Dental Flashcards
How is an inferior alveolar nerve block performed?
Indication: Unilateral mandibular teeth procedures (covers all teeth unilaterally)
Technique
- 25g needle, lignocaine +/- adrenaline
- Apply topical xylocaine viscous prior to injecting
- Retract cheek and palpate coronoid notch with thumb
- Approach at an angle from the contralateral incisor
- Insert needle 1-2cm deep just posterior to thumb (coronoid notch)
- 1-3mls anaesthetic
How is a supraperiosteal block performed?
Indication: Any singular tooth causing pain or needing a procedure
Technique
- 1% lignocaine with small needle
- Inject at the mucobuccal fold around the apex of the affected tooth
- Numbs the tooth itself +/- teeth either side and the lip
How is an inferior orbital nerve block performed?
Indication: Unilateral Maxillary anterior teeth procedures (goes back as far as the 1st molar)
Also for lip and lower face procedures (ie vermillion border crossing laceration repair)
Technique
- 25g needle, lignocaine +/- adrenaline
- Apply topical xylocaine viscous prior to injecting
- Infraorbital foramen located (can be palpated) in line with the pupil at the infraorbital rim
- Insert needle through the mucosa of the 2nd premolar (5th tooth) aiming superiorly at the notch
- Aim approx 2cm and inject 2-3mls of anaesthetic
How is the traditional TMJ relocation technique performed?
Traditional
- May require relaxation/sedation
- Patient lying with head up or seated with head supported posteriorly
- Physician stands in front with elbows flexed, mandible held with thumbs intraorally lateral to lower molars
- Pull down and push backward, should feel immediate
Modified Traditional
- Stand behind the patient instead
- Same maneuvres
How is the TMJ relocation syringe method performed?
- Place 10ml syringe between the posterior upper and lower teeth on one side
- Patient bites down while syringe is rolled back and forth
- Typically the opposite reduces
- Then move syringe to other side and do it again
How is Calcium hydroxide paste applied to fractured teeth?
Indication: Ellis type 2/3 fractures
Technique
- Ideally perform a sub-periosteal or other dental block to numb the teeth
- Mix the catalyst and the base on a mixing pad in equal amounts using a dental spatula or cotton applicator
- Dry the tooth using 02 via nasal cannula, open mouth breathing or biting on gauze
- Apply the paste to the expose area, keep mouth open to dry over a few minutes
- Soft diet, see dentist in 24-36hrs
** If unlikely to get to a dentist within 36hrs then apply dental foil over the top to protect the CaOH seal**
How is dental splint paste (ie COE-PAK etc) applied to luxated teeth?
Indications: subluxed teeth, avulsed teeth that have been re-implanted, complex gingival lacerations with not otherwise controlled bleeding
Technique
- Consider dental block for analgesia
- Mix equal parts catalyst and base on mixing pad with spatula/cotton applicator
- Wear gloves, apply lubricating jelly to fingers to prevent paste sticking to fingers
- Dry the teeth/gingiva, apply paste to affected teeth and to at least one tooth either side (if applicable)
- Ensure paste covers both front and back of the teeth for maximum stability
How are avulsed teeth re-inserted?
Indication: Intact teeth avulsion
Contraindications: Fracture tooth/socket, any significant maxillofacial/head trauma, altered conscious state
Considerations
- Handle the tooth by the crown, touching the tooth can damage the peridontal ligament cells
- Gently rinse the tooth to remove debris
- If delay to re-implantation then place in transport medium ASAP, milk will keep the tooth for 4-8hrs, dedicated mediums (ie Save-A-Tooth) 12-24hrs
Technique
- Gently suction the socket to remove any debris or clot, gently irritgate post
- Re-insert the tooth with slow, gentle pressure
- patient to bite down gently on gauze to help realign the tooth
- Splint the tooth
- ADT, liquid diet, urgent dental/Max Facs
