question

Specialties requiring extra training to administer

answer

Conscious sedation Deep sedation General anesthesia

question

Conscious Sedation -is the patient conscious?

answer

-patient in altered state of consciousness

question

Conscious Sedation -what are used to lower pain and discomfort?

answer

-pain relievers and sedatives are used to lower pain and discomfort

question

Conscious Sedation -can the patient communicate?

answer

-patient can communicate any discomfort and respond to questions or comments

question

Conscious Sedation -is it safe?

answer

-very safe

question

Conscious Sedation -side effects?

answer

-patient may experience a headache, nausea, and brief periods of amnesia afterwards

question

Intravenous Conscious Sedation (IV Sedation) -place of administration?

answer

-sedative drugs administered directly into patient's blood system -IV placed in vein and remains throughout procedure

question

Intravenous Conscious Sedation (IV Sedation) -is patient conscious? -do they remember the procedure?

answer

-patient is conscious, but in deep relaxed state -patient does not remember procedure

question

Oral Sedation -when is this taken?

answer

-taken the night before the appointment

question

Oral Sedation -used to

answer

-used to relieve anxiety

question

Type of Oral Sedation

answer

-Benzodiazepine

question

Two uses of Benzodiazepine Oral Sedation

answer

-Sedative hypnotic: patient is calm and drowsy -Anti-anxiety drug: patient is calm and relaxed

question

Inhalation sedation -when is it used?

answer

-used when IV sedation is difficult to administer

question

Inhalation sedation -provides __________ anesthesia

answer

-potent inhalation agents: odorless and colorless gasses that provide general anesthesia

question

Inhalation sedation -how is it administered?

answer

-administered through facemask, laryngeal mask airway, or an endotracheal tube -patient is closely monitored because agent is not long-lasting (a local anesthetic may also be administered to relieve pain after general anesthetic wears off

question

Inhalation sedation -uses

answer

-relieve pain and cause sleepiness

question

Inhalation sedation -does patient remember procedure?

answer

-patient does not remember procedure

question

Intramuscular sedation -place of injection?

answer

-inject sedative drug into muscle of upper arm or thigh

question

Intramuscular sedation -used in what offices?

answer

-not very common (used more in pediatric dental office)

question

Intramuscular sedation -uses? -effects on the patient?

answer

-ease fearful or anxious patient -patient will be relaxed -patient in dreamy state with an attitude of indifference

question

Intramuscular sedation -does patient remember appointment?

answer

-patient does not remember much of appointment

question

General anesthesia -is patient conscious?

answer

-patient goes into an unconscious state that is carefully controlled by an anesthetist

question

General anesthesia -effects on the patient?

answer

-temporarily alters the central nervous system so that sensation or feeling is lost

question

General anesthesia -where is this used?

answer

-usually given in hospital setting and some oral and maxillofacial surgery

question

General anesthesia -can patient breathe on his/her own?

answer

-ventilator breathes for patient

question

Topical anesthesia -when is this used?

answer

-topical anesthetic is applied to numb an area before the local anesthetic is injected

question

Topical anesthesia -why is this used?

answer

-desensitizes the oral mucosa -used to decrease pain sensation -sometimes used to depress gag reflex when taking intraoral x-rays or impressions

question

Topical anesthesia is used to decrease pain sensation for (5)

answer

-Subgingival scaling -Root planing -Seating crowns -Placing matrix bands -Performing periodontal probing

question

Topical anesthesia -what does this affect?

answer

-affects the small nerve endings in the surface of the skin and mucosa

question

Topical anesthesia -what forms is it available in?

