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BDS2 OSCE > LA Symposium > Flashcards

LA Symposium Flashcards

1
Q

infiltration vs block

A

infiltration = terminal branches of nerves. for soft tissues of area and pulpal anaesthesia in maxilla and lower anterior teeth if alveolar bone is thin

block = beside nerve trunk, abolishes sensation distal to site, for soft tissue/pulpal where bone is too thick i.e. mandible and for multiple tissues in 1 injection

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1
Q

what anaesthetises dental pulp and buccal gingivae

A

buccal infiltration

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2
Q

where and what nerves does palatal infiltration anaesthetise

A

palatal mucoperiosteum NOT PULLP ETC and nasopalatine nerve (anterior 1/3) and greater anterior palatine nerve (posterior 2/3)

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3
Q

what impacts diffusion of anaesthetic

A

increased age due to increased maxillary and mandibular bone density

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4
Q

what does IDB anaesthetise

A
  1. all teeth in quadrant (inferior alveolar nerve)
  2. most of tongue and lingual gingivae on respective side (lingual nerve)
  3. lower lip and chin on one side (mental nerve)

buccal molar mucosa unanaesthetised - need long buccal

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5
Q

how to anaesthetise the lingual nerve

A

using last 1/3 of cartridge after withdrawing 1-2mm from IDB. this catches lingual surface of teeth and soft tissue

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6
Q

where is lingual nerve located in relation to inferior alveolar nerve

A

anterior and medial to inferior alveolar nerve

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7
Q

buccal nerve block / long buccal - why and how

A

why - for lower 6 7 8 that is not numbed in IDB

how - distal and buccal to last molar near anterior border of ramus at level of occlusal plane

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8
Q

what kind of injection anaesthetises premolars/canines/incisors and skin of lower lip and chin

A

mental nerve block i.e. everything anterior to mental foramen

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9
Q

calculation for safe dose

A

max allowed dose mg/kg x weight in kg/10 x 1/concentration of LA

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10
Q

cause and treatment of trismus

A

cause - hitting medial pterygoid

treatment - diazepam and ibuprofen

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11
Q

iatrogenic damage from LA

A

facial palsy from depositing LA in parotid gland as CN VII runs through here

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12
Q

intra oral topical anaesthesia

A

benzocaine 20% flavoured gel

lidocaine 2% gel / 10% spray / 5% ointment

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13
Q

extra oral topical anaesthesia

A

EMLA cream - 5% prilocaine and lidocaine. needs to be applied for 1hr
Ametop gel - tetracaine 4% gel. faster onset than EMLA

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14
Q

quicker half life - lidocaine or articaine

A

articaine - 20 mins

lidocaine 1.5-2hrs

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15
Q

if contraindications are sickle cell anaemia and other haemoglobinopathies what is the drug

A

articaine

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16
Q

contraindications of lidocaine

A

heart block w no pacemaker, impaired liver function, hypotension

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17
Q

max dose lidocaine 2% plain / w epinephrine

A

4.4mg/kg

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18
Q

max dose prilocaine 4% / 3% w felypressin

A

6mg/kg

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19
Q

max dose mepivicaine 3% plain / 2% w epinephrine

A

4.4mg/kg

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20
Q

max dose articaine 4% w epinephrine

A

7mg/kg

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21
Q

what axons are more susceptible to LA and why

A

smaller diameter axons as they have fewer layers of sodium channels

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22
Q

reducing agent in LA preparations

A

sodium metabisulfide - no longer used

23
Q

what preparations are esters

A

benzocaine

24
Q

what preparations are amides

A

lignocaine (aka lidocaine)
prilocaine
articaine
bupivicaine

25
Q

what are vasoconstrictive agents

A

adrenaline / octa- or felypressin

26
Q

action and effects of adrenaline

A
  • binds to alpha receptors in peripheral vasculature for vasoconstriction
  • tachycardia due to impact on beta 1 adrenergic receptors in heart wall
  • increase in HR + BP
27
Q

what should you never give for IDB

A

articaine

28
Q

landmarks for IDB

A

coronoid notch
pterygomandibular raphe
posterior border of ramus

29
Q

symptoms of adrenaline overdose

A

sweating / pallor / anxiety / weakness / palpitations / trembling / headache / dizziness

30
Q

trismus vs facial palsy

A

t - limited mouth opening, onset within hrs of IDB, lasts weeks - months, damage to medial pterygoid (needle too low / forceful administration

fp - complete unilateral facial palsy, onset within mins of IDB, lasts hrs, LA injected into parotid

