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Pharmacology Units 1-10 > Unit 6 > Flashcards

Unit 6 Flashcards

1
Q

What medical and dental history considerations might the DH need to consider prior to the treatment?

A
  1. absolute contraindication
  2. relative contraindication (existing conditions, cardiac, hyperthyroidism, severe diabetic)
  3. medications: beta blockers, tricyclics
  4. previous experience with LA
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2
Q

What sort of physical evaluation would a DH do prior to administering LA?

A
  1. take BP
  2. be aware of weight, HR
  3. anxiety
  4. No LA if BP >200/115
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3
Q

What are some contraindications to epinephrine

A 
MI within last 6 months
Coronary bypass within last 6 months
Uncontrolled high BP (200/115)
Uncontrolled angina (daily episodes)
Uncontrolled arrhythmias
Sulphite allergies ****
Adrenal gland tumours
Uncontrolled hyperthyroidism (thryoid storm)
Cocaine/ methamphetamine
Glaucoma
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4
Q

What are contraindications to Esters/Articaine?

A
  • Cholinesterase inhibitors: (myasthenia gravis/glaucoma)*
  • Atypical plasma cholinesterase *
  • Sulfonamides: ester topical should not be used
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5
Q

What are contraindications to amides?

A
  • H2 Receptor blockers Cimetidine (tagament) decrease hepatic function caution with lidocaine, minimize dose Articaine favourable
  • Beta Blockers: inhibit metabolism in the liver Articaine favoured
  • Malignant hyperthermia – inherited * consult MD prior to use
  • Methoglobinemia ( Prilocaine, benzocaine)*
  • Liver disease/kidney disease
  • Pregnancy (lidocaine safest)
  • Bleeding disorders – risk of puncture
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6
Q

What is surface anestheisa?

A

topical bloccks nerve endings in mucosa

-build confidence and desensitized

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7
Q

What is infiltration?

A

limited area of soft tissue only, or for vasoconstriction in an area of perfuse bleeding

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8
Q

What is a field block?

A

limited area of pulpal and soft tissue, usually on maxilla

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9
Q

what is a nerve block?

A

block in the vicinity of a major nerve trunk, profound pulpal and soft tissue anesthesia (IANB, IO, PSA)

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10
Q

What are the two components to an atraumatic injection?

A
  • the technical aspect

- the equally important communicative aspect

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11
Q

Why should we consider sharpness?

A
  • replace after using 3x

- replace after making bony contact

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12
Q

How does gauge affect LA?

A

smaller more comfortable have to weight with the ability to aspirate effectively

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13
Q

How does rate of injection affect LA?

A

slow is more comfortable, allows time for the solution to disperse with minimal displacement

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14
Q

What is the operator/patient positioning in LA?

A
  • palm up
  • Supine
  • Ensure that as the operator you can see, check your overhead light and position yourself for direct vision
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15
Q

How does stabilization affect LA?

A

increases operator confidence

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16
Q

What is the process in LA?

A

-Review the HH
-Vitals (BP) ok to use automated cuffs
-Checking the care plan/informed consent
[-Only anesthetize areas you can complete..be realistic and also consider the time it may take to complete an area
-If two quadrants can be completed, stay on one side to allow the client to eat more comfortably, avoid self trauma, and swallow easily ( anesthetize area that take longer to diffuse first, and instrument areas with fast metabolism first)]
-Selection of injection techniques
-Selection of anesthetic .. Watch MRD epi and amide
-Topical can be placed in areas to be anesthetized..place all topical needed at once to increase efficiency
-Assemble the syringe and orient the bevel to the bone by rotating the syringe in your hand ( remember the dot on the needle indicates where the bevel is)

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17
Q

What should we do with regards to client communication during LA?

A
  • Today we are going to freeze up the lower right to make our debridement (sc/rp) more comfortable for you?
  • I am going to apply, rub on, some gel to make this procedure more comfortable for you

-Explanations do not need to be long…short and comforting to the client.

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18
Q

What are some key communicative aspects to LA?

Sympathy vs. Empathy

A
  • Tone: Calm and portray confidence
  • Watch what you say: Use place, numb up
  • Avoid negatives: “I know you wont like this” hurt, shot, pain, needle
  • Do not ask if they are OK: Assume they are, watch for nonverbal clues, reinforce they are doing well
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19
Q

When assembling the syringe, what should you do?

A

Always express a small amount of anesthetic into your cup or onto your tray to ensure the carpule is working correctly

Check window..can you see the carpule??

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20
Q

What is the safest way to insert?

A
  • stretch tissue to facilitate penetration
  • palm up
  • bevel to bone
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21
Q

What is the safest way to redirect?

A
  • deposit small amount
  • withdraw
  • reposition
  • aspirate
  • deposit
22
Q

What is the safest way to aspirate

A

always before injecting

PSA aspirate in two planes

23
Q

What is the safest way to deposition?

A
  • Insert, aspirate, deposit
  • One-two minutes /carpule, talk to the client
  • watch bending of the needle
  • If you notice that a “blister forms” during an field block or infiltration stop..insert further, aspirate, deposit
  • Observe the clients reactions, do not wear loupes for injections
24
Q

What do you do post injection?

A

Withdraw and immediately recap the needle, prior to applying pressure or rinsing even if the client reports a bitter taste.

25
Q

What is your post-injection client management?

