question

Define Local infiltration/supraperiosteal:

answer

Small terminal nerve endings in the area of the dental treatment are flooded with local anesthesia solution. Incision is made into the same area in when local anesthesia has been deposited.

question

Define Field block:

answer

Local anesthesia solution is deposited near the larger terminal nerve branches So the anesthetized area will be circumscribed preventing the passage of impulses from the tooth to the CNS. Incision or treatment is made into an area away from injection site max. injections made above apex of tooth are properly termed field blocks.

question

Define Nerve block

answer

local anesthesia is deposited close to main trunk usually at a distance from the site of operative intervention. Examples P S A and I A

question

Supraperiosteal injection (infiltration): What area (hard and soft tissues) will be anesthetized?

answer

Pulp and root of the tooth, buccal periosteum, connective tissues, and mucous membrane

question

Supraperiosteal injection (infiltration): What nerves will be anesthetized?

answer

The large terminal branches of the dental plexus

question

Supraperiosteal injection (infiltration): Why would you want to do this injection (indications and advantages)?

answer

Indications: Pulpal anesthesia of maxillary teeth as apposed to a block Advantages: High accurate rate technically easy injection usually atraumatic

question

Supraperiosteal injection (infiltration): List some contraindications and disadvantages

answer

contraindications: Infection or acute inflammation in area of injection and dense bone covering apices of teeth disadvantages: not recommended for large areas because of the need for multiple needle insertions and the necessity to administer larger total volume of local anesthesia

question

Supraperiosteal injection (infiltration): What is the risk of positive aspiration?

answer

negligible, but less than 1% possible

question

Supraperiosteal injection (infiltration): What length and gauge needle will you use?

answer

25-27 gauge short needle

question

Supraperiosteal injection (infiltration): What is the area of insertion?

answer

height of mucobuccal fold above apex of tooth being anesthetized

question

Supraperiosteal injection (infiltration): What is the target area?

answer

apical region of tooth to be anesthetized

question

Supraperiosteal injection (infiltration): What is the length of the root of this tooth, and why is that significant?

answer

16.1 mm length of the root. This is significant because you have to advance the needle until the bevel is at or above the apical region of the tooth

question

Supraperiosteal injection (infiltration): What landmarks are you looking for?

answer

mucobuccal fold, crown of tooth, root contour of the tooth

question

Supraperiosteal injection (infiltration): How is the bevel of the needle oriented, and why?

answer

orient needle bevel towards the bone and to prevent tearing of the peiosteum

question

Supraperiosteal injection (infiltration): How should the syringe be held, in relation to the tooth?

answer

hold the syringe parallel with the long axis of the tooth

question

Supraperiosteal injection (infiltration): How deep does the needle penetrate the soft tissue here?

answer

only a few milimeters

question

Supraperiosteal injection (infiltration): Is it necessary to contact bone before administering the anesthetic solution?

answer

No

question

Supraperiosteal injection (infiltration): Is a fulcrum necessary?

answer

Yes

question

Supraperiosteal injection (infiltration): When do you aspirate?

answer

Aspirate two times. When the needle is a few milimeters in the soft tissue and once again if the first aspiration was negative

question

Supraperiosteal injection (infiltration): How much anesthetic solution should be deposited?

answer

0.6 ml = 1/3 cartridge

question

Supraperiosteal injection (infiltration): What does it mean if there is "ballooning"of the soft tissue during or after the injection?

answer

anesthetic was delivered too quickly

question

Supraperiosteal injection (infiltration): What are safety features for this injection?

answer

normal risk of intravascular administration and slowness of injection aspiration

question

Supraperiosteal injection (infiltration): Why might you have failure of anesthesia with this injection?

answer

needle tip below apex of tooth, resulting in soft tissue anesthesia only needle tip too far from the bone and solution deposited in the buccal soft tissue only

question

Middle Superior Alveolar Nerve Block (MSA) What nerves are anesthetized with this injection?

answer

middle superior alveolar nerve and it's terminal branches

question

Middle Superior Alveolar Nerve Block (MSA) What areas (hard and soft tissues) are anesthetized with this injection?

