Local – Flashcard
133 test answers
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hard tissue restricting flow of anesthesia
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dense bone
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response to drug based on time of day
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diurnal body rhythms
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soft tissue restriction to flow of anesthesia
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inflammation
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chemical barrier to anesthesia success
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fascial planes
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accessory innervation to mandibular teeth
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mylohyoid nerve
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drug tolerance
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tiachyphylaxis
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Devices used for delivery of local anesthetic solutions have very little impact on local anesthesia failure True or False
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True they do have little impact
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Dental hygiene procedures require less duration of anesthesia than restorative procedures True or false
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False They do not always require less
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needle bevel orientations are not considered critical to the success of any injection True or False
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True they are not critical to success
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I.A. nerve blocks may be unsuccessful when the needle penetration is lateral the the sphenomandibular ligament True or False
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FALSE it is not lateral to
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a 25 gauge needle has less potential for deflection than a 27 gauge needle, although deflection is not a common cause for anesthetic failure True or false
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true 25 gauge do have less deflection than 27
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nerve blocks typically require a similar volume of anesthetic solution to achieve profound anesthesia True or false
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False nerve blocks require more
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a pH of lower than 3.3 can lead to failure of anesthesia because the solution is too acidic True or False
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True ph of lower than 3.3 lead to failure
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aberrant innervations are expected anatomical variations True or False
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False accessory are expected aberrant are not
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fibers from the greater palatine nerve may provide accessory innervation to the palatal roots of maxillary molars True or false
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true fibers provide innervation to molars
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PDL injections can overcome nearly all of the challenges that occur due to accessory and aberrant innervation True or False
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True pdl injections do
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the higher the gauge of a needle, the greater its what is
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flexibility and deflection in tissues is
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a cartridge of anesthesia with a vasoconstrictor hsould have a pH of no lower than
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3.3
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tissue inflammation contributes to less anesthetic failure because the pH of the tissue is what compared to normal
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less than normal
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dense bony prominences, shallow vestibules, dilacerations, and soft tissues such as ligaments create what kind of barriers
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physical
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tachyphylaxis is most likely to occur once anesthetized tissues have returned to what of sensations
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normal levels of sensations
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inadequate anesthesia may typically be caused by all of the following except
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quality of manufactured solutions
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which of the following factors is most likely to correspond to anesthetic failures
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physical and chemical barriers
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which of the following does not have an effect on the ability to achieve profound anesthesia in the presence of inflammation
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choice of topical anesthetic
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which of the following is the best procedure to follow in the presence of inflammation
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select an injectionthat will provide conduction blockade on the nerve trunk away from the area of inflammation
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which of the following nerves is often considered most likely cause of accessory innervation to mandibular first molar
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mylohyoid
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which of the following injection would least likely solve inadequate anesthesia on the palate root of tooth #3
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Facial infiltration
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the gow gates is successful in providin ganesthesia for the mandibular molars in the presence of accessory innervation from the mylohyoid or lingual nerves because
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it anesthetizes the IA nerve trunk higher in the pterygomandibular space
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mepivicaine plain solutions may be used for reinjection following the use of lidocaine 2% with epi for all of the following EXCEPT
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it is a strong vasodilator
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True or False A patient with severe systemic disease is classified as ASA IV
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FALSE classified as ASA III
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True or False If a patient is described as ASA III due to blood pressure levels, recommended dental treatment may be initiated provided that intraoperative monitoring of blood pressure is considered and the patients are referred to physicians within one month
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True ASA III dental treatment may be done but monitoring must be done also and physician must be seen within one month
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True or Fale A score of 18 on Corah's Dental anxiety scale indicates mild fear
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False An 18 is high fear
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True or false a pulse oximiter attached to the patient's finger may detect the presence of methemoglobinemia
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True pulse oximiters can detect methemoglobinemia
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Following a relatively severe heart attack, how long should elective dental treatment be delayed?
