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2e. BDS2 CDS LA Symposium > L115. An Overview of LA Techniques > Flashcards

L115. An Overview of LA Techniques Flashcards

1
Q

L115: What is pain?

A

An unpleasant sensory and emotional experience associated with actual or potential tissue damage

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2
Q

L115: Why do we administer LA?

A

To manage pain

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3
Q

L115: What are the three main components of a LA?

A
  • LA;
  • Vasoconstrictor;
  • Preservative.
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4
Q

L115: What are the two major types of LAs and of these, which ones are mainly used now?

A

Esters and amides

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5
Q

L115: What are the two major vasoconstrictors used in LAs?

A
  • Adrenaline;
  • Felypressin.

(or none!)

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6
Q

L115: What are the advantages of LAs containing vasoconstrictors?

A
  • LA will stay in the area for a longer time;
  • Controlled bleeding;
  • Contributes to maintaining homeostasis;
  • Bloodless field to work in.
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7
Q

L115: Which vasoconstrictor tends to be more effective for prolonging the LA at site?

A

Adrenaline

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8
Q

L115: What vasoconstrictor should be avoided if patients are pregnant or have heart conditions?

A

Felypressin

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9
Q

L115: What are the two major preservatives used in LAs?

A
  • Bisulphite;

- Propylparaben.

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10
Q

L115: What are the advantages of LAs containing preservatives?

A

Prolonged shelf life

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11
Q

L115: Which LA preservative do people more commonly have an allergy to?

A

Propylparaben

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12
Q

L115: For patients with a true allergy to LA, where should they be treated?

A

Referred to anaphylactic clinic

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13
Q

L115: What are the two types of LA injections?

A
  • Infiltration;

- Nerve block.

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14
Q

L115: How and where do infiltration LAs work?

A
  • Used for pulpal anaesthesia where alveolar bone is thin;
  • e.g. maxilla, lower anteriors and soft tissues;
  • LA deposited around terminal branches of nerves.
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15
Q

L115: How and where do nerve block LAs work?

A
  • Used for pulpal anaesthesia where alveolar bone is too thick to allow infiltration technique of LA administration;
  • e.g. mandible, multiple teeth and large areas;
  • LA deposited beside nerve trunk.
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16
Q

L115: When administered, nerve block LAs anaesthetise all nerve fibres x, to it?

A

Distal

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17
Q

L115: In the maxilla, pulpal anaesthesia is achieved by what type of LA injection?

A

Buccal infiltration

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18
Q

L115: In the maxilla, buccal gingivae anaesthesia is achieved by what type of LA injection?

A

Buccal infiltration

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19
Q

L115: In the maxilla, palatal gingivae anaesthesia is achieved by what type of LA injection?

A

Palatal injection

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20
Q

L115: In the mandible, anaesthesia of the molars ( + second premolar) is achieved by what type of LA injection?

A

Inferior dental block (IDB/ IAN)

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21
Q

L115: In the mandible, anaesthesia of the premolars ( + canine) is achieved by what type of LA injection?

A

Mental (incisive) nerve block

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22
Q

L115: In the mandible, anaesthesia of the canines and incisors is achieved by what type of LA injection?

A

Buccal/ labial infiltration

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23
Q

L115: In the mandible, buccal gingivae anaesthesia of the molars ( + second premolar) is achieved by what type of LA injection?

A

(Long) buccal infiltration

24
Q

L115: In the mandible, buccal gingivae anaesthesia of the premolars ( + canine) is achieved by what type of LA injection?

A

Infiltration or long buccal or mental nerve block

25
Q

L115: In the mandible, buccal gingivae anaesthesia of the canines and incisors is achieved by what type of LA injection?

A

Buccal/ labial infiltration

26
Q

L115: In the mandible, lingual anaesthesia is achieved by what type of LA injection?

A

Secondary part of IDB, lingual infiltration

27
Q

L115: If carrying out a restoration of a tooth, what type of LA is required?

A

Pulpal

28
Q

L115: If carrying out an extraction of a tooth, what type of LA is required?

A

Pulpal and gingivae

29
Q

L115: If scaling teeth, what type of LA is required?

A
  • Gingivae;
  • Pulpal;
  • Both.

(depends on procedure!)

30
Q

L115: What equipment is required to administer a LA?

