question

What are the 4 different types of syringes?

answer

Nondisposable syringes, disposable syringes, "safety" syringes, and computer-controlled local anesthestic delivery systems

question

What are the 9 different armamentarium needed for injections?

answer

1. mouth mirror, 2. recapping/needle disposal devices, 3. syringe, 4. cotton pliers/hemostat, 5. gauze squares, 6. cotton swabs, 7. needles of appropriate gauge and length, 8. cartridges of drugs, 9. topical anesthetic agents

question

ADA Criteria for Acceptance of Local Anesthetic Syringes 1. They must be durable and able to withstand?

answer

repeated sterilization without damage.

question

ADA Criteria for Acceptance of Local Anesthetic Syringes 2. They should be cabable of accepting a wide variety of?

answer

cartridges and needles of different manufacture, and permit repeated use.

question

ADA Criteria for Acceptance of Local Anesthetic Syringes 3. They should be inexpensive, self-contained, light-weight, and simple to?

answer

use with one hand.

question

ADA Criteria for Acceptance of Local Anesthetic Syringes 4. They should provide for effective aspiration and be constructed so?

answer

that blood may be easily observed in the cartridge.

question

What are the 7 different Anatomy of a Dental Syringe?

answer

1. thumb ring, 2. finger grip, 3. spring, 4. guide bearing, 5. piston with attached harpoon, 6. syringe barrel, 7. needle adaptor

question

Within a Self Aspirating Syring, the ______ makes it a aspirating syringe.

answer

Harpoon

question

The N- Tralig 45-Degree Angle Adaptor is used only when the ______ needs to be bent.

answer

needle

question

What injection device is used when others fail?

answer

Intraosseous Injection Devices, punctures gingival tissue to bone, by-passes the cortical plate.

question

What is an "Stabident Device" an example of?

answer

Intraosseous Injection Devices

question

What injection device is used on Pedo Patients?

answer

Jet Injection Devices

question

What injection device is needleless syringe?

answer

Jet injector

question

Problems Leakeage during injection is caused by?

answer

improper preparation of the armamentarium or a bent needle.

question

Problems Broken Cartriges may result from?

answer

a badly worn syringe, bent harpoon or bent needle

question

Problems Bent Harpoon produces?

answer

off-center puncture of plunger causing it to rotate as it moves down the cartridge which may lead to a broken cartridge.

question

Problems Disengagement may result from?

answer

too much pressure to the thumb ring during aspiration or a dull harpoon.

question

Problems Surface Deposits may interfere with?

answer

function and appearance.

question

What are the 6 different Anatomy of a Local Anesthetic Needle?

answer

1. needle shaft, 2. beveled tip, 3. cartridge penetraton end, 4. syringe adaptor, 5. hub, 6. needle cap

question

What is the name of the diameter of the lumen of the needle?

answer

Gauge

question

What is the name of the hollow part of the needle?

answer

Lumen

question

The smaller the gauge number, .....?

answer

the greater the diameter of the lumen.

question

What are the 3 average lengths of needles?

answer

Longe-32 mm, Short-20 mm, Ultra Short-12 mm

question

Advantages of Larger Gauge Needles Less deflection occurs with (Larger/Smaller) gauge needles leading to greater accuracy with injections.

answer

Larger

question

The length of needle influences deflecton. True or False

answer

True

question

(Long/Short) needles will deflect more.

answer

Long

question

Aspiration of blood is easier and more reliable through a (larger/smaller) gauge needle.

answer

Larger

question

There is a less chance for needle breakage with a (Larger/Smaller) gauge needle.

answer

Larger

question

Patient perceives no difference between needle gauges. True or False

answer

True

question

_____ is the most common area for needle breakage.

answer

Hub

question

Needles should not be inserted into the tissue to their ____ unless it is absolutely necessary for the success for the injection.

answer

Hub

question

A needle should never be forced against resistance. True or False

answer

True

question

(Larger/Smaller) gauge needles are recommended when used in a highly vascular area or when needle deflection through soft tissue would be a factor.

answer

Larger

question

Pain on insertion may be caused by?

