EXAM I LA and Pain Control

Question 1

___ is the dental procedure that produces the greatest negative response in children

Answer 1

injection

Question 2

even the youngest child treated in the dental office normally has no contraindications for the use of ___

Answer 2

local anesthetic

Question 3

what color band is articaine HCL 4% w/epi 1:100,000?

Answer 3

gold

Question 4

what color band is bupivicaine 0.5% w/epi 1:200,000?

Answer 4

blue

Question 5

what color band is lidocaine HCL 2%?

Answer 5

light blue

Question 6

what color band is idocaine HCL 2% w/epi 1:50,000?

Answer 6

green

Question 7

what color band is lidocaine HCL 2% w/epi 1:100,000?

Answer 7

red

Question 8

what color band is mepivacaine HCL 3%?

Answer 8

tan

Question 9

what color band is mepivacaine HCL 2% w/levonordefrin 1:20,000?

Answer 9

brown

Question 10

what color band is prilocaine HCL 4%?

Answer 10

black

Question 11

what color band is prilocaine HCL 4% w/epi 1:200,000?

Answer 11

yellow

Question 12

what is the “rule of 25” as it applies to anesthetic administration?

Answer 12

for healthy patients, a dentist can safely use 1 cartridge of anesthetic for every 25 pounds of patient weight

Question 13

what is the maximum dosage of lidocaine 2% w/epi 1:100,000?

Answer 13

1 carp (1.8ml) per every 18 pounds of body weight

Question 14

what is the maximum dosage of articaine 4% w/epi 1:100,000?

Answer 14

1 carp (1.8ml) per every 22 pounds of body weight

Question 15

the maximum amount of LA agent needs to be reduced if the patient is receiving a supplementary dose of ___; why?

Answer 15

• enteral or parenteral sedative agent for behavioral management
• the action of the sedative has an additive depressive effect on the CNS and CV systems, and can initiate overdose consequences

Question 16

what is the significance rating for the summation interactions of local anesthetics (ex. lidocaine plus articaine), what is the interaction, and how can it be avoided?

Answer 16

• major
• toxicity of LAs are additive
• total dose of all administered LAs should not exceed the maximum recommended dose of the drugs

Question 17

what is the significance rating for LAs with opioid sedation (ex. LA with demerol), what is the interaction, and how can it be avoided?

Answer 17

• major
• may increase the risk of LA overdose
• minimize the dosage of the LA

Question 18

what is the administration criteria for 2-stage anesthetic injections?

Answer 18

• place topical at the site of injection for 1 min
• administer 0.5ml of LA
• wait 5 min
• administer 2ml of LA at the same injection site over 1 min

Question 19

studies show that children may experience less pain with which injection technique?

Answer 19

2-stage anesthetic injection technique

Question 20

what is used for intrapulpal injections?

Answer 20

brutacaine

Question 21

what is kovanaze, and what is it used for?

Answer 21

• a needleless, intranasally administered spray combination of the esther anesthetic tetracaine HCL plus the vasoconstrictor oxymetazoline HCL
• for regional maxillary anesthesia
  
  • pulpal anesthesia on teeth 4-13, and A-J (children should weigh >40kg or 88lbs)

Question 22

is the mandibular foramen in children located at a level higher or lower than the primary occlusal plane?

Answer 22

lower

therefore, the injection must be made slightly lower and more posterior than for an adult patient

Question 23

what is the average depth of insertion for an inferior alveolar block for a child?

Answer 23

about 15mm, but that varies with the size of the mandible and age of the patient

Question 24

how can the lingual nerve be blocked?

Answer 24

during administration of the inferior alveolar nerve block, if anesthetic is deposited as the needle is withdrawn, it will anesthetize the lingual nerve

Question 25

what is the target of administration for a long buccal nerve block? what is anesthetized?

Answer 25

• mucobuccal fold at a point distal and buccal to the first permanent molar
• all facial mandibular gingival tissue on the side of the injection will be anesthetized
  
  • exception is tissue facial to central and lateral incisors, which may have some innervation from overlapping nerve fibers from the opposite side

Question 26

what nerves are anesthetized in the gow-gates mandibular block?

Answer 26

IA, lingual buccal, mental, incisive, auriculotemporal, and mylohyoid

Question 27

what is the target for gow-gates administration?

Answer 27

• base of the neck of the mandibular condyle
• external landmarks are used to help guide administration
  
  • needle is inserted parallel to the line connecting the tragus of the ear and the corner of the mouth

Question 28

what is the difference between local infiltration of permanent vs primary anterior teeth?

Answer 28

for primary anterior teeth, the injection should be made closer to the gingival margin

Question 29

young children are more likely to experience toxic reactions from anesthetics due to ___

Answer 29

their low body weight

Question 30

___ is a reversal agent of local anesthetics

Answer 30

oraverse