children

Question 1

what are the uses of LA?

Answer 1

operative pain control
haemorrhage control
diagnostic tool

Question 2

what is surface anaesthesia?

Answer 2

anaesthesia of the surface tissues i.e. skin or mucous membranes

Question 3

what is surface anaesthesia used for?

Answer 3

to reduce LA pain on injection
to reduce discomfort of venepuncture
for superficial soft tissue manipulation

Question 4

what is physical surface anaesthesia?

Answer 4

refrigeration anaesthesia
reduce temp
ethyl chloride
rarely used
difficult to direct stream
inadvertent contact w/ teeth discomfort
highly flammable

Question 5

what is topical anaesthesia?

Answer 5

intraoral topical agents
topical anaesthetics for skin
controlled release devices
jet injectors

Question 6

how much tissue does topical anaesthetise?

Answer 6

2-3mm depth

Question 7

describe topical technique?

Answer 7

dry area
apply over limited area
2 mins

Question 8

what are the preparations of topical available?

Answer 8

lidocaine: 2% gel, 10% spray, 5% ointment

benzocaine 20% gel

Question 9

what can topical be used for?

Answer 9

pre-injection
dam clamp
placing matrix
suture removal
exfoliating primary teeth
subgingival scaling
incision of abcess

Question 10

what topical anaesthetics for skin are available?

Answer 10

ELMA crean
5% eutectic mix of prilocaine & lidocaine
-45 min apply
-prior to general/iv sedation
ametop gel
-tetracaine 4% gel (esther)
faster onset

Question 11

what is a topical controlled release device?

Answer 11

patches
incorporation of LA into materials that adhere to mucosa and allow slow release
decrease chance of anaesthetic moving away from application site
under investigation

Question 12

what are advantages of topical jet injectors?

Answer 12

allows anaesthesia up to 1cm
bleeding diatheses where deep injections are contraindicated
sole means achieving la
prior to conventional techniques

Question 13

what are disadvantages of topical jet injectors?

Answer 13

soft tissue damage if careless
frightening sight and sound
taste of solution
expensive

Question 14

describe TENS

Answer 14

non-pharmalogical pain control
transcutaneous electrical nerve stimulation
blocks large myelinated nerve fibres and closes gate to central transmission of small unmyelinated
controlled by px
uses: restorations, primary extractions, pre-LA

Question 15

describe hypnosis

Answer 15

altered state of mind such that suggestions are accepted more readily and acted upon more powerfully
adjunct to LA by decrease pulse rate

Question 16

which LA is typically used in px with cardiac disease?

Answer 16

mepivacaine 3%

Question 17

describe lidocaine

Answer 17

common
anti-arrhythmic drug
-supresses abnormal heart rhythms
rapid onset
half life 1.5-2 hours
infiltration, block, surface anaesthesia
adrenaline vasoconstrictor
-delays resorption 2x duration

Question 18

what are the contra-indications for lidocaine?

Answer 18

heart block and no pace-maker
allergy to LA or corn
hypotension
impaired liver function

Question 19

what are the contra-indications for articaine?

Answer 19

sickle cell and other haemoglobinopathies

Question 20

describe articaine

Answer 20

half life 20 mins
thiophene ring
additional ester group
lower risk of systemic toxicity
more effective for mandibular infiltrations than lignocaine

Question 21

when should you avoid adrenaline containing local?

Answer 21

bp>200mgHg systolic and/or diastolic >115mmgHg

diuretics

Question 22

what are the effects of adrenaline?

Answer 22

binds to alpha-receptors in the peripheral vasculature causing vasoconstriction
tachycardia due to binding B1-adrenergic receptors
increased HR in combination w/ peripheral constriction can lead to increased bp

Question 23

which LA techniques are used in children?

Answer 23

infiltration
intraligamentary
regional block

Question 24

what is ultra short needle used for?

Answer 24

infiltration

Question 25

what is short needle used for?

Answer 25

infiltration

Question 26

what is long needle used for?

Answer 26

ID block

Question 27

what can infiltrations be used for?

Answer 27

anaesthesia in primary teeth, maxillary permanent teeth, mandibular permanent anterior teeth,
prior to intrapapillary and the intraligamental anaestheia in posterior permanent teeth
prior to intrapapilary and palatal/lingual anaesthesia

Question 28

describe infiltration technique

Answer 28

dry mucosa
topical anaesthetic
wipe excess
stretch mucosa
distract px
insert needle
aspirate
inject supraperiosteal as close as possible to apices of teeth
needle 90 degrees to surface
approach via anaesthetised buccal interdental papilla
advance-palatal blanching

Question 29

what are the uses of intraligamental?

Answer 29

to supplement infiltrations

may eliminate need for block

Question 30

what can reduce intraligamental discomfort?

Answer 30

small buccal infiltration

papillary injection

Question 31

describe intraligamental technique

Answer 31

interosseous via cancellous space via PDL
0.2ml per root
more successful w/ vasoconstrictor
32 guage needle
30 degrees to long axis of tooth in mesiobuccal gingival sulcus- advance until resistance
measured dose

Question 32

what is commonly used to administer intraligamental?

Answer 32

the wand
computerised flow of LA
can be used as method for single tooth anaesthesia
also used for infiltration and block

Question 33

describe the mandibular foramen

Answer 33

below occlusal plane

lower than in adults