Local anaesthetic

Question 1

What is pain?

Answer 1

an unpleasant sensory and emotional experience associated with actual/ potential tissue damage

Question 2

Type of LA?

Answer 2

Type
- ester
- amide

Contains vasoconstrictor
- adrenaline
- felypressin
- none

Preservatives
- Bisulphite
- Propylparaben: cause allergy

Question 3

Infiltration

Answer 3

• LA deposited around terminal branches of nerves
• anaesthetise soft tissues
• produce pulpal anaesthesia where alveolar bone is thin
• maxilla
• lower anterior teeth

Question 4

Nerve Block

Answer 4

• anaesthesia deposited beside nerve trunk
• abolishes sensation distal to site
• produce soft tissue anaesthesia
• used where bone is too thick to allow infiltration
• ## mandible

Question 5

Anaesthesia in maxilla

Answer 5

• Buccal infiltration: dental pulp and buccal gingivae
• Palatal injection: palatal gingivae

Question 6

Anaesthesia in mandible

Answer 6

Dental Pulp
- 6-8: IDB/ IAN
- premolars and canine: mental nerve block
- canine-incisors: buccal/ labial infiltration

Buccal gingivae
- 6-8: Long Buccal
- 33-34: long buccal/ mental nerve block/ infiltration
- lower incisors/ canine: infiltration

Lingual Gingivae
- secondary part of IAN
- lingual infiltration

Question 7

What tissues to anesthetise?

Answer 7

• restoration of tooth: dental pulp
• extraction: pulp and gingivae

Question 8

What is the name of topical anesthesia?

Answer 8

Xylonor gingival gel

Question 9

Role of needle bevel

Answer 9

• provide cutting surface that offers little resistance to mucosa as needle penetrate and withdraw from tissue

Question 10

Correct bevel orientation

Answer 10

• bevel towards you during needle placement
• lumen unobstructed

Question 11

Limitations of Infiltration

Answer 11

• if there’s infection
• dense bone

Question 12

Positives of infiltration

Answer 12

• high success rate
• easy
• atraumatic

Question 13

Mental block

Answer 13

• between apices of lower premolars
  do not put needle in foramen

Question 14

Important landmarks of IDB

Answer 14

• coronoid notch of mandibular ramus
• pterygomandibular raphe
• posterior border of mandible
• lower premolar of opp side

site of anesthetic is in region of mandibular foramen

Question 15

Triangle region of IDB

Answer 15

Question 16

How to administer IDB

Answer 16

• thumb place at anterior notch
• needle entry junction of buccal pad of fat/ pterygomandibular raphe
• needle lies contralateral to 5-6
• advance to bony contact -1cm needle visible
• if no bony contact then reposition syringe distally
• if bony contact too soon, then reposition syringe barrel mesially
• aspirate
• inject slowly
• withdraw while injection last 1/3 of solution for lingual anesthesia

Question 17

How to confirm anesthesia?

Answer 17

• ask pt how they feel
• pt will feel rubbery, numb, tingling, swollen

IAN
- tongue and lower lip extending to midline will feel numb/ different
- but can still sense pressure
- test using probe to ensure anesthesia