A
  • Syringe handle and bung;
  • Syringe barrel and needle;
  • LA cartridge.
31
Q

L115: What are the two lengths of needles used in LAs?

A
  • Short (25mm);

- Long (35mm).

32
Q

L115: What must you check before using an LA cartridge?

A

Expiry date (record in notes along with batch number)

33
Q

L115: In the UK, what is the typical volume of solution in one LA cartridge?

A

2.2mL

34
Q

L115: In the UK, what is the typical ppm of adrenaline in one LA cartridge?

A

1 in 80,000

35
Q

L115: In the UK, what are the three main LAs used in dentistry?

A
  • Lignocaine (lidocaine);
  • Articaine;
  • Prilocaine.
36
Q

L115: Which LA has been clinically shown to have increased ability to diffuse through bone?

A

Articaine

37
Q

L115: Which LA is typically mixed with felypressin (vasoconstrictor), instead of adrenaline?

A

Prilocaine

38
Q

L115: When checking a medical hx, what medical condition means that a patient cannot receive an IDB injection?

A

Haemophilia

39
Q

L115: How should topical LA be applied?

A
  • Dry mucosa (so that LA doesn’t dilute);

- Pea sized amount on cotton wool for 1-2 minutes.

40
Q

L115: Why is it important to relax the patient and manage their anxiety?

A
  • If stressed, more likely to feel pain;

- Breathing techniques and muscle relaxation can help to reduce the perception of pain.

41
Q

L115: What typical injection technique should be used to administer a LA?

A
  • Stretch mucosa;
  • Puncture mucosa quickly;
  • Position needle tip at target point;
  • Aspirate;
  • Inject slowly (min. 30 secs).
42
Q

L115: Why is it important to aspirate?

A

To check whether you have entered a blood vessel or not, do not want to inject LA into blood vessel as will affect heart.

43
Q

L115: Why must you inject LA slowly?

A
  • To reduce pain;
  • Too quick = high pressure;
  • Can also cause damage to tissues.
44
Q

L115: What are the limitations of infiltration anaesthesia?

A
  • Pulpal anaesthesia limited to one or two teeth;

- Presence of dense bone/ infection may reduce the effectiveness.

45
Q

L115: What are the positives of infiltration anaesthesia?

A
  • High success rate;
  • Technically easy;
  • Atraumatic.
46
Q

L115: What are the different parts of the alveolar nerve in the maxilla?

A
  • PSA: posterior superior alveolar;
  • MSA: middle superior alveolar;
  • ASA: anterior superior alveolar.
47
Q

L115: What sharps bin should an empty LA cartridge be discarded into?

A

Orange

48
Q

L115: What sharps bin should an LA cartridge containing solution be discarded into?

A

Blue

49
Q

L115: When administering an IDB, what landmarks do you use to identify the site of injection?

A
  • Coronoid notch of the mandibular ramus;
  • Posterior border of the mandible;
  • Pterygomandibular raphe;
  • Lower premolars of the opposite side.
50
Q

L115: What is the pterygomandibular raphe?

A

Skin and connective tissue

51
Q

L115: Why is it beneficial to ask the patient to open wide when administering an IDB?

A
  • Tissue becomes taught;

- Can identify landmarks more easily.

52
Q

L115: Describe the stages of administering a LA.

A
  • Thumb on coronoid notch;
  • Fingers on posterior border of the mandible;
  • 3/4 of the way back between thumb and raphe;
  • Advance needle until bone is contacted;
  • 3/4 of needle should go in;
  • Withdraw needle 1mm;
  • Aspirate (check for blood);
  • If negative, deposit 3/4 of cartridge;
  • Retract 2-4mm of needle, deposit remaining 1/4 for lingual anaesthesia.
53
Q

L115: If bone is not contacted when advancing the needle, what has most likely happened?

A

Needle positioned too posterior (reposition before injection)

54
Q

L115: If you contact bone before 3/4 of the needle is advanced, what has most likely happened?

A

Needle positioned too anterior (reposition mesially before injection)

55
Q

L115: What words can be used to describe a patient’s sensations when anaesthetised?

A
  • Rubbery;
  • Numb;
  • Tingly;
  • Swollen/ fat.

(with an IDB, this should extend to tongue and lower lip)

2e. BDS2 CDS LA Symposium (1 decks)

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