Pain and Anxiety

Question 1

Local anaesthesia

Answer 1

Anaesthesia= loss of all sensation

Sensory nerve supply Responds to things like temperature pain

Sensation felt by electrical impulses sensory neurons to the brain then information acts

Local anaesthesia block the electrical impulses so don’t reach the brain

Question 2

Local anaesthesia drugs either 2.2ml 1.8ml

Answer 2

Anaesthesic-block electrical nerve transmissions

Sterile water-acts as solution

Buffering agent- PH neutral maintains the contents

Preservative-shelf life

Vasoconsitrutictor-prolong action not all Anaesthesia closing local blood vessels so not carried away into blood stream

Question 3

Common Anaesthesia

Answer 3

Lidocaine- 2% lignocaine hydrochloride 1:80000adreline as a vasoconstrictor

Articaine-carticane 1:100000 adrenaline as a Vasco constrictor

Citanest-3%priolocaine hydrochloride octapresin vascocontricter

Mepivacaine-3%no vascoconstricter

Increase rate of heart beat
Affects 
Hypertension hbp
Cardiac arrest poor heart 
Hyperthyroidism overactive thyroid gland

Elderly patients
HRT hormone replacement therapy affects of menopause prevent bones thinning
Thyroxine drug under active thyroid high heart rate
Also with antidepressants

Can use citanest but not pregnancy as it can affect uterus muscles

Question 4

Local anaesthesia equipment

Answer 4

Diagpham silver bit needle pierces
Aspirating technique is designed to avoid the injection into the blood vessels
The plug or jumps back and is released so blood flow into cartilage and correctly goes into nerve

Topical anaesthesia gel 5% lidocaine paste 20% benzocaine

Useful for scaling fitting of matrix bands and stimulation of gag

Question 5

Techniques administration

Answer 5

Nerve blocka soft tissue and jaw bone need to be used for 1 quadrant
Inferior dental block
all lower teeth lingualGum half of tongue lower lip and incisors bucks gum
Only bucaal gum molars not

Mental nerve block- soft tissues buccaneering or labial affected

Posterior superior dental nerve block-nerve maxillary antrum both upper second third molars affected

Question 6

Locals infiltration

Answer 6

Over apex of tooth
Needle insertion mucous membraine soak thru pores of bone anaesthesia the nerve supply
Only for nerve endings not nerve trunk

Upper teeth lower incisals only for gingivae

Question 7

Intraligamentary injection

Answer 7

Infiltration or a nerve block to produce deeper Anastasia around a hyper sensitive tooth

1.8ml gun shaped ligmaject syringe
Nerve block fails cannot be used for gingival infection u less tooth to be extracted

Question 8

Intraosseous injection

Answer 8

Between gum to teeth gingvae into spongy bone 
Short duration 
Doesn’t numb lip check or tongue 
Good for extractions 
Not used for infection on gums 
Directly into sponagy bone

Question 9

Local anaesthesia for extractions

Answer 9

You should also numb surrounding periodontium as well as periodontal ligaments

UPPER TEETH
Local infiltration for label and buckle and palatal sides..by all injection anaesthesia the tooth and buffalo and labial side while palatial peridontium
2nd and 3rd molars=
Posterior superior dental block

LOWER TEETH
inferior dental block injection numbs up the lingual in a part as well end section is mental nerve
The bone in I scope region is thin so u can numb labia and lingual local infiltration rather then the block

Lower molars will need local bucal infiltration

Question 10

Local anaesthesia for restorative treatments

Answer 10

Not needed over loaded unless gingvae areas are just so need removal for the procedure part
-if a cavity has been present and the gum grow over it

-A crown a crown lenghting technique or for denture good look

-crown lost but a been a growth gingiva over growth
Need it for good impressions

UPPER TEETH RESTORATIVE-
enough is local buccal or labial infiltration for 3and 2 molars posterior superior Dental block preferred

LOWER TEETH-
Lower incisors= labial infiltration
Inferior dental nerve block numb every tooth but mental block other than lower molars

Question 11

Preparation for local anaesthesia

Answer 11

If end is broken use artery forceps Spencer Wells or mosquito forceps

Topical service Anastasia applied cotton wall

Cartilage stored use room temperature because cold ones cause pain

Sometimes for large surgical procedures the injection site might be dried and disinfected with iodine or chlorhexidine on a cotton wall for 15 seconds

Question 12

Inoculation injury

Answer 12

I needle is a sort of cross infection no matter how small

A resheathed use so no stick injury like a holder

Stop working immediately so other people are not at risk of cross infection as well

The pierced area should be squeezed and run under warm water you want to encourage bleeding

The winded area should be clean with disinfectant soap tried and covered waterproof dressing

Senior team should be notified The patient’s history medical should be reviewed to see if the HIV positive

If necessary report to the occupational health advisor 0H a I hospital and They will give you advice
The contact details are stored in infection control policy documentation

The incident should also be recorded in the accident book low risk of serious infections or our RIDDOR report written and process followed

