Test 1 Flashcards
Where are topical anaesthetics applied?
To the mucous membranes to anaesthetize the terminal nerve endings
Why must topical be placed on dry tissue for maximum effectiveness?
Wetness causes runoff and/or dilutes the product
Why is the concentration of anaesthetic in topical high?
Concentration is higher for topical because it has to diffuse through the tissues
Sprays that deliver a constant stream of topical can be dangerous because
They amount cannot be controlled and it may go beyond the area intended
What are the generic names of the ester topicals?
Benzocaine
Cetacaine
What are the generic names of amide topicals?
Lidocaine ointment
Lidocaine patch
What is Oraqix?
A needle-free subgingival anaesthetic (amide) topical liquid that turns to gel at body temperature and is made of 2.5% lidocaine and prilocaine
Indications for topical anaesthetics
Probing
Periodontal dressing removal
Suture removal
Rubber dam
Scaling/root planing
Prior to injections
What are the contraindications for topical anaesthetics?
Open sores/lesions
Potential for toxicity
History of allergies or sensitivities
Is Benzocaine 20% an ester or amide?
Ester
What supplies are needed for topical placement?
Cotton tip applicator
Gauze
Topical anaesthetic
Basic exam kit
How long to leave topical on tissue?
1-2 minutes
What is a drug that prevents the generation and conduction of nerve impulses?
Local anaesthetic
True or False: local anaesthetics are vasodilators
True
What does a vasodilator do?
Dilates the blood vessels
Mechanism of action of local anaesthetics
Reducing nerve membrane permeability to sodium ions because sodium ions remain on the outside of the nerve cell an action potential never occurs. Impulse that arrives at blocked nerve segment is unable to be transmitted to the brain
What types of LA are used in dentistry?
Esters and amides
Why are amides more commonly used in dentistry?
Less likely to have an allergic reaction to amides
What are the indications for LA use?
Scaling and root planing
Deep pocket debridement
Tooth/root sensitivity
Furcations
Surgery
RCT/restorative work
What is the absolute contraindication for LA?
Client allergy - LA allergy, sulpha drug allergy, bisulfites allergy
What is a relative contraindication?
Only use after weighing the risk/benefits, or there’s no other choice
What are the relative contraindications for LA use?
Cardiovascular disease
Asthma
Uncontrolled hyperthyroidism
Under active thyroid
Pregnancy
Liver dysfunction
Kidney disease
What should be done in regards to LA for clients with diabetes?
Limit epi as it opposes the effect of insulin
Does LA generally have few interactions with other prescribed drugs?
Yes
How much LA should be administered?
Smallest dose that is clinically effective
How are the effects of LA as a vasodilator countered?
By the addition of vasoconstrictors (epi)
What does the addition of vasoconstrictors do for LA?
Decreases blood flow to the area by constricting the blood vessels
Provides haemostats is
Increases duration of LAs effects
Reduces risk of toxicity
What are the adverse effects of LA?
Needle breakage
Hematoma (swelling, bruising)
Transient facial nerve paralysis
Parathesis (prolonged anaesthia)
Trimus (muscle spam causing lock-jaw)
Edema (accumulation of fluid beneath the skin)
Tissue sloughing
Red, burning, pain
What causes needle breakage?
Poor technique or client movement
What causes hematoma post LA injection?
Puncturing of a blood vessel due to over-insertion
What causes transient facial nerve paralysis post LA injection?
Local into the parotid gland
What causes trismus post LA injection?
Irritation to the nerve sheath after injection due to repeated injections, too large a dose, or contaminated solution
What causes edema post LA injection?
Trauma during injection, infection, or contaminated LA or needle
What causes tissue sloughing when using anaesthetic?
Prolonged use of topical
What causes pain during LA injection?
Careless technique, dull need, rapid deposit of LA
What causes burning pain during injection?
Contaminated LA, heated cartridges, expired LA, rapid deposit of LA
What causes systemic complications of LA?
High plasma concentrations of LA drugs
What is a local anaesthetic overdose?
High blood levels of a drug in various organs and tissues
What may result in a local overdose?
