Local Test 2

Question 1

Intra-osseus anesthesia:
What?
3 examples

Answer 1

LA deposition into cancellous bone supporting tooth

PDL ligament injection
Intra-septal
Intra-osseus

Question 2

Greatest benefit for PDL (ILI) injection

Answer 2

Mandible for localized area

Question 3

Indications and contraindications for PDL

Answer 3

I:

• 1/2 teeth anesthesia
• Isolated teeth in both mand quadrants need it (avoid full IA block)
• Children (avoid IA)
• Risky IA block (hemophilia)

C:

• infection or severe inflammation
• presence of primary teeth

Question 4

Side effects of PDL injection and how to avoid

Answer 4

Discomfort/sensitivity to biting for a few days

Inject slower/less

Question 5

What gets anesthetized when doing an PDL

Answer 5

Bone
Soft tissue
Apical
Pulpal tissues

Question 6

How much is injected in PDL

How long should it take

Answer 6

0.2 mL/20 sec

Question 7

Intraseptal injections anesthetize what

Answer 7

Bone, soft tissue

Question 8

Why would you do an intraseptal injection

Answer 8

Periodontally involved teeth

Question 9

Intraseptal injection:
Where
How much over how long

Answer 9

Papilla, 45˚ to tooth (90˚ to tissue)

0.2-0.4 ml/20 sec

Question 10

Intra-osseus injection:
What is anesthetized?
Complications

Answer 10

Bone, soft tissue, root structures

Fistula formation, perforation

Question 11

Articaine formulation

Answer 11

Septicaine

Question 12

Why is articaine more effective than lido

But also, it isn’t. And causes parathesia

Answer 12

Thiophene ring instead of benzene, increased lipid solubility

Question 13

Each cartridge of LA contains how much

Each 1% of anything = _ mg/ml

Answer 13

1.7 ml

10mg/ml

Question 14

1:100,000 solution contains _mg/ml

Answer 14

0.01mg/ml or 10mcg

1%          = 1/100        = 10mg/ml
0.001%  = 1/100,000 = 0.01mg/ml

Question 15

Adult max safe dose of 2% lidocaine

Answer 15

500 mg

Question 16

70 kilogram adult can have how many cartridges of 1:100,000 EPO?

Max amount of epi is 0.2mg

Answer 16

1: 100,000 is 0.01 mg/ml
0. 2mg max/0.01 mg/ml LA = 20ml total of LA can take

20ml/1.7ml per cartridge = 11 cartridges

Question 17

Healthy adult max epi

Unhealthy?

Answer 17

0. 2

0. 04

Question 18

Epi sensitive patient drug of choice?

Long term soft tissue anesthesia?

Difficulty achieving anesthesia

Answer 18

Mepivacaine 3% w/o vasoconstrictor

Bupivicaine 0.5% with 1:200,000 epi

Articaine 4% with 1:100,000 epi

Question 19

Articaine can’t be used where

Answer 19

Mandibular blocks

Question 20

T/F Gow-Gates and Vazirani-Akinosi are superior to standard IA nerve block

Answer 20

FALSE

Question 21

_ IA block was more successful than a _ one

Answer 21

Slow (60s)

Rapid (15s)

Question 22

If patient has profound lip numbness but no pulpal anesthesia, do what

Answer 22

Supplemental injection NOT repeating IA

Question 23

Intraosseus anesthesia onset takes _

Answer 23

No time (immediate)

Question 24

T/F IO after IA works

Answer 24

TRUE

Question 25

How does an anesthetic reversal agent work

Answer 25

Vasodilation of vascular smooth muscle

Question 26

What needles should be used for IANB

Answer 26

Long and not 30-gauge

Question 27

Needle breaks, what do you do

Answer 27

Stop, refer to OMFS, document it

Question 28

3 things can cause prolonged anesthesia or parasthesia

Answer 28

Needle injury to nerve Contaminated LA LA itself (articaine)

Question 29

4 causes of trismus

Answer 29

Trauma to muscles (multiple needle punctures) Contaminated solutions Hemorrhage Infection

Question 30

How to manage trismus

Answer 30

``` Heat therapy Warm saline rinses Analgesics Muscle relaxants Physiotherapy ```

Question 31

If trismus lasts longer than 48 hours, consider _

Answer 31

Infection

Question 32

Management if hematoma starts

Answer 32

``` Pressure Document Analgesics Antibiotics Ice No heat for 4-6 hrs ```

Question 33

Infection causes

Answer 33

Needle contamination | Spreading infection by solution

Question 34

Idiosyncrasy:

Answer 34

Unexpected response to a drug

Question 35

Cause of overdose levels

Answer 35

``` Total dose is too high Absorption is too rapid Intravascular injection Bio-transformed too slow Eliminated too slow ```

Question 36

How prevalent is atypical pseudocholinesterase

Answer 36

6-7% of patients

Question 37

Esters and amides are hydrolyzed/transformed where

Answer 37

Esters: liver and plasma Amides: liver

Question 38

Better topical

Answer 38

Amide

Question 39

Minimal overdose

Answer 39

``` Talkative Stutter Apprehension Excitability Metallic taste Sweating Higher BP/HR ```

Question 40

Moderate to high overdose symptoms

Answer 40

Tonic clinic seizure CNS depression depressed BP/HR/RR

Question 41

Blood level to have tonic-clonic seizure

Answer 41

>7.5µg/ml

Question 42

If a patient has a severe rxn, do what

Answer 42

``` Stop Get help Patient supine with feet up Establish airway O2 ```

Question 43

3 things people can be allergic to in LA

Answer 43

Esters | Bisulfite or metabisulfite

Question 44

Max number of cartridges of 2% lido 1:100,000 a healthy adult can receive

Answer 44

14 because of lidocaine | But 11 since max dose of epi is less

Question 45

Max cartridges of mepivicaine

Answer 45

8