Module 12 Flashcards
what is the principal sensory nerve to the orofacial complex
trigeminal
what are the 3 divisions that trigeminal nerve is composed of
- ophthalmic
- maxillary
- mandibular
what are the major branches of V2 (maxillary)
- Posterior Superior Alveolar (PSA)
- Middle Superior Alveolar (MSA)
- Anterior Superior Alveolar (ASA)
- Greater Palatine (GP)
- Nasopalatine (NP)
- Infraorbital (IO)
what is the quantity of local anesthetic used for a PSA nerve block
0.9 - 1.8 cc
what is the quantity of local anesthetic used for a MSA nerve block
0.9 - 1.2 cc
what is the quantity of local anesthetic used for a ASA nerve block
0.9 - 1.2 cc
what is the quantity of local anesthetic used for a GP nerve block
0.25 cc
what is the quantity of local anesthetic used for a NP nerve block
0.25 cc
what is the quantity of local anesthetic used for a IO nerve block
1.2 cc
what is the quantity of local anesthetic used for a supraperiosteal infiltration
0.9 - 1.0 cc
what teeth does the MSA nerve innervate
- 1st premolar
- 2nd premolar
- mesial of 1st molar
what tissues does the MSA nerve innervate
buccal gingiva in premolars / 1st molar region
when doing a MSA block what is the target area
slightly apical to the premolars either 1st or 2nd
where is penetration of the mucosa made in a MSA block
along the long axis at the apex of the premolar
what needle is used for a MSA nerve block injection
27 short
how much of the needle length is inserted into the mucosa
1/3 to half
does it matter which way the bevel is pointed?
YES - towards the bone!
how much the carpule do you use for a MSA block
about 1/2 carpule (0.9 - 1.0 cc)
why does it matter which direction the bevel is directed
if it is not directed towards the bone it can inflict pain on the patient
what teeth does the PSA nerve innervate
- 3rd molar
- 2nd molar
- distal 1st molar
what tissue does the PSA nerve innervate
buccal gingiva in the molar region
what is the target area of a PSA injection
apical to the root of the 3rd molar
where is penetration of the mucosa made in a PSA nerve block
just lateral to the 2nd molar at a 45 degree angle to the long axis of the tooth and at a 45 degree angle approaching medially
what do you want to avoid in a PSA nerve block
Pterygoid Plexus
what needle is used for a PSA nerve block
27 short
how much of the needle is inserted into the mucosa in a PSA nerve block
half the needle length
how many carpules are used for this block
1/2 carpule (0.9 - 1.0 cc)
what teeth does the ASA nerve innervate
- canines
- lateral incisors
- central incisors
what tissue does the ASA nerve innervate
labial mucosa & inner aspect of the lip to the midline
what is the target area of an ASA nerve block
apical and slightly distal to the canine
where is penetration of the mucosa made in a ASA nerve block
along the long axis of the canine to the target zone
what needles is used for an ASA nerve block
27 short
how much of the needle is inserted in an ASA nerve block
1/3 to half the needle length
what is a specific instruction for giving an ASA nerve block
pull the lip tight
how many carpules are used for an ASA injection
1/2 carpule (0.9 - 1.0 cc)
which of the following provides pulpal innervation to the maxillary molars?
