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DOH 210 > W4 Local Anaesthesia > Flashcards

W4 Local Anaesthesia Flashcards

1
Q

Describe what local anaesthetics are in dentistry?

A

Local anaesthetic is a loss of sensation to a circumscribed area of the body. Used in dentistry to create reversible blockage of pain/sensation signals in peripheral nerves. Natural vasodilators.

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2
Q

Does LA stimulate or depress CNS?

A

Both

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3
Q

What can LA cause on the heart?

A

Antidysrythmias

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4
Q

Do smooth muscles; relax or constrict during LA?

A

Relax; inhibition of neuromuscular transmission in skeletal muscle.

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5
Q

What is added to LA to stabalise the solution?

A

Salt (hydrochlorides) this makes the molecules stable and sobuable in water.

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6
Q

What is the pH base of LA?

A

pka 8-9. In ECF 7.4pH, it is positively charged and called a CATION.

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7
Q

What is pka?

A

Strength of acid.

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8
Q

What determines speed of onset? (pKa)

A

Determeined by pKa of the solution and the pH of the surrounding fluids.

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9
Q

What does it mean if an anaesthetic has a high lipid solubility?

A

HIGH lipid solubility is more potent as they produce more affection conduction blockade at lower concentration that less sol anaesthetics.

LOWER percentage sol, smaller amount required.

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10
Q

Describe binding affinity on LA and how it works in onset of action

A

Drugs with ↑ protein binding affinity will bind to plasma proteins for longer, resulting in an additional reservoir once the unbound drug has diffused away from site/metabolized.

Also will bind to Na+ channel receptor for longer.

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11
Q

How is local anesthetic carried away from site?

A

Vasodilator action increases perfusion of LA in local area with blood,.
Anesthetic agent is carried away from site more rapidly for metabolisim.

Potential for ↑ bleeding at sit of infection

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12
Q

What affects the mode of action of LA of ↓ tissue pH?

A

Low tissue pH. eg. Inflammation which affects the speed of onset. This has ↓ pH outside of the nerve, this means more LA solution present in cation (+). Less free base avail to penetrate nerbe membrane to action on Na receptor

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13
Q

What affects the mode of action of LA of ↑ tissue vascularity?

A

Inflammation affects th duration of action. More blood vessels present in local area, therefor greater opportunity for LA to be removed from injection sit. & spread.

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14
Q

Define speed and mechanism of absorption of LA

A

Speed can be influced by the chemical nature of the drug. Site of injection
- Local blood flow
- Vasoconstriction.
Greater th absoprtion the greater potential for systemic effects.

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15
Q

How does metabolism make LA less lipophillic?

A

Alters the chemical properties of drugs to make them less lipophillic (disolvable) to enable excretion.

Occurs in the liver, blood, plasma and lungs.

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16
Q

How does metabolisim enable LA excretion?

A

Alters the chemical properties of drugs to make them less lipophillic to enable excretion.

Occurs in the liver, blood, plasma and lungs.

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17
Q

Describe Esters as functional groups

A

Procain/Novocaine, Tetracaine.
Metabolisim: rapidly hydrolyzed in plasma by pseudocholinesterease. It is excreted in urine - can be related to allergic reactions. It can ↑ potential for toxicity. Can be hereditry.

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18
Q

What anaesthetics are Amides groups?
Where are they metabolised?
What may affect metabolisim?

A

Lignocaine/Lidocaine. Prilocaine, Articaine, Bupivacaine, Mepivcaine.
Metabolised in the liver.

  • Rate of breakdown is dependent on hepatic flow.
  • Secondary metabolism in lungs.

Things that may affect metabolism are hypotension, congestive hart failure, cirrhosis.

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19
Q

What is the onset of topical anaesthetics?

A

2-5min

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20
Q

What is the duration of topical duration?

A

15-20 min

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21
Q

What are the indication for topical anesthetics?

A

Prior to anesthetic injection on mucous membranes.

Contraindicated: allergy, eating, drinking

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22
Q

What are the constituants of LA?

A

ADD MORE INFO!

  1. Anaesthetic agent
  2. Stabilisers
  3. Vasoconstrictors
  4. Antioxidants
  5. Preeservativees
  6. Water
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23
Q

What effect does adrenaline have on the body in LA?

A

Naturally occurs in the body. Binds to adrenreceptors.

