Exam 1 - Dental Extractions & Nerve Blocks in Companion Animals

Question 1

what structures are blocked using an infraorbital nerve block?

Answer 1

ipsilateral side - maxillary incisors, canine, pre-molars 1-3, soft tissues rostral to pre-molar 4, skin of the muzzle, & skin of the upper lip

Question 2

what structures are blocked using a caudal maxillary block?

Answer 2

ipsilateral - all maxillary teeth, buccal soft tissues caudal to PM4, soft palate, hard palate, & +/- nasal mucosa

Question 3

how is an infraorbital nerve block done?

Answer 3

thumb of the free hand is placed on the infraorbital canal which is slight dorsal to the distal root of the 3rd maxillary pre-molar

the needle is introduced below the thumb to engage into the foramen & local anesthetic is injected

Question 4

how is a caudal maxillary nerve block done?

Answer 4

mouth is fully opened to reveal the teeth & caudal soft palate, & the caudal edge of the bone on the hard palate is palpated disto-palatal to the last molar

the palpable hollow distal to the bone edge is the ventral surface of the pterygo-palatine fossa where the maxillary nerve lies

needle is inserted just distal to the hard palate into the fossa & slowly advanced to a distance level with the ventral border of the zygomatic arch

local anesthetic is deposited

Question 5

what structures are blocked in a major palatine nerve block?

Answer 5

ipsilateral - soft & hard tissues of the hard palate

Question 6

how is a major palatine nerve block performed?

Answer 6

the greater palatine foramen is located midway between the palatal midline & palatal border of the anterior border of the maxillary 4th premolar tooth

30G needle recommended - needle is inserted with the bevel towards the bone through the mucosa slightly anterior to the greater palatine foramen

needle is slowly advanced until the bone is gently contacted

aspirate & deposit local anesthetic

Question 7

how is a caudal mandibular/inferior alveolar nerve block performed?

Answer 7

intra-oral approach used to locate the mandibular foramen on the lingual surface of the mandible at a point 1/2 way between the last molar & the angular process of the mandible

thumb is placed on the last molar tooth intra-orally & the forefinger on the angular process extra-orally (halfway between these two points - used for smaller animals)

mouth opened wide, lip pulled laterally, & tongue reflected to the opposite side

bevel of the needle is oriented towards the bone & is inserted through the mucosa caudal to the last molar tooth towards the angular process where the needle is then advanced until bone is gently contacted

needle is then advanced along the bone towards the entrance of the foramen until the tip is at the 1/2 point

don’t deposit anything if bone is not contacted

Question 8

what structures are blocked in a caudal mandibular/inferior alveolar nerve block?

Answer 8

all teeth in the mandible, soft palate, hard palate, buccal, & lingual soft tissues

Question 9

what is the first step done when extracting a tooth?

Answer 9

gingiva is elevated off of the tooth to find the furcation (premolars & molars)

Question 10

how are dental elevators properly used?

Answer 10

inserted alongside the tooth & rotated to elevate it

hold it for at least 10 seconds to break down the periodontal ligament using slow force

Question 11

what is consil? what is it used for?

Answer 11

synthetic bone graft material - packed into the space where you have done the extraction to prevent bone resorption/weakening after an extraction is done

Question 12

prior to suturing the gingiva closed in a tooth extraction, what should you do?

Answer 12

smooth out the edges of the alveolar socket to avoid future tissue irritation

Question 13

what suture will you use for dental extractions? why not PDS?

Answer 13

vicryl 4-0/3-0

PDS lasts too long & will cause irritation in the mouth

Question 14

what are some possible complications from tooth extractions?

Answer 14

thermal bone injury from heated bur

tooth or root fracture

jaw fracture

oronasal communication

emphysema from excess air blown into the alveolus or under the gingival flap

sublingual edema from trauma to the mucosa

ocular penetration

Question 15

what nerve block mimics a splash block?

Answer 15

caudal maxillary

Question 16

what is the associated risk of the caudal mandibular/inferior alveolar nerve block?

Answer 16

if the needle is directed lingual/caudal, the tongue can be desensitized, so the animal may chew/lacerate their tongue

Question 17

T/F: it is not advised to enter the greater palatine foramen in a major palatine nerve block in small dogs & cats

Answer 17

true

Question 18

what nerve block is being performed?

Answer 18

infraorbital

Question 19

what nerve block is shown here?

Answer 19

caudal mandibular/inferior alveolar

Question 20

what block is shown here?

Answer 20

caudal maxillary

Question 21

when would you use the major palatine block?

Answer 21

when you are manipulating the palatal soft tissues distal to the canine teeth

Question 22

what nerve block is shown here?

Answer 22

major/greater palatine nerve block

Question 23

when would you use a mental nerve block?

Answer 23

used for procedures on canine & incisor teeth

Question 24

what is blocked by the mental nerve block?

Answer 24

inferior alveolar branches of the mandibular nerve rostral to the 2nd mandibular premolar

Question 25

what nerve block is shown here?

Answer 25

mental nerve block

Question 26

when would you use a caudal mandibular/inferior alveolar nerve block?

Answer 26

procedures on multiple teeth in one mandibular quadrant when buccal soft tissue anesthesia or lingual soft tissue anesthesia is required