Predisposing client factors and drug factors
What are some of the causes of LA overdose?
Injection into a blood vessel
Too much LA injected
Injected too quickly
Slow metabolism of the LA
How to prevent LA overdose?
Aspiration
Minimal doses
Use of vasoconstrictors
Review of health status
Signs and symptoms of mild LA overdose
Disorientation
Nervousness
Flushed skin colour
Apprehension
Twitching, tremors, shivering
Dizziness
Visual/auditory disturbances
Headache
Tinnitus
How to manage a mild LA overdose?
Terminate procedure
Reassure client
Place client in comfortable position
Administer oxygen
Provide CPR if necessary
Monitor vitals
Summon EMS if needed
Allow patient to recover before discharge
Signs of severe LA overdose
Muscle twitching
Convulsions
How to manage LA overdose?
Terminate procedure
Supine position, legs elevated
Call 911
Provide CPR if needed
Administer oxygen
Monitor vitals
Administer an anticonvulsant
Transport patient to hospital after stabilized
When is an epi dose more likely?
If they have a CVS condition or disease
What are the symptoms of an epi overdose?
Tension
Anxiety
Apprehension
Nervousness
Tremors
Increased heart rate
Increased blood pressure
Throbbing headache
Hyperventilation
What are the predisposing factors to LA overdose?
Age - organs may not be fully developed in younger people or diminished in older people
Body weight
Genetics
Disease
Gender
Pregnancy
What are the drugs predisposing factors to an LA overdose?
Potent or weak vasodilator
Drug dose
Route of administration
Rate of injection
Vascularity of injection site
Presence of other vasoconstrictors
Other medications
A comprehensive health assessment will prevent about ___% of potentially life threatening emergencies
90%
The most common overdose reaction of LA with epi is due to
Too large a dose given
The onset of symptoms is gradual but _______ is more common with amides.
May be severe
What is the most intense reaction to LA with epi from?
A rapid intravascular injection
What reduces the systemic toxicity by slowing its absorption of the LA into the CVS?
Vasoconstrictors
How long does the adverse effects of an epi overdose usually last?
5-10 minutes
What are the local signs of an allergic reaction to LA?
Erythema
Urticaria
Puritis
Angioedema
What are the systemic signs of an allergic reaction to LA?
Bronchospasm
Wheezing
Cyanosis
Tachycardia
Laryngeal edema
What is a similar drug to Oraqix but not used for dentistry?
Emla - used for epidural
What happens with Oraqix the longer it is left on?
The deeper the penetration
What does eutectic mean?
Melts or solidifies at a certain temperature
What are the active ingredients in Oraqix?
Lidocaine 2.5%
Prilocaine 2.5%
Does Oraqix anaesthetize the pulp as well?
No
What to check for prior to assembling Oraqix?
If bubble moves back and forth if it doesn’t, but it in cool water or fridge
What is in an Oraqix cartridge?
Lido/prilo
Poloxamers 188 and 407
HCl for pH adjustment
Purified water
pH 7.5-8
How to apply Oraqix?
Apply by tracing it along the margin and waiting 30 seconds
How long does the anaesthetic from Oraqix last?
Approximately 20 minutes
What is maximum application of Oraqix?
5 cartridges per person
How quickly does Oraqix begin working once applied?
30 seconds
How to choose the right LA for your client?
Consider the vasoactivity
Pain control based on length of procedure
Need for post treatment pain control
Client’s health assessment
Allergies
Hemostasis
Why would presence of an infection and the vascularity of an area decrease the duration of LA?
pH changes in the area
What are the amide local anaesthetics?
Arcticane
Bupivacaine
Lidocaine
Mepivacaine
Prilocaine
How much solution in an LA cartridge?
1.8mL
What is the duration of lidocaine 2%?
180-300 minutes
Where is lidocaine 2% metabolized?
In the liver
What LA to choose when antioxidants are contraindicated or CVS conditions?
Mepivacaine 3%
Where is prilocaine metabolized?
In the lungs and some in the liver
Where is articaine 4% metabolized?
90-95% in the plasma
10% in the lungs
What LA would you use for client with liver disease?