SYMPATHOMIMETIC.
Heart: 
↑ HR, 
↑ Co2 
coronary artery dilation
 ↑ BP

Blood vessels:
Acts on: lungs (bronchiolar muscle relaxation)
GI tract (↓ gut contractiability)
metabolisim (inhibits insulin release)

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24
Q

Dfine Felypression

A

It causes vasoconstriction by acting on smooth muscle of the muscular beds, with greater effects on the venous sude of the peripheral circulation.

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25
Q

What is the formula for maxium LA?

A 
#mg/kg (absolute max) x weight = 000mg
000mg / % (00) = 00.00ml
00.00ml / 2.2ml = 0.0 cartridge
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26
Q

Describe functional group esters

A

Metabolisim: rapidly hydrolyzed in plasma by pseudocholinesterase. A metabolite of this para-aminobenzoic acid is excreted in urine.

  • Contra: unable to metabolise ester → prolonged higher levels of LA in blood, increasing potential for toxicity.
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27
Q

Describe the functional group of amindes

A

Metabolisim in the liver - biotransformation in the liver.

  • Rate of breakdown in dependant on hepatic blood flow.
  • May undergo secondary diffusion metabolisim in the lungs.
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28
Q

What are conditions that may affect hepatic blood flow of amide LA’s?

A
  1. Hypotension
  2. Congestive heart failure
  3. Liver function (cirrhosis

Unable to metabolise amide la, thus increasing potention for toxicity.

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29
Q

Is the maxilla bone cortical or cancellous bone?

A

thin cortical bone. This permit diffusion of anaesthetic to n.

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30
Q

What types of maxilla inflitrations are there?

A

Buccal infiltration & Palatal infiltration

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31
Q

What are the indications for buccal infiltration?

A

Pulpal anaesthesia of 1 or 2 teeth.

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32
Q

What nerve is targeted in buccal infiltration?

A

Dependant on the tooth you want to numb. PSA, MSA, ASA.

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33
Q

What areas are anaesthetised in buccal infiltrations?

A

Local pulp, root, buccal periosteum, CT, buccal gingiva & mucous membrane

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34
Q

Where is the target bony site for a buccal infiltration?

A

Slightly distal and superior to apex of target tooth

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35
Q

What is the soft tissue landmark of a buccal infiltration?

A

Height of muccobuccal fold of vestibule adjacent to target tooth.

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36
Q

What should the orientation of the syringe be for a buccal infiltration?

A

Parallel to long axis of tooth in anterior teeth, more oblique as moves posteiorly

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37
Q

What needle length should be used for buccal infiltrations?

A

Short

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38
Q

What is the insertion & amount depositied for a buccal infiltration?

A

3-5mm.

0.5-1ml… 1/4 - 1/2 of a cartridge

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39
Q

What is a consideraton for buccal infiltrations?

A

Flared deciduous roots.
Do distal injections first.
You can inject interproximally between apices of 2 teeth to target both

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40
Q

When is a palatal infiltration indicated?

A

Anaestheises palatal gingiva of corresponding tooth only.

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41
Q

What nerve is targeted for a palatal infiltration?

A

Dependant on tooth you are anaethesising.

  • Nasopalantine
  • Greater palatine
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42
Q

What areas are anaesthetised for palatal injection?

A

Terminal branches on innervating nerves resulting in anaesthesia of local pulp.

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43
Q

What is the target bony site for palatal infiltration?

A

Greatest angle of palate. (Junction of the palatine process of maxilla and alveolar process of maxilla).

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44
Q

What is the soft tissue landmark of palatal infiltration?

A

maximum tissue thickness of the palate. (curvature of palate).

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45
Q

What is the orientation of needle for palatal infiltration?

A

Insert needle at 45 degree angle.

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46
Q

What needle is used for a palatal infiltration? Insertion? & how much do you deposit?

A

Short: insert 1-2mm.

Deposit 0.-0.3mls

47
Q

How many times do you aspirtate for a block techniqe?

A

2 aspirations in different planes. Except for nasopalatine

48
Q

How many block techniques are there for maxilla? Name them?

A 
5!
Anterior Superior Alveolar:
Middle Superior Alveolar:
Posterior Superior Alveolar:
Greater palatine block:
Nasopalatine block:
49
Q

What is the indications for PSA?

A

Suitable if required pulpal/gingival anaesthesia of more than one molar tooth&raquo_space;>.

50
Q

What nerve is targeted for PSA?

A

Posterior Superior Alveolar n.

51
Q

What areas are anaeshetised in PSA?