answer

pulps Maxillary 1st and 2nd premolars and Mesial Buccal root of 1st molar, buccal periodontal tissues and bone over the same teeth

question

Middle Superior Alveolar Nerve Block (MSA) Is it necessary to administer this injection on all patients when scaling in this area? Why or why not? What are the indications and advantages for this injection?

answer

No, because the MSA is present in 28% of the population. Indications: When the I O nerve block fails to provide pulpal anesthesia distal to the maxillary canines and when dental procedures involve both maxillary premolars only. Advantages: Minimizes the number of injections and volume of solution

question

Middle Superior Alveolar Nerve Block (MSA) List any contraindications and disadvantages for this injection.

answer

Contraindications: infection or inflammation in area of needle injection or needle insertion or drug deposition. Where the MSA nerve is absent. Innervations is through the ASA nerve these branches can be anesthetized using MSA technique. No disadvantages

question

Middle Superior Alveolar Nerve Block (MSA) What is the best alternative to this injection, in order to anesthetize from the central incisor through the 2nd premolar?

answer

Local infiltrations, P D L, or I O injections

question

Middle Superior Alveolar Nerve Block (MSA) What is the MOST likely needle length and gauge size to be used?

answer

27 gauge short needle

question

Middle Superior Alveolar Nerve Block (MSA) What is the area of insertion?

answer

height of the mucobuccal fold above the maxillary 2nd pre-molar

question

Middle Superior Alveolar Nerve Block (MSA) What is the target area?

answer

maxillary bone above the apex of the maxillary 2nd pre-molar

question

Middle Superior Alveolar Nerve Block (MSA) How is the bevel oriented?

answer

toward bone

question

Middle Superior Alveolar Nerve Block (MSA) How far is the needle advanced? Should you touch bone with the needle tip?

answer

Into the height of the mucobuccal fold. No bone is contacted.

question

Middle Superior Alveolar Nerve Block (MSA) How much anesthetic solution should you deposit?

answer

0.9 to 1.2 ml = ½ -2/3 cartridge

question

Middle Superior Alveolar Nerve Block (MSA) What are the causes of failure of anesthesia from this injection?

answer

anesthetic solution not deposited high enough the apex of the second premolar deposition of the anesthetic delivered too far from the maxillary bone bone of the zygomatic arch at the site of injection preventing the diffusion of anesthetic

question

Posterior Superior Alveolar Nerve Block (PSA) What nerves are anesthetized with this injection?

answer

Posterior superior alveolar and branches

question

Posterior Superior Alveolar Nerve Block (PSA) What hard and soft tissues are anesthetized?

answer

pulps the of maxillary 3rd, 2nd, and 1st molar with the exception of the Mesial Buccal root of the Maxillary 1st molar and Buccal periodontum and bone overlying these teeth.

question

Posterior Superior Alveolar Nerve Block (PSA) How successful is this injection?

answer

highly successful more than 95 %

question

Posterior Superior Alveolar Nerve Block (PSA) State the advantages and indications for this injection.

answer

Indication: when treatment involves 2 or more molars; when supraperiosteal (local infiltration) is contraindicated or has been ineffective. Advantages: when administered properly, no pain is experienced due to the large area of soft tissue the anesthetic is deposited into and no bone is contacted. High success rate. Minimizes the number of injections needed when compared to infiltration and minimizes amount of anesthesia administered

question

Posterior Superior Alveolar Nerve Block (PSA) State the disadvantages and contraindications for this injection.

answer

Contraindications: when the risk of hemorrhage is too great (hemophiliac) in which case a suprepereosteal or PDL is recommended Disadvantages: risk of hematoma, technique is somewhat arbitrary due to no bony landmarks and Second injection necessary for treatment on Mesial Buccal root of 1st molars in 28% of patients

question

Posterior Superior Alveolar Nerve Block (PSA) What length and gauge of needle is MOST likely to be used for this injection?

answer

a 25 or 27 gauge short needle

question

Posterior Superior Alveolar Nerve Block (PSA) What is the area of insertion?

answer

height of the muccobuccal fold above the maxillary 2nd molar

question

Posterior Superior Alveolar Nerve Block (PSA) What is the target area?

answer

PSA nerve-posteriors, superiors, and medial to the posterior border of the maxilla

question

Posterior Superior Alveolar Nerve Block (PSA) What are the landmarks?

