Local Anesthesia

Question 1

What does the trigeminal nerve do

Answer 1

Provides sensory/afferent innervation for The Teeth, periodontium and gingiva

Question 2

What type of anesthetic is most effective in the maxillary arch and why?

Answer 2

Infiltration because the bone is less dense

Question 3

What type of anesthesia is required for the mandibular arch and why?

Answer 3

Nerve block is required because bone is very dense

Question 4

What does local infiltration do?

Answer 4

Anesthetizes a small area, 1 to 2 teeth by injecting near the tooth apices

Question 5

What does a nerve block do

Answer 5

Anesthetize is a larger area, 3 to 8 teeth by injecting near the nerve trunk

Question 6

What is the target area for a posterior superior alveolar block

Answer 6

Posterior superior alveolar nerve with dental and alveolar branches (posterior superior alveolar foramen)

Question 7

Where is the injection site for the posterior superior alveolar block?

Answer 7

Mucobuccal fold at the Apex of the maxillary second molar

Question 8

Which tissues are anesthetized by PSA

Answer 8

Hard tissue- DB root and palatal root of the first molar, second and third molars; associated periodontium (PDL and alveolar bone)

Soft tissue: buccal a gingiva and cheek

Question 9

What is the target area for the MSA block

Answer 9

Middle superior alveolar nerve with dental and alveolar branches

Question 10

Injection site for an MSA block

Answer 10

Mucobuccal fold at the Apex of the maxillary second pre-Molar

Question 11

Tissues anesthetized by an MSA

Answer 11

Hard tissue- first and second pre-molars, MB root of first molar; associated periodontium

Soft tissue- Buccal a gingiva and cheek

Question 12

Target area for ASA block

Answer 12

Anterior superior alveolar nerve with dental and alveolar branches

Question 13

Injection site for ASA block

Answer 13

Mucobuccal fold at the Apex of the canine just mesial to the canine eminence

Question 14

Tissues anesthetized by an ASA

Answer 14

Hard tissue- canine and incisors

Soft tissue- Facial gingiva and lip

Question 15

Target area for an infraorbital block

Answer 15

Infraorbital nerve which includes both anterior and middle superior alveolar with dental and alveolar branches

Question 16

Injection site for an infraorbital block

Answer 16

Mucobuccal fold at the Apex of the maxillary first pre-Molar

Question 17

Tissues anesthetized by infraorbital block

Answer 17

Hard tissue- incisors, canine, premolars and MB root of the first molar

Soft tissue- facial and buccal gingiva, cheek and lip

Question 18

Target area for the greater Palatine block

Answer 18

Greater Palatine nerve at the greater Palatine for foramen, palatal to the first molar

Question 19

Injection site for the greater Palatine block

Answer 19

Junction of the alveolar process and the hard palate, just distal to the first molar

Question 20

Tissues anesthetized by the greater Palatine block

Answer 20

No hard tissues

Soft tissue: palatal a gingiva from gingiva margins to the midline, and from distal of the canine to distal of the third molar

Question 21

Target area for a Nasopalatine block

Answer 21

Nasopalatine nerve at the incisive foramen just lingual to the central incisors

Question 22

Injection site for the nasopalatine block

Answer 22

Just lateral to the incisive papilla

Question 23

Tissues anesthetized by the NP block

Answer 23

No hard tissue

Soft tissue: palatal gingiva from canine to canine 

Question 24

Target area for the inferior alveolar block (inferior alveolar nerve with lingual nerve; mandibular block)

Answer 24

Inferior alveolar nerve superior to mandibular foramen, this anesthetizes the lingual nerve also

Question 25

Injection site for the inferior alveolar block

Answer 25

Medial surface of the ramus, distal to the last molar, 6 to 10 mm superior to the occlusal surface, between the coronoid notch and the Pterygomandibular line/Raphe

Question 26

Tissues anesthetized by IA block

Answer 26

Hard tissues- molars, pre-molars, canine and incisors to midline Soft tissue: facial gingiva anterior to the mental foramen and lip

Question 27

Target area for the lingual nerve block

Answer 27

Lingual nerve

Question 28

Injection site for the lingual nerve block

Answer 28

This nerve branch is anesthetized when you administer the mandibular block

Question 29

Tissues anesthetized by lingual block

Answer 29

No hard tissue All lingual gingiva from the last molar to the midline; anterior 2/3 of the tongue and the floor of the mouth

Question 30

Target area for the buccal/long buccal block

Answer 30

Buccal nerve

Question 31

Injection site for the buccal block

Answer 31

Buccal tissue on the anterior border of the ramus just distal and buccal to the last molar in the arch

Question 32

Tissues anesthetized by buccal block

Answer 32

No hard tissue Buccal gingiva of the molars

Question 33

Target area for the incisive block

Answer 33

Incisive branch of inferior alveolar at the mental foramen; the inferior alveolar bifurcates at the mental foramen to form the incisive nerve and the mental nerve

Question 34

Injection site for the incisive block

Answer 34

Mucobuccal fold between the apices of the pre-molars

Question 35

Tissues anesthetized by the incisive block

Answer 35

Hard tissues: incisive nerve. Premolars, canine and incisors Soft tissue: mental nerve. Facial and buccal gingiva and lip anterior to the mental foramen

Question 36

What happens when a toxic drug overdose occurs

Answer 36

Circulating blood level of the drug becomes Too high and reaches a toxic level for the individual

Question 37

Typical causes of overdose

Answer 37

Intravascular injection: prevented by aspiration prior to deposition of the anesthetic Excessive total drug dose: affected by drug volumes, drug choice, patient weight, age, physical medical status Rapid absorption into the circulatory system: affected by rate of injection, presence or absence of a vasoconstrictor or vascularity of injection site Reduced elimination and/or metabolism of drug: reduced kidney or liver function, circulation, as a result of congestive heart failure 

Question 38

Allergies and anesthesia

Answer 38

Rare with amide drugs Symptoms range from mild localized erythema or itching to anaphylaxis or laryngeal Edema Onset may occur within a few seconds to several hours

Question 39

What are the most common allergens found in anesthetics

Answer 39

Sodium bisulfite which is an antioxidant/preservative or Ester topical anesthetic

Question 40

Cause and symptoms of psychogenic reactions to anesthesia

Answer 40

Caused by anxiety response to the injection procedure Symptoms include Vasodepressor syncope and hyperventilation.

Question 41

Trismus

Answer 41

Spasms of the jar muscles that restrict opening or make it uncomfortable, occurs with IA block and PSA block

Question 42

Hematoma

Answer 42

Blood from the vein leaks into the surrounding tissues; can occur with any injection, especially with the PSA, Ayo and IEA blocks; aspiration should always be attempted to avoid injecting into a blood vessel

Question 43

Needle track infection

Answer 43

Can occur with any injection, most serious with the PSA due to close proximity of the pterygoid Venous plexus and the maxillary artery; and with the IA due to close proximity to the parotid gland

Question 44

Paresthesia

Answer 44

Trauma to nerve resulting in persistent anesthesia, usually lasting a few days or weeks; may persist for months to a year and/or become permanent

Question 45

Epithelial desquamation

Answer 45

Tissue sloughing. May follow prolonged application of topical anesthetic