MIDTERM REVIEW

Question 1

What does a nerve block involve?

Answer 1

Depositions near major nerve trunks at a greater distance from the area of treatment. Provides a wider area of anesthesia

Question 2

What does a field block involve?

Answer 2

Injections near larger terminal nerve branches

Question 3

What do infiltration injections involve?

Answer 3

Deposition near or directly at small terminal nerve endings in the immediate area of treatment

Question 4

What is ASA class I

Answer 4

Healthy patient where routine care with use of anesthetic is ok

Question 5

What is ASA class II

Answer 5

Mild to moderate disease that is well controlled. Routine care is ok with possible limitations to length and complexity as indicated

Question 6

What is ASA class III

Answer 6

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

Question 7

What is ASA class IV

Answer 7

Severe incapacitating disease that is a constant threat to life. Care should be provided by specialized personnel

Question 8

What are the 3 anesthetics we use in clinic?

Answer 8

Articaine 4%, 1:200,000 epi
Lidocaine 2%, 1:100,000 epi
Mepivicaine 3% plain

Question 9

What is the brand name for articaine?

Answer 9

Septocaine

Question 10

What is the brand name for lidocaine?

Answer 10

Xylocaine

Question 11

What is the brand name for mepivicaine?

Answer 11

Carbocaine

Question 12

CNS signs of toxicity

Answer 12

First signs are excitatory then depressive. Tremors or seizures

Question 13

CVS signs of toxicity

Answer 13

Hypotension
Decreased force of heart contractions
Inhibition of cardiac arrhythmias 
Tachycardia
Hypertension
Increased cardiac output

Question 14

How may hematomas occur, how do we treat them?

Answer 14

Punctured or lacerated blood vessels
Rapid swelling, discomfort, asymmetry, and mild trismus are symptoms

Ice packs for the first day

Question 15

What is trismus, how is it treated?

Answer 15

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.

Question 16

How do we handle patients who have medical complications?

Answer 16

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

Question 17

What is the function of vasoconstrictors? Why do we use them?

Answer 17

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

Question 18

How are ester anesthetis metabolized?

Answer 18

In the blood

Question 19

How are amide anesthetics metabolized?

Answer 19

In the liver

Question 20

What are A fibers?

Answer 20

Cutaneous, fast-conducting, “first pain”
Bright, sharp quality

Respond to mechanical stimuli but not thermal or chemical

Question 21

How are nerves stimulated?

Answer 21

Nerve fibers depolarize when sodium ions enter the cell when nerves become excited

A fibers are myelinated and conduct quickly
C fibers are slower

Question 22

Basic facts about the trigeminal nerve

Answer 22

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

Question 23

What is the hydrodynamic theory?

Answer 23

Fluid movement in and out of the dentin tubules

This excites the nerves in the tooth, sending signals to the pulp

Question 24

What is Gate Control Theory?

Answer 24

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.

Question 25

Why is benzocaine only used as a topical?

Answer 25

Lacks a tertiary amine that provides water solubility

ester

Question 26

What is the injection site for the ASA? How deep do we go? What size needle? What does it numb?

Answer 26

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

Question 27

What is the injection site for the MSA? How deep do we go? What size needle? What does it numb?

Answer 27

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

Question 28

What is the injection site for the PSA? How deep do we go? What size needle? What does it numb?

Answer 28

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

Question 29

What is the injection site for the ASA? How deep do we go? What size needle? What does it numb?

Answer 29

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