answer

muccobuccal fold, maxillary tuberosity, and zygomatic process of the maxilla

question

Posterior Superior Alveolar Nerve Block (PSA) How is the bevel of the needle oriented?

answer

bevel of the needle toward bone

question

Posterior Superior Alveolar Nerve Block (PSA) How do you access the area to insert the needle properly?

answer

For left P S A nerve block, a right handed administer should sit at the 10 o'clock position facing the patient For a right P S A never block, right handed administer should sit at 8 o'clock position facing the patient.

question

Posterior Superior Alveolar Nerve Block (PSA) How is the needle advanced, and at what angles, in order to reach the site of the deposit of the anesthetic?

answer

advanced needle slowly upward, inward and backward in one movement (not three) upward - superiorly at a 45 degree angle to the occlusal plane inward - medially toward the midline at a 45 degree angle to the occlusal plane backward - posteriorly at the 45 degree angle to the long axis of the 2nd molar

question

Posterior Superior Alveolar Nerve Block (PSA) Should you contact bone with the needle with this injection?

answer

no

question

Posterior Superior Alveolar Nerve Block (PSA) How far should the needle penetrate for this injection? How much of the needle should remain visible when at the proper depth of penetration?

answer

normal size adult; 16 mm places the needle tip in the immediate vicinity of the foramina through which the P S A nerves enter the posterior surface of the maxilla. With a short needle (average length 20 mm), approximately 4 mm should remain visible

question

Posterior Superior Alveolar Nerve Block (PSA) Discuss aspiration techniques for this injection. Is positive aspiration likely?

answer

aspirate in 2 planes- rotate syringe barrel (needle bevel) ¼ turn to re-aspirate. Positive aspiration is 3.1 % (likely)

question

Posterior Superior Alveolar Nerve Block (PSA) How much anesthetic solution should be deposited for this injection?

answer

0.9 - 1.8 ml of anesthetic solution

question

Posterior Superior Alveolar Nerve Block (PSA) What precautions should be taken with this injection?

answer

depth of the needle penetration should be checked over insertion (too deep) increases risk of hematoma Too shallow might still provide adequate anesthesia

question

Posterior Superior Alveolar Nerve Block (PSA) What are the causes and remedies for failure of anesthesia from this injection?

answer

Needle too lateral-correction—redirect needle tip medially. Needle not high enough -correction—redirect needle tip superiorly Needle too far posterior—correction--- withdraw needle to proper depth.

question

Posterior Superior Alveolar Nerve Block (PSA) Discuss the 2 major complications from this injection.

answer

1.- hematoma--- produced by over insertion of needle into the pterygoid plexus of veins. Max. artery may also be perforated. Hematoma develops in the buccal tissue within minutes. 2.- Mandibular anesthesia---V3 is located lateral to PSA nerve. Deposition of anesthetic lateral to desired location may produce varying degrees of mandibular anesthesia.

question

Anterior Superior Alveolar Nerve Block (ASA) or Infraorbital Nerve Block What nerves are anesthetized with this injection?

answer

ASA, MSA, and IO nerves : inferior palpebral , lateral nasal,and superior labial

question

Anterior Superior Alveolar Nerve Block (ASA) or Infraorbital Nerve Block What areas (hard and soft tissues) are anesthetized with this injection?

answer

Pulps of maxillary central incisors through canines on injected side and Mesial Buccal root of the 1st molar. Buccal (labial) periodontium and bone of the same teeth. Lower eyelid, lateral aspect of the nose, and upper lip

question

Anterior Superior Alveolar Nerve Block (ASA) or Infraorbital Nerve Block What are the indications and advantages for this injection?

answer

Indications: dental procedures involving more than 2 max. teeth and their overlying buccal tissues. Inflammation or infection (which contraindicates supraperiosteal injection); if cellulitis is present, the maxillary nerve block may be indicated in lieu of the I O nerve block. When supraperiosteal injections have been ineffective because od dense cortical bone. Advantages: simple technique; comparatively safe with minimal amounts of anesthesia solution used and needle punctures.

question

Anterior Superior Alveolar Nerve Block (ASA) or Infraorbital Nerve Block List any contraindications and disadvantages for this injection.