answer

-available in gels, ointments, liquids, or metered sprays

question

Topical anesthesia -composition (2)

answer

Ester - Benzocaine Amide - Lidocaine

question

The concentration of solution for _______ ____________ is greater than the concentration of solution used for ______ ____________

answer

-the concentration of solution for topical anesthetics is greater than the concentration of solution used for local anesthetics

question

This has a greater risk for allergic and/or toxic reactions

answer

Topical anesthesia

question

ADA recommends topical anesthetics be left for how long

answer

ADA recommends topical anesthetics be left for 1 minute for the solution to be most effective

question

Local anesthesia -effects

answer

-produces deadened or pain-free area -sensory impulses are temporarily blocked

question

Local anesthesia -only works when

answer

-only works when it contacts the nerve fibers carrying impulses to the brain or the small nerve endings picking up sensations in the tissue

question

Local anesthesia -site of injection

answer

-injected into soft tissues

question

Local anesthesia -available in what forms

answer

-available in liquid form and supplied in premeasured carpules or cartridges -come in cans or blister packs

question

Local anesthesia -chemical compounds

answer

Ester Amides

question

Local anesthesia -Ester examples (2)

answer

-propoxycaine -procaine

question

Local anesthesia -Amides examples (6)

answer

-lidocaine -mepivacaine -prilocaine -articaine -bupivacaine -etidocaine

question

Vasoconstrictors -effects on duration of local anesthetic

answer

-the duration of local anesthetics depends on the presence or absence of a vasoconstrictor (longer lasting if contains vasoconstrictor)

question

Vasoconstrictors -short-duration

answer

-last about 30 minutes and contain no vasoconstrictor

question

Vasoconstrictors -intermediate-duration

answer

-Intermediate-duration: last about 60 minutes and usually contain a vasoconstrictor; most anesthetics

question

Vasoconstrictors -long-duration

answer

-Long-duration: lasts longer than 90 minutes and contains a vasoconstrictor

question

Why are vasoconstrictors added to anesthetics (5)

answer

-constrict the blood vessels around injection site -reduce blood flow in the area -slow the absorption of the anesthetic into the bloodstream (affects intensity and duration) -lowers the level of local anesthetic solutions in the bloodstream (decreases the risk of a toxic reaction) -decreases bleeding at the operating site

question

What is the most commonly used vasoconstrictor?

answer

epinephrine

question

The dilution of vasoconstrictors is referred to as a ________

answer

ratio (1:20,000/1:50,000/1:100,000/1:200,000)

question

Analgesia

answer

absence of pain

question

Analgesic

answer

drug that relieves pain

question

Anesthesia

answer

partial or complete loss of sensation with or without the loss of consciousness caused by disease, injury, or injection or inhalation of an anesthetic agent

question

Sedation

answer

state of calmness or process of reducing nervous excitement

question

Paresthesia

answer

sensation of feeling numb; can be permanent but major concern of short-term numbness is that patients may injure themselves by biting the tongue, cheeks, or lips

question

Paresthesia may be caused by

answer

-Trauma to the nerve sheath (covering) during the injection -Hemorrhage into or around the nerve sheath, causing pressure on the nerve -Injection of local anesthetic contaminated by alcohol / disinfecting solution near a nerve

question

Allergic reaction

answer

hypersensitive reaction to an anesthetic solution

question

Allergic reaction -Clinical manifestations

answer

swelling, redness, ulcerations, difficulty swallowing and breathing

question

Toxic reactions

answer

symptoms that appear to result from overdose or excessive administration of an anesthetic solution

question

Toxic reaction -first symptom

answer

-stimulation of the Central Nervous System (CNS) ->Patient becomes more talkative, apprehensive, and excited with increased pulse rate and blood pressure followed by depression of the CNS as the drug dissipates

question

Reactions to anesthetics depend on

answer

-The type of anesthetic solution -Amount of anesthetic injected -Rate at which the solution was injected and absorbed -Patient's characteristics

question

Chart notations

answer

-Type of anesthetic -Type of injection -Percent of solution -Number of cartridges administered -Any reaction the patient experienced

question

Types of injections are determined by

answer

injection site and innervation of the area or specific tooth

question

Local infiltration -where to place anesthetic solutions

answer

-into tissues near the small terminal nerve branches for absorption

question

Local infiltration -used for

answer

-root planing -soft tissue incision for a biopsy, gingivectomy, or frenectomy

question

Field block also known as

answer

Local infiltration anesthesia

question

Field block -is deposited near

answer

larger terminal nerve branches

question

Field block prevents impulses from passing from the _______ to the _____

answer

tooth to the Central Nervous System

question

Field block -used for

answer

dental procedures involving the teeth or bone on the maxillary and mandibular anterior regions

question

Field block -injection site

answer

given near apex of tooth and involves one or two teeth

question

Field block -how long before patient feels numb

answer

2-3 minutes

question

Nerve Block -injection site

answer

near main nerve trunk

question

Nerve block -prevents what from passing from the site to the brain (including any branches of the nerve trunk)

answer

pain sensation

question

Which block eliminates sensations over a larger area?

