LA techniques

Question 1

What are the 5 steps in insuring a good injection technique?

Answer 1

-stretch mucosa -position needle tip at target point -puncture mucosa quickly (use distraction) -aspirate -inject slowly

Question 2

How long should you inject LA for?

Answer 2

No less than 30 seconds

Question 3

At the point/tip of the needle, what happens to the diameter of it?

Answer 3

It becomes thinner (and bevelled)

Question 4

What is the role of the bevel on the needle?

Answer 4

To provide a cutting surface that offers little resistance to mucosa as the needle penetrates and withdraws from the tissue

Question 5

Describe the bevel orientation you want to have during needle placement.

Answer 5

Want the bevel towards you during needle placement

Question 6

Where do you want the bevel to be during an infiltration ?

Answer 6

-bevel away from the bone

Question 7

Why do you want the bevel of the needle to be away from the bone during infiltration injections?

Answer 7

Because if the bevel is towards the bone, the edge of the needle is likely to penetrate the periosteum Periosteal injections are more likely to evoke a painful response

Question 8

How should the needle be positioned in an ID block?

Answer 8

Makes no statistical or clinical difference

Question 9

What are some myths about LA regarding the needle length, diameter and temp?

Answer 9

-needle length influences discomfort (it doesn’t) -needle diameter influences discomfort -people think warm temp of needle will be more comfortable (P cannot detect if between 15 and 37 degrees)

Question 10

How do you identify the injection site in a buccal infiltration?

Answer 10

Identify injection site in the reflection of mucosa below apex of the tooth You want to inject slightly distally to the target tooth

Question 11

What kind of anaesthesia do you get with infiltration anaesthesia ? (describe how much is anaesthetised also)

Answer 11

-pulpal anaesthesia limited to one or 2 teeth -also get associated soft tissue anaesthesia

Question 12

What are the limitations of infiltration anaesthesia?

Answer 12

-If inject into infection then this could cause further spread of the infection - the LA needs to diffuse through dense bone meaning that you may not get full anaesthesia

Question 13

What are the advantages/positives of infiltration anaesthesia?

Answer 13

-high success rate -technically easy -atraumatic to tissues

Question 14

Describe the technique for buccal infiltration.

Answer 14

-stretch cheek -puncture mucosa with correct bevel of needle -advance needle until over the apex of the tooth -if contact bone, withdraw slightly -aspirate -if negative aspiration the inject slowly

Question 15

After injecting the LA in a buccal infiltration. What are the next 5 steps?

Answer 15

-remove syringe from mouth -slide sheath down to first click -massage the LA into tissues -wait 2 mins for anaesthesia -test to see if the area is sufficiently anaesthetised

Question 16

What LA injections are performed as buccal infiltration?

Answer 16

-mental block -buccal injections

Question 17

Where is the injection site for a mental nerve block?

Answer 17

Between the apices of the lower premolars

Question 18

Where should you NOT try to put the need while performing a mental nerve block ? Why?

Answer 18

In the mental foramen - can damage the nerve

Question 19

What needle size is used for an ID block?

Answer 19

35mm needle

Question 20

What are the 4 important landmarks for an IDB block?

Answer 20

-coronoid notch of the mandibular ramus -posterior border of the mandible -pterygomandibular raphe -lower premolar teeth of the opposite side

Question 21

Describe the hand positioning for an inferior alveolar nerve block.

Answer 21

Thumb goes on the cornoid process and fingers externally on the posterior border of the mandible

Question 22

Why are the opposite premolar teeth an important landmark?

Answer 22

because this is where the barrel of the needle is going to go

Question 23

The site of anaesthetic depositions in an IDB block is what region?

Answer 23

Region of the mandibular foramen

Question 24

What are the limitation if the IDB block is delivered too inferiorally?

Answer 24

-increased onset time -increased lingual nerve injury

Question 25

What are the steps in delivering an inferior alveolar nerve block?

Answer 25

-thumb placed at anterior notch -needle entry at buccal fat/pterygomandibular raphe -advance to bony contact - withdraw from bony contact and aspirate -inject slowly

Question 26

What do you do if get no bony contact?

Answer 26

Re-position syringe distally

Question 27

What do you do if you get bony contact too soon?

Answer 27

Resposition syringe barrel mesially

Question 28

How do you confirm anaesthesia?

Answer 28

-Ask the patient how it feels (should feel rubbery, numb, tingly, swollen/fat BUT ability to sense pressure remains) -can test mucosa with probe if carrying out extraction or oral surgery

Question 29

Where should feel numb etc in an IDB block?

Answer 29

-Tongue and lower lip extending to the mid-line