answer

Contraindications: discrete treatment areas (1-2 teeth only), hemostasis of localized area can not be achieved adequately. Disadvantages: psychological fear for the administrator, anatomical difficulty defining landmarks and for patients: an extraoral approach to the infraorbital nerve may prove disturbing.

question

Anterior Superior Alveolar Nerve Block (ASA) or Infraorbital Nerve Block What injections could be used as an alternative to this injection, in order to anesthetize from the central incisor through the 2nd premolar?

answer

Supraperiosteal, P D L, or I O injection for each tooth Infiltration for the periodontium and hard tissues Maxillary nerve block

question

Anterior Superior Alveolar Nerve Block (ASA) or Infraorbital Nerve Block What is the PREFERRED needle length and gauge size to be used?

answer

25 gauge long (recommended) or short needle for children and smaller adults

question

Anterior Superior Alveolar Nerve Block (ASA) or Infraorbital Nerve Block What landmarks are useful for this injection? What should you palpate?

answer

Mucobuccal fold, infraorbital notch, and infraorbital foramen. Palpate the infraorbital foramen

question

Anterior Superior Alveolar Nerve Block (ASA) or Infraorbital Nerve Block What is the pathway the syringe should follow?

answer

The syringe is oriented toward the infraorbital foramen, the needle is held parallel to the long axis of the tooth

question

Anterior Superior Alveolar Nerve Block (ASA) or Infraorbital Nerve Block What is the area of insertion?

answer

Needle is inserted at the height of the mucobuccal fold over the 1st pre-molar

question

Anterior Superior Alveolar Nerve Block (ASA) or Infraorbital Nerve Block What is the target area?

answer

Infraorbital foramen

question

Anterior Superior Alveolar Nerve Block (ASA) or Infraorbital Nerve Block How is the bevel oriented?

answer

Toward bone

question

Anterior Superior Alveolar Nerve Block (ASA) or Infraorbital Nerve Block How far is the needle advanced? Should you touch bone with the needle tip?

answer

Approx. 16 mm for adult of average height. In a patient with a high (deep) mucobuccal fold or a low infraorbital foramen, less tissue penetration is necessary than in one with a shallow mucobuccal fold or high infraorbital foramen. No, the needle tip should not touch bone, the bevel of the needle should be facing into the infraorbital foramen and the needle tip touching the roof of the foramen.

question

Anterior Superior Alveolar Nerve Block (ASA) or Infraorbital Nerve Block How much anesthetic solution should you deposit?

answer

0.9-1.2 ml of anesthetic solution

question

Anterior Superior Alveolar Nerve Block (ASA) or Infraorbital Nerve Block What are the causes of failure of anesthesia from this injection?

answer

Needle contacts bone below IO foramen. Needle deviation medial or lateral to IO foramen

question

Anterior Superior Alveolar Nerve Block (ASA) or Infraorbital Nerve Block What, if any, complications can occur from this injection?

answer

Rarely, a hematoma may develop across the lower eyelid and tissues between it and the IO foramen

question

Greater Palatine Discuss some strategies for atraumatic palatal injections.

answer

-provide adequate topical anesthesia to site of needle penetration. -use pressure anesthesia at the site before and during needle insertion and deposition. -maintain control over needle. Deposit anesthesia solution slowly -trust your abilities in completing procedures

question

Greater Palatine What nerve is anesthetized with this injection?

answer

Greater palatine nerve

question

Greater Palatine What areas (hard and soft tissues) are anesthetized with this injection?

answer

Posterior portion of hard palate and its overlying tissue, extending to 1st pre-molar and medially to midline.

question

Greater Palatine What are the indications and advantages for this injection?

answer

Indications: palatal soft tissue is necessary for restorative therapy on 2 or more teeth and for pain control during perio or oral surgery involving palatal soft or hard tissue. Advantages: minimizes needle penetration and volume of solution; minimizes patient discomfort

question

Greater Palatine List any contraindications and disadvantages for this injection.

answer

Contraindication: inflammation or infection at injection site and smaller areas of therapy Disadvantages: no hemostasis except in the immediate area of injection and potentially traumatic

question

Greater Palatine What is the MOST likely needle length and gauge size to be used?

answer

27 gauge short needle

question

Greater Palatine What is the area of insertion?