answer

dull needle. Change needles after three or four penetrations.

question

Breakage may be caused by?

answer

bending needle or from changing direction of the needle when it its embedded in tissue or sudden patient movement.

question

Pain on withdrawl caused by?

answer

barbs on the tip. May be produced during manufacture but is probably due to forceful contact of the needle with bone.

question

It's ok to use a needle on more than one client? True or False

answer

False

question

Needles should be changed after several tissue _______ in the same client.

answer

penetrations

question

Needles should be covered with a ______ ______ when not being used to prevent accidental needle stick.

answer

protective sheath

question

Pay attention to the uncovered needle tip. Properly dispose of needle. What is the proper order?

answer

Recap, Remove, Discard

question

According to OSHA Recapping or needle removal must be accomplished through the use of a?

answer

mechanical device or one-handed technique

question

CDC Suggested Needle Recapping: The "______" method is a simple one-handed method of recapping a contaminated needle.

answer

Scoop

question

The dental ______ is a glass cylinder that holds local anesthetic drugs and other contents in solution for injection into oral tissues.

answer

cartridge

question

What are the 4 anatomy of the dental drug cartridges?

answer

1. cylindrical glass tube, 2. stopper, 3. aluminum cap, 4. diaphragm

question

The rubber plunger inside of a dental cartridge is made of?

answer

silicon

question

What are the 5 contents of Anesthetic Cartridges?

answer

1. Distilled water (diluent-majority of solution), 2. Local anesthetic drug, 3. Vasoconstrictor drug (if present), 4. sulfite preservative (w/ vasoconstrictors), 5. Sodium chloride (isotonic tissue compatibility)

question

Which of the 5 contents of Anesthetic Cartridges, is used as a blockade of nerve function?

answer

Local Anesthetic Drug

question

Which of the 5 contents of Anesthetic Cartridges is an isotonicity of the solution?

answer

Sodium Chloride

question

Which of the 5 contents of anesthetic Cartridges is the volume?

answer

Sterile Water

question

Which of the 5 contents of anesthetic cartridges increases depth and duration of anesthesia, decrease absorption of local anesthetic and vasopressor?

answer

Vasopressor

question

Which of the 5 contents of anesthetic cartridges is an antioxidant?

answer

Sodium (meta) bisulfite

question

ADA Color-Coding System is used for?

answer

The brand name and concentration

question

Care and Handling of Cartridges 1. Packaging-? 2. Preparation-? 3. Warmers-? 4. Storage-?

answer

1. Packaging- tins and blister packs, 2. Preparation- ready to use, 3. Warmers- not necessary, may produce problems, 4. Storage- original packaging, room temperature, away form direct sunlight

question

What are the 4 integrity of cartridges and contents?

answer

1. air bubbles in cartridges, 2. leakage at the cap, 3. leakage at the stopper, 4. displacement of stoppers

question

What are 8 different problems that can happen with cartridges?

answer

1. bubble in the cartridge, 2. extruded stopper, 3. burning on injection, 4. sticky stopper, 5. corroded cap, 6. rust on the cap, 7. leakage during injection, 8. broken cartridge

question

A (BB) sized bubble may be seen in the cartridge. Is this normal?

answer

Yes. nitrogen gas is put into the cartridge during meanufacturing to prevent oxygen being trapped in the cartridge and potentially destroying the vasopressor.

question

A large bubble in the cartridge greater than ___ is the result of freezing. It causes the stopper to ______ and should not be used.

answer

2mm; extruded

question

Problems associated with burning on injection includes what 5 things?

answer

1. normal response to the pH of the drug, 2. cartridge containing sterilizing solution, 3. overheated cartridge, 4. cartridge containing a vasopressor, 5. older cartridge

question

Extruded stopper may be caused by?

answer

freezing or absorption of disinfecting solution through the latex diaphragm. Cartridges should never be stored in disinfecting solution of any kind.

question

Corroded cap may be caused by?

answer

immersion of cartridge in "cold" sterilizing solution

question

Leakage during injection results from?

answer

improper preparation of the armamentarium-needle being placed before cartridge is inserted.

