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BDS2 LA Symposium > Overview of LA techniques > Flashcards

Overview of LA techniques Flashcards

1
Q

What is the definition of pain?

A
  • An unpleasant sensory and emotional experience associated with actual or potential tissue damage
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2
Q

What are the 2 types of LA and which type is used more?

A
  • Esters and amides

- Amides are used more now

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3
Q

What are the 2 functions of having a vasoconstrictor in LA?

A
  • Cause BV’s to constrict which is advantageous for us because we can keep LA in area for longer period of time
  • Another function is to control bleeding to help with haemostasis
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4
Q

What are the 2 possible vasoconstrictors in LA?

A
  • Adrenaline

- Felypressin

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5
Q

Which vasoconstrictor must you not use on pregnant patients?

A

Felyperessin

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6
Q

What has happened if a patient says they do not like LA with adrenaline because it ‘makes them feel funny’?

A

The LA has been injected into a BV

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7
Q

What are the 2 preservatives that can be used in LA?

A
  • Bisulphite

- Propylparaben

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8
Q

Which preservative in LA tends to cause a problem with allergens?

A
  • Propylparaben
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9
Q

What are the 2 types of LA injection?

A
  • Infiltration

- Nerve block

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10
Q

What is an infiltration LA injection?

A
  • LA solution deposited around terminal branches of nerves
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11
Q

When are infiltration LA injections used?

A
  • Used to anaesthetise soft tissues

- Used to produce pulpal anaesthesia where alveolar bone is thin (maxilla, lower anterior teeth)

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12
Q

What is a nerve block LA injection?

A
  • Anaesthetic deposited beside the nerve trunk

- Abolishes sensation distal to the site

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13
Q

Where do nerve blocks abolish the sensation from?

A
  • Distal to the site injected
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14
Q

Where are nerve block LA injections used?

A
  • To produce soft tissue anaesthesia

- Used where bone is too thick to allow infiltration (mandible)

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15
Q

Which type of LA injection would you give in the maxilla for dental pulp?

A

Buccal infiltration

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16
Q

Which type of LA injection would you give in the maxilla for the buccal gingivae?

A

Buccal infiltration

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17
Q

Which type of LA injection would you give in the maxilla for the palatal gingivae?

A
  • Palatal injection (infiltration)
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18
Q

Which type of LA injection would you give in the mandible for dental pulp of the lower molars (and second premolars)?

A
  • Inferior alveolar nerve block
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19
Q

What does IDB stand for?

A
  • Inferior dental block
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20
Q

Which type of LA injection would you give in the mandible for dental pulp of the lower premolars and canine?

A
  • Mental (incisive) nerve block
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21
Q

Which type of LA injection would you give in the mandible for dental pulp of the lower canine and incisors?

A
  • Buccal/labial infiltration
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22
Q

Which type of LA injection would you give in the mandible the lingual gingivae?

A
  • Secondary part of inferior alveolar end block is given
  • Lingual infiltration

(when giving IBD - initially aiming for the inferior alveolar nerve however if you withdraw 2-3mm can also get the lingual nerve which supplies the tongue on that side)

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23
Q

What tissues would you anaesthetise if you were restoring a tooth?

A
  • Dental pulp
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24
Q

What tissues would you anaesthetise if you are doing an extraction?

