Miscellaneous

Question 1

2% lidcaine with 1:100k epi
Limiting amount for lidocaine?
Limited amount for epi?

Which of the two is the limiting factor for a 130 lb patient?
Max # of cartridge’s?

Answer 1

Lido: 7 mg/kg (3.3 mg/lb).
Epi: 0.2 mg

For 140 lb pt, 7 cartridge lido and 11 cartridge epi.

LImited factor is lidocaine (7 cartridge).

Question 2

What are symptoms of local anesthesia systemic toxicity? (10)

Answer 2

Tinnitus, metallic taste, circumoral numbness, altered mental status, slurred speech, hypotension, bradycardia, seizures, ventricular arrhythmias, and cardiac arrest

Question 3

How should you manage local anaesthetic systemic toxicity?

Answer 3

1. Activate EMS
2. Ensure adequate oxygenation
3. If IV established (can treat cardiac aspects, seizures, bradycardia,

Question 4

1. Partoid, submand, and sublingual glands contribute what percent of saliva?
2. Normal daily production?
3. Which gland contributors to resting (unstimulated) saliva?
4. Which gland contributes to stimulated?
5. What gland contributes to both (but at low rates)?

Answer 4

1. 90%
2. 0.5 and 1.5 liters
3. Submandibular
4. Parotid gland
5. Sublingual

Question 5

The salivary glands produce mucous or serous saliva? (Parotid, submandibular, sublingual)

What nerves control via parasympathetic innervation?

Answer 5

1. Parotid: Serous (via Stenton’s duct) - watery, enzyme-rich, and contains amylase. Lacks mucous acini
2. Submandibular: Mixed (mostly serous, some mucous) - Contains amylase, mucins, lysozyme
3. Sublingual: Mixed (mostly mucous, some serous) - thick due to mucins
4. Parotid - Glossopharyngeal nerve (IX)
5. Submandibular - Facial (VII)
6. Sublingual.- Facial (VII)

Question 6

Which systemtic diseases lead to systemic salivary gland hypofunction / xerostomia?

Answer 6

Sjogren syndrome, rheumatoid arthritis, systemic lupus erythematosus, and head & neck cancer therapy

Question 7

1. Lidocaine is what type of anesthetic?
2. What’s the mechanism of action?
3. What’s an example of the alternate type of anesthetic used in dental?
4. What’s difference between lidocaine and articaine? (Hint: what “ring” does articaine have)

Answer 7

1. Amide (not ester)
2. Blocks nerve signals that send pain to the brain
   a. Binds to sodium channels
   b. Prevents sodium flow
   c. Turns off nerves
3. Ester (benzocaine)
4. Articaine has faster onset and a thiophrine ring that can penetrate tissue and bone better

Question 8

What are examples of abrasives in toothpaste? (5)

Answer 8

1. Calcium carbonate
2. Calcium phosphate dihydrate
3. Alumina
4. Silica
5. Sodium bicarbonate

Question 9

Exposed root-surface cementum and dentin are abraded at rates __ and __ times the rate of enamel?

Answer 9

35 and 25, respectively

Question 10

25% Aluminum chloride mechanism of action?

Does it interfere with PVS or bonding?

Answer 10

Vasoconstriction and coagulation of proteins, leading to hemostasis

No does not

Question 11

Ferric sulfate mechanism of action?

Does it interfere with VPS or bonding? How?

Answer 11

Reacts with blood proteins to form ferric ion-protein complex

Yes, interferes with bonding and VPS. The ferric ions can inhibit polymerization