Unit 9 Flashcards
During an inferior alveolar injection, the client jumps suddenly and the needle breaks off. What should the dental hygienist do?
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
What would a localized complication be considered?
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
What would a systemic complication be considered?
attributed to the drug administered
What are three categories of LA complications?
- primary or secondary complication
- mild or severe complication
- transient or permanent complication
what is primary complication
experienced by the patient at the time of the injection
eg burning sensation at the time the drug is adminstered
what is a secondary complication
apparent after the injection is completed
caused by the injection of the anesthetic drug, but experienced shortly after the injection or later
what is a mild complication
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
what is a severe complication
requires a definite plan of treatment to resolve
such as anaphylaxis, requires immediate treatment and drug intervention
need to document
What is a transient complication?
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
What is a permanent complication?
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
What causes a needle to break?
- sudden, unexpected movement of the patient or needle
- poor technique (excessive bending)
How can you prevent a needle from breaking?
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)
Which needle is most commonly reported as breaking off in a patients tissue?
30 guage
make sure the needle never bends. When doing mand injections making sure to have hold of the mandible
Which needle is most commonly reported as breaking off in a patients tissue?
30 guage
make sure the needle never bends. When doing mand injections making sure to have hold of the mandible
What will you use to remove the needle fragment if you see it?
hemostats or cotton pliers
what instrument should you have on your tray just in case?
hemostats or cotton pliers
stress the importance of being prepared
When is the only time you reuse needle after bony contact?
after you do an IAN then long buccal injection
What are some potential causes of burning while injecting?
- non sterile carpule contaminated with disinfectant
- large bubbles in carpule
- heated carpules
- expired carpules esp those containing a vasoconstrictor
- pH of vasoconstrictor
What are some causes of pain during injection?
- poor technique
- dull needle
- barbed needle
- injecting quickly
- non sterile carpule contaminated with disinfectant
- large bubbles in carpule
- pain on injection -use topical
What are some causes of hematomas?
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
How do you prevent hematomas?
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
A hematoma is most likely to result following the administration of which injection?
PSA
What are the two next most common injections associated with hematomas?
IA and mental nerve block
What should a hygienist do should their client develop a hematoma?
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
What causes facial paralysis?
local anesthetic is deposited in the partotid gland overinsertion during the IANB
During which injection is the partoid gland most likely to be inadvertently anesthetized?
IANB
Where is the parotid gland located?
on the posterior border of the ramus
is facial paralysis permanent?
usually it is a temporary loss of function of facial expression muscles
How do you prevent facial paralysis?
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
What should a hygienist do should their client experience facial paralysis?
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
What should a hygienist do should their client experience facial paralysis?
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
What is paralysis?
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)
What causes paresthesia?
Irritation to nerve following injection of contaminated solution
Edema places pressure on nerve
Trauma to nerve sheath – electrical shock
Hemorrhage around nerve sheath
How do you prevent paresthesia?
Store anesthetic cartridges properly
Avoid placing cartridges in disinfectant solution
Utilize proper technique, Lidocaine for IANB
What is the definition of paresthesia?
persistent anesthesia or anesthesia well beyond the expected duration, or altered sensation such as tingling or itching well beyond the expected duration.
Which nerve does paresthesia most commonly occur?
Lingual and IA Nerve
With which anesthetic solution does paresthesia have a higher occurrence?
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.