question

What are 4 way a cartridge may be broken?

answer

1. use of excessive force to seat harpoon, 2. bent harpoon, 3. extruded stopper, 4. damage during shipping

question

What are the 6 things that cartridges should be inspected for?

answer

1. integrity (intact), 2. clarity of the solution, 3. presence of large air bubbles, 4. damaged or tarnished caps, 5. damaged or leakage stoppers, 6. lapsed expiration dates

question

Comprehensive ______ ______ is the foundation for the safe delivery of local anesthetic drugs.

answer

patient assessment

question

Examples Medical Compromise 1 Atypical plasma cholinesterase -1 in 2820 -What drug agents should be avoided?

answer

Esters and Articaine

question

Examples Medical Compromise 1 Methemoglobinemia -Increased risk with what two drug agents? -Substitite other amides for ______ and other topicals for ______ -Avoid ______ or ______ when excessive doses of acetaminophen are used

answer

-Prilocaine and Benzocaine -Prilocaine; Benzocaine -Prilocaine; Benzocaine

question

Examples Medical Compromise 1 Liver or Kidney dysfunction -Significant liver or kidney dysfunction in category ASA __ is a relative contraindication for local anesthesia.

answer

III

question

Examples Medical Compromise 1 What is the hereditary disease with reaction to general anesthesia causes tachycardia, muscle rigidity & fever, slight risk for amides to trigger: physician consult.

answer

Malignant Hypothermia

question

Uncontrolled diabetes can lead to _____ _____, poor ______, and _______ failure.

answer

heart disease, poor circulation, and kidney failure. half-life may be extended

question

Examples Medical Compromise 2 What are some medical compromised patients?

answer

Cardiovascular disease and hyperthyroidism, myocardial infarct, cardiovascular accident (CVA), transient ischemic attacks (TIA), hypertension, uncontrolled diabetes

question

What are 3 examples of non selective beta blockers?

answer

Propranolo (Inderal), Nadolol (Corgard), and Timolol (Blocadren)

question

What blood pressure values requires defer treatment, immediate referral?

answer

180/110 or greater

question

What blood pressure values: treatment may be initiated with monitoring, prompt medical referral?

answer

160/100 or greater

question

What blood pressure values has no contradiction for treatment, suggest medical referral?

answer

greater than 120/80 but less than 160/100

question

What are Drug-Drug Interactions?

answer

-Use of multiple local anesthetics -Vasoconstrictor (epi) and nonselective beta adrenoreceptors (Inderal, Corgard) -Adrenoreceptors can trigger hyperthyroidism event in patients

question

Examples Medical Compromise 3 Allergies -Specific local anesthetics; if a pt is allergic to any ester, which should be avoided? -______; preservative for LA drugs with vasoconstrictors. Also used in foods and drinks (think salad bar lettuce and wine) -______; not possible!! Rxns to ___ are classified as nonallergic adverse drug events.

answer

-all esters must be avoided -Bisulfites -Epinephrine; epi

question

Many prescribed drugs and other substances can affect the pharmacology of local anesthetics. Local anesthetics, in turn, can alter the actions and metabolism of a number of medications and other substances True or False

answer

True

question

"Street Drugs" - ______; according to Little et al, 6 hr waiting perion. Malamed states 24 hr waiting period. May result in hypertensive crisis, stroke and myocardial infarction.

answer

Cocaine

question

"Street Drugs" -______; avoid LA with vaso for 24 hrs. May result in hypertensive crisis, stroke and myocardial infarction

answer

Methamphetamines

question

"Street Drugs" - _______ detensifies the LA.

answer

Alcohol

question

Psychological Compromise ______ and ______ can produce both psychological and physiological changes in the body that can impact the ability to administer local anesthesia and the effectiveness of the local anesthetic.

answer

anxiety and fear

question

Psychological Compromise - ______ care interfere with patient being able to deal with situation.

answer

Psychiatric

question

Always use the (Most/Least) amount of local anesthetic or vasoconstrictor needed to achieve the disired effect.

answer

least

question

Basic Injection Guidelines What are the 3 injection definitions?

