Overview of LA Techniques

Question 1

What component in LA aids in haemostatic control?

what are examples

Answer 1

vascoconstrictors

adrenaline
felypressin

Question 2

What are the two types of LA?

Answer 2

ester
amide

Question 3

Infiltration VS Block

Answer 3

Infiltration: solution deposited around nerve terminals
Block: solution deposited near nerve trunk

Question 4

What does infiltration anaesthetise?

Answer 4

Used to anaesthetise soft tissues

Used to produce pulpal anaesthesia where alveolar bone is thin

Maxilla

Lower anterior teeth

Question 5

What does block anaesthetise?

Answer 5

Abolishes sensation distal to site

Used to produce soft tissue anaesthesia

Used where bone too thick to allow infiltration

Mandible

Question 6

When should you use LA?

Answer 6

Restoration of tooth

Extractions and Surgical procedures

Scaling

Question 7

What technique should you use to anaesthetise the maxilla?

(pulp, gingivae (palatal/buccal))

Answer 7

Anaesthesia of the dental pulp
- Buccal infiltration

Anaesthesia of the buccal gingivae
- Buccal infiltration

Anaesthesia of palatal gingivae
- Palatal infiltration

Question 8

What technique should you use to anaesthetise the mandibular dental pulp?

(molars, premolars etc)

Answer 8

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

Question 9

What technique should you use to anaesthetise the mandibular buccal gingivae?

(molars, premolars, etc)

Answer 9

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

Question 10

What technique should you use to anaesthetise the mandibular lingual gingivae?

Answer 10

Secondary part of inferior alveolar nerve block if given ( lingual nerve block)

Lingual infiltration

Question 11

What are the parts of the armamentarium?

Answer 11

 Syringe ( + rubber bung)
 Needle (+ barrel)
 Cartridge of local anaesthetic solution

Question 12

What does an increase in gauge mean?

advantages

Answer 12

> 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

Question 13

When is a short syringe barrel used and when is a long syringe barrel used?

Answer 13

 Short 25 mm for infiltration
 Long 35 mm for Inferior Alveolar Nerve Block

Question 14

What should you write down concering the cartridge?

Answer 14

expiry date and batch

Question 15

What is the steps of the injection technique?

Answer 15

 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)

Question 16

What are the limitations and positives of buccal infiltration?

Answer 16

Limitations
 Infection may limit effect
 Dense bone may limit effect

Positives
 High success rate
 Technically easy
 Atraumatic

Question 17

Why should you withdraw slightly at the contact of bone for a infiltration?

Answer 17

to avoid entering the periosteum (very painful)

needs to be supraperiosteum (just above periosteum)

Question 18

What should you do if you aspirate blood

Answer 18

change cartridge, reposition needle and repeat

Question 19

For a palatal infiltration, what length of needle should be used?

Answer 19

short

Question 20

At what contact should you begin injecting a palatal infiltration?

Answer 20

contact of bone

Question 21

What is a PSA injection used for?

What can it not be used for?

Answer 21

 Effective in achieving pulpal anaesthesia for the first, second and third molars
 Mesiobuccal on first maxillary molar not reliable anaesthetised

Question 22

What is a MSA injection used for and where is the site of injection?

Answer 22

 MB of 1st maxillary molar, Premolars and maxillary canine
 MB fold over the 2 premolar

Question 23

What is a ASA injection used for and where is the site of injection?

Answer 23

 Successful anaesthesia a of maxillary incisors and canine on the side of delivery
 MB fold over 1st premolar target is the infraorbital foramen

Question 24

What does a block in the greater palatine anasthesise?

Answer 24

Posterior portion of hard palatal and overlying soft tissues as far as first premolar and medially to midline

Question 25

What does a block in the nasopalatine anasthesise?

Answer 25

Anterior portion of hard palate (soft and hard tissue) bilaterally from mesial of right first premoalr to the mesial of left first premolar

Question 26

Where is the site of a mental nerve block?

Answer 26

 Between apices of lower premolars
 Do not try to put needle in foramen

Question 27

Where is the site of a buccal injection?

Answer 27

 Lower buccal gingivae slightly distal to the tooth to be treated

Question 28

What are the important landmarks of an inferior alveolar nerve block?

Answer 28

 Coronoid notch of the mandibular ramus
 Posterior border of mandible
 Pterygomandibular raphe
 Lower premolar teeth of the opposite side

Question 29

What is the site of injection in an IANB?

Answer 29

mandibular foramen

Question 30

From what distance to the mandibular occlusal plane should the needle be inserted?

Answer 30

6-10mm

Question 31

Where should the thumb be positioned in a IANB?

Answer 31

anterior coronoid notch

Question 32

Where should the syringe be at the opposite side of the mouth?

Answer 32

mandibular premolars

Question 33

If bone isn’t contacted in IANB, what should be done?

Answer 33

reposition syringe distally

Question 34

If bone is contacted too soon, what should be done?

Answer 34

reposition syringe barrel mesially

Question 35

If carrying out an extration or oral surgery, what can be tested to ensure anaesthesia of the area?

Answer 35

testing mucosa with probe