Local Anaesthetic: Techniques Flashcards
What are the two types of LA injections?
Infiltration
Block
Where does an infiltration act?
On nerve terminals
What do the infiltration injections numb?
Soft tissue
Pulp (in areas of thin alveolar bone i.e. maxilla and lower anteriors)
How long should you wait after an infiltration injection before carrying out work?
2 - 3 minutes
What are the disadvantages of using an infiltration injection?
Only anaesthetise 1 or 2 teeth at the site.
Can’t be used if there is infection present.
What are the advantages of using an infiltration injection?
High succes rate
Atraumatic to the tissues
Easy technique
Patients with what type of blood disorder can infiltration injections be carried out but NOT block injections?
Haemophiliacs - as infiltrations are atraumatic to the tissues and blocks can be in close proximity to blood vessels.
Where do block injections act?
On nerve trunks
What do block injections anaesthetise? (2)
Soft tissues
Pulp in areas of thick and thin alveolar bone i.e. mandibular and maxillary molars.
How long should you wait after a block injection before carrying out treatment?
> 5 mins but < 10 mins
7-8
List the types of injections to numb maxillary teeth.
Buccal infiltration
Posterior superior alveolar neve block
Middle superior alveolar nerve block
Anterior superior alveolar nerve block
List the types of injections to numb maxillary gingiva.
Buccal infiltration
Palatal infiltration
Nasopalatine blocks
What block injection numbs the maxillary premolars?
Middle superior alveolar nerve block.
What block injection numbs the maxillary molars?
Posterior superior alveolar nerve block / middle SAN block for the MB cusp of 1st molar.
What injection numbs the maxillary canines?
Middle/anterior superior alveolar nerve block
What injection numbs the maxillary anteriors?
The anterior superior alveolar nerve block
Where do you inject when carrying out a posterior superior alveolar nerve block?
Mesiobucccal fold over the 2nd maxillary molar
Where do you inject when carrying out a middle superior alveolar nerve block?
Mesiobucccal fold between the 1st molar and the 2nd maxillary premolar.
Where do you inject when carrying out an anterior superior alveolar nerve block?
Mesiobuccal fold over the 1st premolar
Where do you inject when carrying out a nasopalatine block?
Near the incisive foramen on the hard palate. (behind anteriors)
aim for the lateral aspect of the incisive papilla
Describe the technique for crying out a buccal infiltration. (10)
Apply topical and wait 1-2 mins (remove topical)
Stretch the mucosa over the area
Insert the needle distally (to the tooth) with the bevelled end of the needle facing you.
Advance the needle until it is over the apex of the tooth.
Contact bone then withdraw.
Aspirate
Inject the solution slowly.
Massage the LA into the tissues
Wait 2-3 mins
Test for loss of sensation.
How would you test sensation in the teeth before starting treatment?
Extraction - probe the PDL
Restorative - do not probe the PDL.
Describe the technique for carrying out a palatal infiltration. (numbing of the gingiva)
Place handle of the mirror on the palate as a compression and distraction tool.
Insert the needle midway between the greatest depth of the palatal vault and the gingival margin.
Inject slowly - there should be resistance and blanching of the tissues.
What injections would you use to anaesthetise the lower molars and the 2nd premolar?
Inferior alveolar nerve block
What injections would you use to anaesthetise the lower premolars and the canine?
Mental/incisive nerve block
What injections would you use to anaesthetise the lower canine and anteriors?
Labial/buccal infiltration
What injections would numb soft tissues in the mandible? (4)
Long buccal infiltration
Mental nerve block
Infiltrations - buccal/lingual
2nd part of an IDB (inferior alveolar nerve block)
How would you numb lingual gingiva? (2)
2nd part of an IDB (inferior alveolar nerve block)
- Retract the needle 2-3mm to target the lingual nerve.
lingual infiltration
Where do you insert the needle to carry out a long buccal infiltration?
Buccal sulcus distal to the 2nd molar
What size of needle is required for the IDB?
35mm (yellow)
What position should the patient be in for an inferior alveolar nerve block?
Upright position
What are the landmarks used in an inferior alveolar nerve block?
Pterygomandibular raphe
Coronoid notch of the mandibular ramus (Thumb of the left hand)
Posterior border of the mandible (fingers of the left hand)
Lower premolars of the opposite side. (cartridge of anaesthesia should be resting on these)
In reference to the lower molar; where should the needle be inserted?
6 - 10mm (1cm) above the lower molar.
Why should the bone be contacted in an IDB?
To ensure that the parotid gland has not been punctured - could lead to anaesthetisation of the facial nerve and unilateral facial palsy.
Describe the technique for delivering a mental block.
Inject the needle between the 4 and 5 (premolars)
What must you always do before assembling the local anaesthetic?
Check the name, expiration date and batch number (all should be recorded in patient notes.
Why must you aspirate after injecting?
To ensure the solution isn’t injected into the blood vessel.
What speed should local anaesthetic be delivered?
1ml every 30 seconds
What are the consequences of fast delivery of LA?
Pain during procedure
Trauma to the nerve/ tissue which results in;
Bruising
Post op pain
What SHARPS bin should the needle be disposed of in?
Orange lidded SHARPS
What SHARPS bin should the local anaesthetic cartridge be disposed of in?
Blue lidded SHARPS
What SHARPS bin should the local anaesthetic cartridge with residual solution be disposed of in?
Blue lidded SHARPS
How long does TOPICAL anaesthetic take to work?
2 mins approx (1-2)
How long does TOPICAL anaesthetic have an EFFECT for?
2 - 10 minutes
What is the pterygomandibular raphe?
a ligamentous band that connects the buccinator
and the superior constrictor
