Pain And Anxiety Management Flashcards by Faye Sitron

What 2 groups can local anesthesia be broken down into?

Esters and Amides

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Esters

Higher incidence of allergic reaction

Shorter acting

Metabolized in the blood plasma

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Amides

Low incidence of allergic reaction

Potential for toxicity & overdose

Metabolized in the liver

Causes vasodilation of local blood vessels

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What are reasons to use vasoconstrictors?

Safety – potential for toxic reaction

Longevity- duration is increased

Effectiveness- depth and profoundness is increased

Hemostasis- decreased

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Types of vasoconstrictors

Epinephrine- used in concentrations of 1:1000,000 and 1:200,000

Levonordefrin- Half as potent as Epinephrine and may have a less cardiac effect

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Risks of using vasoconstrictors

Hypersensitivity to drug
Medically compromised
Heart disease
Stroke
Recent heart surgery

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Other names for lidocaine (amide)

Xylocaine, octocaine, lignospan

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What is the first amide and still most widely used dental anesthetic that is also available as a topical?

Lidocaine

Used with vasoconstrictor (epinephrine)

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What are indications for local anesthesia?

Any treatment that may cause the patient pain: scaling and root cleaning, excessive instrumentation, challenging areas like pockets and furcation, sensitive route surfaces, inflamed tissues and excessive bleeding

Also for application of crowns, bridges, Endo, surgeries etc.

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Armamentarium needed for local anesthesia

Syringe
Needle
Topical
Gauze
Anesthetic
Needle guard or recapping device

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Describe the type of syringe that should be used

Should be an aspirating syringe

Made of metal or plastic that can be sterilized

Single use syringes can also be used

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What are the different needle lengths?

Long- 1.5”/32-40mm
Short- 1”/20-25mm
Ultra short- 1/2”/10-12mm

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What gauge needles do we use?

25, 27 and 30

The smaller the number the larger in size and stiffer= less breakage, more accurate and easier aspiration

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Describe the cartridge or Carpule used

Made of glass that holds anesthetic. 1.7 to 1.8 mL

Labeled with type of anesthetic, manufacture and expiration date

Pre-sterilized, color-coded and disposable

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Storage of anesthetic carpule

Store in a cool place away from light and it’s own container. Never in alcohol or any liquid solution

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Do not use carpule if:

Cloudy, broken, bubble to large or small, expired, extruded stopped, rusted/corroded or rusted top

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Major groups of topical anesthetic’s

Esters and amides

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Esters used as topicals

Benzocaine, ethyl aminobenzoate (Hurricaine, cetacaine)

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Amides used as topicals

Lidocaine and lidocaine hydrochloride

How are topicals supplied?

As liquid, gel, ointment, spray and patch

How long is the onset of effects from a patch?

2 to 5 minutes and full affect us after 15 minutes and duration is approximately 45 minutes

How long is the onset for most topical esters?

Most answer is 30 seconds and reaches full affect after a few minutes and duration is approximately 10 minutes

How long is the onset for topical amides?

I said is 1 to 2 minutes in full affect me take five minutes in duration is approximately 15 minutes

What should you do before the application of topical anesthetic?

Consult medical history
Determine agent to be used
Explain purpose and effect to the patient
Dry the area
Apply with cotton tipped swab
After application, wipe area and rinse

What are the four main types of pain management?

Topical (benzocaine, lidocaine, citanest (liquid), dentapatch, oraquix (injectable)) Drugs- codeine, Valium General anesthesia- intravenous sedation Nitrous oxide gas

Basic injections in the maxillary arch

``` ASA MSA PSA Infraorbital (IO) Greater Palatine (GP) Nasopalatine (NP) Infiltration ```

What area does an ASA injection target? Where is the topical placed?

Canine and incisors and supporting structures Topical placed at the Apex of the canine

What does the MSA injection target? Where is the topical placed?

Middle superior alveolar- first and second pre-molars, Mesiobuccal root of first molar and supporting structures Topical placed at the Apex of the maxillary second premolar

What does the PSA injection target? Where is the topical placed?

Posterior superior alveolar- Second third and first molar excluding mesiobuccal root and supporting structures Topical placed at the Apex of the maxillary second molar

What does the infraorbital injection target? Where is the topical placed?

Premolars, canine, incisors and supporting structures. Includes ASA and MSA Topical placed at the Apex of the maxillary first premolar

What does the greater Palatine injection target? Where is the topical placed?

No hard tissues, soft tissues- palatal tissues from teeth to midline from distal of the third molar to the canine Topical placed just distal to the first molar

What does the nasopalatine injection target?

No hard tissues, palatal tissues from left canine to right canine Topical placed at the incisive papilla

What does and infiltration injection target? Where is the topical placed?

Teeth associated with the area Topical placed at mucobuccal fold of tooth to be injected

What are the different mandibular injections?

Long buccal Inferior alveolar with lingual (mandibular block) (IAMB) Gow-Gates techniques Akinosi Mental and incisive

What does the long buccal injection target? Where is the topical placed?

No hard tissue and facial of molars Topical placed distal to the third molar

What does the inferior alveolar with lingual injection target?

Molars, premolars, canine and incisors to midline as well as supporting structures Topical is placed in the retromolar area

How to place an inferior alveolar nerve block

Retract the lip Placed thumb on anterior surface of the ramus Approach from the opposite pre-molars

What does the lingual injection target? Where is the topical placed?

No hard tissue and all of the lingual gingival to midline, 2/3 of the tongue and floor of the mouth Topical placed in the retromolar area

What does the show-Gates technique target?

Hard tissue- mandibular teeth to midline, body of mandible and inferior portion of ramus and soft tissue is facial and lingual, anterior 2/3 of tongue, floor of the mouth, posterior area of cheek and temporal regions Topical placed in retromolar area

What does the Akinosi injection target? Where is the topical placed?

Closed mouth mandibular block. Used for patients that have trouble opening Topical is placed in the retromolar area

What does the mental and incisive injection target? Where is the topical placed?

Hard tissues- premolar, canine, incisors and associated supporting structures. Soft tissues Topical placed in the mucobuccal fold between pre-molars

Injections that can be used in either arch

Inter-papillary Periodontal ligament

What does the inter-papillary injection target?

No hard tissue, tissue surrounding the tooth

What does the periodontal ligament injection target?

Hard tissue- Individual teeth and adjacent soft tissue

Uses for topical anesthesia

``` Preparation for local anesthesia Prevent gagging while taking radiographs Temporary relief of ulcers and wounds During instrumentation Suture removal ```