anesthesia with 2% lidocaine with 1:100K eli?
91%
What is the success rate of intraossesous anesthesia
80% (98% with 3.6 mL)
What is the success rate of intraosseous anesthesia with 4% Articaine with 1:100K eli?
86%
What are side effects of intraosseous injections?
Large uptake causes systemic effect of increased heart rate that is transient (avoid by using 3% Mepivicaine plain)
Where is the location for a Stabident intraosseous injection site?
Attached gingiva so can locate hole
What are ideal areas to do intraosseous injections?
Distal to the tooth working on
What indication is there that you have perforated the cortical plate and are int he trabecular bone where you desire to give the intraosseous injection?
Feel al little back pressure
What is the major difference of the X-tip system and the Stabident?
X-tip can be done in unattached gingiva because it leaves a guide into the bone giving a repeatable injection port
What is the best option for achieving profound anesthesia on a tooth with irreversible pulpits?
Supplemental intraosseous injection
What are 2 ways to increase maxillary anesthesia efficacy?
- Use an agent with a vasoconstrictor
2. Use 2 carpules (3.6mg) 2% Lido 1:100K epi
The use of 2 carpules as well as a vasoconstrictor do what to aide anesthesia: increase amount of anesthesia or increase duration of anesthesia?
Duration
Of the maxillary teeth, which are the only ones that respond better to articaine than lidocaine?
Lateral incisors only
Does a V2 block work for the maxillary premolars and maxillary anteriors?
No only for molars
Does the infraorbital block work for anesthesia of the maxillary anteriors?
No. Only for molars.
Does the infraorbital block work for anesthesia of the maxillary incisors?
No
Will a PSA work for a 1st molar?
No, only for 2nd molar
What percentage of maxillary teeth require supplemental intraosseous anesthesia?
12%
What anesthetic technique works best for necrotic teeth?
Block anesthesia if possible
Should you inject into a swelling or around it?
Around it
Is supplemental intraosseous injection indicated for a necrotic tooth?
No