answer

Local infiltrations, field blocks and nerve blocks

question

Basic Injection Guidelines What are the 3 key terms relevant to basic injection steps?

answer

penetration site, needle pathway and deposition site (apex of tooth and mm depth)

question

How many basic steps serve as standard operating procedures (SOPs) for monitoring safe injection techniques, patient comfort, documentation, and follow up?

answer

10

question

Which step is Pre-injection Patient Assessment?

answer

Step 1; Thorough patient evaluation -consider precautions and contraindications -indentify necessary modifications -select appropriate techniques and anesthetic drugs

question

Which step is Informed Consent?

answer

Step 2; In a language patients can understand, Provide opportunities to ask questions, Explain procedures recommened (explain the need for each), Clarify risks and rewards (including the risks of failing to treat, Provide acceptable alternatives

question

Which step is Assemble Armamentarium?

answer

Step 3; Assembly of the appropriate armamentarium, Confirmation of the proper function of each local anesthetic delivery device

question

Which step is Pre-injection Preparation?

answer

Step 4; Supportive communication, PREP (Prepare, Rehearse, Empower and Praise)

question

Which step is Prepare Injection Site?

answer

Step 5; Dry the tissue, Apply topical anesthetic for 2 mins

question

What step is the Initiate Injection?

answer

Step 6

question

What step is Aspiration? -Positive -Negative -False Negative -Two planes; only 1-2 mm necessary; beginners often withdral the needle totally

answer

Step 7; One of the two most important safety steps in the delivery of local anesthetic agents is the aspiration test. Slow delivery is the other.

question

Which step is Deposition and Rate?

answer

Step 8; Slowly deposit the LA solution- 1 cartridge in 1 minute-beginners often insert deeper and faster

question

Which step is Completion of Injection?

answer

Step 9; Slowly withdraw the syringe, Recap needle or reload syringe "make your needle safe", Observe the patient, Record the injection on the patient chart

question

Which step is Documentation of Local Anesthetics?

answer

Step 10; The patient's record must include: Date of administration, Type of drugs administered (topical/injectable), Injections administered (area of delivery), Total volume of drugs administered, Results of aspiration "positive" or "negative"

question

What are the 3 things you must to when getting authorization:

answer

1. Take to clinic dentist; 2. Client health history; 3. Clinic book -There will be a form inserted in your clinic book to be filled out for every injection you administer.

question

What is the definition for Musculoskeletal disorders and cumulative trauma disorders?

answer

Injuries or disorders of the nerves, tendons, muscles, joints, cartilage, and spinal discs.

question

Local complications Burning on injection caused by?

answer

pH of LA solution, rapid injection of LA solution, contamination of LA cartridge, warmed cartridges

question

Local complications Management specific problems include?

answer

infection, discomfort, edema

question

Local complications Edema caused by? What is the management for this?

answer

-trauma, infection, allergy, hemorrhage, injection of contaminated solution, hereditary angioedema -Reduce swelling ASAP

question

Local complications Sloughing of tissue caused by?

answer

reaction to topical or local anesthetic-epithelial desquamaton. Sterile abscess may develop secondary to prolonged ischemia resulting from use of LA with epi.

question

What is the management for Sloughing of Tissues?

answer

Palliative, Epithelial desquamation resolves in a few days, sterile abscess resolves in 7-10 days.

question

Local complications How does Hematoma occurs with injections? What are the managements for this?

answer

-Nicking a blood vessel during injection- PSA (most frequent), IANB -Apply direct pressure for several minutes, ice, analgesics, advise may have trismus

question

What are the prevention of Hematomas?

answer

Minimize the number of needle penetration, Avoid trauma, Careful anatomic assessment, Observing appropriate technique

question

Do all Hematomas occurs instantaneously?

answer

No, can show up later

question

-Trismus is defined as a motor disturbance of the ______ nerve. -______ can lead to trismus.

answer

-trigeminal -Hematomas

question

What is the define as spasm of the jaw muscles causing a restriction of movement. Caused by trauma to muscles of blood vessels in the infratemporal fossa, contaminated LA solutions, hemorrhage, infection?

