Local Anesthesia- Ch 5,6,7,8 Notes: The syringe, needle, cartridge and additional – Flashcards
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Name the term that describes a syringe where the cartridge is inserted from the side of the barrel of the syringe.
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breech-loading
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Name 6 parts of the syringe
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1. needle adaptor 2. piston 3. harpoon 4. barrel 5. finger grip 6. thumb ring
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How do self-aspirating syringes work?
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they use the elasticity of the rubber diaphragm in the anesthetic cartridge to obtain negative pressure for aspiration
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What is one advantage of self-aspirating syringes?
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easy to perform multiple aspirations throughout the period of LA deposition
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BLANK syringes are used for PDL injections
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Pressure syringes
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What is one disadvantage of pressure syringes?
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"too easy" to administer leading to too rapid injection
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BLANK injection work at very high pressure to force liquid through intact skin or mucous membranes.
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Jet injections
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T/F: The jet injector is an adequate substitute for the more traditional needle and syringe in obtaining pulpal or regional block anesthetic.
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FALSE
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Aspiration with the plastic disposable syringes requires two hands because there is no
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no thumb ring
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Safety syringes protect the needle after injection by moving the front collar of the needle as a guard. This prevents a contaminated needle from
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injury to health care providers
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What does CCLAD stand for?
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Computer Controlled Local Anesthetic Delivery
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Features of CCLAD
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penlike grasp foot activated control reduction in pain
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What does DPS stand for in the STA system?
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Dynamic Pressure Sensing Single Tooth Anesthesia
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The STA system gives you feedback on
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fluid exit pressure at the needle tip
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The ability of the STA system to maintain lower pressure allows
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the absorption of greater volumes of anesthetic PDL injections are "guided"
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The STA system produces fewer
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musculoskeletal problems over the long term
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What does CCS stand for?
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Comfort Control Syringe
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What system has an injection that begins at an extremely slow rate and after 10 seconds automatically increases speed to a preprogrammed injection rate?
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CCS
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After every 5 autoclavings, the syringe should be BLANK
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dismantled and lubricated
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The harpoon should be cleaned with a brush after BLANK
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each use
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Decreased sharpness of the harpoon may result in failure to remain embedded in the cartridge BLANK
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stopper
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A bent harpoon may cause
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cartridge breakage. A bent harpoon produces an off-center puncture of the plunger causing it to rotate as it moves down the cartridge.
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BLANK syringes should never be used for local anesthetic injections.
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non-aspirating
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What is the most dangerous component of dental armentarium?
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The needle
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What are the 5 parts of the needle?
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1. Bevel 2. shaft 3. hub 4. syringe adaptor 5. cartridge penetrating end
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T/F: The bevel of the needle will not affect deflection.
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FALSE- The greater the angle of the bevel with the long axis of the needle, the greater will be the degree of deflection as the needle passes through soft tissue.
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A needle whose point is centered on the long axis is called
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Huber point or Truject and will deflect to a lesser extent
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Two needle factors
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length of shaft diameter of lumen
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BLANK is the piece through which the needle attaches to the syringe
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hub
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BLANK of the needle perforates the diaphragm
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cartridge penetrating end
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BLANK is the diameter of the lumen
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gauge
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T/F: The smaller the gauge, the greater the diameter of the lumen
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TRUE- A 30 gauge needle is smaller than a 25.
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T/F: Patients know when a larger gauge needle is used.
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FALSE- patients cannot distinguish between 23, 25, 27 and 30 gauge needles.
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What are the advantages of larger gauge needles
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less deflection greater accuracy when the depth of soft tissue is greater less needle breakage aspiration is easier
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Larger gauge needles should be used when the risk of positivie aspiration is increased such as during
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inferior alveolar posterior superior alveolar mental or incisive nerve block
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What is the preferred dental needle gauge.
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25 (can be used for all anesthetic techniques in the dental office)
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When is it good to use the 30 guage needle?
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for localized infiltration or for hemostasis
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Deflection is greater when
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more tissue is penetrated greater degree of bevel
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What is one technique used to reduce deflection?
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BRIT- birotational insertion technique, rotating the needle back and forth while advancing through soft tissue.
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The more exaggerated the bending of the needle when it is BLANK and BLANK
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longer needle smaller diameter
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BRIT decreases deflection while also reducing the BLANK needed to penetrate the tissue
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reduces the force needed
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What are the 3 lengths of needles that are available?
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Long short ultrashort (30 gauge only)
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What is the length of a short needle?
