Endo Anesthesia

Question 1

• \_\_\_\_\_\_ and
considerate, caring manner are the
cornerstone of modern dental
practice and are your greatest
practice builders

Answer 1

“Painless” injections

Question 2

T/F: RCT is impossible without

profound LA *

Answer 2

True

Question 3

The mucosa for an injection should be ____

Answer 3

Dry

Question 4

T/F: Vigorously shaking or gently 
squeezing the lip or cheek while 
injecting is a distractiontechnique thought to activate the 
faster Alpha fibers to “close the 
gate”*

Answer 4

True

Question 5

Should the injection be done fast or slow?

Answer 5

Slow

Question 6

_____ inection is very painful

Answer 6

Palatal

Question 7

Use _____ to help alleviate the pain of the palatal injection before

Answer 7

Endo ice

Question 8

No more than ___/____ a carpule on palatal injection

Answer 8

1/4 carpule

Question 9

Are lip signs enough to do RCT?

Answer 9

No; need lip to feel thick and fat

Question 10

Although any pulp inflamed tooth may present problems in achieving adequate anesthesia, your biggest challenge will probably present as a _____ with _____

Answer 10

mandibular molar with acutely inflamed pulpitis*.

Question 11

In clinical practice, local anesthesia may be influenced by the
local availability of free base, as only the non-ionized portion
______ can diffuse through the neuronal membrane.

Answer 11

(free base)

Question 12

Thus, local anesthetics are relatively ineffective when injected
into tissues with an ______ pH (e.g. pyogenic abscess, inflamed
pulp) which is presumably due to reduced release of free base *

Answer 12

acid pH

Question 13

First, use an ________ drug in an effort to
reduce inflammation, revert the pores to normal &
raise the patient’s pain threshold. Such an inexpensive
& simple benefit.

Answer 13

anti-inflammatory drug

Question 14

Should you give buccal infiltration to mand tooth before or after lip signs?

Answer 14

After lip sings

Question 15

What lip signs should you have for a IA block?

Answer 15

Thick and fat lip on that side to midline

Question 16

How many carpules should you use for a IA block for endo?

Answer 16

2

Question 17

IA block should occur ___ - ___ mm above occlusal plane

Answer 17

6-10 mm

Question 18

IA block should go _____ to pterygomandibular raphe

Answer 18

Lateral

Question 19

How long will effective pulpal anesthesia last?

Answer 19

30-90 mins

Question 20

How long does local anesthesia take to start acting?

Answer 20

1-20 mins

Question 21

T/F: It WILL be necessary to monitor the patient and RE-INJECT during the course of MOST or ALL Clinic Sessions.*

Answer 21

True

Question 22

If pulp is necrotic, should you give LA?

Answer 22

Yes; always give it for endo

Question 23

___ is more successful to use for buccal infiltration

Answer 23

Articaine

Question 24

___ LA type:
Esters = (Novacaine, Procaine) more side effects, higher
probability of allergic reaction, no longer in favor or
commonly available in U.S.

Answer 24

Esters

Question 25

____ LA type: = all the rest, available & preferred. • Duration: – Short ( < 60 min.) 3% Mepivacaine (Carbocaine®) – Medium (60-120 min.) Lidocaine, Articaine – Long (> 120 min.) 0.5% Bupivacaine w/ 1:200,000 epi. (Marcaine®) (probably is LEAST profound LA>>Gross, R etal ....Double Blind comp of Bupivicaine/Lido ....JOE, Sep ’07 33(9)pp1021-4) • Vasoconstrictor (None, 1:200,000, 1: 100,000, 1:50,000) • Aspirate (REPEATEDLY) to AVOID INTRA-VASCULAR injection*

Answer 25

– Amides

Question 26

What technique was mentioned to give another IA block option?

Answer 26

Gow-Gates

Question 27

If IA and buccal infiltration don't accomplish full anesthesia, what is the next option to anesthetize?

