Unit 9

Question 1

During an inferior alveolar injection, the client jumps suddenly and the needle breaks off. What should the dental hygienist do?

Answer 1

Remain calm
Keep a hand in the client’s mouth to prevent closure and the client swallowing or to prevent the needle fragment from embedding further into the tissue
If visible, use a hemostat or cotton pliers to remove the needle fragment (locking good to prevent drop)
If not visible, take a radiograph to assess
Refer to a dentist oral surgeon is necessary ( some fragments may be left if the risk to remove outweighs the potential benefit)
Document incident carefully and thoroughly

Question 2

What would a localized complication be considered?

Answer 2

can occur in the region of the injection and can be attributed to the anesthetic needle, administration technique and/or to the anesthetic drug administered

Question 3

What would a systemic complication be considered?

Answer 3

attributed to the drug administered

Question 4

What are three categories of LA complications?

Answer 4

• primary or secondary complication
• mild or severe complication
• transient or permanent complication

Question 5

what is primary complication

Answer 5

experienced by the patient at the time of the injection

eg burning sensation at the time the drug is adminstered

Question 6

what is a secondary complication

Answer 6

apparent after the injection is completed

caused by the injection of the anesthetic drug, but experienced shortly after the injection or later

Question 7

what is a mild complication

Answer 7

it will resolve without requiring treatment (need to inform the client)

such as burning sensation, or temporary and will resolve shortly after the deposition of the solution

Question 8

what is a severe complication

Answer 8

requires a definite plan of treatment to resolve

such as anaphylaxis, requires immediate treatment and drug intervention

need to document

Question 9

What is a transient complication?

Answer 9

may appear severe at the time of their observation but will eventually resolve without any residual effects

such as a hematoma, which can cause severe swelling and bruising but will resolve over time without any residual effects

Question 10

What is a permanent complication?

Answer 10

leaves a residual effect

such as nerve damage associated with the inferor alveolar nerve block - the damage could last for a few weeks, months or indefinitely

Question 11

What causes a needle to break?

Answer 11

• sudden, unexpected movement of the patient or needle

- poor technique (excessive bending)

Question 12

How can you prevent a needle from breaking?

Answer 12

Prepare the client prior to injection
Use long, large-gauge needle (25 gauge)
Do NOT bend or curve the needle prior to or during
Insert slowly; never force needle
Avoid sudden direction changes, stabilize mandible
Never insert to hub (hubbing)

Question 13

Which needle is most commonly reported as breaking off in a patients tissue?

Answer 13

30 guage

make sure the needle never bends. When doing mand injections making sure to have hold of the mandible

Question 14

Which needle is most commonly reported as breaking off in a patients tissue?

Answer 14

30 guage

make sure the needle never bends. When doing mand injections making sure to have hold of the mandible

Question 15

What will you use to remove the needle fragment if you see it?

Answer 15

hemostats or cotton pliers

Question 16

what instrument should you have on your tray just in case?

Answer 16

hemostats or cotton pliers

stress the importance of being prepared

Question 17

When is the only time you reuse needle after bony contact?

Answer 17

after you do an IAN then long buccal injection

Question 18

What are some potential causes of burning while injecting?

Answer 18

• non sterile carpule contaminated with disinfectant
• large bubbles in carpule
• heated carpules
• expired carpules esp those containing a vasoconstrictor
• pH of vasoconstrictor

Question 19

What are some causes of pain during injection?

Answer 19

• poor technique
• dull needle
• barbed needle
• injecting quickly
• non sterile carpule contaminated with disinfectant
• large bubbles in carpule
• pain on injection -use topical

Question 20

What are some causes of hematomas?

Answer 20

Inadvertent puncturing of a blood vessel (artery) (watch clients on blood thinners, or with bleeding disorders)
Overinsertion of needle during PSA injection
Improper technique
Multiple needle penetrations
Other injections prone are IANB and Incisive

Question 21

How do you prevent hematomas?

Answer 21

Short 25-gauge needle for PSA
Know your anatomy
Modify injection technique for patient size
Minimize the number of needle insertions
Set all angles before insertion, maintain stable fulcrum, aspirate in multiple planes

Question 22

A hematoma is most likely to result following the administration of which injection?

Answer 22

PSA

Question 23

What are the two next most common injections associated with hematomas?

Answer 23

IA and mental nerve block

Question 24

What should a hygienist do should their client develop a hematoma?

Answer 24

Swelling – apply direct pressure immediately for a minimum of 2 minutes
Apply ice to the region at the time of the incident
Apply warm packs the next day (20 min on/off)
Discuss possibility of soreness and limited movement – with the client..
Instruct patient that swelling and discoloration will disappear after 7 to 14 days
Dismiss patient when bleeding has stopped
Follow up with a phone call

Question 25

What causes facial paralysis?

Answer 25

local anesthetic is deposited in the partotid gland overinsertion during the IANB

Question 26

During which injection is the partoid gland most likely to be inadvertently anesthetized?

Answer 26

IANB

Question 27

Where is the parotid gland located?

Answer 27

on the posterior border of the ramus

Question 28

is facial paralysis permanent?

Answer 28

usually it is a temporary loss of function of facial expression muscles

Question 29

How do you prevent facial paralysis?

Answer 29

Proper technique for IANB, use 25 gauge long needle
Contact bone prior to depositing solution
Redirect barrel of syringe more posterior if bone is not contacted

Question 30

What should a hygienist do should their client experience facial paralysis?

Answer 30

Reassure patient that paralysis will last only a few hours
Ask patient to remove contact lenses
Close eyelids manually
“Record the event, and information provided to the patient
Allow client to determine if they want to continue tx or not

Question 31

What should a hygienist do should their client experience facial paralysis?

Answer 31

Reassure patient that paralysis will last only a few hours
Ask patient to remove contact lenses
Close eyelids manually
“Record the event, and information provided to the patient
Allow client to determine if they want to continue tx or not

Question 32

What is paralysis?

Answer 32

Clinically diverse neurological effects
Altered sensation and or persistent partial or complete numbness
Also can include changes to taste sensation if chorda tympani is involved
Lingual nerve most frequently involved (unifascicular in 33% of patients)
“shock in lingual nerve 3-7% of the time not a predictor or lingual nerve damage
Articaine?*** (on exam)

Read articaine article (IAN-lidocaine, GG-articaine)

Question 33

What causes paresthesia?

Answer 33

Irritation to nerve following injection of contaminated solution
Edema places pressure on nerve
Trauma to nerve sheath – electrical shock
Hemorrhage around nerve sheath

Question 34

How do you prevent paresthesia?

Answer 34

Store anesthetic cartridges properly
Avoid placing cartridges in disinfectant solution
Utilize proper technique, Lidocaine for IANB

Question 35

What is the definition of paresthesia?

Answer 35

persistent anesthesia or anesthesia well beyond the expected duration, or altered sensation such as tingling or itching well beyond the expected duration.

Question 36

Which nerve does paresthesia most commonly occur?

Answer 36

Lingual and IA Nerve

Question 37

With which anesthetic solution does paresthesia have a higher occurrence?

Answer 37

articaine there seems to be a 4% higher occurrence than with prilocaine

proper technique includes not moving the needle while it is in deep tissue; almost completely withdraw the needle from the tissue, then redirect the needle.