anesthetics in dentistry

Question 1

components of local anesthetics

Answer 1

1) local anesthetic
- block neural pain transmission
2) HCl
- adjust pH down, help with stability, inhibit oxidation of vasoconstrictor
3) vasoconstrictor
- helps with dilation
4) sodium disulfite or metabisulfite (only if there is vasoconstrictor)
- antioxidant, allergy potential
5) sodium
- osmotic balance
6) distilled water

Question 2

technique

Answer 2

1) infiltration
- faster onset
2) block
- longer duration
3) anesthetic agent
- diffusion, concentration, lipid solubility and protein binding
- presence of vasoconstrictor NOT concentration

Question 3

vasoconstrictor in local anesthetic

Answer 3

1) slow rate of uptake in bloodstream
2) increase duration
3) induce localized hemostasis
- increase safety and use

Question 4

dental anesthetic

Answer 4

1) 2% lidocaine HCl 1:100k (RED) or 1:50k epinephrine (GREEN)
2) max dose 3.2 mg/lb
3) pulpal anesthetic
- 60 mins infiltration
- 90 mins block
4) soft tissue 2-4 hours

Question 5

don’t want palpitations

Answer 5

1) 3% mepivacaine HCl (polocaine, carbocaine, and others)
2) no sulfites and no vasoconstrictors
3) pulpal anesthesia
- 20 mins infiltration
- 40 mins block
4) soft tissue anesthesia
- 2-4 hours

Question 6

chronic drug use

Answer 6

1) one without vasoconstriction is more appropriate
- ex. weed drug, can cause cardiac arrest if has vasoconstriction

Question 7

4% prilocaine HCl with 1:200k epinephrine

Answer 7

1) max dose is 4 mg/lb
2) pulpal anesthesia
- 40 min (infiltration)
- 60 mins (blocks)
3) soft tissue anesthesia 2-4 hours

Question 8

hybrid 4% articaine HCl with 1:100k (gold) and 200k (silver)

Answer 8

1) max dose is 3.2 ml/lb
2) pulpal anesthesia
- 40 mins (infiltration)
- 70 mins (block)
3) soft tissue
-3-6 hours

**superior as infiltration in maxillary arch!

Question 9

0.5% bupivacaine 1:200k (cobalt)

Answer 9

1) 0.9 ml/lb
2) 40 mins for infiltration
210 mins for block
3) soft tissue
- 5-12 hrs

best for analgesic, post op pain

*DONT GIVE TO CHILD OR SPECIAL HEALTHCARE NEEDS

Question 10

oraqix

Answer 10

1) eutectic mix of local anesthesia
2) thermosetting gel approved for perio
3) mixture of lidocaine and prilocaine (25 mg/ml each)

• good for SRP

Question 11

clinical protocol

Answer 11

1) main clinic
- must specify which type
- 2 cartridge allowed after start check
- need approval for additional
2) oral surgery
- allows to use 5 cartridge after start check
- after 5, need approval

Question 12

needs approval and signature

Answer 12

1) 2% lido 1:50k (green)
2) 4% arti 1:100k (gold)
3) 4% arti 1:200k (silver)
4) 0.5% buvipiva 1:200k (blue)
5) oraqix

Question 13

buffering

Answer 13

1) 8.4% sodium bicarbonate solution
- buffer from onset
- FDA approved for all anesthetics in USA
- main clinic and ER
2) precise mix of anesthetic and buffer
- don’t need as much

Question 14

stance on 4%

Answer 14

1) not to be used for blocks
2) evidence supports potential neurotoxicity
3) no significance regarding articaine compared to lido
4) at the discretion of faculty, block can be provided

Question 15

a stopper is about

Answer 15

0.2 ml

Question 16

max doses for children

Answer 16

1) ARE DIFFERENT!

Question 17

calculations

Answer 17

1) 1.8 ml is cartridge
2) 1% is 10 mg/ml
3) 1:100k = 0.001% solution = 0.01 mg/ml = 10 micrograms/ml
4) always calculation known to unknown

Question 18

if you are not here

Answer 18

1) submit before 4:30