local anaesthetic

Question 1

what is the purpose of vasoconstrictors in LA?

Answer 1

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

Question 2

what are some adverse effects of LA?

Answer 2

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

Question 3

what are the two types of LA?

Answer 3

• amide e.g. lignocaine

- ester e.g. articaine has ester ring association

Question 4

what vasoconstrictors are used in LA?

Answer 4

• none
• adrenaline
• felypressin (do not give pregnant woman)

Question 5

Name some preservatives found in LA

Answer 5

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

Question 6

describe an infiltration technique

Answer 6

• 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)

Question 7

describe a block technique

Answer 7

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

Question 8

what tissues need anaesthetised when restoring and tooth?

Answer 8

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

Question 9

what tissues need anaesthetised for extraction and surgery ?

Answer 9

pulp
gingivae
surrounding tissue

Question 10

what tissues need anaesthetised for scaling?

Answer 10

gingivae

pulp

Question 11

how do you anaesthetise the dental pulp in the maxilla?

Answer 11

buccal infiltration

Question 12

how do you anaesthetise the buccal gingivae in the maxilla?

Answer 12

buccal infiltration

Question 13

how do you anaesthetise the palatal gingivae in the maxilla?

Answer 13

palatal infiltration

Question 14

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

Answer 14

IANB

Question 15

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

Answer 15

mental/incisive nerve block

Question 16

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

Answer 16

buccal and labial infiltration

Question 17

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

Answer 17

long buccal infiltration

Question 18

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

Answer 18

infiltration OR long buccal OR mental nerve block

Question 19

how to anaesthetise the lower incisors and canines gingivae?

Answer 19

buccal/labial infiltration

Question 20

how to anaesthetise the lingual gingivae in the mandible?

Answer 20

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

Question 21

describe the bevel

Answer 21

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

Question 22

what are the benefits of a greater gauge?

Answer 22

-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

Question 23

what is a short shaft length and use?

Answer 23

20-25mm used for infiltration

Question 24

what is a long shaft length and use?

Answer 24

30-35mm for IANB

Question 25

what is the most fragile part of the needle?

Answer 25

the hub, never insert to hub

Question 26

what colour is lignocaine band?

Answer 26

blue

Question 27

what colour is articaine band?

Answer 27

gold

Question 28

how many ml in a LA cartridge?

Answer 28

2.2ml

Question 29

what goes in the notes from LA syringe?

Answer 29

syringe handle sticker, batch number and expiry date of LA

Question 30

how do you prepare mucosa for LA?

Answer 30

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

Question 31

how would you perform the infiltration technique?

Answer 31

- 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

Question 32

how much LA is administered routinely for fillings/extractions?

Answer 32

1/2-3/4 of a cartridge

Question 33

describe a buccal infiltration technique

Answer 33

- 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

Question 34

what may limit the effect of infiltration anaesthesia?

Answer 34

infection and dense bone

Question 35

describe the palatal infiltration technique?

Answer 35

- 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

Question 36

why is there resistance to palatal deposition of LA

Answer 36

tissue is firmly adherent to underlying periosteum

Question 37

how much LA needed for palatal infiltration?

Answer 37

0.2-0.4ml

Question 38

how do you confirm anaesthesia?

Answer 38

- 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

Question 39

Describe how you would give an IANB?

Answer 39

- 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

Question 40

what are the IANB landmarks?

Answer 40

- 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

Question 41

what happens if give IANB too low?

Answer 41

increased lingual nerve injury increased onset time no change in IV

Question 42

what teeth does the posterior superior alveolar nerve block anaesthetise?

Answer 42

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

Question 43

how to give PSA block

Answer 43

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

Question 44

how popular is MSA nerve

Answer 44

28% of population

Question 45

what teeth will MSA block?

Answer 45

MB of 1st maxillary molar and premolars and canine

Question 46

where do you administer and MSA block?

Answer 46

MB fold over the 2nd premolar

Question 47

what does and ASA block anaesthetise?

Answer 47

maxillary incisors and canine on side of delivery

Question 48

where do you administer an ASA block?

Answer 48

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

Question 49

what does the greater palatine block anaesthetise?

Answer 49

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

Question 50

what does the nasopalatine block anaesthetise?

Answer 50

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

Question 51

where do you administer a mental nerve block?

Answer 51

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

Question 52

where do you administer a buccal infiltration?

Answer 52

slightly distal to the tooth to be treated