answer

nerve block eliminates sensations over a larger area than infiltration or field block anesthesia

question

Nerve block -how long before it takes effect?

answer

4-5 minutes

question

Maxillary - Infiltration Affects

answer

individual teeth

question

Maxillary - Infiltration Location of injection

answer

Near the apex of the tooth; most commonly used on the maxillary anteriors

question

Maxillary - Anterior Superior Alveolar Nerve Block (AKA infraorbital nerve block) Affects

answer

Maxillary central and lateral incisors and cuspid in a single quadrant

question

Maxillary - Anterior Superior Alveolar Nerve Block (AKA infraorbital nerve block) Location of injection

answer

Height of the mucobuccal fold at the maxillary 1st premolar

question

Maxillary - Middle Superior Alveolar Nerve Block Affects

answer

Maxillary premolars in one quadrant and mesial of maxillary 1st molar

question

Maxillary - Middle Superior Alveolar Nerve Block Location of injection

answer

Height of mucobuccal fold at the maxillary 2nd premolar

question

Maxillary - Posterior Superior Alveolar Nerve Block Affects

answer

The maxillary 2nd and 3rd molars, the distobuccal and palatal roots of the 1st molar The buccal tissues adjacent to these teeth

question

Maxillary - Posterior Superior Alveolar Nerve Block Location of injection

answer

Apex of the 2nd molar toward the distobuccal root

question

Maxillary - Greater Palatine Nerve Block Affects

answer

The hard palate and soft tissues covering the hard palate from the distal of the canine posteriorly

question

Maxillary - Greater Palatine Nerve Block Location of injection

answer

Anterior to the greater palatine foramen, middle of the maxillary 2nd molar on the palate

question

Maxillary - Nasopalatine Nerve Block Affects

answer

The anterior 1/3 of the hard palate from canine to canine

question

Maxillary - Nasopalatine Nerve Block Location of injection

answer

The lingual tissue adjacent to the incisive papilla

question

Maxillary - Maxillary Nerve Block Affects

answer

The buccal, palatal, and pulpal tissues in one quadrant Skin of the lower eyelid, side of nose, check, and upper lip

question

Maxillary - Maxillary Nerve Block Location of injection

answer

Height of the mucobuccal fold above the distal of the maxillary 2nd molar

question

Mandibular - Infiltration Affects

answer

Individual teeth

question

Mandibular - Infiltration Location of injection

answer

Near the apex of the individual tooth

question

Mandibular - Inferior Alveolar Nerve Block (AKA mandibular block) Affects

answer

A mandibular quadrant including the teeth, mucous membrane, anterior 2/3 of the tongue and floor of the mouth, lingual soft tissues, and periosteum

question

Mandibular - Inferior Alveolar Nerve Block (AKA mandibular block) Location of injection

answer

Inside of the mandibular ramus, posterior to the retromolar pad, below and anterior to the mandibular foramen

question

Mandibular - Buccal Nerve Block Affects

answer

Buccal tissue adjacent to the mandibular molars only

question

Mandibular - Buccal Nerve Block Location of injection

answer

Mucous membrane to the distal and toward the buccal of the last mandibular molar tooth in the arch

question

Mandibular - Lingual Nerve Block Affects

answer

The lingual tissues and side of the tongue Mandibular teeth to the midline

question

Mandibular - Lingual Nerve Block Location of injection

answer

Lingual to mandibular ramus and adjacent to maxillary tuberosity

question

Mandibular - Mental Nerve Block Affects

answer

The mandibular premolars, canines, and facial tissues adjacent to these teeth

question

Mandibular - Mental Nerve Block Location of injection

answer

Anterior to the mental foramen, between the apices of the roots of the mandibular premolars

