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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
what preparations are amides
lignocaine (aka lidocaine) prilocaine articaine bupivicaine
25
what are vasoconstrictive agents
adrenaline / octa- or felypressin
26
action and effects of adrenaline
- 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
what should you never give for IDB
articaine
28
landmarks for IDB
coronoid notch pterygomandibular raphe posterior border of ramus
29
symptoms of adrenaline overdose
sweating / pallor / anxiety / weakness / palpitations / trembling / headache / dizziness
30
trismus vs facial palsy
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
how does damage to medial pterygoid happen
needle too low | excessively forceful administration
32
what reducing agents cause reactions
sodium metabisulfates = corn allergy | methyl parabens = blueberry allergy
33
to reduce pain in anxious patient
1. topical - benzocaine 20% or xylocaine 5% 2. slow delivery rate 3. reassurance and relaxation 4. distraction
34
why aspirate
injecting adrenaline into blood vessel can cause cardiovascular or CNS toxicity as well as tachycardia and hypertension. potentially lethal
35
extraction of 14. what LA technique would you use
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
3 branches of maxillary nerve
zygomatic, pterygopalatine ganglion, infraorbital
37
3 trunks of mandibular division
main trunk posterior trunk anterior trunk
38
why may your anaesthetic not work
necrosis infection handler technique anatomy of patient
39
3 divisions of trigeminal arise from
trigeminal ganglion found in middle cranial fossa
40
CNV1 exits middle cranial fossa via
superior orbital fissure
41
CNV2 exits middle cranial fossa via
foramen rotundum
42
CNV3 exits middle cranial fossa via
foramen ovale
43
after exiting skull where does each branch of CNV go
V1 - orbit V2 - pterygopalatine fossa V3 - infratemporal fossa
44
sensory innervation of CNV3
general sensation of anterior 2/3s of tongue tempoauricural skin lower lip and chin mandibular teeth
45
motor innervation CNV3
muscles of mastication
46
relationship between lingual nerve and chorda tympani
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
relationship between lingual nerve and chorda tympani
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
function of CNV2 (maxillary)
sensory - lower eyelid, cheek, side of nose, part of nasal cavity, upper lip, hard and soft palate, maxillary teeth and gingivae
48
5 branches of maxillary nerve that exit pterygopalatine fossa
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
anterior trunk CNV3
``` 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
posterior trunk CNV3
``` 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
main trunk CNV3
``` motor = branch to tensor tympani, branch to tensor veli palatini, nerve to medial pterygoid sensory = meningeal nerve (sensory to dura mater) ```
52
inferior alveolar nerve branches in relation to oral cavity
branches include: incisive nerve to lower anterior teeth and mental nerve to skin of chin and lower lip
53
lower teeth and gingivae general sensory supply
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
anterior 2/3s tongue
general sensation supplied by lingual nerve from CNV3 | taste supplied by CNVII (facial nerve) via chorda tympani which travels with lingual nerve
55
posterior 1/3 tongue
both touch and taste supplied by glossopharyngeal CNIX

BDS2 OSCE (8 decks)

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