Infiltration Injections

Question 1

What are the 6 six we need to consider before we give LA?

Answer 1

• Do you need LA? Is it for pain control? Bleeding?
• Is it safe to use? Review medical history? Anxious?
• What procedure are we performing? (depends on nerve supply)
• Which nerves need to be anaesthetised?
• Gain consent from patient (risks vs benefits)
• Prepare the appropriate LA

Question 2

What does valid consent require? (2)

Answer 2

• The patient understands what is proposed

- The patient gives consent freely without coercion

Question 3

Before loading a cartridge what do we need to check? (5)

Answer 3

• Check LA is appropriate for patient
• The date
• Check for damage
• Check it is clear
• Check for bubbles

Question 4

Where should an infiltration LA in the oral mucosa be deposited?

Answer 4

In connective tissue under epithelium

Question 5

Safety syringes are self aspirating what does this mean?

Answer 5

If needle is in a vessel this creates negative pressure which draws blood into the cartridge

Question 6

What should you do if your safety syringe cartridge draws blood?

Answer 6

Take needle out and start again

Question 7

What position should you put a patient in when preparing a patient for an injection?

What are the benefits of this? (2)

Answer 7

• Fully supine (horizontal)
• Aids cranial blood flow
• Prevents fainting

Question 8

A patient who is anxious may not want to be fully supine what do you do then?

Answer 8

Compromise by tilting the chair back at least 30° to the vertical

Question 9

Give an overview of the 6 steps of infiltration

Answer 9

• Apply topical anaesthetic
• Retract soft tissue fully
• Needle entry
• Aspiration
• Deliver solution
• Withdraw needle

Question 10

Explain the steps taken to apply a topical anaesthetic during an infiltration (5)

Answer 10

• Dispense a pea sized amount of gel into dampen dish
• Use cotton roll with tweezers to pick up anaesthetic
• Clean & dry mucosa before application
• Retract lip and apply gel to injection site
• Allow 3-4 min for anaesthesia

Question 11

What needle and solution would you normally use for a maxillary buccal infiltration?

Answer 11

• 30 gauge
• Short needle
• Lidocaine with adrenaline (1:80000)

Question 12

Where should a needle enter during an infiltration?

Answer 12

• Depth of buccal sulcus

- Above tooth to be anaesthetised

Question 13

How quick should you dispense the LA solution?

Answer 13

1ml over about 30 seconds

Question 14

Give 2 examples of topical anaesthetics

Answer 14

• 20% Benzocaine gel

- 5% Lignocaine

Question 15

Explain the link between topical anaesthetic concentration and LA concentration

Answer 15

Concentrations are higher in topical then injections

Question 16

If 2% lignocaine with 1:80000 adrenaline used how long with pulpal anaesthesia last?

Answer 16

45 minutes

Question 17

Describe the location of where a palatal infiltration will occur

Answer 17

• Palatal mucosa just distal to tooth of interest

- Infiltrate into palate 10-15 mm from gingival margin (into fleshiest part of palate

Question 18

Why is infiltration the better option when anaesthetising deciduous dentition?

Answer 18

Because bony cortex Is not as dense

Question 19

Describe how you would anaesthetise lower incisors in adults (2)

Answer 19

• Deposit solution both buccally and lingually in apical region of tooth
• Volume 0.5ml each side

Question 20

What is the onset of anaesthesia in lower incisors?

Answer 20

8-10 mins

Question 21

What are the details needed when record keeping for LA? (6)

Answer 21

• Type of LA
• Vasoconstrictor
• Volume
• Batch number
• Injection given
• Patient reaction

Question 22

How is painless anaesthesia achieved? ()

Answer 22

• Appropriate use of topical anaesthesia
• Holding mucosa taut
• Slow needle penetration
• Slow delivery of solution