A

Pulpal tissue, alveolar bone, CT, PDL, buccal gingiva corresponding to maxillary 1st, 2nd, 3rd molar. Except MB root ipsilateral side of injection

52
Q

What is the target bony site for PSA?

A

Lower infratemporal surface of maxilla

53
Q

What is the soft tissue landmark?

A

Height of mucobuccal fold over the second molar

54
Q

What is the orientation of syringe for PSA?

A

45 degree angle directed superiority, medially and slightly posterior (one continuous movement)

55
Q

For PSA injection chose a needle length, amount deposited, and length of time

A

Short: insertion 15mm.
Amount deposited 3/4 - 1/2
Deposit over 30-60 seconds.

56
Q

What is a consideration of PSA?

A

Injecting near pterygopalatine space - haematoma formation if unctures maxillary artery or pterygoid plexus.

Aspirate in 2 planes

57
Q

What are the indications for the MSA?

A

Suitable if requie pulpal/gingival anaesthesia of both premolars.

58
Q

What n. is targeted for MSA?

A

Middle Superior Alveolar n,

59
Q

What area is anaesthetised with a MSA injection?

A

Pulp tissue, alveolar bone, CT, PDL and buccal gingiva corresponding to the premolars and MB root of macillary 1st molar on ipsilateral side of injection

60
Q

What is the target bony site for MSA?

A

Superior and slightly distal to the apex of second premolar

61
Q

What is the orientation for the MSA injection?

A

Parallel to long axis of tooth in anterior teeth, more oblique as moves posteiorly

62
Q

What needle length should be used & what is the insertion and amount for MSA?

A

Short.
Insertion: ensure tip depth is above apex of 2nd premolar
1/2 cartridge

63
Q

How much do you deposit for a MSA injection?

A

App. 0.9-1.2mls

1/2 cartridge

64
Q

What are some considerations for MSA injection?

A

Lateral aspect of maxilla slight concave, may need to angle slightly medially.

65
Q

What are the indications for ASA?

A

Suitable if require pulpal/gingival anaesthesia of more than one anterior tooth.

66
Q

What n. is targeted for ASA?

A

Anterior Superior Alveolar never

67
Q

What area is anaesthetised for ASA?

A

Pulpal tissue, alveolar bone, CT, PDL, buccal gingival corresponding to the canine, lateral incisor and central incisor on ipsilateral side of injection

68
Q

What is the target area for the ASA?

A

Distal to lateral incisor close to the apex of the canine.

69
Q

What are the soft tissue landmarks for ASA?

A

Height of mucobuccal fold in the area of lateral incisor and cainine.

70
Q

What would the orientation for the syringe be for an ASA injection?

A

Same as buccal infiltration - parrelle with long axis of tooth

71
Q

What needle length should be used, how far do yo insert and amount deposited ASA?

A

Short needle.
Insertion 10-15ml
Amount deposited 1/2

72
Q

When is a greater palatine block indicated?

A

Suitable if require gingival anaesthesia of molar/premolar region of hard palate

73
Q

What n. is targeted with the greater palatine block?

A

Greater palatine n.

74
Q

What is the target bony site for greater palatine block?

A

Greater palatine foramen

75
Q

What are the soft tissue landmarks for greater palatine block?

A

Junction of soft and hard palate, slightly distal 1cm medial to 2nd premolar.

76
Q

What is the orientation of the syringe for a Greater Palatine block?

A

Advance syringe from opposite side, approx 45 degrees.

77
Q

What needle length and insertion is required for a Greater Palantine block?

A

Short:
Insertion: 2-3mm.
Amount deposited 0.25-0.5mls.

78
Q

What is a main consideration for Greater palatine block?

A

Aspiritaion as greater palatine artery is close.

79
Q

When is a Nasopalatine block indicated?

A

Suitable if require gingival anaesthesia of anterior region of hard palate.

80
Q

What n. is targeted with a Nasopalatine block?

A

Nasopalatine

81
Q

What area is anaethetised with a Nasopalatine block?

A

Palatal gingiva and mucosa of anterior 1/3 of hard palate, ipsilateral to site of injection

82
Q

What is the target bony site for a nasopalatine block?

A

Incisive foramen

83
Q

What is the soft tissue landmarks for a Nasopalatine block?

A

Incisive papilla, located posterior to central incisors, in the midline.

84
Q

What is the orientation of the syringe for a Nasopalatine block?

A

45 degree angle.

Lateral to incisive papilla!

