managing local anesthesia for endo

Question 1

articaine

Answer 1

1) amide and ester properties

Question 2

amides

Answer 2

1) metabolized hepatic system

Question 3

ester

Answer 3

1) metabolized by plasma

Question 4

intermediate duration of pulpal anesthesia

Answer 4

1) about 60 minutes

Question 5

which anesthetics are safe to use for pregnancy

Answer 5

1) lidocaine is safe
2) articaine, bupivacaine, mepivacaine category C

Question 6

maxillary teeth

Answer 6

1) 1-2 carps of 4% articaine with 1:100k epi
2) buccal infiltration and 1/4 carp on the lingual aspect for rubber dam clamp

Question 7

success of lidocaine in maxillary

Answer 7

1) works well

Question 8

does increasing cartridge of anesthetics help in maxillary

Answer 8

1) not really, just use 1 carp

Question 9

articaine sucess rate

Answer 9

1) higher than lidocaine for incisors
2)about the same for molars

Question 10

buccal plus palatal

Answer 10

1) usually better for hot tooth
2) gets more numb

Question 11

PSA

Answer 11

1) might cause a hematoma
2) usually infiltration is better

Question 12

augmentation

Answer 12

1) supplement at the 30 minute mark
2) do not wait until the whole time

Question 13

standard protocol for mandibular teeth

Answer 13

1) anteriors
- infiltration 1-2 carps of articaine
2) molars and premolars
- IA block with 2% lidocaine
- give a supplemental infiltration of articaine 1/2 buccal, 1/2 lingual when they start to feel tingly

Question 14

how to check for anesthesia

Answer 14

1) endo ice for RCT because you are going all the way to the nerve
2) leave it on for several seconds

Question 15

why is failure of a block higher for anteriors

Answer 15

1) central core theory
2) axons in the outer area innervate molars and premolar
3) but the inner core area innervates the anteriors

Question 16

anesthesia success in symptomatic irreversible pulpitis

Answer 16

1) not a hot tooth, IANB is 75-90% success
2) with a hot tooth, IANB success is 15-57%
3) people with significant pre op pain 16%

Question 17

septocaine vs lidocaine for blocks

Answer 17

1) success is the same
2) suggestion to not use articaine
- 5x more risk for nerve injuries
- risk for paresthesia…is overall still really really low
- so maybe the result is overblown

Question 18

medications for pre-op

Answer 18

1) ibuprofen

Question 19

nitrous

Answer 19

1) success is 50%

Question 20

patient related factors

Answer 20

1) hx of diabetes and pre-op pain interfere
2) pts. with red hair has MC1R
- may have more anxiety and fear

Question 21

supplemental anesthetic injections

Answer 21

1) intraosseous
- special syringe to go into cortical bone
- success is a lot higher
2) intraligamentary
- PDL injection
3) intrapulpal
- FINAL resort

Question 22

considerations for intraosseous

Answer 22

1) do not do in painful teeth with necrotic pulp
2) do not do it with cellulitis or abscess
3) or bisphosphonate issues

Question 23

buccal infiltration after block

Answer 23

1) articaine > lidocaine for supplementals

Question 24

PDL injection

Answer 24

1) use intraligamentary syringe
- grab that
2) the manual PDL injection may not have enough pressure
3) often may feel occlusion is high afterward
4) may be painful

Question 25

intraosseous

Answer 25

1) slow speed handdrill to drill into the bone
2) then use needle to insert into the sleeve

Question 26

intrapulpal

Answer 26

1) super painful
2) success is backed on presence of back pressure
3) success drops when access is large

Question 27

gow gates vs IAN

Answer 27

1) no difference for a hot tooth

Question 28

can always do a pulpotomy only

Answer 28

1) 96% pain relief
2) do not need to start debridement if not time