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six months after a heart attack
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Epinephrine is contraindicated in a patient with what
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uncontrolled hypothyroidism
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a petient with chronic obstructive pulmonary disease requiring oxygen is classified as ASA what
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ASA IV
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a patient with well-controlled NIDD is classified as
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ASA II
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what is the maximum recommended dose of epinephrine for patients in category AMC III with cardiovascular disease
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0.04 mg
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according to the 2007 AHA guidelines, which of the following conditions does not require antibiotic premedication for the prevention of infective endocarditis
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hemophillia
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following a CVA or a TIA how long should elective dental treatment be delayed
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Six months after a stroke
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Which of the following are initial signs and symptoms of methemoglobinemia
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gray cyanosis of mucous membranes, lips, nail beds
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which of the following local anesthetic drugs may represent a relative contraindication for patients with compromised liver functions
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lidocaine
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A patient with asthma is classified as ASA type
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Asthma is ASA II
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a patient with congestive heart failure is classified as ASA type
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CHF is ASA III
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patients with poorly controlled diabetes may have a relative contraindication to the use of
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epinephrine
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nerve fiber that releases adrenaline
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adrenergic
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smooth muscle contraction
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Alpha receptor
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cardiac stimulation
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beta 1 receptor
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smooth muscle relaxation
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beta 2 receptor
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adrenal gland neurotransmitters
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catecholamines
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adrenaline
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epinephrine is adrenaline
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synthetic catecholamine
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levonordefrin is synthetic
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vasoconstrictor not used in dentistry
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norepinepnrine is not used in dentistry
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mimics sympathetic mediators
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sympathomimetic mimics
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contains a nitrogen atom
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amide
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body's management of a drug
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biotransformation
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positively charged ion
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cation
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pKa
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dissociation constant
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removal of drug by kidneys
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elimination
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50% of a drug is removed from circulation
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elimination half-life
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identifies chemical natrure of local anesthetic drug
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intermediate chain
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uncharged molecule
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neutral base
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effect of local anesthetic drug on nerve membrane
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specific receptor theory
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restricts vascular flow
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vasoconstrictor restricts vascular flow
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which of the following is Not a desirable characteristic of local anesthetic drugs
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distributed easily
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during normal nerve function which ion is easily displaced when a membrane is stimulated
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calcium is easily displaced
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which portion of the local anesthetic molecule passes through the nerve membrane
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base
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which percentage is bupivicaine found in
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0.5%
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why do manufacturers manipulate the pKa's of local anesthetic drugs
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clnically useful onset time of anesthesia
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what factor decreases the effectiveness of local anesthesia when tissues are inflamed
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inflammatoin causes a decrease in pH of surrounding tissues
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what factors influences the shift of the neutral base form (RN) of local anesthetic molecules to the cation form (RNH+) whitin the axoplasm
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H+ ions are sufficently available in the axoplasm at a pH of 7.4
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which portion of the local anesthetic molecule binds to receptor site inside the nerve membrane, preventing depolarization
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cation
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prilocaine is biotransfomed by the
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liver, kidneys, and lungs
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ester-type local anesthetic drugs are biotransformed in the
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blood by pseudocholinesterase
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elimination of half life refers to the time it takes for half of the drug to be
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out of the circulation
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MRD stands for
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maximum dose recommended that can be safely administered in most situations
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what is the clnically safest available diluction of vasoconstrictor with lidocaine
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1:100,000
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what is the primary site of biotransformation of lidocaine
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liver
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what percentage is prilocaine
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4%
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what percentage is procaine
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3%
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what percentage of lidocaine is excreted by the kidneys unchanged
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10%
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what is known for the sulfur ring
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bupivicaine
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what is lidocaine's pregnancy factor
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pregnancy factor B
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name the atom present in the ring structure of articaine that helps to make it more lipophilic
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sulfur
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Mepivicaine is a weak or strong vasodilator
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weak vasodilator
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what type is the shortest time for lido (%)
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Lidocaine 2% plain is the shortest