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20-25mm (20mm standard)
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What is the length of a long needle?
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30-35mm (32mm standard)
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The weakest portion of the needle receiving the greatest stress during needle advancement is at the BLANK
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hub
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Long needles are preferred for deep injections such as
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inferior alveolar Gow Gates Akinosi infraorbital maxillary nerve blocks
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After how many insertion should a needle be discarded?
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After 3-4 insertions, the needle becomes dulled. Tissue penetration becomes increasingly traumatic
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Needles should not be BLANK because no injection technique requires a needle to be BLANK for success of the injection.
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bent
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T/F: No attempt should be made to change the direction of the needle when it is embedded in tissue.
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True- the needle should first be withdrawn almost completely from the tissue then alter the direction.
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T/F: Sometime you need to force a needle against resistance,
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FALSE- NEVER!
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What forms when needles contact hard bone?
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fish hook barbs
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T/F: Anesthetic cartridges are standard the world round
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FALSE: Australia and UK = 2.2 ml Japan and France = 1 ml
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The stopper is also called the
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plunger or bung
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A stopper with BLANK allows it to traverse the glass cylinder more easily.
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silicone
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T/F: Cartridges whose plungers are flush or extruded beyond the glass cylinder should not be used.
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TRUE- a large bubble may indicate that the anesthetic was frozen and contaminated. An extruded stopper with no bubble was probably stored in chemical disinfecting solution
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BLANK holes in the diaphragm may lead to leakage.
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ovoid
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BLANK allows any solution that the cartridge is immersed in to diffuse into the cartridge contaminating the local anesthetic
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semipermeable diaphragm
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BLANK is applied to all cartriges to protect in case of cartridge breakage and provide a label for the drug.
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Thin Mylar plastic label
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T/F: The LA drug is stable and is capable of being autoclaved, heated or boiled without breaking down.
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TRUE- BUT other components of the cartridge (vasopressor and cartridge seals) are more easily destroyed
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T/F: LA is more acidic if it contains vasopressors
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true
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BLANK is added as a preservative to protect the vasopressor from oxidation.
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sodium bisulfite (reacts with oxygen) May increase the burning sensation if the cartridge is close to it's expiration
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BLANK is added to the cartridge to make the solution isotonic with tissues of the body
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sodium chloride
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BLANK is the diluent of the cartridge and provides the volume.
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distilled water
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Previously added and now prohibited was a bacteriostatic, fungistatic and antioxidant.
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methylparaben
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T/F: After autoclaving, cartridges should be stored in their original container.
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FALSE- never autoclave but, true, store in original container
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Local anesthetics should not be left exposed to direct BLANK
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sunlight
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The BLANK of local anesthetic boxes should be reviewed periodically
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package insert
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The bubble in the cartridge is made up of
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nitrogen gas- about 1-2mm is bubbled into the cartridge during manufacture to prevent oxygen from being trapped inside
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T/F: if the aluminum cap on the cartridge is damaged, the cartridge should be discarded.
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True- the underlying glass may have been damaged as well
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Hairline cracks or chips may be found at the thin neck of the cartridge
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look for them on all other cartridges if there is a broken cartridge found in the container.
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BLANK minimizes the risk of post injection infection
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topical antiseptic
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Name some types of topical antiseptic
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Betadine (iodine) Merthiolate (thimerosal) NOTE: Topicals containing alcohol should NOT be used because of tissue irritation
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Before any iodine containing antiseptics are used, you should determine BLANK
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if the patient has any adverse reactions to iodine containing products
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If topical antiseptics are used, a BLANK should be used to prepare the area.
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sterile gauze wipe
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What is the recommended use for topical anesthetic?
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Minimal use at the end of an applicator stick place for 1 minute
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Profound soft tissue analgesia is obtained with the use of topical anesthetic after how long
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2-3 minutes
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EMLA is a mixture of
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lidocaine and prilocaine
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BLANK sprays of topical anesthetics are potentially dangerious and not recommended for routine use.
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Unmetered sprays
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When considering allergic reactions to topical anesthetics, please consider the preservatives such as
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methylparaben
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Applicator sticks have a good use to BLANK
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compress tissue during palatal injections
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Cotton gauze should always be used to BLANK
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1. wipe area of injection 2. dry mucous membranes for better visibility
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T/F: Larger gauze (4X4) is recommended to stop bleeding.
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true
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T/F: Whenever gauze is place into and left in the mouth for a period of time, a length of dental floss should be ties around it.
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true
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A BLANK should be readily available at all times
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hemostat