Answer 27

PDL injections

Question 28

``` FIRST CHOICE: IF regional block or infiltration prove insufficient . . . THE INTENT: to FORCE anesthetic solution down along the PDL and through the cribriform plate to reach apical neural elements in the medullary space . . . Wedge needle as deeply into PDL as possible. Start at DB. Warn patient of pain at injection. Use @% Lidocaine w/ 1:100,000 epi. Duration of anesthesia = 15-30 min. only (get the pulp OUT ASAP) No Waiting -Can use ligajet -Must have back pressure -Inject at 4 line angles ```

Answer 28

PDL ligament injections

Question 29

Last choice-- (painful and ultra short acting but immediate relief) a. Use 30 gauge needle (#25 file) wedged as far in canal as possible. b. Must bind tightly in canal c. Warn patient –Injection Must hurt –twice . . . Most painful of injections d. Duration: minutes only (extirpation only –will not last for shaping or obturation) get pulp out NOW e. Do NOT count on repeating this injection f. Do distal canal of lower molar first

Answer 29

Intrapulpal injections

Question 30

When is it acceptable to inject into swelling tissue?

Answer 30

NEVER

Question 31

_____ swelling is pointing and may soon drain spontaneously. The patient is probably not running a fever and is able to open fully. Acceptable to infiltrate apically and laterally or do infra-orbital block or both. Debride the pulpal spaces and consider Incise & Drain.

Answer 31

Localized swelling

Question 32

``` ____ swelling: Patient here is seriously ill, running a fever and probably cannot open her mouth sufficiently to debride pulpal spaces. I&D, drain & antibiotics may need to precede Pulpal Extirpation. ```

Answer 32

Generalized swelling/cellulitis

Question 33

``` _____ of a Cellulitis such as this is a very serious, life-saving procedure best accomplished in the hospital under the supervision of an oral surgeon or MD. The FIRST thing to do here is REFER * I.V. Antibiotics + I&D will follow Either the tooth is removed or the pulp extirpated as soon as patient is stabilized and able to open the mouth. This patient has a life threatening infection requiring immediate care. Sub-lingual, Sub- Mental, Sub- mandibular Spaces ```

Answer 33

Drainage

Question 34

Local anesthetics cause _____ interruption of the conduction of impulses in peripheral nerves by causing a local decrease in the rate and degree of depolarization of the nerve membrane such that the threshold potential for transmission is not reached when everything goes well.

Answer 34

reversible

Question 35

These effects are due to blockade of _____ channels, thereby impairing ion flux across the membrane resulting in disruption of impulse conduction.

Answer 35

Na channels

Question 36

Most local anesthetic agents are tertiary amine bases that are administered as water soluble hydrochlorides . After injection, the tertiary amine base is liberated by the relatively _____ pH of normal tissue fluids:

Answer 36

alkaline

Question 37

In tissue fluid the local anesthetic will be present in both an ionized and non-ionized form ; their relative proportions depend on the ___ in the area*

Answer 37

pH

Question 38

Only the _____ base then diffuses through the nerve sheath, peri- neuronal tissues and the neuronal membrane, to reach the axoplasm.

Answer 38

non-ionized

Question 39

Most common LA – Safe & Effective Drug. Derivative of Xylidine (1.7ml/carpule) – Each carp. contains 34 mg. of anesthetic. – Max. safe adult dosage = 8 carpules (272 mg.) – Detoxified primarily in LIVER (beware severe LIVER disease) – No solution proven to be superior for pulpal anesthesia – Not contraindicated in patients with heart disease (monitor closely) – Not contraindicated in pregnant women (after 1st trimester) – Not contraindicated in nursing mothers – Because of epinephrine content, should not be routinely used in patients on MAO inhibitors or tricyclic antidepressants. Probably best choice for routine RCT at UMKC

Answer 39

2% Lidocaine with 1:100,000 epi. (Xylocaine®)

Question 40

Most controversial (Septocaine®) – Safe & Effective Drug. Contains both amide and ester linkage – Each carp. contains 68 mg. of anesthetic.(twice as toxic as Lidocaine) – maximum safe adult dosage = 4 carpules (272 mg.) – Also contains a unique Sulfur molecule (Sulfur allergy problems?) – Mel Hawkins, U/Toronto says no as S molecule is bound. – Reputation of providing superior anesthetic effect (NOT proven) – Potential to cause neuropathies: paresthesia rare but 5 times as likely as with lidocaine or mepivicaine. Lawyers know this! Be Safe! Avoid N. Blocks with Articaine* – No known incident at UMKC in past decade. – Drug interactions with MAO inhibitors, tricyclic antidepressants and phenothiazides.

Answer 40

• 4% Articaine with 1:200,000 epi.

Question 41

Delays systemic absorption which increases the duration AND increases the effectiveness of the LA. Also retards bleeding (surgery).

Answer 41

Epi

Question 42

T/F: You must get your pt. “numb” or abort the | procedure.

Answer 42

True

Question 43

However, if after ___-____ carps, pt. still isn’t “numb”, seriously consider re-scheduling with sedation

Answer 43

3-4 carps

Question 44

What are the 4 Solutions to hot maxillary tooth?

Answer 44

PSA 2nd Div Block Infraorbital block Palatal block

Question 45

What is the solution for hot. max tooth?

Answer 45

Gow-Gates block