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Pain Control > Supplemental Injection Techniques > Flashcards

Supplemental Injection Techniques Flashcards

1
Q

Breakdown of Intaosseous supplemental anesthesia techniques

A
  1. PDL injection
  2. intraseptal injection
  3. IO anesthesia (intraosseous)
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2
Q

PDL injection AKA - when? (general)

A

intraligamentary injection

when IAN not adequate

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3
Q

Indications for PDL injection

A

1, if dont want IAN but need anesthetic for 1 or 2 manidbular teeth in a quarant

  1. bilateral isolated mandibular teeth (don’t want to give two blocks)
  2. tx in children
  3. tx when nerve blockis contraindicated
  4. use as a possible aid in diagnosis of mandibular paion
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4
Q

contraindictions for PDL injection

A
  1. infection or severe inflammation in injection site
  2. primary teeth, when the permanent tooth bud is present
  3. patient who requires a “numb” sensation for comfort (not geeting anesthesia of lip, tongue, other soft tissue)
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5
Q

PDL injection advantages

A
  1. prevents anesthesia of lip, tongue, other soft tissue
  2. minimum doses of LA required (.2 ml per root)
  3. alternative to partially successful regional blcok
  4. rapid onset
  5. less traumatic than conventional blocks
  6. well suite in children
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6
Q

minimum doses of LA required for PDL injection?

A

.2ml per root

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7
Q

disadvantages of PDL injection

A
  1. proper needle placement may be difficult to achieve
  2. leakage of LA into pt’s mouth produces unpleasant taste
  3. excess pressure can have adverse effects
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8
Q 
technique for PDL injection 
needle?
insert?
landmarks?
orient bevel?
A

needle? 27 short needle (not 30)

insert? = long axis of the tooth, on its mesial and distal roots interproximally

landmarks? = roots of tooth and periodontal tissues

orient bevel? = toward root of tooth and advance apically until resistance is met

if one root – make needle safe
multi-rooted? - repeat procedure on other root

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9
Q

administer rate of LA in PDL injection?

A

.2ml of LA over 20 seconds

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10
Q

patient position in PDL injection?

A

supine or semi-supine position

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11
Q

indication of success in PDL injection?

A

significant resistance to deposition of the LA

may be ischemia of soft tissue adjacent to the injection site

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12
Q

intraseptal injection?
useful when?
path of diffusion?

A

similar to PDL

useful – in prividing osseous and soft tissue anesthesia and hemostasis for perio currettage and flap procedures

path of diffusion = LA is thourgh the medullary bone, as in PDL

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13
Q

areas anesthetized in intraseptal injection?

A

bone, soft tissue, root

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14
Q

indications for intraseptal injection?

A

pain control and hemostasis for sfot and osseous tissue perio treatemnt

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15
Q

advantages to intraseptal injection

A

similar to the PDL one-
- no lip or tongue numbness, minimum volume of LA, decreases bleeing, atraumatic, immeiate onset of action, few post-op complications, useful for periondtially involved teeth

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16
Q

disadvantages to to intraseptal injection

A
  • mutliple tissue punctures
  • bitter taste of LA if leakage occurs
  • short duration of action of pulpal anesthesia
  • requires clinical experience for success
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17
Q 
technique for intraseptal injection 
needle?
insert?
landmarks?
orient bevel?
A 
needle? = 27 g short 
insert?= center of the interdental papilla adjacent to the tooth being treated

landmarks? = papillary triangle, 2 mm below the tip of papilla, equidistant from adj. teeth (on either side)

orient bevel? = towards the apex

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18
Q

syringe orientation in intraseptal injection?

A

orient needle 45 degrees to long axis of the tooth, at a right angle to the soft tissue, with the bevel facing the APEX of the tooth

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19
Q

advance needle until when in intraseptal technique?

A

until bone contact – then push needle slightly deeper (1-2 mm) into the interdental septum

20
Q

administer rate of LA in intraseptal injection?

