L.12,13,14-Radio, LA, Ext Flashcards
The most important point about Radiographs for a patient: there is no general indication for taking radiographs, a ________ is performed first, then other assessments. Then if there are indications, a _______ is taken.
clinical exam…radiograph
SLOB RULE: If an object moves WITH the head (same) it is on the _______ (aka ______) side of the arch.
Lingual (Palatal)
SLOB RULE: If an object moves OPPOSITE to the head of the x-ray beam, the object is on the ________ (aka ______) of the arch.
buccal…labial
What is the nickname for a bitewing?
a “caries detecting” radiograph
The recommendations for taking x-rays are subject to clinical judgment and may not apply to _____ patient.
They are to be used by dentists only after reviewing the patient’s health history and completing a clinical _______.
EVERY…EXAM
Dental Radiation accounts for __% of al healthcare x-rays
1%
Which gland is most susceptible to dental radiograph exposure?
thyroid
In radiology: Know What You ______ to See Before You Shoot
EXPECT
What are the 8 indications for dental x-rays in children?
1.Growth and Development (pano) 2.Caries 3.Pulp 4.Integrity 5. Bone 6.Post op 7.Anomalies 8. Pain/Swelling
What % of carious lesions can be seen by X-ray?
40-50%
Size 0 films are typically for children under ___ years of age. They can be used for what 2 views?
7…bitewings and PA
Size 1 film is typically used for children over ___ years and for these two views:
7 years…bitewings and PA
Size 2 film is considered for what age range and what position?
Adults and posterior (bitewings, PA, modified occlusal)
Size __ film is used for LARGE occlusal shots and works for most children…they can be used for an ________ lateral view
4….extraoral
What is the best behavioral control method to used for x-rays?
Tell, show, do
How often do I take x-rays? every ______ as long as there is evidence of caries or High Risk Factors
6 months
How often do I take x-rays? every ____-____ if no caries and no high risk factors
12-24 mo
How often do I take x-rays? For an adolescent at LOW risk for caries take every ___-____
18-36 mo
Interesting…how long does it take for caries to progress through the OUTER half of enamel on a PRIMARY tooth?
1 year
Interesting…how long does it take for caries to progress through the INNER half of enamel on a PRIMARY tooth?
1 year
Interesting…how long does it take for caries to progress through the enamel on a PERMANENT tooth?
3 years
We never take routine ________ view films. There must always be a reason for these films.
occlusal
How many views of a traumatized tooth do we take?
3
The dose from a Pano is equivalent to how many PA’s?
4
The main anatomical differences for kiddo’s: 1. Short and narrow ________ 2. Mandibular foramen located ______ the mandibular occlusal plane 3. ________ bony structure 4. Bone is less _______, so infiltration has quick onset
1.ascending ramus 2.below 3.small 4.dense
Which maxillary injection is ROUTINELY USED in pedo? When administering this shot, always start on the ______ side of the tooth…
infiltration…DISTAL
What is a good supplemental injection on the maxillary to aid in numbing the palatal tissues?
interdental
Mandibular infiltrations can be useful in pedo too! Mainly for which teeth?
incisors, cuspids, and minor operative on primary molars
Which mandibular injection can anesthetize all 5 primary teeth?
The incisive nerve block
Topical Anesthetic: Systemic absorption of a ________ topical anesthetic must be considered when calculating the total amount of anesthetic administered
________ topicals have little or no absorption potential
lidocaine….benzocaine
**What is the most common complication to local anesthetic in pedo?*
Self inflicted trauma from chewing of the lip
What are the two ways you can overdose a pedo patient with LA? So what are the two methods for making sure this does not happen?
1.IV injection 2.large volumes…1.ASPIRATE 2.CALCULATE
Local anesthetic toxicity develops when the blood level of the drug in the ______ or ______ becomes too high
brain…heart
What are the 2 main effects of LA overdose? (IN ORDER PLEASE!)
1.CNS EXCITATION followed by seizure 2.CNS DEPRESSION followed by unconsciousness
What are the final effects of LA overdose?
CardioRespiratory Arrest
What is the key to handling a negative reaction to Local Anesthetic?
Make sure airway is open and administer O2!!!
Two popular anesthetic solutions used in Pediatrics:
________ ___% and ________ __%…Both have Epinephrine 1:100,000….Anesthetic Cartridges are labeled 1.7 or 1.8ml depending on manufacture….You should calculate for ___ ml
Lidocaine 2%…..Septocaine 4%…Calculate for 1.8ml
What does 2% mean? ___mg/ml and therefore ___ml (amount of liquid in vial) x ___mg/ml = ____mg of 2% lidocaine in a cartridge
20mg/ml….1.8ml x 20mg/ml = 36mg of 2% lidocaine in a cartridge
**HOW MANY mg of 2% lidocaine is in a stopper full? (hint…0.2ml)
0.2ml x 20mg/ml = 4 mg of Lidocaine 2% in a stopper full
How many mg of 2% lidocaine is in 1 ml of solution?
