Practical Techniques

Question 1

what are the 2 types of topical normally used in dentistry?

Answer 1

• benzocaine gel

- xylonor gel

Question 2

what are the 3 types of LA available?

Answer 2

• Xylocaine (adrenaline 1:80,000)
• citanest (4% with no vasoconstrictor / 3% with octapressin)
• mepivacanine

Question 3

what is a extra short needle used for?

Answer 3

30G for intraligamentory

Question 4

what is a short needle used for?

Answer 4

30G for infiltration and mental block

Question 5

what is a long needle used for?

Answer 5

27G for dental block.

Question 6

what nerve supplies the lower teeth?

Answer 6

mandibular branch of the trigeminal nerve.

Question 7

what nerve supples the lingual soft tissues of the mandible?

Answer 7

lingual nerve

Question 8

what nerve supplies the buccal tissue of the mandible?

Answer 8

buccal nerve

Question 9

why cant the infiltration technique be used on the lower teeth?

Answer 9

because the bone is thicker around the lower teeth.

Question 10

what muscle does the inferior alveolar nerve block go through?

Answer 10

buccinator muscle.

Question 11

what teeth/soft tissues does the inferior alveolar nerve block numb up?

Answer 11

lower molars and premolars. 
lingual nerve (lingual soft tissues)

Question 12

how much La should be used for a long buccal injection?

Answer 12

1/4 cartridge of LA.

Question 13

what teeth/soft tissues does the mental injection numb up?

Answer 13

La to lower premolars and canines.

Question 14

how can you ensure that LA solution has entered the mental foramen?

Answer 14

massage solution around the area after injection.

Question 15

what nerve supples the upper teeth?

Answer 15

anterior, middle and posterior branches of the maxillary division of the trigeminal never.

Question 16

what nerves supples the upper palatal soft tissues?

Answer 16

long sphenopalatine nerve and greater palatine nerve.

Question 17

what nerve supplies the upper buccal soft tissues?

Answer 17

superior alveolar nerve.

Question 18

why is is best to give LA slowly in upper teeth?

Answer 18

more comfortable for the pt and beuase solution needs to pool around the apex of the tooth.

Question 19

when is the papillary injection used?

Answer 19

used for perio procedures.

Question 20

how is the papillary injection administered?

Answer 20

the papilla mesial and distal to the tooth. Needle inserted at the level of the cervical margin into papilla.

Question 21

what is consious sedation?

Answer 21

depresses the CNS enabling tx to be carried out but still being able to communicate.

Question 22

why would a patient need sedation?

Answer 22

due to anxiety and medical issues.

Question 23

what are the social contraindications for the use of sedation?

Answer 23

• alcohol and drug use - may have damage to the liver.

- lack of appropriate adult escort - mildly sedated for 24 hours after.

Question 24

what are the medical contraindications for the use of sedation?

Answer 24

• sever/uncontrolled systemic disease
• midication interactions with the sedation drug
• allergy
• pregnancy
• psychosis (may disinhibit pts current meds)
• respiratory infection

Question 25

what are the dental contraindications for the use of sedation?

Answer 25

- anterior teeth are difficult with inhalation sedation | - multi-rooted endo and long procedures not ideal.

Question 26

what is sedation taken orally used for?

Answer 26

as a premedication.

Question 27

what type of drug is different as a premedication for sedation?

Answer 27

- benzodrazepines ( midazolam for sedation and diazepam as the premedication)

Question 28

what are the advantages of taken a sedation drug orally?

Answer 28

- simple to give - cheap - can be very effective - patient friendly - self administered

Question 29

what are the disadvantages of taken a sedation drug orally?

Answer 29

- unpredictable - cannot give a little and see how it works - rapid recovery - still may need to cannulate.

Question 30

what are the advantages of inhalation sedation?

Answer 30

- reduces pts perception og pain - safe for children. - no needles - reliable and predictable - good safety record - no special pt arrangements.

Question 31

what are the disadvantages of inhalation sedation?

Answer 31

- specialist equiptment - occupational side effects (VitB12, fertility issue, if not placed correctly can effect operator) - nitrous oxide pollution - claustrophobia - nasal obstruction - requires psychological back up

Question 32

what are the advantages of intravenous sedation?

Answer 32

- non-irritant - wide margin of safety - no set does, so can give a little at a time. - rapid induction - reversible - amnesiac effect (pt cannot remember after)

Question 33

what are the disadvantages of intravenous sedation?

Answer 33

- respiratory depression - paradoxical disinhibition - no analgesia - post-op supervision - monitoring equipment needed - amnesiac effect (pt cannot remember after)

Question 34

How is intra-nasal sedation different to intravenous?

Answer 34

given up the nose.

Question 35

with intra-nasal sedation is a canula still required?

Answer 35

yes but it can be given after sedation.

Question 36

what are the environmnetal factors that allows for sedation to be carried out in the dental practice?

Answer 36

- ground floor - protected entrance area - parking close by - tx rooms adequate size - recovery room.

Question 37

In regards to LA what should be recorded in the patients notes?

Answer 37

- type and site of injection - type and dose of LA and vasoconstrictor given. - type of needle used - pts weight (if significant) - adverse reactions seen. - post-op instructions + warnings given - record of consent and advise. - batch numbers of materials used.