answer

Soft tissue slightly anterior to the GP foramen

question

Greater Palatine What is the target area? What are the landmarks?

answer

Target: Greater palatine nerve Landmarks: G P foramen and junction of the maxillary alveolar process and palatine bone.

question

Greater Palatine How is the bevel oriented?

answer

Toward the palatal soft tissue

question

Greater Palatine What is the pathway of the syringe?

answer

Advance syringe from the opposite side of mouth at a right angle to the target area

question

Greater Palatine What are the correct patient and operator positions?

answer

Patient: in supine position, extended neck, mouth wide open and head turned left or right for improved visibility Operator: sit facing patient at 7 or 8 o'clock position for right GP block and for left GP block sit facing same direction as patient at 11 o'clock.

question

Greater Palatine How do you find the greater palatine foramen?

answer

With a cotton swab apply pressure at the junction of hard palate and alveolar process medial of 1st molar. Palpate posteriorly until swab falls into a depression of the GP foramen

question

Greater Palatine How long do you apply pressure to the injection site?

answer

For a minimal of 30 seconds

question

Greater Palatine How far is the needle advanced? Should you touch bone with the needle tip?

answer

Less than 10 mm. No, you should not touch bone with the needle tip.

question

Greater Palatine How much anesthetic solution should you deposit?

answer

0.45-.06 ml of solution

question

Greater Palatine What change in the tissue do you notice as you deposit more solution?

answer

Ischemia (blanching)

question

Greater Palatine What safety features are in place for this injection?

answer

Contact with bone and aspirating

question

Greater Palatine What are the causes of failure of anesthesia from this injection?

answer

Unilateral anesthesia: if the solution is deposited to one side of the incisive canal Inadequate palatal soft-tissue anesthesia: if fibers of the G P nerve overlap those of the nasopalatine nerve

question

Greater Palatine What complications can occur with this injection?

answer

Ischemia and necrosis of soft tissue when highly concentrated vasoconstrictor solution used for hemostasis over prolonged period of time ( never use norepinephrone) Hematoma is possible but rare Some patients may be uncomfortable if their soft palate becomes anesthetized

question

Nasopalatine Nerve Block What nerves are anesthetized with this injection?

answer

Nasopalatine nerves bilaterally

question

Nasopalatine Nerve Block State the advantages and indications for this injection.

answer

Advantages: minimizes needle penetration, volume of solution, minimizes patient discomfort from multiple needle penetrations Indications: when palatal soft tissue anesthesia is necessary for restorative therapy on more than 2 teeth. For pain control during perio or oral surgical procedures involving palatal soft and hard tissue

question

Nasopalatine Nerve Block State the disadvantages and contraindications for this injection.

answer

Disadvantages: no hemostasis except in the immediate area of injection and potentially the most traumatic intraoral injection. Contraindications: inflammation or infection at the injection site and smaller area of therapy (one or two teeth)

question

Nasopalatine Nerve Block What length and gauge of needle is MOST likely to be used for this injection?

answer

27 gauge short needle

question

Nasopalatine Nerve Block What is the area of insertion?

answer

Palatal mucosa just lateral to the incisive papilla

question

Nasopalatine Nerve Block What is the target area?

answer

Incisive foramen beneath the incisive papilla

question

Nasopalatine Nerve Block What are the landmarks?

answer

Central incisors and incisive papilla

question

Nasopalatine Nerve Block How is the bevel of the needle oriented?

answer

Toward the palatal soft tissue

question

Nasopalatine Nerve Block What are the proper patient and operator positions?

answer

Patient: in supine position, mouth open wide, neck extended, and head turned to the left or right for improved visibility Operator: sit at 9 or 10 o'clock position facing in the same direction as the patient.

question

Nasopalatine Nerve Block How do you minimize trauma for this injection?

answer

Use the multiple needle penetrating technique involving 2 to 3 injections. 1st injection: infiltration of 0.3ml into labial frenum, 2nd injection: penetration through the labial aspect of the papilla between the maxiallary central incisors toward the incisive papilla and 3rd injection: use only when the second injection does not provide adequate palatal anesthesia

question

Nasopalatine Nerve Block How do you stabilize the syringe during the injection?

answer

Palm up, using finger support, and fulcrum

question

Nasopalatine Nerve Block How long do you apply pressure at the site?