answer

Trismus

question

What are the management for Trismus?

answer

Heat therapy, warm saline rinses, analgesics, muscle relaxants, physiotherapy

question

What are the prevention of Trismus?

answer

Minimize number of needle penetrations, Change needles frequently, Assure needle contamination does not occur

question

What the pain on injection prevention?

answer

1. Provide adequate pre-anesthesia, 2. Maintain a slow rate of deposition, 3. Administer plain local anesthetic solutions first (if plain solutions are to be administered), 4. If a drug causes a "burning" sensation, substitute another appropriate drug

question

Broken Needles Risk Factors Unexpected movements What are 3 factors increasing risk?

answer

1. Smaller diameter needles needles in deeper penetrations, 2. Bending needles at the hub, 3. needle penetrations to the hub needle breakage is uncommon today; however, litigation is possible should it occur

question

Local complications Neelde breakage causes are?

answer

bending the needle and sudden patient movement especially after insertion to the hub

question

What are the managements for needle breakage?

answer

Remove it if a fragment is visible or Refer to OS if not visible

question

Local complications -Soft-tissue or Self-injury is caused by? -What are managements for this?

answer

-the patient inadvertently biting the tissues while still anesthetized -Analgesics, antibiotics, saline rinses lubricant

question

For Self-injury, What can be used for anesthesia reversal?

answer

OraVerse

question

_______ is a broad term for a number of related but clinically diverse neurological effects that all result form nerve injury. It is defined as asn altered sensation and /or persistent partial or complete numbness.

answer

Paresthesia

question

Local complications What are the managements for Parethesia?

answer

Reassure the patient, reexamine the area every 2 months, refer to OS if lasts 1 year tip of the tongue is the most common place for numbness.

question

What are the Prevention of Paresthesia?

answer

1. Slow deposition, 2. Reduce volumes for 4% drugs by 50%, 3. For articaine, use high block techniques- Gow Gates or Vazirani Akinosi, 4. In palate, limit volumes less than or equal to 0.9 ml.

question

Articaine is not used on IA? True or False

answer

true

question

Local complications Facial Nerve Paralysis commonly caused by?

answer

injection of LA into the parotid gland (IANB). Dry eye and dropping of face on affected side.

question

What are the management for Facial Nerve Paralysis?

answer

Reassure patient, remove contacts, eye patch to keep cornea from drying.

question

Local complicaitons Post Anesthetic Intraoral Lesions- recurrent aphthous stomatitis or herpes simplex caused by? What are the managements for this?

answer

-intraoral LA injection -manage the symptoms. Ulcerations last 7-10 days with or without treatment.

question

What are 4 way to reduce risk for Necrosis?

answer

1. Avoid epinephrine at 1:50,000, 2. Avoid excessive durations of topical anesthetic, 3. Avoid excessive blanching- tissue should not turn "stark white", 4. Avoid extensive distention of tissues- tissue should not bulge or "balloon"

question

Infections Manifestation of postanesthetic infections include what 3 things?

answer

1. Pain, 2. Trismus, 3. Overt signs and symptoms are rare

question

Local complications Infection major cause is by? What are the managements for this?

answer

-contamination of the needle befor use -Low grade infection is rare and is seldom recognized immediately. Treated as trismus initially. If not better in 3 days then prescribe antibiotics.

question

Prevention Postanesthetic Infections If infection is present, what should be done?

answer

use a new needle for each penetration and discard needles

question

Prevention Postanesthetic Infections What should be used for immune compromised patients?

answer

use antiseptics before penetrations and consult patients physician for use of antibiotics

question

Systemic complications Whenever any drug is administered, two types of actions may be observed. What are they?

answer

1. Desirable actions, which are clinically sought and usually beneficial, 2. Undesirable actions, which are additional and not sought.

question

Systemic complications Of the 3 systemic complications: Overdose, Allergy and Idiosyncratic reaction Which occurs most frequently?

answer

Overdose

question

Systemic complications What are the 3 principles to consider?