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which formulation of articaine is correct
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4% articaine with 1:100,000 epi
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the maximum recommended dose for lidocaine is
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300 mg per appointment
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what is the target for the IA
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mandibular foramen
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a minimum of what ml of anesthetic solution is required for an IA nerve block due to large diameter of the nerve
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1.5 ml of solution for the IA
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True or False lingual is usually given with IA
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False lingual only given when needed
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True or False Buccal is usually given with IA
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False buccal only given when needed
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the depth of insertion for a mental nerve block is typically how many mm
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4-6mm
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the optimum site of penetration for infiltration injections is at the
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hight of the mucobuccal fold closest to the tooth apex being anesthetized
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the deposition site for an infiltration injection is where
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at the apex of the tooth
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an anatomical variation that can complicate an MSA injection is the presence of a large
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zygomaticoalveolar crest
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the optimal site of penetration for an ASA injectin is at the hight of the mucobuccal fold what to the canine eminence
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anterior to the canine eminence
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the needle pathway of an MSA injection parallels the long axis of the
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maxillary second premolar
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which of the folowing is an anatomical barrier to the success of an infiltration technique
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large exostoses
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studies have demonstrated the absence of the MSA nerve in
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50-72% of individuals
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what anatomical feature may restrict the penetratoin site for an MSA injection
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zygomaticoalveolar crest may restrict penetration
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True of False the rate of deposition of a solution for all palatal injections should be 0.4ml over 40 seconds
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False the rate should Not be .4 over 40 seconds
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True or False The gate control theory suggests that pressure anesthesia blocks the stimulation of non nociceptive fibers
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FALSE blocks the response of nociceptive fibers
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True or False for palatal injections, if swelling or blanching occurs, withdraw the needle and choose another penetratin site
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FALSE slow it down to stop blanching and swelling
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True or False the penetration site for a GP injection is in the fossa located anterior to the GP foramen
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True gp injection is in the fossa located anterior to the gp foramen
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the two-step method for pre-anesthesia for palatal injections includes a one-minute application of topical anesthesia and
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firm pressure for a subsequent minute
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which statement correctly describes a precaution when using 4% local anesthetic for a palatal injection
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reduce total volumes by 50%
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which one of the folowing is the most important consideration for palatal local anesthetic procedures
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adminster solutions slowly
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which of the following best describes the nerves anesthetized by AMSA nerve block
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ASA, MSA, NP, GP nerves all anesthetized by AMSA
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the field of anesthesia for an AMSA nerve block includes
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pulpal anesthesia of the cental and lateral incisors, canine, premolar, and palatal tissue to the midline through the molars; and frequently the buccal periodontium of the pulpally affected teeth
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terminal fibers of the GP nerve overlap the
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nasopalatine nerves
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which statement best describes the penetration site for GP
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slightly anterior to the greater palatine foramen
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the two most important safety steps in the delivery of local anesthetic agents are
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rate of delivery and aspiration
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True or False smaller gauge used for deep penetration because of less flexible and larger lumen provides for ease of accuracy
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TRUE smaller gauge better for deep penetratin and larger lumen provides ease of accuracy
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True or False Heat causes sediment in cartridge
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True heat causes sediment
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true or false a cartridge with bubbles should be disgaurded
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true bubbles hsould be thrown out
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what injection deposits local anesthetic near larger terminal nerve branches
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field block
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what injection deposits local anesthetic near major nerve trunks at a greater distance from the area of treatment, which provides wider areas of anesthesia
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nerve block
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what is the primary reason a needle bevel is oriented toward bone during injection
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to reduce trauma to periosteum when bone is contacted
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which statment describes the correct positioning of the long window of the syringe
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toard the clinician to permit visibility through the injection
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which stament best describes why retractoin of tissue keeping th etissue taut is important during injection
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it allows for ease of needle penetration and establishes a point of stability for the syringe
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which stament correctly describes a false-negative aspiration
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rotating the syringe slightly a quarter turn and reaspirating will release the bevel from a vessel wall
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glass cylinder
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cartridge
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32 mm
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long needle
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22mm
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short needle
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holloow part of needle
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lumen
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aspiratoin and administer slowly is most important true or false
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true aspiration and administer slowly
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the strength of nerve impulses weakens as the energy transfers from one section of nerve membranes to the next true or false
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false
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the electrical potential of a nerve axoplasm in the resting state is approximately -70 mV true or false
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true approx. -70
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