answer

Pressure is maintained until deposition of solution is complete

question

Nasopalatine Nerve Block How is the needle advanced in order to reach the site of the deposit of the anesthetic?

answer

Advance needle slowly at a 45 degree angle toward the incisive foramen until bone is gently contacted depositing small volumes of anesthetic along the way approx. 5 mm

question

Nasopalatine Nerve Block How much anesthetic solution should be deposited for this injection? Is it always possible or necessary to deposit the maximum amount stated?

answer

0.45 ml or less= ¼ cartridge and no, it is not always necessary to deposit the maximum amount stated

question

Nasopalatine Nerve Block What are safety features associated with this injection?

answer

Aspiration and contact with bone

question

Nasopalatine Nerve Block What precautions should be taken with this injection?

answer

Against pain - do not insert directly into incisive papilla. Do not deposit solution too fast. Do not deposit too much solution Against infection - do not insert needle through the incisive canal

question

Nasopalatine Nerve Block What are the causes and remedies for failure of anesthesia from this injection

answer

Unilateral anesthesia if solution is deposit to one side of incisive canal reinserted into anesthetized tissue and re-inject into un-anesthetized area Inadequate palatal soft tissue anesthesia in area of max. canine and 1st pre-molar Local infiltration may be necessary as a supplement in anesthetized area

question

Nasopalatine Nerve Block Discuss the major complications from this injection.

answer

Ischemia and necrosis of soft tissues, when highly concentrated vasoconstrictor solution is used for hemostasis over prolonged period of time ( never use norepinephrone) Hematoma is possible but rare because of the density and firm adherence of palatal soft tissues to bone Due to the density of the soft tissues, anesthetic solution may "squirt" back out the needle puncture site either during administration or after needle withdrawal.

question

Inferior Alveolar including Lingual (Mandibular) Nerve Block What is the success rate for this injection and why?

answer

85-90 %, due to intraoral landmarks not consistently reliable

question

Inferior Alveolar including Lingual (Mandibular) Nerve Block What area (hard and soft tissues) will be anesthetized?

answer

Mand. Teeth to midline, body of mand. Inferior portion of ramus, buccal mucoperiosteum, mucous membrane anterior to mand. 1st molar, anterior 2/3 of tongue and floor of the oral cavity, lingual soft tissue and periosteum

question

Inferior Alveolar including Lingual (Mandibular) Nerve Block What nerves will be anesthetized?

answer

Inferior alveolar, incisive, mental and lingual nerve

question

Inferior Alveolar including Lingual (Mandibular) Nerve Block Why would you want to do this injection (indications and advantages)?

answer

Indications: procedure on multiple mand. teeth in one quadrant, when buccal soft tissue anesthesia is necessary, and when lingual soft tissue anesthesia is necessary Advantages: one injection provides a wide area of anesthesia

question

Inferior Alveolar including Lingual (Mandibular) Nerve Block List some contraindications and disadvantages.

answer

Contraindications: infection or acute inflammation and patients who might bite their lip or tongue Disadvantages: wide area of anesthesia, rate of inadequate anesthesia, intraoral landmarks not consistently reliable and positive aspiration is high

question

Inferior Alveolar including Lingual (Mandibular) Nerve Block What is the risk of positive aspiration?

answer

10-15%

question

Inferior Alveolar including Lingual (Mandibular) Nerve Block What length and gauge needle will you use?

answer

25 gauge long needle

question

Inferior Alveolar including Lingual (Mandibular) Nerve Block What is the area of insertion?

answer

Mucosa membrane on medial side of ramus

question

Inferior Alveolar including Lingual (Mandibular) Nerve Block What is the target area?

answer

I A nerve as if passes downward toward the mand. foramen, but before it enters into the foramen

question

Inferior Alveolar including Lingual (Mandibular) Nerve Block What landmarks are you looking for?

answer

Coronoid notch Pterygoimandibular raphe Occlusal plane of mand. posterior teeth

question

Inferior Alveolar including Lingual (Mandibular) Nerve Block How is the bevel of the needle oriented, and why?

answer

Less critical with this block because needle approaches IA nerve at a right angle

question

Inferior Alveolar including Lingual (Mandibular) Nerve Block What are the correct patient and operator positions for giving this injection?