question

Mandibular - Incisive Nerve Block Affects

answer

Premolars, canine, lateral, and central incisors Buccal mucous membrane from the mandibular 2nd premolar, the lips, and chin

question

Mandibular - Incisive Nerve Block Location of injection

answer

At the height of the mucobuccal fold in front of the mental foramen

question

the equipment needed to administer local anesthetic includes

answer

Syringe Needle Anesthetic

question

Most common type of syringe

answer

aspirating syringe

question

Syringe designed to...

answer

allow the operator to check the position of the needle before depositing the anesthetic solution

question

Syringes made out of

answer

metal (stainless steel) - autoclavable or nonmetal (plastic) - disposable or autoclavable

question

Parts of the aspirating syringe

answer

Thumb Ring Finger Grip/Bar Syringe barrel Plunger or Piston rod Harpoon Threaded end of the syringe

question

Thumb Ring

answer

-Located at one end of the syringe -Allows the operator to aspirate and apply force during injection -Check for tightness

question

Finger Grip/Bar

answer

-Supports index and middle fingers as anesthetic solution is administered

question

Syringe barrel

answer

-Holds the cartridge -One side of the barrel is open so that the cartridge can be loaded (breech-loading syringe) -Opposite the open side is a window for operator to view the solution left in the cartridge

question

Plunger or Piston rod

answer

-Located inside the syringe barrel -Rod with harpoon on the end -Used to apply force to the rubber stopper in the anesthetic cartridge to expel the solution

question

Harpoon

answer

-Barbed tip at the end of the piston rod that engages the rubber end in the cartridge -Allows operator to aspirate with the syringe -When operator pulls thumb ring back, the engaged harpoon pulls rubber end of the cartridge

question

Threaded end of the syringe

answer

-where needle attaches to the syringe

question

Once the needle is placed in the tissues, the operator retracts the thumb ring creating ____________ ____________

answer

negative pressure

question

Needle used to...

answer

penetrate the tissues and direct the local anesthetic solution from the carpules into surrounding tissues

question

Needles are made of

answer

stainless steel - disposable

question

Lengths of needles (2)

answer

Short (1 inch) Long (1 5/8 inch)

question

Short needles used for

answer

-injections that require little penetration of the soft tissues -Infiltration injections -Field Block injections -Posterior Superior Alveolar Nerve Blocks -Incisive Nerve Blocks -Mental Nerve Blocks

question

Long needs used for

answer

-injections that require penetration of several layers of soft tissue -infraorbital nerve blocks -buccal nerve blocks -maxillary nerve blocks -mandibular nerve blocks

question

Needle -Gauge/Diameter

answer

25, 27, 30 gauge

question

The ___________ the gauge, the ___________ the diameter of the needle

answer

smaller, larger

question

Which gauge needle is used when there is a high risk of positive aspiration

answer

25-gauge

question

what is positive aspiration

answer

drawing blood into the cartridge

question

Lumen

answer

the internal opening of the needle, where the anesthetic solution flows through

question

parts of the needle

answer

bevel shank hub syringe end

question

bevel of the needle

answer

slanted tip of the needle that penetrates the soft tissues

question

shank of the needle

answer

length of the needle from the hub to tip of the bevel (AKA shaft)

question

along the inside of the ________ runs the lumen

answer

shank

question

hub of the needle

answer

part of the needle that attaches to the threaded end of the syringe -plastic or metal -normally prethreaded

question

syringe end of the needle

answer

end of the needle that punctures the diaphragm end of the anesthetic cartridge

question

If the operator penetrates the tissue with the needle more than ___ times during a procedure, the needle should be changed, because disposable needles become dull

answer

4

question

Needlesticks can occur when?

answer

-during transfer of syringe -during recapping procedure

question

What may be used for protection against a needlestick?

