Unit 7 Flashcards
What are some general considerations when doing LA?
- Maxillary bone is lense dense ( cancellous ) than mandibular bone ( cortical)
- Except bone over the maxillary first molar (zygomatic)
- Greater blood supply therefore LA will not last as long
- Need to inject as close to periosteum without touching to increase the concentration gradient
- Stretch tissue to facilitate penetration of the needle
- Discuss with client the need to rest on the face
- In general anesthetize from posterior to anterior
What are the properties of the infiltration technique?
Also known as supraperiosteal injection
Supraperiosteal injections are recommended when pulpal anesthesia is needed on a limited number of teeth or anesthesia of the periodontium is needed in a localized area.
Supraperiosteal injections can be successfully administered on every tooth in the maxillary quadrant.
What are some problem solving techniques when doing an infiltration?
Pain due to needle against periosteum
-Withdraw needle and reinsert farther away (lateral) from the periosteum
Inadequate anesthesia due to depositing solution inferior to apex or if dense bone covers the apices
- Seen in children
- Seen around maxillary central incisors where apex lies beneath the nasal cavity
What are properties of the posterior superior alveolar block?
- The PSA injection is recommended for pulpal anesthesia of the molar teeth and associated periodontium.
- To decrease the risk of intravascular injection with the PSA, ensuring adequate aspiration is critical. -Aspirate, rotate needle 45˚ re-aspirate Always re-aspirate if repositioning **
- It is recommended that the PSA block be given before any of the other maxillary facial injections or palatal injections to allow the necessary time for the larger molars to become completely anesthetized
What are some problem solving techniques when doing a PSA?
Premature bony contact
- Cause: needle is at more than 45-degree angle at midline
- Technique adjustment: Withdraw syringe and reinsert it closer to occlusal plane to reduce the angle to less than 45 degrees
Hematoma
-Cause: overinsertion into pterygoid plexus of veins and/or artery
-Technique adjustment:
Use more conservative method with short needle; advance to one fourth the depth of short needle
Use extraoral pressure over region with sterile gauze
Reassure patient
What are the properties of the middle superior alveolar technique?
Teeth anesthetized: Maxillary first & second premolars and mesiobuccal root of maxillary first molar in (28% of population)
Other structures anesthetized: Periodontium of anesthetized teeth and buccal soft tissue of premolar region
What are some technique adjustments when doing an MSA?
Presence of buccal frenum at injection site
Technique adjustment:
-Insert needle more posterior to injection site and retract frenum more anteriorly
-Avoid injecting through the frenum
Discomfort during injection
- Avoid moving injection site so posterior as to lose maxillary premolar coverage upon insertion
- -Withdraw needle and reinsert farther away (lateral) from periosteum
- Injecting too rapidly
- -Inject slowly – the acidic nature of the anesthetic agent and too rapid of injection speed both contribute to patient discomfort
What are some causes of inadequate anesthesia?
- Injecting inferior to apex of maxillary second premolar
- Dense bone covering apices
- Injecting into an area of infection
- Increase risk of needle-tract infection
What are some technique adjustments with inadequate anesthesia?
- Increase depth of penetration and deposit just superior to apical region of second premolar
- Administer Infraorbital block
What are the properties of the anterior superior alveolar technique?
Commonly used with MSA instead of using an infraorbital block
Consider crossover of ASA nerve to contralateral side of patient
Anesthetizes the pulp of the maxillary canine and the incisor teeth, the associated periodontium, gingiva, and facial soft tissue.
What are some causes and adjustments with discomfort when doing an ASA?
Causes:
- Needle against the periosteum
- Injecting too rapidly
Technique adjustment:
- Withdraw needle and reinsert farther away (lateral) from periosteum
- Inject slowly – the acidic nature of the anesthetic agent and too rapid of injection speed both contribute to patient discomfort
What are some causes and adjustments with inadequate anesthesia when doing an ASA?
Causes:
- Injecting inferior to apex of maxillary canine
- Dense bone covering apices
- Injecting into an area of infection
- Increase risk of needle-tract infection
Technique adjustment:
- Increase depth of penetration and deposit just superior to apical region of maxillary canine
- Administer Infraorbital block
What are some properties of the infraorbital nerve block technique?
Nerves anesthetized: Infraorbital nerve Anterior superior alveolar nerve Middle superior alveolar nerve Inferior palpebral nerve Lateral nasal nerve Superior labial nerve
Use:
Anesthesia is needed for maxillary anterior teeth in one quadrant
If supraperiosteal injection, MSA block or ASA block are ineffective due to dense bone or infection in target area
What is the post injection technique following the infraorbital injection?
Once the needle is carefully withdrawn and capped, an important postinjection procedure is to maintain pressure and massage the solution into the infraorbital foramen for approximately 2 minutes to enhance anesthetic diffusion.
How do you problem solve pain with the infraorbital injection?
Cause: Needle against the periosteum
Remedy: Withdraw needle and reinsert farther away (lateral) from periosteum
