Landmarks for Local Anesthia- Part of CUM FINAL

Question 1

type of injection that
anesthetizes a small area—one or two
teeth and associated structures—when the
local anesthetic agent is deposited near
terminal nerve endings

Answer 1

Local infiltration

Question 2

type of injection that
anesthetizes a larger area than a local
infiltration because the local anesthetic is
deposited near large nerve trunks

Answer 2

Nerve block

Question 3

abnormal sensation from an

area such as burning or prickling

Answer 3

Paresthesia

Question 4

Bones involved in Local Anesthia are

Answer 4

maxilla
palatine
mandible

Question 5

Soft tissues will serve as ____ _____,
but due to variation among patients, you
must learn to rely mainly on visualization
and palpation of hard tissues

Answer 5

initial landmarks

Question 6

The clinician must never progress the needle
through an area with an ______ ________ ________ to prevent spread of dental
infection. Effectiveeness is greatly reduced in areas administered

Answer 6

abscess, cellulitis, or

osteomyelitis

Question 7

Why is local anesthia of the maxilla more successful than the mandible ?

Answer 7

• Bone over facial surface of max teeth is less dense than that of the mandible
• Less variation of anatomy of the maxillary and palatine bones with respect to landmarks than the mandible

Question 8

PSA
MSA
ASA
IO
NP
AMSA

Answer 8

Maxillary nerve anesthesia

Question 9

Maxillary molar teeth and associated buccal tissues

Answer 9

PSA

Question 10

Maxillary premolars and mesiobuccal root of 1st molar, and associated buccal tissues

Answer 10

MSA

Question 11

Maxillary canine and incisors and associated facial tissues

Answer 11

ASA

Question 12

Maxillary anterior and premolar teeth and associated facial tissues

Answer 12

Infraorbital IO

Question 13

Palatal tissues distal to maxillary canine

Answer 13

GP

greater palatine

Question 14

Palatal tissues between the right and left maxillary canines

Answer 14

NP

nasopalatine

Question 15

The only injection that crosses the midline

Answer 15

Nasopalatine

Question 16

Pulpal and soft tissue anesthia of large area covered by ASA, MSA, GP and NP

Answer 16

Anterior Middle Superior Alveolar AMSA

Question 17

PSA Target Area

Answer 17

PSA nerve as it enters the maxilla through the posterior superior alveolar foramina on the maxilla’s infratemporal surface

Question 18

PSA penetration site

Answer 18

Height of the mucobuccal fold at the apex of the maxillary second molar, distal to the zygomatic process of the maxilla

Question 19

In some patients, the MB root of the first molar is not innvervated by the PSA, but by the ___ , a second injection may be necessary

Answer 19

MSA

Question 20

PSA must avoid injecting into the

Answer 20

pteryoid plexus

Question 21

MSA Target Area

Answer 21

MSA nerve at the apex of the maxillary second premolar

Question 22

Penetration site of MSA

Answer 22

-Penetration site: Height of mucobuccal fold at the
apex of the maxillary
second premolar ž

-Needle is inserted
until its tip is located
superior to the apex of
the maxillary second
premolar without
touching the bone

Question 23

Possible complications of MSA

Answer 23

Over-insertion complications such as a

hematoma are rare with the MSA

Question 24

ASA target area:

Answer 24

ASA nerve at the apex of the maxillary canine

Question 25

Penetration site ASA

Answer 25

Penetration site: tissues at the height of the mucobuccal fold at the apex of the maxillary canine, just anterior to and parallel with the canine eminence.

Question 26

Possible complications of ASA

Answer 26

over insertion with complications like a hematoma are rare with the ASA

Question 27

``` -Anesthetizes MSA and ASA nerves (max. premolars, canine, and incisors and supporting structures) ž ``` -Ta r g e t a r e a : infraorbital foramen.

Answer 27

IO

Question 28

IO penetration site:

Answer 28

height of the mucobuccal fold tissues at the apex of the maxillary first premolar.

Question 29

IO possible complications

Answer 29

May get a hematoma across lower eyelid and tissues between it and the infraorbital foramen

Question 30

GP/Greater Palatine Target Area

Answer 30

``` anterior to where the nerve exits the greater palatine foramen, at the junction of the alveolar process and hard palate ```

Question 31

GP penetration site:

Answer 31

anterior to depression created by the greater palatine foramen. The depression can be palpated about midway between the palatine raphe and the lingual gingival margin.