85
Q

What needle length should be used, insertion and amount deposited for a Nasopalatine block?

A

SHORT
Incertion 2-3mm
Amount: 0.25-0.5mls
↓ quarter of a cartridge

86
Q

When is a mandibular buccal infiltration indicated?

A

Suitable to anaesthetise the lower anteriors & deciduous molars prior to eruption of 6’s.

87
Q

What n. is targeted in a mandibular buccal infiltration?

A

Incisive n for anteriors

- IAN for deciuous E’s D’s

88
Q

What areas are anaethestied with a mandibular buccal infiltration?

A

Terminal branches on innervating nerve of adjacent tooth.

Local pulp, root, buccal periosteum, CT, buccal gingiva and mucous membrane,

89
Q

What is the orientation of syringe for mandibular buccal infiltration?

A

Parralle with long axis of tooth, towards apex

90
Q

When is a lingual infiltration indicated?

A

It is a supplementary local infiltration of the lingual n.

91
Q

What would the orientation of lingual infiltration

A

Parralle with long axis of tooth. Be careful not to insert in FOM! Can create haemotomia

92
Q

When is a IAN indicated?

A

Pulpal anaesthesia of molar and premolar teeth.

93
Q

What n. is targeted with an IAN block?

A

Inferior Alveolar Nerve is the pterygoidmandibular space (incisve and mental terminal branches anaesthetised).
In the pterygoidmandibular space sol diffuses into lingual n.

94
Q

What areas are anaesthetised with an IAN block?

A

IAN: all mandibular teeth pulp. Buccal gingiva, periosteum, CT, mucous membrane anterior to first molar.
Lingual n.: lingual, gingva, FOM, anterior 2/3 of the tongue. On ipsilateral side of injection

95
Q

What is the target bony site for IAN?

A

Prior to entry: mandibular foramen… superior to lingula on medial border of ramus.
Palpate coronoid notch

96
Q

What is the soft tissue landmarks for the IAN block?

A

Anterior border of the pterygomandibular space.

97
Q

What is the orientation of the syringe for a IAN block?

A

1cm above the premolars on the contralateral side.

98
Q

What is the insertion for IAN block?

A

25mm until hit bone, withdraw slightly then aspirate.

Amount deposited: 1.5-1.8mls over 60 secs.

99
Q

What are the considerations when placing IAN block?

A

Size of buccal fat pad. Size of ramus. Dental arch and alignment of teeth.

If tongue is not number, withdraw slightly and deposit 0.msl to target Lingual n.

100
Q

When is a long buccal block indicated?

A

If anaesthesia of buccal gingiva of mandibular molars.

101
Q

What nerve is targeted with a long buccal block?

A

Long buccal nerve.

102
Q

What areas are anaesthesied with a long buccal block

A

Buccal gingiva of lower posterior teeth and the adjacent mucobuccal fold.

103
Q

What is the target bony site for a long buccal block?

A

Anterior border of ramus - targeting nerve as it leaves pterygomandibular space, crosses the ramus of the mandible beore it pierces the buccinator.

104
Q

What is the soft tissue landmark for the Long Buccal Block?

A

Mucous membrane distal and buccal to last molar in the arch,

105
Q

What is the orientation of syringe for IAN block?

A

Parallel to occlusal plane on the side of injection?

106
Q

What needle length can you chose, insertion and amount deposited for IAN

A

LONG:
25mm insertion
1/2-3/4 catridge

107
Q

What are the indications for a incisive/mental block?

A

When tx is limited to mandibular anterior teeth, and full quadrant is not necessary

108
Q

What n. are targeted with an incisive/mental block?

A

Incisive n. and mental n.

109
Q

What areas are anesthetized with a mental block

A

Incsive n: Pulp, CT, PDL, buccal gingiva and soft tissue of premolars, canine and incisor teeth ipslateral side to injection.
Mental n: lip skin, mucosa and muscles of lower lip ipsilateral side to injection.

110
Q

What is the target bony site for incisive block?

A

Mental foramen

111
Q

What is the soft tissue landmark for an incisive block?

A

Between apices of lower premolars

112
Q

What is the orientation of syringe for a mental block?

A

Parallel to occlusal place of the side of injection OR

Parallel to long acis of tooth for bi.

113
Q

What needle length is needed, insertion and amount for a mental injection?

A

Short. Insertion 5-6mm.

Amount deposited 0.5-0.6mls 1/4 cartridge

DOH 210 (22 decks)

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