answer

Patient: in supine position, mouth open wide to permit greater visibility and access to the injection site. Operator: for right I A N B, a right handed operator should sit at 8 o'clock position facing the patient for a left I A N B, a right handed operator should sit at the 10 o'clock position facing the patient

question

Inferior Alveolar including Lingual (Mandibular) Nerve Block Where should you keep your finger or thumb during the injection?

answer

Finger or thumb of the left hand on the coronoid notch

question

Inferior Alveolar including Lingual (Mandibular) Nerve Block What is the correct pathway for the syringe to follow?

answer

Barrel of syringe is placed contra-laterally in corner of mouth over the mand. pre-molars

question

Inferior Alveolar including Lingual (Mandibular) Nerve Block How do you stabilize the syringe during the injection?

answer

Palm up and finger support

question

Inferior Alveolar including Lingual (Mandibular) Nerve Block What 3 parameters must you consider regarding the needle penetration?

answer

1. height of injection 2. anterioroposterior site of injection 3. penetration depth

question

Inferior Alveolar including Lingual (Mandibular) Nerve Block What is the reason and remedy, if you contact bone before you reach site to deposit anesthetic?

answer

The needle tip is usually too far anteriorly (laterally) on ramus -slightly withdraw the needle but do not remove from the tissue and redirect the needle until a more appropriate depth of insertion is obtained

question

Inferior Alveolar including Lingual (Mandibular) Nerve Block What is the reason and remedy, if you do not contact bone?

answer

The needle tip is usually to far posterior (medially) slightly withdraw needle and reposition syringe barrel more posteriorly

question

Inferior Alveolar including Lingual (Mandibular) Nerve Block When do you aspirate? How common is positive aspiration with this injection?

answer

After bone is contacted, withdraw approx. 1 mm and aspirate. 10-15 %.

question

Inferior Alveolar including Lingual (Mandibular) Nerve Block How much anesthetic solution should be deposited?

answer

1.5 ml solution over 60 seconds

question

Inferior Alveolar including Lingual (Mandibular) Nerve Block How and when do you anesthetize the lingual nerve?

answer

After the second negative aspiration, deposit a portion of the remaining solution (0.1 ml) to anesthetize the lingual nerve

question

Inferior Alveolar including Lingual (Mandibular) Nerve Block What are safety features for this injection?

answer

Needle contacting bone preventing overinsertion

question

Inferior Alveolar including Lingual (Mandibular) Nerve Block Why might you have failure of anesthesia with this injection, and how would you remedy that?

answer

Deposition of anesthesia too low, to correct: reinject at a higher site Deposition of anesthetic too far anteriorly, to correct: redirect the needle tip posteriorly

question

Inferior Alveolar including Lingual (Mandibular) Nerve Block What complications may occur?

answer

Hematoma Trismus (muscle soreness) Transient facial paralysis

question

What should you do if the patient gets a hematoma?

answer

Pressure and cold to the area for 3-5 minutes

question

Buccal Nerve Block What nerve is anesthetized with this injection?

answer

Buccal Nerve

question

Buccal Nerve Block What areas (hard and soft tissues) are anesthetized with this injection?

answer

Soft tissues and the periodontum buccal to the mandibular molar teeth

question

Buccal Nerve Block What are the indications and advantages for this injection?

answer

Indications: when buccal soft tissue anesthesia is needed for dental procedures in the mand. molar region Advantages: high success rate and technically easy.

question

Buccal Nerve Block List any contraindications and disadvantages for this injection.

answer

Contraindications: infection on acute inflammation in area of injection Disadvantages: painful if needle contacts periosteum during injection

question

Buccal Nerve Block What is the MOST likely needle length and gauge size to be used?

answer

25 gauge long needle

question

Buccal Nerve Block What is the area of insertion?

answer

Mucous membrane distal and buccal to the most distal tooth in mand. arch

question

Buccal Nerve Block What is the target area? What are the landmarks?

answer

Target area: Buccal nerve as it passes over the anterior border of ramus Landmarks: mand. molars and mucobuccal fold

question

Buccal Nerve Block How is the bevel oriented?

answer

Toward bone during injection

question

Buccal Nerve Block What is the pathway of the syringe?