A

Recap, Rinse as LA bitter, pressure if needed

Advice client on what to expect,

26
Q

What is your post appointment client management?

A

Avoid hot foods
Do not bite or traumatize area
Advice parents to watch children

27
Q

What is the documentation required to meet the Practice Standards for the College of Dental Hygienists of BC?

A 
To comply with CDHBC
Must include:
LA Drug
Vasoconstrictor if used
Volume administered
Injection technique and location
Client’s reaction

For example:
Left PSA 4% Articaine with 1:200,00 epinephrine, ¾ carpule. Topic benzocaine, normal reaction

28
Q

What is the gold standard for documentation? What do we do at CC?

A

At CC
We calculate the mg of LA drug as this is the gold standard of documentation

LA: topical benzocaine, noraml reaction, IANB, Buc, Infiltration #4.1, 1.5 carpules of 4% Articaine (108mg) with 1:200,000 epinephrine (.0135mg), client reported feeling a bit light headed immediately after administration, good after resting for 1 minute.

29
Q

What is the protocol for disprensary when using LA?

A
  • Request a syringe, # of carpules ( epi, plain), # needles ( sh/lg) # of topicals. Operators assemble the syringe
  • Place all used “local anesthetic syringes, carpules and needles” on the blue tray marked for such at the return window of the dispensary.
  • Do not disassemble the needle from the syringe or remove the carpule.
  • The needle should be recapped securely immediately after your injection.
  • Used needles that have been removed from your syringe at your unit should be recapped safely at both ends (one-handed scoop technique).
  • Unused carpules and needles (with the seal intact) should be place in a paper cup with a scrap of paper saying “unused”, and returned to the return window of the dispensary.
30
Q

Where is the incisive forament (nasopalatine forament) located?

A

This foramen is located .5 – 1.0mm behind the maxillary incisors. Through this foramen passes the nasopalatine nerve, which is the pathway for the 3rd division of the 5th cranial nerve.

31
Q

where is the infraorbital forament located?

A

This foramen is located just inferior to the orbit on the front of the maxillary bone. The terminal branches of the maxillary division of the 5th cranial nerve pass through this opening.

32
Q

Where is the infraorbital sulcus located?

A

This sulcus courses along the floor of the orbit. It contains the infraorbital nerve and vessels. It courses anteriorly to become the infraorbital canal, which opens at the infraorbital foramen.

33
Q

Where is the canine eminence located?

A

This is a boney protuberance associated with the root of the maxillary canine.

34
Q

Where is the incisive fossa located?

A

This depression in the maxillary bone is medial and anterior to the canine eminence and is associated with the roots of the lateral and central incisors. It is lateral to the midline and present bilaterally.

35
Q

Where is the maxillary sinus located?

A

This sinus is located within the maxillary bone and is in close association with the roots of the maxillary teeth.

36
Q

Where is the maxillary tuberosity located?

A

This structure is the posterior convexity of the maxillary body. It is a landmark for the posterior superior alveolar injection.

37
Q

Where is the posterior superior alveolar foramen (foramena) located?

A

This foramen is found on the zygomatic surface of the maxilla about 1cm superior to the gingival margin on the distal of the maxillary 3rd molar. It is here that the posterior superior alveolar nerve enters the maxilla.

38
Q

Where is the malar strut (zygomatic process) located?

A

A projection of bone found above the maxillary first molars which sutures with the zygomatic arch. This landmark becomes significant during the posterior superior alveolar nerve block.

39
Q

Where is the greater palatine foramen located?

A

This foramen is located at the lateral border of the transverse palatine suture. It is the exit pathway for the anterior palatal nerve, vein and artery.

40
Q

Where is the angle of the mandible located?

A

That point where the body and ramus meet with a definite change in direction.

41
Q

Where is the coronoid process located??

A

An extension of the ramus in the anterior and superior direction. This process forms the anterior superior border of the ramus.

42
Q

Where sit eh coronoid notch located?

A

The greatest depth of the anterior border of the ramus of the mandible. This landmark is very important during the inferior alveolar nerve block.

43
Q

Where is the internal oblique line (ridge) located

A

This is a ridge of bone which begins on the inner ramus and travels anterior to the third molar.

44
Q

Where is the external oblique line (ridge) located?

A

This is a ridge of bone which continues from the anterior border of the ramus along the external surface of the body of the mandible beside the mandibular molars.

45
Q

Where is the lingula located?

A

A body projection on the medial aspect of the ramus, found midway between the greatest concavities of the anterior and posterior borders. This landmark is essential to the location of the mandibular foramen just posterior and inferior to it.

46
Q

Where is the mandibular foamen located?

A

The foramen found on the medial aspect of the ramus just posterior and inferior to the lingual. The inferior alveolar nerve passes through this opening as it travels to the mandibular teeth and lips.

47
Q

Where is the mental foramen located?

A

An opening in the body of the mandible found at the apex of the premolars. This opening slants in an inferior, distal direction and is the point of exit for the mental nerve.

48
Q

Where is the incisive fossa located?

A

A depression in the mandible found superior to the mental tubercles and lateral to the mental protuberance. This is the location of small nutrient canals allowing for infiltration anesthesia of the mandibular incisors.

49
Q

Where is the mental protuberance?

A

pointiest part of the chin

50
Q

Where is the mandibular symphaysis?

A

divot between lower anterior and mental protruberance

Pharmacology Units 1-10 (13 decks)

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