Articaine
What LA has the highest risk of toxicity?
Bupivicaine 0.5%
When are all LA drugs potentially life threatening?
If administered intravascularly, particularly if injected rapidly
Effects of LA action depends on
Variation of anatomic structure
Type of injection
Too far from bone
Vascularity of tissue
Injection technique
Accuracy of anaesthetic administration
For the diameter of the lumen needle gauge, the higher the number
The smaller the diameter
What are the most recommended needle gauges for LA?
25 or 27
What do you want the pH to be to improve the onset of LA?
6-7
What can cause issues in LA for asthmatics?
Sulfites added as preservatives
What do you need to check your LA cartridge for?
Cloudy
Discoloured
Sediments
Rusted metal hub
Expired
Leaky
What is in the LA carpule?
LA
Epi
Preservative
Sodium hydroxide
Sodium chloride
Where is LA deposited in a local infiltration?
Close to the smaller terminal nerve endings
Where is LA deposited in the supraperiosteal injection?
Near the large terminal nerve branches above the apex of the tooth
Where is a nerve block LA injection deposited?
Close to main nerve trunk often some distance from the treatment area
Where is the posterior superior alveolar nerve block injected and what teeth does it affect?
Into the tuberosity of the posterior superior alveolar nerve to numb the maxillary 1st to 3rd molars.
Where is the middle superior alveolar nerve injection done and what teeth does it affect?
Above the maxillary 2nd premolar and numbs the premolars and the MB root of the 1st molar.
Where is the anterior superior alveolar nerve injection done and what teeth does it affect?
Above the canine and numbs the maxillary canine to central.
Where is the nasopalatine injection done and what does it numb?
At the incisive papilla and numbs the maxillary lingual tissues not the teeth
Where is the greater palatine injection done and what does it numb?
Into the area of the greater palatine foramen and numbs the maxillary lingual tissues not the teeth
Where is an infraorbital nerve injection done and what does it numb?
At the infraorbital foramen and numbs the maxillary central to the mesial root of the first molar
Where is the middle superior alveolar nerve injection done and what does it numb?
Above the maxillary 2nd premolar and numbs the premolars and MB root of the 1st molar.
Where is a supraperiosteal injection done and what does it numb?
At the apex of the selected tooth and numbs individual teeth
Why would a supraperiosteal injection be done over a posterior superior alveolar nerve block?
It is safer
Where is an inferior alveolar nerve block done and what does it numb?
Just above the mandibular foramen and numbs the entire mandibular quadrant
Where is a buccal block injection done and what does it numb?
In the mucobuccal fold distal and at the height of the occlusal plane of the most posterior molar and it numbs the buccal gingival tissues of the mandibular molars
Where is a mental incisive injection done and what does it numb?
At the mucobuccal fold just anterior to the mental foramen and numbs facial gingival tissue anterior to the mental foramen
When is the PSA injection recommended?
For pulpal anaesthesia of the molar teeth
When is an MSA injection recommended?
For pulpal anaesthesia of premolar teeth
When is an ASA injection recommended?
For pulpal anaesthesia of the anterior teeth
When is the IO injection recommended?
For pulpal anaesthesia of the anterior and premolars in one quadrant
When is the GP injection recommended?
For lingual soft tissue anaesthesia distal from the canine
When is the NP injection recommended?
For lingual soft tissue anaesthesia from canine to canine
What needs to be recorded in the ROC for topical?
Product
% of active ingredient
Location
Flavour
What needs to be recorded in the ROC for local?
Product
% of active ingredient
Ratio of epi or none
Injection(s) location(s)
Number of carpules
Client reaction
Name of the DDS
What are the two types of ultrasonic?
Magnetostrictive
Piezoelectric
When was the ultrasonic scaling device introduced?
1950s
The ultrasonic is a power-driven device converting high frequency electrical energy into
Mechanical energy in the form of rapid vibrations
What are the benefits of ultrasonic instrumentation?
Rapid calculus removal and less hand fatigue for the clinician
True or False: ultrasonic instrumentation is recommended for both supraperiosteal and subgingival treatment
True
What are the parts of the magnetostrictive ultrasonic scalers?