answer

Syringe is directed toward injection site with bevel facing down, toward bone and syringe aligned parallel with the occlusal plane on the side of injection.

question

Buccal Nerve Block What are the correct patient and operator positions?

answer

Patient is in supine position For right buccal nerve block, operator is sitting at 8 o'clock facing the patient. For left buccal nerve block, operator is sitting at 10 o'clock facing in the same direction as the patient

question

Buccal Nerve Block How far is the needle advanced? Should you touch bone with the needle tip?

answer

Usually 1-2 mm; seldom more than 2-4 mm Yes, you should touch bone with the needle tip

question

Buccal Nerve Block How much anesthetic solution should you deposit?

answer

0.3 ml =1/8th of a cartridge over 10 seconds.

question

Buccal Nerve Block What safety features and precautions are in place for this injection?

answer

Needle contacting bone to prevent over insertion. Minimum positive aspiration Precautions: Pain on insertion from striking unnesthetized periosteum and local anesthetic solution not being retained at the injection site

question

Buccal Nerve Block What is a cause of failure of anesthesia from this injection?

answer

inadequate volume of anesthetic retained in the tissues

question

Buccal Nerve Block What complications can occur with this injection?

answer

hemotoma

question

Mental/Incisive Nerve Block What nerve is anesthetized with this injection?

answer

Mental and terminal branches of I A nerve

question

Mental/Incisive Nerve Block What hard and soft tissues are anesthetized?

answer

Buccal mucosa membrane anterior to mental foramen around 2nd pre-molar to the midline and skin of lower lip

question

Mental/Incisive Nerve Block State the advantages and indications for this injection.

answer

Indications: when buccal soft tissue anesthesia is necessary for procedures in the mand. anterior to the mental foramen Advantages: high success rate, technically easy, and atraumatic

question

Mental/Incisive Nerve Block State the disadvantages and contraindications for this injection.

answer

Contraindications: infection or acute inflammation Disadvantages: hematoma

question

Mental/Incisive Nerve Block How common is positive aspiration with this injection?

answer

5.7 % positive aspiration

question

Mental/Incisive Nerve Block What length and gauge of needle is MOST likely to be used for this injection?

answer

25 or 27 gauge short needle

question

Mental/Incisive Nerve Block What is the area of insertion?

answer

Mucobuccal fold at or just anterior to mental foramen

question

Mental/Incisive Nerve Block What is the target area?

answer

Mental nerve as it exits the mental foramen usually between pre-molars

question

Mental/Incisive Nerve Block What are the landmarks? How do you find the foramen?

answer

Mand. pre-molars and mucobuccal fold Palpating in mucobuccal fold until concave or irregularity is felt. Look at radiographs

question

Mental/Incisive Nerve Block How is the bevel of the needle oriented?

answer

Toward the bone during injection

question

Mental/Incisive Nerve Block What are the proper patient and operator positions?

answer

Patient is in supine or semisupine position. For right or left mental block the operator is sitting in front of the patient (facing the patient)

question

Mental/Incisive Nerve Block How do you stabilize the syringe during the injection?

answer

Palm up and finger assist.

question

Mental/Incisive Nerve Block What is the pathway of the syringe for this injection?

answer

Penetrate mucous membrane at injection site of canine or 1st pre-molar needle is directed downward toward the mental foramen

question

Mental/Incisive Nerve Block How is the needle advanced in order to reach the site of the deposit of the anesthetic?

answer

Slowly until the foramen is reached

question

Mental/Incisive Nerve Block How much anesthetic solution should be deposited for this injection? What should you do if ballooning of the tissue occurs?

answer

0.6 ml= 1/3 cartridge over 20 seconds. If tissue balloon occur, stop injection deposition and withdraw needle; wait 2-3 min before commencing the procedure.

question

Mental/Incisive Nerve Block What procedure should you do after removing the needle from the injection site with this injection?

answer

Apply pressure to injection site for 2 minutes; produces more effective results

question

Mental/Incisive Nerve Block What are safety features and precautions associated with this injection?

answer

The region is anatomically safe contacting bone is painful—avoid contact or deposit small amount of solution before contact bone

question

Mental/Incisive Nerve Block Discuss the major complications from this injection.

answer

Hematoma

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