A

.2 to .4 ml of LA over 20 seconds

21
Q

complications in intraseptal?

A

rare – may be some post op pain and duration of the anesthetic is variable

22
Q

intraosseous injection - general description

A

necessitated round bur into interseptal bone that has been surgically exposed then needle inserte into the site for LA administration

23
Q

3 types of intraosseous injection

A
  1. stabident system – 2 parts so harder to place LA into previous drilled hole– led to the alternative stabident system
  2. X-tip - eliminates problem of re-entering needle into previously positioned hole
  3. intraflow
24
Q

X-tip description

A

eliminates problem of re-entering needle into previously positioned hole

composed of a rill gude an guide sleeve

drill leads the guide sleeve through the cortical plate, after which it is separated and withdrawn — then guide sleeve remains in the bone and the LA can be administered

25
Q

intraflow system

A

specially modified slow-speed hanpiece with needle / drill that does perforation through bone and delivers th eLA

26
Q

type of LA for IO and why?

A

a “plain” LA is recommended b/c high incidence of palpations noted when vasopressor-containing LA’s are used

site is relatively vascular so volume of LA administered should be kept to minimum to avoid overdose

27
Q

indication for IO?

A

pain control for tc on single or multiple teeth in quadrant

28
Q

advantages to IO?

A
  1. lack of lip or tongue
  2. atraumatic
  3. immediate onset of action
  4. few post-op complications
29
Q

disadvantages to IO?

A

requires special syringe

30
Q

positive aspiration with IO? alternative to what?

A 
0% 
alternative - other methods 
- PDL
-intraseptal
- supraperiosteal
-regional nerve block
31
Q

X-tip technique

A
  1. prepare soft tissue site
  2. perforation of cortical plate – hold perpendicular to the corticol plate and gently push through gingiva until rest against bone then go through pecking motion until feel loss of resistance
  • dont hold in one spot - can overheat the bone
  • take drill out but leave sleeve in duration of procedure
32
Q

injection with x-tip uses what needle?

A

ultrashort needle into the cancellous bone

33
Q

complications with IO injection?

A
  1. palpations
  2. postinjection pain? - unlikely
  3. fistula at site of perforation
  4. separation of the perforator or cannula (rare)
  5. perforation of lingual plate of bone
34
Q

duration of LA in IO injection?

A 
pulpal = 15-30 minutes 
vascon= 30 mins 
plain = 15 minutes
35
Q

intrapulpal injection?

A

pulp needs to be exposed fisrt but deposited directeld into chamber of tooth involve providing adequate LA.

36
Q

disadvantages of Intrapulpal?

A

HURTS - but lasts very short

bitter taste if leaks

may be difficult to enter certain canals

need opening into pulp chamber for optimal effectiveness

37
Q

advantages if intrapulpal?

A

lac of lip and tongue being anesthetized, minimum amount of LA needed and quick rapid onset of action and few post-op complications

38
Q

alternative to intrapulpal?

A

IO

39
Q

deposition of LA in intrapulpal? how much and what needle?

A

25 to 27 short or long needle

deposit under pressure
.2-.3 ml of LA

40
Q

oraverse?

A

phentolamine mesylate- reversal of soft tissue anesthetisia caused by LA with vasoconstrictors (with epi)

has to be administered in same technique and area of LA deposition

41
Q

Electronic Dental anesthesia?

A

transcutaneous electrical nerve stimulation (TENS)

- vibrations before injection so may not perceive the pain

42
Q

use of EMLA contraindicate in who? and why?

A

below the age of 6 months because of possible developement of methemoglobinemia

43
Q

onpharma only used for which LA’s

A

those with a vasoconstrictor in it and it is a bicarbonate neutralizing solution added to the LA (NaHCO3) - sodium bicarbonate

because these ph’s are low (like lidocaine with epi)

44
Q

oraverse not recommended in who?

A

use in children less than 6 years of age or weighing less than 15 kg

45
Q

oraverse chemical name

A

phentoalamine mesylate

Pain Control (12 decks)

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