LA - Complications Flashcards
serious side effects with LA are very rare. what are some procedures that minimize the chances of LA complications? x4
- correctly assess the patient’s medical history and medication
- choose the correct drug
- use a safe dose
- administer LA carefully
what are the 3 main complications of LA?
- failure of LA to work
- local complications
- systemic complications
give 5 examples of local complications of LA?
- physical trauma
- chemical damage
- prolonged paraesthesia
- facial nerve block
- intravascular injection (tachycardia and hypertension)
give 4 examples of systemic complications of LA?
- fainting
- LA toxicity
- vasoconstrictor toxicity
- allergy
what are the effects of LA failure on the dentist and patient? x6
- distress for dentist and patient
- unable to complete procedure
- longer appointments/disrupted schedule
- loss of patient confidence
- can lead to patient perception that they are resistant to LA - possible avoidance
- dental anxiety
what may an anxious patient about LA failure?
- anxious about injections
- anticipation of pain
- misinterpretation of sensations: vibration & sensations from non-anaesthetized teeth
4 main causes of LA failure?
- technique
- anatomical problems
- presence of acute infection/inflammation
- anxiety and pain perception
LA failure: techniques
what are 7 types of technical errors that lead to LA failure?
- wrong injection: wrong nerve injected
- wrong solution: e.g. no vasoconstrictor
- insufficient solution
- failure to aspirate
- speed of injection
- wrong place: landmark/anatomy problems, short of apex for infiltration
- technique/method: consider deviation of needle
what are 5 anatomical factors associated with LA failure?
- shape of mandible
- some people have very wide/slim mandibles, sizes vary - foramina position
- mandibular foramen varies with adults and children
- often inject too low
- bifid IAN - accessory nerve supply
- long buccal nerve
- lingual nerve
- mylohyoid nerve
- upper cervical nerves - sphenomandibular ligament
- barriers to diffusion
management of LA failure - failed infiltration to upper 1st molar? x4
- consider anatomy
- infiltrations mesially and distally to the tooth
- palatal infiltration assess
- supplemental technique
management of LA - failed inferior alveolar nerve block?
- reassess landmarks
- repeat conventional IAB, and/or buccal and lingual infiltrations (articaine)
- supplemental technique
- try different approach (akinosi-assess)
- work to sensible maximum doses
akinosi injection - high block: how is it done?
- closed mouth
- needle entry above 7’s
- pass needle back 2.5cm
physical trauma: what are 3 examples and their consequences?
- needle penetrates nerve: very painful, must withdraw needle immediately
- local bleeding in injection site: trismus if bleeding into muscle,
- patient inflicted: pt may bite onto anesthetized lip, or burn an area numbed by LA. must avoid by giving post op instructions
prolonged altered sensation:
- example?
- caused by?
- chemical damage: linked to?
- management?
- anaesthesia or paraesthesia
- physical trauma to nerve; withdraw needle do not injfect
- higher concentration LAs; e.g. articaine
- monitor until full recovery, refer to specialist if no improvement, reassure - will usually resolve
facial nerve block:
- how does it happen?
- error caused by?
- another risk associated with facial nerve block?
- symptoms of facial nerve block?
- if needle is too deep, if bone is not touched
- errors in landmarks, anatomical variations
- injection of LA into parotid gland
- muscle of facial expression paralyzed, unilateral loss of muscle tone, unable to blink - risk of eye damage, must give patient eye patch