Question 13

Patient advice of the local Anastasia

Answer 13

Sensation lost several hours 2 roughly

Do you not eat drink smoke we might burn and hurt yourself

Chewy foods should be avoided

When the Anastasia is wearing off you feel something like pins and needles which is called paraesthesia

Wait until that’s finished to start eating or drink

If you have a nerve block injection it might be tender on the tissues of your mouth

Intraligamentary cause soreness around gingeva

Contact surgery if anything

Question 14

Anxiety control

Answer 14

Two main anxiety control

General anaesthesia only is hospital
Unconscious

Conscious sedation can be done in a dental clinic or community clinic the techniques
Oral sedation
Inhalation sedation
Intravenous sedation

A state of relaxation used for a long procedures restorative
Special-needs patients who are uncooperative can have the Maison mache general Anastasia all sedation technique on the hospital premises under endotracheal Anastasia in hospital with critical care

Patient state of mine acupuncture and Hypno ptosis

Question 15

General Anastasia endotracheal anaesthesia

Answer 15

Endotracheal Anistasia mixture of gases that go directly into the lungs through nas preaches like tube
Floor nose nasopharyngeal
Then a special instrument called laryngoscope guided thru trachea
The oropharynx pack with gauze protect forgien body

No danger of obstruction

Question 16

Refferal for general anaesthesia

Answer 16

A referral letter medical history and dental relevance Justify the use of general anaesthesia

Clear explanation given hospital dentist satisfied and appropriate

Written consent obtained

Give clear comprehensive pre-and post up instructions

Comply with dental requirements

Staff must be trained for critical care throughout leaving without adult if needed provide recovering for the patient

Reasons for local Anastasia and dental workplace for hospital

Young patients who need one or more extractions of a permanent or Carious adult tooth who will not cooperate

Older patient patients impacted the molar surgical technique

All the patience of a dental infection where LA can I be you so safely without extra spread

Patients request only for XLA

Question 17

Conscious sedation

Answer 17

Gives the state of Relaxation
Insures the patient has they got protective airways
Patience remain conscious is able to understand
Verbal contact remain throughout
So the needle can be put in

If patients are to Nervous And won’t cooperate

ORAL SEDATION-can be given the night before the dental appointment and second one 1 hour before the treatment it is a sedative tablet temazepam or diazepam

INHALATION SEDATION- known as relative analgesic breathes a mixture nitrous oxide and oxygen nasal mask duration of the dental appointment

INTRAVENOUS SEDATION-drug injected into patients vein anxiety removed

Question 18

Advantages of sedation technique

Answer 18

Patients are conscious throughout and cooperate they
retain their reflexes in the airways there is
no need for general Anastasia for long periods
and a separate anaesthesiaist
this is not required

But GDC has given strict lines on the sedation
Full medical history before
Patient should be given alternatives and explained
A form has to be given
Written consent
Adequate recordkeeping of the drug
Everyone was should stay within their own limits of skill and experience
The dentist takes the responsibility of the sedation injection
Appropriate and minimal amount of drug use
Second appropriate trained person
An ideal person will be a dental sedation nurse

Conscious sedation guidelines
This technique must either be used when suitable equipment and drugs immediately available
Everyone has to be trained to monitor patient
Supervision must be hold until the dentist thinks they’re going to be discharge to adult escort

Question 19

Oral sedation

Answer 19

The pre-medication of temazepam and diazepam can be used for gag reflex when impressions taken reducing them

Or sedation is suitable for adults but not for children because they are addicted if they overused

Escort available

Less sedated than other techniques

Pulse oximeter machine should be used to monitor
Connected to the finger probe because the pulse rate oxygen levels and blood
Will make a sound of something is wrong

Question 20

Inhalation sedation

Answer 20

Safest and best for children under 16

Mixture of nitrogen oxide and oxygen

Administrate through autoclave a disposable nose mask nasal hood they are called

Checks are given before entered into sedation
All equipment is working full of gas cylinders and spare gas cylinders

Adult escort accompany the patient patient’s records have been read again

Pre-operative instructions have been obeys

Patient is not suffering from a cold that will affect the breathing through the nose

Hundred percent oxygen given at 1st to the nasal had to get used to it

Then adjusted for 10 percent nitrous oxide administrated

Patient told relaxing feeling come 5 percent added u can hear patient voice

Further 5 percent
To accept injection and dental treatment required

End of procedure nitrogen oxide switched off 100% oxygen given the two mins

Praise the patient for future appointments

Ask patient to remove nasal hood

Sit up

12 hours
Don’t drive don’t operate machinery don’t drink alcohol don’t sign legal documents

Advantages

Light snack 2 hours before hand

Don’t need pulse oxide meter

Safe for children’s and simple

Disadvantages

Prevent oxygen normal machine cannot be used

Scavenging system removed form surgery inhaled by staff

COSHH Regulations followed working with gasses

Not for pregnant

Nitrogen oxide addictive

Question 21

Intravenous sedation

Answer 21

Give us more level of consciousness

High levels of anxiety like surgical extraction

Hypnovel injection midazolam injected into the vein

Doesn’t produce anaesthesia or analgesic

Provides relaxation to the brain to except the local anaesthetic to be administrated

