OD 20 - Advanced pain control Flashcards
What are the 6 reasons LA fails?
Technique Pharmaceutical How invasive treatment is Anatomical Pathology Psychological
Why would LA fail due to technique?
Incorrect position - try again
Insufficient solution injected
Injected too fast - blocks better success over 1 minute to allow concentration around the N trunk
What happens to LA if it keep to higher temperature conditions?
Adrenaline oxidises, therefore reducing effectiveness
Why would LA fail due to patients anatomy?
Dense cortical bone preventing diffusion
Mandibular foramen higher
Mental foramen can vary in position between 3 and 6 - palate
Accessory nerve supply - crossover of L and R IAN innervation to incisors
Why would LA fail due to pathology?
Inflamed pulp more difficult to anaesthetise
Altered pH, therefore increased vascularity so loss of LA faster
Why does articaine infiltration bone better?
Higher concentration and smaller particles
When would you repeat IANB?
If tooth is asymptomatic
If no ST anaesthesia
Not to repeat if ST anaesthesia and irreversible pulpitis
What are the 2 higher mandibular blocks called?
Gow Gates
Akinsoi-Vazirani
How is Gow Gates injection done?
Mouth open
Palatal cusps of 7s
Inter-tragal notch
How is Akinsoi-Vazirani injection done?
Mouth closed
Used in trismus or severe gag reflex
No bony end point, placed distal to 7
Where is crestal/interseptal injection placed?
Into papilla
