local anesthesia

Question 1

case

Answer 1

1) 7 year old mike for first time restoration
2) he is anxious but can manage vaccines

Question 2

local anesthesia is similar

Answer 2

1) except for different craniofacial anatomy

Question 3

superior dental plexus

Answer 3

1) posterior, middle, anterior superior branches of maxillary nerve

Question 4

maxilla

Answer 4

1) thinner

Question 5

mandible

Answer 5

1) IA nerve
2) thicker
3) bony structure smaller than adults

Question 6

mandibular foramen location

Answer 6

1) <6 years
- below occlusal plane
2) 6-9
- at the level
2) >9 years
- slightly above

Question 7

clinical significance of bone density vs maxilla vs mandible

Answer 7

1) infiltration is more successful in maxilla

Question 8

mandibular ramus is

Answer 8

shorter and narrower anterior-posteriorly
- avoid facial nerve
- you can use 21 mm short needle

Question 9

armamentatium

Answer 9

1) eye protection
2) molt mouth prop
3) cotton 2x2 gauze
4) needle
5) benzocaine

Question 10

never bend needle

Answer 10

1) needles can break
2) kids move
3) incorrect administration technique

Question 11

N2O

Answer 11

1) anxiolytic
2) distorts time passage
3) raises pain threshold
4) 100% oxygen for 5 minutes to prevent diffusion hypoxia

Question 12

N2O contraindications

Answer 12

1) combative
2) emphysema
3) otitis media
4) nasal obstruction
5) URIs
6) cardiomyopathy
7) severe asthma
8) pregnant women in first trimester

Question 13

rapid induction

Answer 13

1) deliver 30-50% N2O immediately
2) 100% O2 post op

Question 14

N2O indications

Answer 14

1) for anxious but cooperative patients
2) long appointments
3) emergency appointments
4) gag reflex

Question 15

N2O effects

Answer 15

1) tingling
2) floating
3) relaxation, happiness

Question 16

averse effects of N2O

Answer 16

1) falling asleep startled awakening
2) nausea, vomiting due to over sedation
3) chronic N2O/O2 exposure
- birth defects, spontaneous abortion, reduced fertility

Question 17

LA bind to

Answer 17

1) sodium channels and prevent action potential

Question 18

maxillary infiltration

Answer 18

1) 1,2 molars, canines, laterals, centrals, 1st permanent molar
2) 1/3 carpule
3) 2-3 mm at the mucobuccal fold

Question 19

mandibular infiltration

Answer 19

1) not for first permanent molar
2) simple operative procedures

Question 20

interdental infiltration

Answer 20

1) soft tissue anesthesia
2) directly into papilla
- perpendicular to long axis of tooth
3) blanching

Question 21

palatal sulcular infiltration

Answer 21

1) inject just beyond the depth of mid palatal sulcus

Question 22

palatal infilfration

Answer 22

1) for profound pulpal anesthesia is required
2) anesthetize the apical area of the palatal root
- use mirror handle and cotton tip

Question 23

long buccal

Answer 23

1) supplement IA
2) when mandibular permanent molars are erupted
3) infiltration next to perm first molar

Question 24

PDL infiltration

Answer 24

1) inject at proximal line angle, bevel towards bone
2) 2-3 mm to PDL space
3) contraindication is infection

Question 25

PSA

Answer 25

1) not common in peds
2) varying anastomosis in posterior and middle superior nerves

Question 26

IA

Answer 26

1) thumb in notch of anterior border of ramus and index finger of posterior border
2) 2/3 carpule and aspirate

Question 27

behavior management

Answer 27

1) establish rules, euphemisms, distraction and teamwork

Question 28

hidden syringe

Answer 28

1) stabilize the head, chin high
2) assistant uncaps
3) perform injection

Question 29

oral sedation

Answer 29

1) medication by mouth, drowsy
2) certification
3) BP and Oxygen monitoring

Question 30

general anesthsia

Answer 30

1) deep sedation
2) intubation
3) full mouth rehabilitation / patients with special healthcare needs