IDB

Question 1

Describe placing an IDB.

Answer 1

• use thumb to retract patient’s cheek
• palpate the coronoid notch with thumb
• locate pterygomandibular raphe
• pull the mucosa tight and ask patient to open as wide as possible
• approach needle from contralateral premolars
• insert needle 1cm above last molar, in the triangle created by the raphe and coronoid notch
• advance needle until bone contacted
• retract 1cm and aspirate
• slowly deposit LA
• inject 2/3 of cartridge before beginning to withdraw depositing last 1/3 as lingual block

Question 2

How do you check for anaesthesia of IAN?

Answer 2

• ask patient how their face feels on that side (numb, swollen)
• for XLA probe PDLs and mucosa

Question 3

What needle is used for an IDB?

Answer 3

Yellow (long)

Question 4

What LA is contraindicated for IDB?

Answer 4

Articaine

Question 5

What should you check prior to placing LA?

Answer 5

• date
• batch number
• LA type

Question 6

How do you dispose of an LA needle?

Answer 6

• ensure needle is locked (double click)
• separate needle from cartridge if possible
• needle placed in orange sharps bin
• cartridge placed in blue sharps bin
• if unable to separate, place everything into blue sharps bin

Question 7

When is an IDB contraindicated?

Answer 7

• absence of anatomical landmarks
• infection in path of needle
• bleeding disorder

Question 8

When is prilocaine contraindicated?

Answer 8

When the patient is pregnant, and the solution contains felypressin

Question 9

When is articaine contraindicated?

Answer 9

Preferably not used for IDBs

Question 10

When is lidocaine contraindicated?

Answer 10

Liver disease (instead patients should be treated with articaine as it is metabolised in the plasma)

Question 11

When is lidocaine with adrenaline contraindicated?

Answer 11

• uncontrolled/unstable hypertension
• cardiac disease (ie unstable rhythm)
• advanced diabetes

Question 12

What is the safe LA to give to renal patients?

Answer 12

Lidocaine

Question 13

What is the safe LA to give to liver patients?

Answer 13

Articaine

Question 14

What LA should be administered for XLA of lower teeth?

Answer 14

• IDB
• lingual
• long buccal block (if posterior)

Question 15

How do you administer a long buccal block?

Answer 15

• retract cheek and pull tissues taught
• insert needle parallel to occlusal plane, disto-buccal to the 7
• advance needle 3-4mm
• aspirate and deposit 1/4 cartridge

Question 16

What LA should be administered for a restoration of a molar?

Answer 16

IDB

Question 17

What LA should be administered for a restoration with a matrix band of a molar?

Answer 17

• IDB
• lingual
• long buccal block

Question 18

What needle is used for a long buccal block?

Answer 18

Yellow (long)

Question 19

What LA is indicated for a patient with hypertension or CV disease?

Answer 19

• plain lidocaine
• prilocaine

Question 20

What LA is indicated for a patient on beta blockers?

Answer 20

Prilocaine

Question 21

What LA is indicated for a patient on tricyclic antidepressants?

Answer 21

Lidocaine with adrenaline (2 max)

Question 22

What LA is indicated for a patient with a latex allergy?

Answer 22

Prilocaine

Question 23

What LA is indicated for a patient with controlled hypertension?

Answer 23

Lidocaine

Question 24

What LA is indicated for a patient on MAOIs?

Answer 24

Prilocaine

Question 25

What LA is indicated for a patient non-potassium sparing diuretics?

Answer 25

Prilocaine

Question 26

What LA is indicated for a patient who uses cocaine?

Answer 26

Prilocaine

Question 27

What is the first line LA?

Answer 27

2% lidocaine with 1:80,000 adrenaline

Question 28

What are common causes of allergies with LA?

Answer 28

- latex bung - preservative - hypersensitivity to amides

Question 29

What is the max dose of lidocaine?

Answer 29

4.4mg/kg = 44mg/10kg 1 cartridge contains 44mg => 1 cartridge per 10kg

Question 30

What is the max safe dose of prilocaine?

Answer 30

6mg/kg = 60mg/10kg 1 cartridge contains 66mg => 1 cartridge per 10kg

Question 31

What is the max safe dose of articaine?

Answer 31

7mg/kg = 70mg/10kg 1 cartridge contains 88mg => 1 cartridge per 8kg

Question 32

What is the standard preparation of lidocaine?

Answer 32

2.2ml 2% lidocaine with 1:80,000 adrenaline

Question 33

What is the standard preparation of prilocaine?

Answer 33

2.2ml 3% prilocaine with felypressin 0.03units/ml

Question 34

What is the standard preparation of articaine?

Answer 34

2.2ml 4% articaine with 1:100,000 adrenaline