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Questions and Answers
What is the purpose of a nasal cannula?
What is the maximum needle penetration for maxillary injections in children?
What is the most common dental office/clinic medical emergency?
What is the most common local anesthetic complication in children?
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What is the primary purpose of nitrous oxide sedation?
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What is the limiting drug in local dental anesthesia?
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What is the color of the tank for Nitrous Oxide?
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What is the MRD of epinephrine for a healthy patient?
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What is the purpose of the Vazirani-Akinosi injection?
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Why is it necessary to give 100% O2 for at least 3-5 minutes at the end of nitrous oxide sedation?
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What is the insertion site for the Inferior Alveolar (IA) injection?
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What is a contraindication for nitrous oxide sedation?
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What type of nerve fibers does the Mandibular branch of the Trigeminal nerve carry?
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What is the minimum percentage of oxygen that should be maintained during nitrous oxide sedation?
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What is the flow rate used for adult patients during nitrous oxide sedation?
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What percentage of nitrous oxide has been shown to produce analgesia?
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What are the two branches of the Inferior Alveolar (IA) nerve?
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Which of the following is NOT a branch of the Trigeminal nerve?
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Through which foramen does the Mandibular branch of the Trigeminal nerve exit the skull?
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What nerves are branches of the Inferior Alveolar Nerve?
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What causes 'Lingual Shock' when giving an inferior alveolar nerve injection?
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Which tooth or teeth may have a branch from the mylohyoid nerve and have problems with anesthesia?
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What is the absolute maximum number of cartridges of Lidocaine/1:100,000 epi that can be given?
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Who is known as the 'Father of Anesthesia'?
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What is the purpose of a scavenger system in nitrous oxide sedation (N2O-O2)?
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Study Notes
Nasal Cannula and Anesthesia
- A nasal cannula is a nose cone or mask used for administering nitrous oxide sedation.
Mandibular Anesthesia
- In children, needle penetration for maxillary injections is LESS THAN 2 mm due to less dense maxillary and mandibular bones.
- Supraperiosteal injections of the mandible can be used in children at the level of the plane of the mandibular teeth.
- In adults, supraperiosteal injections work better in the maxilla than the mandible due to denser mandibular bone.
Local Dental Anesthesia
- Most adverse reactions to local dental anesthesia occur within 5-10 minutes of injection.
- The most common local anesthetic complication in children is biting of the lower lip.
- Maximum Recommended Dose (MRD) is the limiting drug in local dental anesthesia, calculated using patient's weight, drug concentration, and amount of anesthetic in a standard cartridge.
Calculating MRD
- To calculate MRD, you need the patient's weight, drug concentration as a percentage, and the amount of anesthetic in a standard cartridge.
- Example: 2% Lidocaine = 2 x 10 x 1.8 mL in a standard anesthetic cartridge = 36 mg/mL.
Epinephrine MRD
- Epinephrine MRD for healthy patients is 0.2 mg per appointment.
- Epinephrine MRD for compromised patients is 0.04 mg per appointment.
Vazirani-Akinosi Injection
- The Vazirani-Akinosi injection is used for patients with Trismus (difficulty opening the mouth).
Inferior Alveolar (IA) Injection
- The IA injection is the most used injection in dentistry.
- Insertion site for IA: Long needle length, inserted 20-25 mm.
- The three landmarks for IA:
- Pterygomandibular raphe
- Mandibular plane of occlusion
- Coronoid notch
Branches of Inferior Alveolar Nerve
- The IA nerve divides into two branches: Mental nerve and Incisive nerves.
Trigeminal Nerve (V)
- The Trigeminal nerve has three branches:
- V1 – Ophthalmic
- V2- Maxillary
- V3- Mandibular
- The Mandibular branch is the largest branch of Trigeminal and carries both sensory and motor nerve fibers.
Lingual Shock
- Lingual shock occurs when moving the needle through the Asse and past the lingual nerve during an inferior alveolar nerve injection.
Mylohyoid Nerve
- The mylohyoid nerve can cause incomplete anesthesia of mandibular first molars due to accessory innervation.
Nitrous Oxide Sedation
- Nitrous oxide is used as an anxiolytic, anesthetic, and analgesic.
- Tanks for Oxygen and Nitrous Oxide are colored green and blue, respectively.
- 100% O2 should be given for at least 3-5 minutes at the end of nitrous oxide sedation to prevent diffusion hypoxia.
- Nitrous oxide sedation is generally considered to be a weak inhalation general anesthetic that can provide mild, moderate, or deep sedation but NOT general anesthesia.
Contraindications for Nitrous Oxide Sedation
- Nitrous oxide is contraindicated in:
- Eye surgery recently using intraocular gas
- Pregnant patients (teratogenic)
- Severe respiratory compromise or obstruction
- Patients with a history of stroke, hypotension, and other cardiac conditions.
Scavenger System
- A scavenger system in nitrous oxide sedation collects and removes excess nitrous oxide to prevent it from being vented back into the room.
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Description
This quiz covers the use of nasal cannula in anesthesia and mandibular anesthesia techniques, including needle penetration and supraperiosteal injections in children and adults.