answer

stick shield

question

What is a stick shield

answer

a rectangular piece of cardboard that slips onto the needle cap

question

Procedure if needlestick occurs

answer

1. Go to sink and wash wound area thoroughly with soap and water 2. Notify dentist and find out which patient the instrument was used on 3. Review patient's chart and medical history 4. Follow CFC and OSHA protocol for occupational exposure to bloodborne pathogens

question

Anesthetic Cartridge also called

answer

carpule

question

Cartridge/Carpule

answer

glass cylinder that contains the anesthetic solution

question

Parts of the cartridge

answer

Glass cartridge Rubber stopper or plunger Aluminum cap Diaphragm

question

Glass cartridge covered by

answer

thin plastic label

question

Purpose of the thin plastic label covering glass cartridge

answer

provides protection to patient, dentist, and assistant should the glass break

question

What sort of information is on the label covering the cartridge

answer

-Volume of anesthetic -Brand name -Solution concentration -Vasoconstrictor ratio (if added) -Lot number -Expiration date

question

Each anesthetic cartridge contains how much solution?

answer

1.8mL

question

In a 2% solution the volume or amount of anesthetic is

answer

36 mg

question

In a 3% solution the volume or amount of anesthetic is

answer

54 mg

question

rubber stopper or plunger of cartridge

answer

-located in the harpoon end of the cartridge -most treated with silicone so it slides easily -should be slightly indented from the end of the cartridge

question

aluminum cap of the cartridge

answer

-located at the opposite end of the cartridge from the rubber plunger -silver colored -fits tightly around neck of glass cartridge -in the center of the end is a thin diaphragm

question

diaphragm of the cartridge

answer

-where the syringe end of the needle penetrates the anesthetic solution -made of latex rubber

question

examine cartridges for

answer

-Expired shelf-life dates -Large bubbles -Extruded plungers (caused by solution being frozen) -Corrosion (caused by immersion in disinfection solutions -Cracks around neck region and rubber stopper -Rust on aluminum caps (caused by a broken or leaking anesthetic cartridge)

question

cartridge should be discarded when

answer

after use on each patient

question

where should the cartridge be stored

answer

at room temperature in a dark place

question

if dentist wants to wipe diaphragm with solution before use

answer

Wipe with 2x2 gauze sponge moistened with 91% isoprophyl alcohol or 70% ethyl alcohol

question

charting for anesthetic administration, note...

answer

-The type of injection given -Type of topical and local anesthetic administered -If anesthetic contains vasoconstrictor -Percentage of solution -Number of carpules used -Any reactions by the patient -Some dentists also want to record needle(s) used and volume (in milligrams) of solutions used

question

supplemental anesthetic techniques

answer

-intraosseous anesthesia -periodontal ligament injection -intrapulpal injection -electronic anesthesia -computer-controlled local anesthesia delivery system

question

Intraosseous anesthesia -location of injection

answer

-places local anesthetic directly into the cancellous (spongy) bone

question

Intraosseous anesthesia used for

answer

-used for anesthesia in a single tooth or multiple teeth in a quadrant

question

Intraosseous anesthesia affects

answer

-the bone, soft tissue, and root of tooth/teeth are anesthetized

question

When is intraosseous anesthesia used?

answer

-useful for patients who do not like the feeling of a numb lip and tongue

question

Is intraosseous anesthesia fast acting?

answer

-immediate in action

question

Is intraosseous anesthesia cause trauma

answer

-atraumatic

question

Intraosseous anesthesia -administration

answer

-special system for administration: Perforator

question

Perforator

answer

solid needle that attaches to a slow-speed handpiece -The needle perforates the cortical plate of bone and leaves a very small hole for anesthetic needle to be placed

question

What size needle is used to administer intraosseous anesthesia?

answer

8-mm, 27-gauge needle inserted into the hole for administration of the anesthetic

question

Periodontal ligament injection also known as

answer

intraligamentary injection

question

periodontal ligament injection use...

answer

-used for pulpal anesthesia of one or two teeth in a quadrant -sometimes used as an adjunct to another injection where patient is only partially anesthetized -used as an aid for diagnosing abscessed teeth and when a patient does not want the lip and tongue to be numb

question

Technique of periodontal ligament injection

answer

involves inserting the needle into the gingival sulcus along the long axis of the tooth to be treated on the mesial or distal or the root

question

Intrapulpal injection places anesthetic where?