A
  • Pulp and gingivae
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25
What tissues would you anaesthetise if you were doing a scaling?
- Either the gingivae or the pulp AND gingivae
26
What equipment do you need for LA?
- Syringe handle and bung - Syringe barrel - Cartridge
27
What are the 2 lengths of needle used for LA and which injection are they used for?
- Short 25mm for infiltration | - Long 35mm for infe rior alveolar nerve block
28
What do you need to check about the cartridge and put in the notes before you use it?
- The expiry date and batch number
29
Which LA would you use for people with liver disease?
Articaine because it is not processed in the liver 
30
How would you put the handle together?
- All elements separate - Slide chunkier part onto the longer part - Chunkier part is where you are going to place your finger (rest area) - Loop (where you are going to put your thumb) - Bung is going to keep chunkier part on and stop it from sliding down - Bung is placed with the thicker end towards the handle (if put on other way the cartridge will get stuck in the barrel)
31
How would you insert the cartridge into the needle barrel?
- Insert in with the gold end into needle barrel itself | - Pres that down until you hear the little bit of plastic puncture
32
What does 1 click of the safety plus system mean?
- This means the needle can still be used
33
What does a double click of the safety plus system mean?
- Once you do this it will be locked and you will not be able to access the needle again 
34
How should you prep the patient for LA injections? (4 points)
- Check their medical history - Position in chair - Dry mucosa - Apply topical for 1-2 minutes (pea size on cotton wool)
35
What are the steps for a good injection technique? (5 points)
- Stretch mucosa - Puncture mucosa quickly (use distraction) - Position needle tip at target point - Aspirate (to ensure you are not in a BV) - Inject slowly (no less than 30 seconds)
36
What orientation should the needle be when injected?
- Bevel towards you during needle placement 
37
What is the role of the bevel of the needle?
- The role of the bevel is to provide a cutting surface that offers little resistance to mucosa as the needle penetrates and withdraws from the tissue 
38
What should the needle position be like for an infiltration injection?
- Bevel away from bone - If the bevel is towards the bone, the edge of the needle is likely to penetrate the periosteum - Periosteal injections are more likely to evoke a painful response
39
What should the needle position be like for an inferior alveolar nerve block injection?
- Makes no statistical difference or clinical difference
40
If you aspirate and see blood in the cartridge what should you do?
- This shows you are in a BV - If this happens you stop and take out the needle - Then you replace the cartridge
41
At what speed should you administer LA?
- Very slowly | - 'drip it in'
42
What are 3 common myths about giving LA?
- Needle length influences discomfort - Needle diameter influences discomfort - temperature influences discomfort (patients cannot detect if between 15 and 37 degrees)
43
What are the limitations of infiltration anaesthesia? (2 points)
- Infection (may not be able to achieve full pulpal anaesthesia) - Dense bone (may not be able to get anaesthesia if the bone is dense)
44
What are the positives of infiltration anaesthesia? (3 points)
- High success rate - Technically easy - Atraumatic to the tissues
45
What is the process of doing a buccal infiltration? (5 points)
- Stretch cheek - Puncture mucosa with correct bevel of needle - Advance needle until over the apex of the tooth - If contact bone, withdraw slightly - Aspirate (if negative inject slowly, if positive, reposition and repeat)
46
Once you have done the injection for buccal infiltration what should you do? (6 points) 
- Remove syringe from mouth - Slide sheath down to first click - Can replace cartridge if need further injections - Massage LA into tissues - Wait for 2 mins for anaesthesia - Test before you start the treatment
47
What is a posterior superior alveolar nerve block in the maxilla good for?
- Achieving pulpal anaesthesia for the first, second and third molars - Mesio-buccal on first maxillary molar NOT reliably anaesthetised
48
Where would you insert the needle for a posterior superior alveolar nerve block in the maxilla?
- MB fold over maxillary 2nd molar 
49
What is a middle superior alveolar nerve block in the maxilla good for?
- MB of 1st maxillary molar, premolars and maxillary canine 
50
Where would you insert the needle for a middle superior alveolar nerve block in the maxilla?
- Mesio-buccal fold over the 2nd premolar 
51
What is an anterior superior alveolar nerve block in the maxilla good for?
- Successful anaesthesia of maxillary incisors and canine on the side of delivery 
52
Where would you insert the needle for an anterior superior alveolar nerve block in the maxilla?
- Mesio-buccal fold over 1st premolar target is the infraorbi tal foramen
53
Which sharps bin should the needle be put into?
- The orange sharps bin 
54
Which sharps bin should an empty cartridge be put in?
- The orange sharps bin
55
Which sharps bin should a cartridge with remaining LA be put into?
- The blue sharps bin
56
Which bin should the rubber bung be put into?
- Clinical waste bin
57
Where should you insert the needle for a mental block (in the mandible)?
- Between apices of lower premolars
58
Where would you want to insert the needle for a buccal in jection?
- Administer slightly distal to the tooth to be treated
59
What are important landmarks when giving an inferior alveolar nerve block? (5 points)
- Coronoid notch of the mandibular ramus - Posterior border of the mandible - Pterygomandibular raphe - Lower premolar teeth of the opposite side - The site of anaesthetic deposition is in the region of the mandibular foramen
60
How would you give an inferior alveolar nerve block? ( 9 points)
- Thumb places at anterior notch - Needle entry junction of buccal pad of fat/ pterygomandibular raphe - Syringe lies over contra lateral 5-6 - Advanced to bony contact (1cm of needle visible) - If no bony contact reposition syringe distally - If bony contact comes too soon, reposition syringe barrel mesially - When in correct position withdraw from bony contact - Aspirate - Inject slowly (for lingual anaesthesia withdraw while injection last 1/3 of solution)
61
How can you confirm that you have achieved anaesthesia? (4 points)
- Ask the patient how it feels (rubbery, numb, tingly, swollen/fat) - IANB (tongue and lower lip extending to the mid-line on that side should feel different, ability to sense pressure remains) - If carrying out an extraction or oral surgical procedure consider testing mucosa with a probe to ensure anaesthesia

BDS2 LA Symposium (3 decks)

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