MIDTERM REVIEW Flashcards
What does a nerve block involve?
Depositions near major nerve trunks at a greater distance from the area of treatment. Provides a wider area of anesthesia
What does a field block involve?
Injections near larger terminal nerve branches
What do infiltration injections involve?
Deposition near or directly at small terminal nerve endings in the immediate area of treatment
What is ASA class I
Healthy patient where routine care with use of anesthetic is ok
What is ASA class II
Mild to moderate disease that is well controlled. Routine care is ok with possible limitations to length and complexity as indicated
What is ASA class III
Severe disease that limits activity but is not incapacitating.
Routine use of anesthetic is ok within guidelines. Limit procedural stress, length of appointment and get proper rest the night before treatment
What is ASA class IV
Severe incapacitating disease that is a constant threat to life. Care should be provided by specialized personnel
What are the 3 anesthetics we use in clinic?
Articaine 4%, 1:200,000 epi
Lidocaine 2%, 1:100,000 epi
Mepivicaine 3% plain
What is the brand name for articaine?
Septocaine
What is the brand name for lidocaine?
Xylocaine
What is the brand name for mepivicaine?
Carbocaine
CNS signs of toxicity
First signs are excitatory then depressive. Tremors or seizures
CVS signs of toxicity
Hypotension Decreased force of heart contractions Inhibition of cardiac arrhythmias Tachycardia Hypertension Increased cardiac output
How may hematomas occur, how do we treat them?
Punctured or lacerated blood vessels
Rapid swelling, discomfort, asymmetry, and mild trismus are symptoms
Ice packs for the first day
What is trismus, how is it treated?
Limited opening or range of motion due to trauma, injury etc.
Most commonly caused during treatment when teh needle is inserted too far medially during an IANB causing damage to the medial pterygoid muscle
Treatment includes analgesics, warm salt water rinses, PT, muscle relaxants, occlusal appliances etc.
How do we handle patients who have medical complications?
No treatment within 6 months of a heart attack or stroke.
Limit use of epinephrine, max 2 cartridges 1:100,000 or use anesthetics w/o vasoconstrictors
What is the function of vasoconstrictors? Why do we use them?
They reverse vasodilation improving the depth of anesthesia as well as prolonging the effects and reducing the amount in the blood and reducing bleeding at the site of infection
How are ester anesthetis metabolized?
In the blood
How are amide anesthetics metabolized?
In the liver
What are A fibers?
Cutaneous, fast-conducting, “first pain”
Bright, sharp quality
Respond to mechanical stimuli but not thermal or chemical
How are nerves stimulated?
Nerve fibers depolarize when sodium ions enter the cell when nerves become excited
A fibers are myelinated and conduct quickly
C fibers are slower
Basic facts about the trigeminal nerve
5th cranial nerve, the largest of the cranial nerves
3 branches/divisions: I- Opthalimic. II- Maxillary. III- Mandibular
Maxillary exits through the foramen rotundum
Mandibular exits through the foramen ovale
Small motor root, large sensory root
What is the hydrodynamic theory?
Fluid movement in and out of the dentin tubules
This excites the nerves in the tooth, sending signals to the pulp
What is Gate Control Theory?
Balance between the larger nerve fibers traveling towrd the brain and smaller fibers traveling to the spinal cord.
Both carry impulses through the same gate but the larger fiber impulses inhibit impulses from the smaller ones
More activity from the larger fibers means less pain sensation. More activity from smaller fibers means more pain sensation.
Why is benzocaine only used as a topical?
Lacks a tertiary amine that provides water solubility
ester
What is the injection site for the ASA? How deep do we go? What size needle? What does it numb?
Height of the mucobuccal fold at the apex of the canines.
3-6mm in depth using a 27 short needle
Numbs the canines, laterals and centrals
What is the injection site for the MSA? How deep do we go? What size needle? What does it numb?
Height of the mucobuccal fold at the apex of the 2nd premolar.
5-8mm in depth using a 27 short needle
Numbs the premolars an dthe mesiobuccal cusp of the 1st molar
What is the injection site for the PSA? How deep do we go? What size needle? What does it numb?
Height of the mucobuccal fold of the 2nd molar
14-16mm in depth using a 27 short needle
Numbs the maxillary molars and the distobuccal cusp of the 1st molar
What is the injection site for the ASA? How deep do we go? What size needle? What does it numb?
Just anterior to the greater palatine foramen on the roof of the mouth
3-6mm in depth using a 27 short needle
Numbs the maxillary palatal tissues but not the teeth- from the distal of the canines to the molars