a - ASA
b - MSA
c - PSA
d - Inferior Alveolar Nerve
c - PSA
what teeth does the GP innervate
NONE
what tissues does the GP innervate
palatal soft tissue and bone from the distal of the canine to the junction of the hard and soft palate and medial towards the midline
what is the target area for a GP nerve block
greater palatine foramine
where is penetration of the mucosa made in a GP nerve block
- just anterior to the greater palatine foramen
- 1/2” medial to the disto-palatal cusp of the 2nd molar
how is the needle positioned in a GP nerve block
nearly perpendicular to the mucosa
what is a cotton tip applicator used for in a GP nerve block
to locate GP foramen since tissue is thicker there & to eliminate patient discomfort
what is a specific technique for administering the GP nerve block
- apply pressure to the cotton tip perpendicular to the bone until tissue blanches
- keep pressure on the applicator during penetration and first couple of drops
- ease pressure as anesthetic is delivered
what needles is used for the GP nerve block
27 short
how much of the needle is inserted in a GP nerve block
needle is inserted until BEVEL IS BURIED
how is the bevel positioned in a GP nerve block
laterally towards the soft tissue
how much of the carpule is administered in a GP nerve block
1/4 carpule (0.25 cc) or until the tissue blanches
what teeth are innervated by the NP nerve
NONE
what tissues are innervated by the NP nerve
- palatal soft tissue and bone anterior to the portion of the hard palate from distal of one canine to the distal of the other canine
what is the nasopalatine nerve block also called
incisive nerve block
what is the target area of the NP nerve block
incisive foramen
where is penetration of the mucosa in NP nerve block
- just lateral to the incisive papilla toward the posterior portion of the papilla
- at a 45 degree angle to the palatal bone
what is the specific technique for NP nerve blocks
- apply pressure to cotton tip on incisive papilla until tissue blanches
- keep pressure on applicator during penetration and first couple of drops
- ease pressure as anesthetic is delivered
what needle is used for a NP nerve block
27 short
how much of the needle is inserted in a NP nerve block
until bevel is buried
how much of a carpule is used in a NP nerve block
1/4 carpule (0.25 cc) or until tissue blanches
the greater palatine nerve innervates the following teeth:
a - 1-3
b - 4-5
c - 6-8
d - the greater palatine nerve provides no pulpal innervation
d - the greater palatine nerve provides no pulpal innervation
what teeth does the IO nerve innervate
- canine
- incisors to midline
- 75% premolars + part of 1st molar
what tissue does the IO nerve innervate
buccal gingiva associated with teeth affected
what does the IO nerve innervate in addition to the teeth and tissue
the skin of the lower eyelid, upper lip, and lateral aspect of the nose
what is the target area of the IO nerve block
- near infraorbital foramen
- inferior to the orbital rim
where does penetration of the mucosa occur in IO nerve block
- parallel to the 1st premolar
- angled toward the infraorbital foramen
what needle is used for an IO nerve block
25 long or 27 short
in an IO nerve blcok insertion is made until ___
bone is contacted (about half the needle length)
how much of a carpule is used in an IO nerve block
3/4 carpule (0.9 -1.2 cc)
what is the superperiosteal injection used for
- pulpal anesthesia of 1-2 teeth
- soft tissue anesthesia of limited area
what is the target area of a supraperiosteal injection
apical region of the tooth to be anesthetized
where is penetration of the mucosa in a supraperiosteal injection made
along the long axis of the maxillary tooth to the target zone
what needle is used for a supraeriosteal injection
27 short
where is the supraperiosteal injection insertion made
at the height of the mucogingival fold with the needle advancing to the apical region of the tooth
how much of a carpule is used for a supraperiosteal injection
1/3 carpule (0.6 cc)
when giving a PSA block you should use a 25 gauge long needle
a - true
b - false
b - false
27 short, a long needle is too long and is more likely to encounter the pterygoid plexus and increase the risk of hematome
needle re-capping has to be done with __
one hand
how do you prepare a syrnige
engage the harpoon into the stopper with gentle but firm pressure on the thumb ring until the harpoon is FLUSH with the rubber
how do you unload a syringe
- take re-capped syringe to sharps container
- unscrew needle to remove while holding the cardboard
- discard needle ONLY in sharps container by pushing capped end through cardboard
- retract piston by pulling back on the thumb ring
- remove carpule & dispose in sharp container
what do you do if the syringe needle adaptor remains on the hub
remove it with cotton pliers, do NOT use your fingers
what do you do if the rubber stopper remains on the harpoon
remove it with cotton pliers, do NOT use your fingers