Question 32

KEYS for greater palatine injection

Answer 32

``` ž Because overlying tissue is firmly adhered to the palatal bone, use pressure anesthesia posterior to the injection site to blanch tissues and reduce discomfort. ž Deposit the anesthetic SLOWLY! ```

Question 33

Possible Complications of GP

Answer 33

soft palate may be inadvertently anesthetized, which is harmless, but may be uncomfortable for patient who may gag

Question 34

During the GP injection which nerve may be anesthetized causing soft palate anesthia

Answer 34

Lesser palatine/feels like cant swallow

Question 35

Nasopalatine Block Target area

Answer 35

``` b o t h the right and left NP as they exit the incisive foramen, beneath the incisive papilla ```

Question 36

NP Block Injection Site

Answer 36

palatal tissues lateral to the incisive papilla Pressure anesthesia is also applied, from the contra lateral side

Question 37

Possible complications of NP

Answer 37

Complications such as a hematoma are extremely rare

Question 38

AMSA Anterior Middle Superior Alveolar Block Target Area

Answer 38

Tissues of the hard palate between the apices of 1st and 2nd premolars

Question 39

Anterior Middle Superior Alveolar Block AMSA Injection Site

Answer 39

``` an area bisecting the apices of the maxillary premolars, midway between lingual gingival margin and median palatal raphe ```

Question 40

Possible complications of AMSA

Answer 40

``` blanching will be noted after the AMSA block. If blanching is excessive, there may be postoperative tissue ischemia and sloughing. Other complications are rare. ```

Question 41

``` Inferior Alveolar Block (IA) Buccal Block (Long Buccal) Incisive Block Mental Block Gow Gates ``` These are all for 1. Maxillary Nerve Anesthesia 2. Mandibular Nerve Anesthia

Answer 41

Mandibular nerve anesthia

Question 42

Target Area for Inferior Alveolar Block

Answer 42

``` slightly superior to the entry point of the IA nerve into the mandibular foramen ž ***LA must be acurately deposited within 1mm of the target area to achieve anesthesia*** ž Mainly hard tissues are used as landmarks, such as the coronoid notch and occlusal plane of mandibular teeth ```

Question 43

When giving an IA the anesthetic must be acurately deposited within __ mm of the target areas to achieve anesthia

Answer 43

1mm

Question 44

IA injection iste

Answer 44

Pterygomandibular space = portion of infratemporal space between medial pterygoid muscle and ramus

Question 45

Possible Complications of IA

Answer 45

possible transient facial paralysis (if facial nerve is mistakenly anesthetized—incorrect injection of anesthetic into parotid gland); hematoma; muscle soreness; paresthesia—usually from trauma to the lingual nerve (rare)

Question 46

Possible lingual shock can come from 1. IA 2. AMSA 3. NP

Answer 46

IA

Question 47

Buccal Block- Long Bucval Target Area:

Answer 47

``` buccal nerve located on the anterior border of the mandibular ramus ```

Question 48

Long Buccal Block Penetration site

Answer 48

buccal tissues that are distal and buccal to the most distal molar tooth in the arch

Question 49

Complications of Buccal are

Answer 49

rare

Question 50

Incisive Block and Mental Block Target Area:

Answer 50

``` a n t e r i o r to the depression caused by the mental foramen, usually located at the height of the mucobuccal fold between the apices of the mandibular first and second premolars ```

Question 51

Incisive Block and Mental Block | Penetration Site:

Answer 51

``` height of the mucobuccal fold tissues, between apices of first and second premolars The difference: Pressure is applied after the injection to force more LA into the foramen, anesthetizing both the shallow mental, and deeper incisive. ```

Question 52

Complications of Mental and Incisive Blocks

Answer 52

RARE

Question 53

Gow-Gates Target Area

Answer 53

``` anteromedial border of the mandibular condyle neck, just inferior to the insertion of the lateral pterygoid muscle ```

Question 54

Gow-Gates Penetration site

Answer 54

``` soft tissues just distal to the maxillary second molar; vertical height of the injection is established using the height of the mesiolingual cusp of max 2nd molar; use an extraoral line for guidance (intertragic notch to ipsilateral labial commisure of the lip) ```

Question 55

Possible Complications of Gow-Gates and disadvantages

Answer 55

- Complications: anesthesia of the lower lip (can lead to trauma) ž -Disadvantages: LA takes longer to take effect; injection lasts longer, and a larger volume of anesthetic may be necessary; trismus is possible -Trismus = spasm of muscles making it difficult to open

Question 56

Your patient needs a filling on #6. Which of the following injections is most appropriate?

Answer 56

ASA

Question 57

SRP you need to anesthetize a. Pulp b. Soft tissue

Answer 57

BOTH