IV IV sedation produces amnesia and is suitable for patients of the age of 16

Snack allow but not less 2 hours before

Injection usually given on then on top of hand DORSUM or vein in between elbow ANTECUBITAL FOSSA

Vein called VENEPUNCTURE sits in there

Different needles is butterfly needle vendlon needle
Y-can needle

Process called titration ensure doesn’t become over dosed and fall unconscious

Slurring speech difficulty in touch

Equipment you should have available throughout resuscitation kit and drug Flumazenil (anexate) emergency antidote pulse oximetry machine

Must not be left unattended in the room recovery takes an hour

Same as previous instructions

Advantages

No nasal mask in the way

Rapid controlled sedation

Very effective and amnesia produced good for future confidence next procedure

No nitrous oxide pollution in the surgery no long-term risk of stuff

Disadvantages

Drug does not produce analgesia so you have to use local Anastasia to carry out

For children under 16 the drug is unpredictable

Should be careful is over 65 elderly patients have problem liver function and unable to excrete the drug

Respiratory depression areas will need to be supported if this happens

Once drug is given it can’t be switched off need to be an adult supervision for the rest of the day

The technique of accidentally injecting an artery instead of a vein

Special monitoring equipment is extremely expensive

Question 22

Dental Nurses duty

Answer 22

Able to assist the dentist in the preparation of all the agents and equipment monitor the patient throughout and inform dentist of any impending problems
Require and assist effectively any emergency things
No everything in emergency emergency care of what to do

Question 23

BOTH Inhalation and intravenous sedation

Answer 23

Check or pre-op instructions and see if patient is still fit for sedation

Monitor and resuscitate equipment ready for correct functioning

Monitor the patient’s skin colour respiratory rate and pulse

Inform dentist of any changes in patient condition

Be prepared for immediate assistance in a substation procedures dentist direction

Save got the patient until dentist a lot of them to return home with escort

Before leaving sedation qualified dental nurse remove cannula apply dressing and give instructions of everything make sure hazardous waste goes into the bin

Question 24

Duties specific inhalation sedation

Answer 24

Check the machine correct function in still in the lab in insure spell oxygen and nitrous oxide available

Question 25

Duty specific care of intravenous sedation

Answer 25

Have blood pressure monitor and equipment ready assist in its records

Lay armour drugs syringe needle labels cannula wipes and dressings

Laye out all dental instruments

Help raise the vein when necessary

Have pulse oximetry meter ready for use

Question 26

Care of patient

Answer 26

Extra support from dental nurse if people nervous

Caring compassionate, all times

Three nurses trained may be required
Oneness assistance sedation and monitoring patient

Second nurse assistant dentist to complete treatment

Third nurse monitoring previous patient in recovery area

Question 27

Monitoring patient’s

Answer 27

COLOUR-lips nail beds fingers ears purple cyanosis deficient oxygenation sweating serve deficieny

BREATHING-watching the inhalation sedation machine rhythmic movement of upper abdomen
Pulse oximeter record blood oxygen 95-100 normal
Alarm indicate below 90% could be due to a airway blockage

PULSE-radial pulse inner wrist/ carotid pulse neck
Oximetry machine automatically indicate Attached finger probe

BLOOD PRESSURE-usually taken with machine automatic systolic pressure maximum slowly let’s go diastolic pressure between heart beats

Measured through millimetres of mercury
HEALTHY -120/80 s/d
Preop anxious patient might be high
Above 140/90 cardiovascular problem unsuitable for intravenous sedation so use inhalation

Question 28

Blockage of the airway

Answer 28

Caused by obstruction in the Larynx Patient’s face is blue the skin is clear me but sweat over it rise and pulse and blood pressure patient also wheezing was snoring

It blocks the laryngeal entrance can be fixed by pulling jaw foreard

Block it by a foreign body is extremely serious it’s right under conscious sedation as the reflexes

Question 29

Overdose of anaesthetic or sedative

Answer 29

Overdose may paralyse respiratory muscles

If so reverse affects anecdote flumazenil reverse midazlom injection

A cardiac arrest may happen unless oxygen introduced

Question 30

Resuscitation/ emergency procedures

Answer 30

Collapse occurs during such as sedation then use basic life support

Effective manual suction device to clear the airways

Orpharyngeal guedel air ways

Manual pulmonary resuscitator eg laerdal pocket face mask

Resuscitation drugs including flumazneil

Syringes and needles for drawing up and injecting emergency drugs

A cylinder of oxygen

Question 31

Hypnosis

Answer 31

Alternate the state of mind verbal achieving hypnotises suggestion

For example dragon words link then an out an example as you breathe if you saw yourself becoming more and more relaxed

Question 32

Acupuncture

Answer 32

Reduce anxiety there is disorders produce anaesthesia

Needle pricks causes the body to release his own painkillers called ENDORPHINS which as local analgesia

Form of hynisis

Distraction of pain
Works for gag reflex impression long term dental chronic pain temporomandibular disorders