answer

1. No drug exerts a single action, 2. No clinically useful drug is entirely devoid of toxicity, 3. The potential toxicity of a drug rests in the hands of the user

question

Systemic complications Overdose accounts for up to ___% in some estimates. Overdose reactions are ____ related.

answer

99%; dose

question

Initial Signs and Symptoms Local Anesthetic Overdose Manifestation of central nervous system (CNS) excitation: includes what 4 things?

answer

1. Ringing in the ears (tinnitus), 2. Metallic taste in the mouth, 3. Increased anxiety, 4. Circumoral (whole mouth) tingling or numbness

question

Systemic complication Clinical Manifestations -Initial manifestations of LA overdose are usually ______ in nature -This phase may be extremely brief or not occur at all -The first clinical symptom may be _____-_____ seizures

answer

-excitatory -tonic-clonic

question

System complications -Mild OD generally occurs ___-___ mins after administration of LA -Severe overdose occurs quickly within ___min(s) -For a severe overdose, the probable cause is injection into?

answer

-5-10mins -1min -a blood vessel

question

System complications Vasoconstrictor overdose, more common with? What are the managements?

answer

-gingival retraction cord -most overdose are of short duration and require little or no intervention

question

Prevention Local Anesthesia Overdose What are the 4 ways?

answer

1. Assess MRD based on weight and health status, prior to injection, 2. Administer all doses slowly, 3. Aspirate to avoid intravascular deposition, 4. Reaspirate throughout injections

question

What are the signs and symptoms of LA overdose in the CNS from mild to severe?

answer

mild- lightheadedness, tinnitus, confusion and circumoral numbness; mod- muscle twitching, auditory/visual hallucinations; severe- tonic-clonic seizures, unconsciousness, respiratory arrest

question

What are the signs and symptoms of LA overdose in the CVS from mild to severe?

answer

mild- hypertension, tachycardia; mod- decreased contractility and cardiac output hypotension; severe- sinus bradycardia, ventricular dysrhythmias, cirulatory arrest

question

Signs and Symptoms of Vasoconstrictor Overdose What are the moderate signs & symptoms of CVS?

answer

generalized signs of fear and anxiety, nausea, restlessness, heart racing, intense anxiety, weakness, tremor, severe headache, hyperventilation, palpitation and shaky

question

Signs and Symptoms of Vasoconstrictor Overdose What are the severe signs & symptoms of CVS?

answer

serious elevation in blood pressure and heart rate, cardiac dysrhythmias, premature ventricular contractions (PVCs), ventricular tachycardia, ventricular fibrillation, circulatory arrest and stroke

question

What is it called when a drug is given and worn off, a second injection is given and patient doesn't get as numb or duration isn't long enough?

answer

tachyphylaxis

question

What is the major difference between overdose and allergy ?

answer

Allergy are not dose dependent

question

Systemic allergy reactions is (more/less) frequent than local, yet far more serious. -Most frequent after topical anesthetic contact -Usually limited, respond well to antihistamines -May occur due to?

answer

less -Local anesthetic drugs themselves, Sulfite preservatives with vasoconstrictors, If an ester, to the byproduct of hydrolysis (PABA)

question

Recommend OTC Benadryl or prescribe __________, an active ingredient in Benadryl, when a patient says they allergic to all LA.

answer

diphenhydramine

question

Systemic allergic reactions are?

answer

life-threatening emergencies and require prompt responses. termination of treatment and activate emergency protocol

question

Management Systemic Allergic Reactions 2 -Administer oxygen -Administer epinephrine; adult ___mg intramuscularly or subcutaneously and child ___mg -Administer diphenhydramine; adult ___mg intramuscularly or subcutaneously and child ___mg

answer

-0.3mg; 0.15mg -50mg; 25mg

question

Use the (most/least) amount of LA to get desired anesthesia.

answer

least

question

Is it ok to leave a patient following administration of LA?

answer

no

question

What are Idiosyncratic Events?

answer

Adverse events may occur that have no known etiology.

question

Most undesirable reactions to LA's are produced not by the drugs but as a?

answer

response to the act of drug administration.

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