Insert
Handpiece
Base unit
Foot switch
What are the parts of the piezoelectric ultrasonic scaler?
Tip
Handpiece
Base Unit
Foot switch
What is the primary action of ultrasonic instrumentation?
Mechanical action
What are the other actions of ultrasonic instrumentation?
Irrigation
Cavitation (formation and collapse of bubbles)
Acoustic microstreaming
How is the conversion of electrical current into high-frequency mechanical vibrations attained in an ultrasonic scaler?
By a transducer that is either magnestotrictive or piezoelectric
What does the term ultrasonic describe?
A non-audible range of acoustic vibrations that are a unit of frequency referred to in cycles per second or hertz.
How do the ultrasonic scalers work?
Foot pedal activated
Electric current sent through the generator into the handpiece
The transducer converts the electrical energy to mechanical causing the tip to vibrate
The mechanical action of the working end removes calculus, oral biofilm and root constituents that are contacted directly with the tip
What is the number of times the tip of the insert moves back and forth in a second?
Frequency
What is a manual unit?
If the clinician can control the frequency, it is considered a manual unit
Where would a manual unit be beneficial?
With deposit removal a lower setting could be used for light deposits and a higher setting for more tenacious deposits
Most units are auto-tuned with a preset frequency that automatically tunes the
Cycles per second to a maximum efficiency for each insert
What is the energy in the handpiece that creates movement of the working end?
Power
What does changing the power change?
The distance the working end move and/or the length of the stroke
What is the different between frequency and power?
Frequency is how many times the unit tip moves in a second while power is how large the working length stroke of the unit tip are
What refers to the distance the tip travels in a single vibration?
Tip displacement
Why does an ultrasonic use water flow?
Cools the transducer and tip of the insert
Controls bleeding
Increases visibility
Provides lovage
Removes root surface constituents
Irrigates sulci and pockets
Water spray is critical to prevent root surface damage
What power and water setting is best for ultrasonic use?
Low to medium
What are the disadvantages to ultrasonic use?
Client may not like water spray
Aerosol production
Tinnitus
Less tactile sensation than curettes
Continuous suction needed for water removal
Can you use the ultrasonic detect calculus?
No
What is a sonic instrumentation?
Driven by compressed air in a frequency from 2500 kHz to 8000 kHz. Has slower vibrations
What type of movement does sonic instrumentation move in?
Elliptical motion
What sides are active for sonic scalers?
All sides
What sides are active for ultrasonic magnetostrictive scalers?
All sides
What sides are active for ultrasonic piezoelectric scalers?
Lateral sides
How does the sonic scaler move?
Elliptical motion
How does the ultrasonic magnetostrictive scaler move?
Elliptical motion
How does the ultrasonic piezoelectric scaler move?
Linear motion
How many CPS does the sonic scaler do?
2,500 - 7,000 CPS
How many CPS does the magnetostrictive scaler do?
18,000 - 45,000 CPS
How many CPS does the piezoelectric scaler do?
25,000 - 50,000 CPS
Are Hertz and CPS the same thing?
Yes
What is the core of the magnetostrictive scaler units?
A stack of metal strips of a ferrite rod
What type of strokes to use when using the magnetostrictive scalers?
Keep in motion, overlapping, multidirectional strokes with not a lot of pressure
What does K refer to?
The kHz
What does kHz refer to?
The CPS
How should water come out of units with an internal flow system?
As a fine mist at the end of the tip
What is an external flow unit?
A tube that is connected to the tip of the ultrasonic scaler to allow the flow of water
What does the transducer of a piezo consist of?
Ceramic crystals
Is water necessary to cool the piezo transducer?
No as less heat is generated but it is still required to cool the friction produced between the working end and the tooth
How to choose an insert for the ultrasonic?
Consider tip and handle design
Compatibility with frequency of kHz of unit
Method of fluid delivery
The stack of 30 kHz inserts are ______ than the 25 kHz
Shorter
What generates the greatest amount of energy in a magnetostrictive insert?
The point
How much of the tip is active in an ultrasonic unit?