1ml x 20mg/ml = 20mg of Lidocaine 2% in a ml of solution
How many mg of SEPTOCAINE 4% is in a 1.8ml solution?
1.8ml x 40mg/ml = 72mg of Septocaine 2%
***How many mg of Septocaine 4% is in a stopper full?
0.2ml x 40mg/ml = 8mg of Septocaine 4%
*** What is the MAX DOSE/Weight for Lidocaine 2% with Epi? (in BOTH mg/kg and mg/lb pleeeeze)
4.4mg/kg (or 2mg/lb)
*** What is the max dose for Septocaine 4% with epi? (in both mg/kg and mg/lb pleeeze)
7mg/kg (or 3.18 mg/lb)
What if a 100 lb child needs both Lido 2% and Septo 4%…what is the maximum dose for each and which number do you not exceed?
Lido 2% max = 200 mg….Septo 4% max = 318 lbs….dont exceed the lower number with overall amount of either drug
Without looking at body weight (which needs to be done first), what are the ABSOLUTE MAXIMUM DOSAGES for Lidocaine 2% and Septocaine 4%?
Lido 2% = 300 mg… Sept 4% = 500mg
What is the main problem with vasoconstrictor in the LA?
it prolongs numbness in the area and leads to more cheek/lip biting
Calculate dosage of Epi 1:100,000….. How many mg/ml? how many mg/cartridge?
.01mg/ml x 1.8ml = .018 mg Epi/ cartidge
What is the conversion for kg to lbs? What is the BADASS method for mentally converting lbs to kg?
1 kg = 2.2 lbs…..since were in America- (Lbs/2) - 10% = Kg….example: 100lbs/2 - 5 = 45kg when actual is 45.45)
What is the major thing to look out for in an obese child/patient?
blood volume does not necessarily relate to body weight!
Every injection we do in Pedo uses 1/4 of a cartridge, EXCEPT Which two?
- IA nerve block and 2. IA for canines…they both use 1/2 cartridge
DOCUMENTATION OF LADocumentation must include the type and dosage of local anesthetic in ______. Vasoconstrictors, if any, must be noted either in _________ or concentration
mg….mg
DOCUMENTATION OF LA Documentation may include the ____ of injection(s) given (eg, infiltration, block), _______ selection and patient’s reaction to the injection.
type…needle
DOCUMENTATION OF LA__________ instructions (eg, behavioral and dietary precautions) should be given
to the patient and/or caregiver.
Postoperative
DOCUMENTATION OF LAIf the local anesthetic was administered in conjunction with sedative drugs, the
doses of all agents must be noted on a ____-based record.
TIME BASED (nitrous yo!)
DOCUMENTATION OF LAin patients for whom the maximum dosage of local anesthetic may be a concern,
the ______ should be documented preoperatively.
weight
What are the optimal % of N20 and O2 during delivery?
30-50% N20 and 70-50% O2
How long do you diffuse N2O with pure O2 for full recovery??
5 min
What is the minimum ventilation (in L) for N20? (Hint it = 500mL Tidal Volume x 12 RR)
500ml TV x 12 RR = MI of 6L
Contraindications for N2O: Which lung disease? Which inner ear pressure? Which trimester for Pregnancy?
- COPD 2.Otitis Media 3.1st Trimester
Is it safe to administer N2O to a patient with Asthma?
YES! even indicated for it
We typically use _____ induciton in administering N20 to adults, and ______ induction when administering to kids..
titration…rapid
In adults, what are the % ranges for N20?
40-60%!!! (Peds were 30-50%)
EXAMPLE: Total Flow of N20…___L of O2/ ___L of N2O = 40% N2O…
3L of O2 / 2 L of N20 = 2/5 or 40% of N2O
How much excess gas is excavated in a scavenging system?
97% of the gas is scavenged
**IN BRODSKY’s scale: Which classification would you never sedate? What % coverage do we have?
class 4 = more than 75% of airway covered by the tonsils
VITALS: Pulse and Respiratory rate _______ with age. Blood Pressure ________.
decrease…increases
What is the quickest way to estimate BP on a kiddo?
Systolic = 90 + (2xAge)…example-Systolic BP for a 5 year old = 90 + (5x2) =100
What is the FIRST concern with PEDO ext?
the permanent successor
Which forceps and what hand movements do you use for a primary anterior ext?
1 and ROTATIONAL movement ONLY!! (don’t Fx the buccal or ling plate!!)
Which forceps and what hand movements do you use for maxillary primary molars?
150small…palatal, buccal, palatal (NO rotation)
**Separated Roots during Ext: Attempt to REMOVE when, clearly visible, accessible, and there is low risk of ______ the permanent tooth below!
damaging
**Separated Roots during Ext: leave them when the fragment is ______ and immobile, and there is a high risk of damage or displacement of the permanent tooth
embedded
Which size gauze to you leave at the extraction site with a pedo patient? (think about risk of aspiration)
4x4
