Overview of LA Techniques Flashcards
What component in LA aids in haemostatic control?
what are examples
vascoconstrictors
adrenaline
felypressin
What are the two types of LA?
ester
amide
Infiltration VS Block
Infiltration: solution deposited around nerve terminals
Block: solution deposited near nerve trunk
What does infiltration anaesthetise?
Used to anaesthetise soft tissues
Used to produce pulpal anaesthesia where alveolar bone is thin
Maxilla
Lower anterior teeth
What does block anaesthetise?
Abolishes sensation distal to site
Used to produce soft tissue anaesthesia
Used where bone too thick to allow infiltration
Mandible
When should you use LA?
Restoration of tooth
Extractions and Surgical procedures
Scaling
What technique should you use to anaesthetise the maxilla?
(pulp, gingivae (palatal/buccal))
Anaesthesia of the dental pulp
- Buccal infiltration
Anaesthesia of the buccal gingivae
- Buccal infiltration
Anaesthesia of palatal gingivae
- Palatal infiltration
What technique should you use to anaesthetise the mandibular dental pulp?
(molars, premolars etc)
Lower molars (and second premolar)
- Inferior alveolar nerve block (IAN/IDB)
Lower premolars* and canine
- Mental (incisive) nerve block
Lower canine and incisors
- Buccal/labial infiltration
What technique should you use to anaesthetise the mandibular buccal gingivae?
(molars, premolars, etc)
Lower molars and second premolar
- (Long) Buccal infiltration
Lower first premolar and canine
- Infiltration or long buccal or mental nerve block
Lower incisors and canines
- Buccal/labial infiltration
What technique should you use to anaesthetise the mandibular lingual gingivae?
Secondary part of inferior alveolar nerve block if given ( lingual nerve block)
Lingual infiltration
What are the parts of the armamentarium?
Syringe ( + rubber bung)
Needle (+ barrel)
Cartridge of local anaesthetic solution
What does an increase in gauge mean?
advantages
> gauge needles result in less deflection as pass through tissues = > accuracy
> increase in gauge = smaller needle hole
> gauge reduces risk of breakage
> gauge easier aspiration – resistance to flow is greater with smaller gauged needles
When is a short syringe barrel used and when is a long syringe barrel used?
Short 25 mm for infiltration
Long 35 mm for Inferior Alveolar Nerve Block
What should you write down concering the cartridge?
expiry date and batch
What is the steps of the injection technique?
Stretch mucosa
Puncture mucosa quickly (use distraction)
Position needle tip at target point
Bevel of need towards bone
Aspirate
Inject slowly - no less than 30 seconds (drip slowly)
What are the limitations and positives of buccal infiltration?
Limitations
Infection may limit effect
Dense bone may limit effect
Positives
High success rate
Technically easy
Atraumatic
Why should you withdraw slightly at the contact of bone for a infiltration?
to avoid entering the periosteum (very painful)
needs to be supraperiosteum (just above periosteum)
What should you do if you aspirate blood
change cartridge, reposition needle and repeat
For a palatal infiltration, what length of needle should be used?
short
At what contact should you begin injecting a palatal infiltration?
contact of bone
What is a PSA injection used for?
What can it not be used for?
Effective in achieving pulpal anaesthesia for the first, second and third molars
Mesiobuccal on first maxillary molar not reliable anaesthetised
What is a MSA injection used for and where is the site of injection?
MB of 1st maxillary molar, Premolars and maxillary canine
MB fold over the 2 premolar
What is a ASA injection used for and where is the site of injection?
Successful anaesthesia a of maxillary incisors and canine on the side of delivery
MB fold over 1st premolar target is the infraorbital foramen
What does a block in the greater palatine anasthesise?
Posterior portion of hard palatal and overlying soft tissues as far as first premolar and medially to midline
What does a block in the nasopalatine anasthesise?
Anterior portion of hard palate (soft and hard tissue) bilaterally from mesial of right first premoalr to the mesial of left first premolar
Where is the site of a mental nerve block?
Between apices of lower premolars
Do not try to put needle in foramen
Where is the site of a buccal injection?
Lower buccal gingivae slightly distal to the tooth to be treated
What are the important landmarks of an inferior alveolar nerve block?
Coronoid notch of the mandibular ramus
Posterior border of mandible
Pterygomandibular raphe
Lower premolar teeth of the opposite side
What is the site of injection in an IANB?
mandibular foramen
From what distance to the mandibular occlusal plane should the needle be inserted?
6-10mm
Where should the thumb be positioned in a IANB?
anterior coronoid notch
Where should the syringe be at the opposite side of the mouth?
mandibular premolars
If bone isn’t contacted in IANB, what should be done?
reposition syringe distally
If bone is contacted too soon, what should be done?
reposition syringe barrel mesially
If carrying out an extration or oral surgery, what can be tested to ensure anaesthesia of the area?
testing mucosa with probe
