difference between an infiltration and a block anaesthesia?
infiltration
- around terminal branches
- for soft tissue where pulpal anaesthesia able through thin bone
- thus used for the mandible anterior & maxillary teeth
block
- at nerve trunk
- stops sensation distal to block
- for soft tissue where bone too thick for infiltration
- used in posterior mandible
pros and cons of infiltration anaesthesia?
pros
- technically easy
- atraumatic
- high success rate
cons
- pulpal anaesthesia limited to 1 or 2 teeth
- infection and dense bone limits effect
- sore bellow periosteum
what are the components of anaesthetic
type
- ester or amide
vasoconstrictor
- none, adrenaline or felypressin
preservatives
- bisulphite
- propylparaben
injections used to anaesthetise maxillary pulp, buccal and palatal gingiva?
buccal infiltrations for pulp and buccal gingiva
palatal infiltration for palatal gingiva
how to anaesthetise mandible pulps of teeth where bone is too thick for infiltration? (molars, premolars and canine)
lower molars (and second premolar) - IDB
lower premolars (and canine) - mental (incisive) nerve block
canine (and incisors) - buccal and labial infiltration
what does IDB/IAN mean in LA?
inferior dental block otherwise know as inferior alveolar nerve block
injection given for mandibular buccal gingiva for 1. lower molars and second pre molar, 2. first premolar and canine and 3. lower incisors and canine
- long buccal
2.
description of how to anaesthetise an entire side of the mandible (pulps, lingual gingiva, anterior AND posterior gingiva)
- IDB given to anaesthetise the pulps of the entire half arch and the anterior buccal gingiva (1-5)
- when retracting the needle from IDB release part of the cartridge to anaesthetise the lingual nerve (lingual gingiva and tongue)
- second injection is a long buccal block and for the long buccal nerve when there is an extraction of a posterior necessary as this still innervates the posterior buccal gingiva
how to anaesthetise mandible lingual and buccal gingiva of the mandible (123 & 34 & 45678)
123 buccal - buccal/labial infiltration
34 buccal - infiltration/long buccal block/mental nerve block
45678 buccal - long buccal infiltration
ALL lingual gingiva - IDB drawback while releasing to anaesthetise lingual nerve OR lingual infiltration
what are the benefits of a higher gauge needle for LA
thinner needle so less deflection of tissue, greater accuracy, reduced risk of breakage, easier aspiration
how many ml is there in a LA and what syringe type do we use
2.2ml and safety needles
osce station: assemble LA safety needle
- check expiry date and note batch number of anaesthetic cartridge
- unpack everything minding rubber bung and put decontamination label in patient notes
- assemble everything
- when done can resheath (1 click) or lock (2clicks)
LA injection technique
- stretch mucosa and puncture quick with distraction
- aspirate at injection target area
- inject slowly (30sec min) NOT continuous, but drip method
- resheath and massage tissue
- wait 2 mins then check if worked
where inject LA for mental nerve block
between apices of premolars
process for a palatal injection
- short needle injected 5-10mm palatal to centre of crown
- while applying pressure behind injection site
- 45 degree angle injection with bevel facing soft tissue
- when hit bone deposit 0.2-0.4ml slowly
process for giving an IDB in LA? (hand positions and needle positions)
non working hand fingers - posterior border of mandible
non working hand thumb - coronoid notch
needle
- 35mm needle used
- LA valve over opposite premolars
- needle inserted next to the deepest part of the pterygomandibular raphe at about 6-10 mm above occlusal plane
- marker for needle entry is in between the coronoid notch and the deepest raphe (but closer to the raphe) and angled from opposite premolars so the needle reaches the area around the sigmod notch at the condyle where the alveolar nerve is
process - needle should hit bone with 1cm of needle still visible then retract 1 cm and aspirate (if before 1cm left then move mesial as too early, if dont hit bone then the vise versa)
what are the markers for helping you give an IDB in the right position in LA?
- coronoid notch
- coronoid process
- sigmoid notch
- condyle
- posterior border of the mandible
- pterygomandibular raphe
describe lidocaine/lingocaine/xylocaine
- amide type LA
- lidocaine HCL 2%
- for infiltration, blocks, etc
- either plain or 1:80,000 adrenaline
- half life up to 2 hrs
- contraindications
- heart block without pacemaker
- allergy to LA or Corn
- hypotension
- impaired liver function
describe articane
- amide type LA
- articane 4%
- infiltrations or blocks but as stronger and very good at diffusing to pulp through alveolar bone generally just infiltrations
- half life of 20 mins
- contraindications
- sickle cell patients and other haemoglobinpathies
describe citanest/prilocaine
- amide LA
- prilocaine HCL 3%
- infiltration and blocks
- either plain or with felypressin octapressin
describe mepivicaine
- 3% plain
- typically used in patients with cardiac disease as has less of a need for vasocontrictor than lidocaine as will naturally last longer
what to do if patient has a panic attack (i.e. over LA)
lie them flat down, loosen neck clothing and improve room ventilation
what are the contraindications for LA when a patient is on beta blockers?
BP increases as vasodilatory receptors blocked
what are the contraindications for LA when a patient is on beta blockers and for using adrenaline?
Beta blockers - BP increases as vasodilatory receptors blocked
adrenaline (epinephrine) - when taking diuretics (further reduces potassium levels)
-
BLS10
-
Surveying6
-
Perio0
-
LA44
-
PMPH4
-
Restorative11
-
Charting19
-
Denture Design10
-
LA Types and Dosage5
-
LA Building needle and Injecting1
-
MODIFIED plaque and bleeding scores3
-
Denture Design NEW9
-
History (medical History)7
-
Eruption dates7
-
Splint and Tooth Trauma2
-
Waste Streams0
-
oral landmarks2