4mm
When using the ultrasonic scaler you use work from the ______ in an _____ direction
CEJ
Apical
Why may square points be detrimental?
May cause damage to root surface
What angulation should you be on with the cavitron tip?
0 - 15 degrees
What are diamond coated piezo tips for?
Furcations
Overhangs
Tenacious calculus
What are universal cavitron inserts for?
Supra or initial debridement of moderate or heavy calculus
What are cavitron precision thin inserts used for?
Light deposit debridement
Deplaquing
What are cavitron furcation inserts for?
Debridement of furcations
What are cavitron implant inserts for?
Biofilm and calculus removal around titanium implants and abutments
What power to use implant inserts on?
Low
What are left and right cavitron inserts good for?
Root surface convexities
What type of action is vibration of the tip, tip action that provides power is dependent on the stroke, frequency, type of tip motion and angulation of the motion against the tooth.
Mechanical action
What type of action is created by the formation and collapse of bubbles in the water by high-frequency sound waves surrounding an ultrasonic tip, results in lavage to remove biofilm and loosen debris?
Cavitation
What type of action is the agitation of fluids surround the instrument tip that any destroy or disrupt bacteria?
Acoustic microstreaming
Cavitation and microstreaming can remove biofilm up to ____ mm from the point of conact
0.5mm
What is a pacemaker contraindication of an ultrasonic scaler?
Unshielded pacemakers make be disrupted, consult with cardiologist. Newer, shielded pacemakers are not affected
What are contraindications for ultrasonic scalers?
Unshielded pacemaker
Communicable disease
Demineralizations
Sensitivity
Veneers
Crowns
Titanium implants
Children
Immunosuppressed
Chronic pulmonary disease
Cardiovascular disease with secondary pulmonary disease
Dysphagia (swallowing difficulty)
Cystic fibrosis
Why are cavitrons not used for children?
They have larger pulp and can be damaged from the cavitron use
What should clients be advised about with cavitron use?
Water spray
Sensitivity, power can be adjusted if necessary
POI for extensive perio clients
What to record in the ROC for cavitron use?
Location of use
Client reaction
POI
What needs to be worn/used when using the cavitron?
N95
Shield
Gown
HVE
When to replace a cavitron tip?
Wear of 2mm
Where is air polishing used?
Supragingival only
What is the most common air polishing powder?
Sodium bicarbonate
What does air polishing remove?
Stain and biofilm
How does air polishing work?
It uses a handpiece that delivers a spray of warm water and prophy powder under pressure
What the indications for prophy jet?
Supragingival extrinsic stain
Biofilm
Plaque biofilm
What is subgingival air polishing?
A relatively new technique that uses a combination of glycine-based power with water and compressed air which is safe for subgingival use
Do clinicians require special training in the proper use for a subgingival air polishing device?
Yes
What are the advantages of prophy jet?
Less time needed than rubber cup polishing
Removes stain three times as fast as hand scaling
Creates less operator fatigue
Golden standard in prepping teeth for PFS
Can render cementum surfaces uniformly smooth
Virtually 100% of endotoxins and bacteria can be removed
Microscopic outer layer of enamel is kept in tact
Less discomfort during procedure for client
What are the contraindications for supra prophy jet?
Sodium reduced diet
Respiratory problems
Immunocompromised
Pregnant or breastfeeding
Chemo/radiation
Communicable infection
Allergy to powder
Medications affecting the body’s acid-base balance
Restorations
Implants
Cementum
Dentin
Periodontal pocket
What are the contraindications for subgingival prophy jet?
Respiratory problems
Immunocompromised
Chemo/radiation
Communicable infection
Allergy to powder
What type of stroke should be used with prophy jet?
A constant circular pattern over the tooth surface
The prophy jet nozzle should be held ___ mm away from the tooth surface
3 - 5 mm
Prophy jet powder is directed ___ from the gingiva
Away
What angle should the prophy jet nozzle be held on?
30-60 degrees facial
80 degrees poster teeth
90 degrees occlusal
Air polish teeth for no more than ____ to ___
Half to one full second
How often to change mask when using prophy jet?
Every 20 minutes