31
Q

how does damage to medial pterygoid happen

A

needle too low

excessively forceful administration

32
Q

what reducing agents cause reactions

A

sodium metabisulfates = corn allergy

methyl parabens = blueberry allergy

33
Q

to reduce pain in anxious patient

A
  1. topical - benzocaine 20% or xylocaine 5%
  2. slow delivery rate
  3. reassurance and relaxation
  4. distraction
34
Q

why aspirate

A

injecting adrenaline into blood vessel can cause cardiovascular or CNS toxicity as well as tachycardia and hypertension. potentially lethal

35
Q

extraction of 14. what LA technique would you use

A

infiltration (distal to apex of tooth) to catch posterior, middle and anterior branch of alveolar nerve
use a shorter 25mm blue needle
bevel to bone

36
Q

3 branches of maxillary nerve

A

zygomatic, pterygopalatine ganglion, infraorbital

37
Q

3 trunks of mandibular division

A

main trunk
posterior trunk
anterior trunk

38
Q

why may your anaesthetic not work

A

necrosis
infection
handler technique
anatomy of patient

39
Q

3 divisions of trigeminal arise from

A

trigeminal ganglion found in middle cranial fossa

40
Q

CNV1 exits middle cranial fossa via

A

superior orbital fissure

41
Q

CNV2 exits middle cranial fossa via

A

foramen rotundum

42
Q

CNV3 exits middle cranial fossa via

A

foramen ovale

43
Q

after exiting skull where does each branch of CNV go

A

V1 - orbit
V2 - pterygopalatine fossa
V3 - infratemporal fossa

44
Q

sensory innervation of CNV3

A

general sensation of anterior 2/3s of tongue
tempoauricural skin
lower lip and chin
mandibular teeth

45
Q

motor innervation CNV3

A

muscles of mastication

46
Q

relationship between lingual nerve and chorda tympani

A

fibres from facial nerve (CNVII) via chorda tympani travel in lingual nerve (branch from CNV3) and carry:
taste - to anterior 2/3s of tongue
parasympathetic - to submandibular and sublingual glands via synapse at submandibular ganglion

46
Q

relationship between lingual nerve and chorda tympani

A

fibres from facial nerve (CNVII) via chorda tympani travel in lingual nerve (branch from CNV3) and carry:
taste - to anterior 2/3s of tongue
parasympathetic - to submandibular and sublingual glands via synapse at submandibular ganglion

47
Q

function of CNV2 (maxillary)

A

sensory - lower eyelid, cheek, side of nose, part of nasal cavity, upper lip, hard and soft palate, maxillary teeth and gingivae

48
Q

5 branches of maxillary nerve that exit pterygopalatine fossa

A
  1. greater & lesser palatine nerves exit via palatine canal
  2. posterior superior alveolar nerve exits via pterygomaxillary fissure
  3. infraorbital nerve exits via inferior orbital fissure
  4. nasopalatine nerve exits via sphenopalatine fossa
  5. pharyngeal nerve exits via palatovaginal canal
49
Q

anterior trunk CNV3

A 
motor = deep temporal nerves, nerve to lateral pterygoid, masseteric nerve 
sensory = buccal nerve (not to be confused with buccal branch of facial cranial nerve)
50
Q

posterior trunk CNV3

A 
sensory = lingual nerve, auriculotemporal nerve
mixed = inferior alveolar nerve - once it enters mandible via mandibular foramen it is only sensory, the motor parts come off the mylohyoid muscle
51
Q

main trunk CNV3

A 
motor = branch to tensor tympani, branch to tensor veli palatini, nerve to medial pterygoid 
sensory = meningeal nerve (sensory to dura mater)
52
Q

inferior alveolar nerve branches in relation to oral cavity

A

branches include: incisive nerve to lower anterior teeth and mental nerve to skin of chin and lower lip

53
Q

lower teeth and gingivae general sensory supply

A

premolars + molars = inferior alveolar nerve
incisors + canines = incisive branch of IAN
palatal gingivae = lingual nerve
buccal gingivae = buccal nerve
anterior gingivae = mental nerve from IAN

54
Q

anterior 2/3s tongue

A

general sensation supplied by lingual nerve from CNV3

taste supplied by CNVII (facial nerve) via chorda tympani which travels with lingual nerve

55
Q

posterior 1/3 tongue

A

both touch and taste supplied by glossopharyngeal CNIX

BDS2 OSCE (8 decks)

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