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BDS2 Clinical dentistry > local anaesthetic > Flashcards

local anaesthetic Flashcards

1
Q

what is the purpose of vasoconstrictors in LA?

A

aid haemostatic control and increase the amount of time the drug stays in the area

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2
Q

what are some adverse effects of LA?

A

systemic toxicity, allergy, trismus, ocular complications, non-surgical parathesis, interactions, methemoglobinemia

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3
Q

what are the two types of LA?

A
  • amide e.g. lignocaine

- ester e.g. articaine has ester ring association

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4
Q

what vasoconstrictors are used in LA?

A
  • none
  • adrenaline
  • felypressin (do not give pregnant woman)
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5
Q

Name some preservatives found in LA

A

bisulphite
propylparaben (allergy/not used)
a lot of allergies related

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6
Q

describe an infiltration technique

A
  • LA solution is deposited around the terminal end branches of nerves
  • used to anaesthetise soft tissues
  • used for pulpal anaesthesia where bone is thin (maxilla and lower anterior)
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7
Q

describe a block technique

A
  • LA deposited at nerve trunk
  • used to produce soft tissue anaesthesia
  • used where bone is thicker (mandible)
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8
Q

what tissues need anaesthetised when restoring and tooth?

A 
pulp
soft tissues (matrix band, dam)
homeostatic management in fixed prosthodontics work
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9
Q

what tissues need anaesthetised for extraction and surgery ?

A

pulp
gingivae
surrounding tissue

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10
Q

what tissues need anaesthetised for scaling?

A

gingivae

pulp

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11
Q

how do you anaesthetise the dental pulp in the maxilla?

A

buccal infiltration

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12
Q

how do you anaesthetise the buccal gingivae in the maxilla?

A

buccal infiltration

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13
Q

how do you anaesthetise the palatal gingivae in the maxilla?

A

palatal infiltration

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14
Q

how do you anaesthetise the pulp of lower molars and second premolar?

A

IANB

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15
Q

how do you anaesthetise the pulp of lower premolars and canine?

A

mental/incisive nerve block

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16
Q

how do you anaesthetise the pulp of lower canines and incisors?

A

buccal and labial infiltration

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17
Q

how do you anaesthetise the buccal gingivae of lower molars and second pre molar?

A

long buccal infiltration

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18
Q

how do you anaesthetise the buccal gingivae of first premolar and canine?

A

infiltration OR long buccal OR mental nerve block

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19
Q

how to anaesthetise the lower incisors and canines gingivae?

A

buccal/labial infiltration

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20
Q

how to anaesthetise the lingual gingivae in the mandible?

A
  • if giving IANB, retract needle and give lingual nerve block in same injection
  • lingual infiltration
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21
Q

describe the bevel

A

tip of the needle, cutting surface to penetrate mucosa with as little resistance as possible.

22
Q

what are the benefits of a greater gauge?

A

-greater lumen needles result in less deflection when passing through tissues
-reduces risk of breakage
-easier aspiration
lower the gauge number the greater the lumber diameter

23
Q

what is a short shaft length and use?

A

20-25mm used for infiltration

24
Q

what is a long shaft length and use?

A

30-35mm for IANB

25
Q

what is the most fragile part of the needle?

A

the hub, never insert to hub

26
Q

what colour is lignocaine band?

A

blue

27
Q

what colour is articaine band?

A

gold

28
Q

how many ml in a LA cartridge?

A

2.2ml

29
Q

what goes in the notes from LA syringe?

A

syringe handle sticker, batch number and expiry date of LA

30
Q

how do you prepare mucosa for LA?

A

dry with cotton wool/gauze and apply topical for 1-2 min

31
Q

how would you perform the infiltration technique?

A
  • stretch mucosa
  • puncture mucosa
  • position needle and target point with the bevel of the needle towards bone
  • aspirate (if blood remove cartridge and start again)
  • inject slowly, no less than 30s, drip by drip
32
Q

how much LA is administered routinely for fillings/extractions?

A

1/2-3/4 of a cartridge

33
Q

describe a buccal infiltration technique

A
  • Stretch mucosa
  • Puncture mucosa with correct bevel of needle (Want bevel open towards bone)
  • Advance needle until over the apex of tooth
  • If contact bone, withdraw slightly
  • Aspirate – if negative inject slowly, if positive reposition and repeat
  • Remove syringe, slide sheath one click
  • Massage LA into tissues and wait 2 mins for anaesthesia
34
Q

what may limit the effect of infiltration anaesthesia?

A

infection and dense bone

35
Q

describe the palatal infiltration technique?

A
  • use short needle
  • inject 5-10mm palatal to the centre of crown
  • apply pressure directly behind injection site with mirror handle or cotton swab
  • insert at 45 degree angle to injection site with bevel angled at soft tissue
  • advance and slowly deposit anaesthetic and until contact is made with bone
  • blanching of tissue should immediately follow deposition
36
Q

why is there resistance to palatal deposition of LA

A

tissue is firmly adherent to underlying periosteum

37
Q

how much LA needed for palatal infiltration?

A

0.2-0.4ml

38
Q

how do you confirm anaesthesia?

A
  • ask patient how it feels - rubbery, numb, tingly, fat
  • IANB - tongue and lower lip extending to midline should feel different, can still sense pressure
  • if extraction/surgery test with probe
39
Q

Describe how you would give an IANB?

A
  • 35mm needle
  • stretch mucosa
  • thumb placed on anterior notch
  • needle entry to buccal pad/pterygomandibular raphe
  • advance to none contact/1cm needle visible
  • if no bony contact reposition needle distally
  • if bony contact too soon reposition needle mesially
  • when in correct position withdraw slightly and aspirate
  • inject slowly
  • for lingual anaesthesia, withdrew while injecting the last 1/3
40
Q

what are the IANB landmarks?

A
  • coronoid notch of mandibular ramus
  • posterior border of mandible
  • pterygomandibular raphe
  • lower premolar teeth of opposite side
  • site of deposition is inn region of mandibular foramen
41
Q

what happens if give IANB too low?

A

increased lingual nerve injury
increased onset time
no change in IV

42
Q

what teeth does the posterior superior alveolar nerve block anaesthetise?

A

pulpal anaesthesia of first second and third molars but 1st molar MB not reliable

43
Q

how to give PSA block

A

insert needle at MB fold over maxillary 2nd molar at 45 degree angle upward and 45 degree backward for about 16mm

44
Q

how popular is MSA nerve

A

28% of population

45
Q

what teeth will MSA block?

A

MB of 1st maxillary molar and premolars and canine

46
Q

where do you administer and MSA block?

A

MB fold over the 2nd premolar

47
Q

what does and ASA block anaesthetise?

A

maxillary incisors and canine on side of delivery

48
Q

where do you administer an ASA block?

A

MB fold over 1st premolar, target is the infraorbital foramen

49
Q

what does the greater palatine block anaesthetise?

A

posterior portion of hard palate and overlying soft tissues as far as first premolar and medially to midline

50
Q

what does the nasopalatine block anaesthetise?

A

anterior portion of hard palate (soft and hard tissues) bilaterally from right first premolar to the medial of left first premolar

51
Q

where do you administer a mental nerve block?

A

between the apices of lower premolars
massage the LA!!
do not put needle in formen

52
Q

where do you administer a buccal infiltration?

A

slightly distal to the tooth to be treated

BDS2 Clinical dentistry (2 decks)

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