LA Flashcards
A fifty year old male requires subgingival debridement of quadrant 2. They are taking Cardol for high blood pressure.
1. What is an appropriate choice of local anaesthetic?
2. What structures need to be anaesthetized?
3. The branch of which nerve/s needs to be anesthetized?
4. What technique do you need to perform to achieve this? Describe the technique.
Buccal and palatal infiltrations (See separate technique handout)
You notice ‘ballooning’ of the oral mucosa at the injection site. What is the likely cause of this? How would you manage this?
Injecting too quickly – reduce injection speed, gently massage the site to disperse solution
During the injection, the patient complains of a very sharp transient electric shock like pain. They don’t have this pain during the appointment, or after treatment. 3 days later they present to you, and their primary complaint is that they still can’t feel their tongue. What may have resulted in this? How would you manage this client?
Many causes of pain during injection such as
- Careless technique
- Too rapid injection- torn tissues
- Subperiosteal injection
However when pain is quite pronounced usually result from unintentional prick of an anatomical stricture with needle tip. Because the client complains of prolonged post treatment anaesthesia it is likely that you may have caused direct trauma to a nerve during IAN Block (Which this sharp pain is characteristic of)
Because of the anatomy of the Pterygomandibular space, and the fact that the lingual nerve is positioned medial and anteriorly to the IAN nerve, it is more frequently nicked during IAN blocks than the IAN nerve itself. (whereas IAN nerve more likely to be damaged during surgery of lower molars (Most frequently wisdom teeth given how close their position is to the IAN in the Mandibular canal)
Management:
Explain what has happened- and state that it is an infrequent risk of having local anaesthesia.
Should wear off and resolve in days- but can last weeks and in very rare cases may not return at all.
Examine pt and determine degree and extent of anaesthesia- DOCUMENT!! have pt reviewed by Dental officer
May last up to 8 weeks- rebook client in every 2 weeks in early stages and assess for signs of sensation returning such as paraesthesia
If not resolved after 8 weeks refer client to a neurologist or oral surgeon for consultation
needlestick injury
What post-operative instructions should be provided to the patient and their guardian(s) following the procedure?
Careful to bite, chew on lips to avoid tissue trauma. Parents to monitor.
Do not eat anything too hot/cold until numbing wears off. Idealing wait until numbing wears off (~2 hrs)
Exo post op: avoid spitting, rinsing or straw sucking for the day, no physical exercise. Rest, rinse with salt water, resume tomorrow brushing teeth without disturbing wounds, soft food diet first 2 days.
Call office if any issues or prolonged bleeding.
What are some potential complications that should be monitored post-operatively, and how should they be managed if they occur?
Maxillary injection site/numbers
Mandibular injections
LA duration
Slow onset
local complications
Trismus
local complications
Haematoma/ Ecchymosis
Prolonged altered sensation: nerve damage
Electric shock
pain/burn/needle break
top 3 systemic complications la
other 3 systemic complications la