answer

directly into pulp chamber or root canal of the involved tooth

question

when is an intrapulpal injection used?

answer

when there is difficulty in securing pain control

question

Which needles are used for an intrapulpal injection?

answer

25- or 27-gauge short or long needles

question

Sometime the needle for an intrapulpal injection is _______ to access the pulp canal

answer

bent

question

Electronic anesthesia success level

answer

low to moderate level of success

question

When is electronic anesthesia used?

answer

-used when placing restorations, muscle relaxation, determining the patient's centric occlusion -used when local anesthetics are contraindicated (i.e. patients who are allergic to local anesthetics or who are extremely fearful of the injection) -when used with nitrous oxide inhalation sedation, effectiveness is improved

question

Computer-controlled local anesthesia delivery system use...

answer

-used to administer all traditional infiltration and block injections -adjusts the pressure for low-resistant tissues to high-resistant tissues -can be used for injections on the palate and periodontal ligament

question

_____________ delivers a controlled pressure and volume of anesthetic solution at a rate that is commonly below the pain threshold

answer

microprocessor

question

What type of needle and cartridges are used with the computer-controlled system?

answer

-standard anesthetic cartridges and any size or gauge Luer Lock needle can be used with the system -foot control is used to activate the delivery of the anesthetic

question

Nitrous Oxide Sedation provide

answer

relaxation and relieve apprehension or fear

question

Nitrous Oxide Sedation -is patient conscious? -effects on the patient?

answer

-patients maintain consciousness while taking the edge off the pain -patients report floating sensation, tingling fingers, and feeling that time is passing quickly -raises the pain threshold without the loss of consciousness so that patient can talk and follow directions

question

How is nitrous oxide sedation administered?

answer

through small nosepiece

question

What does nitrous oxide sedation affect?

answer

the central nervous system

question

Who was the first to use nitrous oxide?

answer

Horace Wells

question

What is the exposure limit for nitrous oxide?

answer

25 ppm

question

Twice a year, chairside personnel exposed to nitrous oxide should be checked with

answer

diffusive samplers (dosimeters) or with infrared spectrophotometers

question

During administration of nitrous oxide monitor

answer

-heart rate -blood pressure -respiratory rate -responsiveness of the patient

question

Patients who need special consideration with regards to nitrous oxide sedation?

answer

-women in first trimester of pregnancy -infertile people using in vitro fertilization procedures -immunocompromised people at risk of bone marrow suppression -people with neurological complaints

question

Nitrous oxide may cause

answer

fertility problems for those who work with and around it long term

question

Equipment for nitrous oxide sedation

answer

-Delivered through tubing connected to a nosepiece and tanks of nitrous oxide and oxygen -Flow meter and adjustment controls -Excess gas and air exhaled from patient flows through scavenging nasal hood

question

Scavenging nasal hood

answer

a mask inside another mask

question

Parts of the scavenging nasal hood (Inside and Outside masks)

answer

-Inside mask - receives nitrous oxide that flows directly to the patient and from the patient to the outside mask -Outside mask - connected to reservoir bag and vacuum system, which carries away exhaled and additional gases from the treatment area, patient, and dental team members

question

color of cylinders of nitrous oxide

answer

blue

question

color of cylinders of oxygen

answer

green

question

Patients who would benefit from the use of nitrous oxide sedation

answer

patient who.. -Fear dental treatment -Have a very sensitive gag reflex -Can breathe through their nose -Have a heart condition (because of stress reduction and oxygen) -Have a long appointment

question

Contraindications for use of nitrous oxide sedation (patients who should not receive nitrous oxide sedation)

answer

-Patients unable to breathe through their nose -Patients involved in drugs or psychiatric treatment -Women in the first trimester of pregnancy -Immunocompromised people at risk of bone marrow suppression -Infertile people using in vitro fertilization procedures -People with neurological complaints

Chapter 20 Anesthesia and Sedation – Flashcards

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