Questions and Answers
Describe uses for ester and amide local anesthetics.
In the US, we only inject amide local anesthetics in dentistry. We use ester anesthetics in topical applications.
Describe the classification of local anesthetics based on duration of action.
Short: ~20-40 minutes, Intermediate: up to 70 minutes, Long: up to 8 hours.
State examples of short-acting, intermediate-acting, and long-acting local anesthetics.
Short-acting: Lidocaine 2%, Mepivacaine 3%, Prilocaine 4%; Intermediate-acting: Prilocaine 4% (nerve block), Lidocaine 2% with epi 1:50,000; Long-acting: Bupivacaine 0.5% with epi 1:200,000.
ID important patient selection criteria for local anesthetic use during a dental procedure: _____
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Differentiate between an absolute versus relative contraindication to local anesthetic use.
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Discuss the factors that affect the depth and duration of a local anesthetic agent's action.
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Summarize specific anatomical considerations that may affect the duration of local anesthesia.
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Study Notes
Classification of Local Anesthetics
- Uses of Anesthetics: Amide local anesthetics are primarily injected in US dentistry, while ester anesthetics are often used for topical applications in other countries.
Duration of Action
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Classification Based on Duration:
- Short-acting local anesthetics provide anesthesia for approximately 20-40 minutes.
- Intermediate-acting types last up to 70 minutes.
- Long-acting anesthetics can last around 8 hours, depending on the injection technique.
Examples of Local Anesthetics
- Short-Acting Anesthetics: Examples include Lidocaine 2%, Mepivacaine 3%, and Prilocaine 4% (when used for infiltration).
- Intermediate-Acting Anesthetics: Prilocaine 4% (nerve block) and Lidocaine 2% with epinephrine (1:50,000) are common.
- Long-Acting Anesthetics: Bupivacaine 0.5% with epinephrine (1:200,000) is an example.
Patient Selection Criteria
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Key Factors in Selecting Anesthetic:
- Duration of required pain control.
- Necessity for post-procedural pain management.
- Requirement for hemostasis during the procedure.
- Consideration of any contraindications related to the anesthetic agent.
Contraindications to Local Anesthetic Use
- Absolute Contraindications: These involve circumstances where the drug must not be administered at all, such as a documented allergy.
- Relative Contraindications: Preference to avoid the anesthetic due to potential risks; if necessary, use the lowest effective dose and concentration.
Factors Affecting Anesthetic Action
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Influences on Efficacy:
- Individual patient response, including hyper and hypo responders.
- Accuracy of drug administration technique.
- Tissue condition, specifically pH levels.
- Anatomical variations among patients.
- Injection type, whether supraperiosteal/infiltration or nerve block.
Anatomical Considerations for Local Anesthesia
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Injection Techniques:
- Supraperiosteal injections may provide effective pulpal anesthesia for maxillary teeth, but dense alveolar bone can impede depth of anesthesia.
- Children’s lower zygomatic arch may result in shorter duration or insufficient depth when injecting over maxillary first and second molars.
- Palatal root flares extending toward the midline can complicate adequate anesthesia delivery.
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Description
Explore the classification and uses of local anesthetics in dental practices. This quiz covers the types based on duration of action, examples of anesthetics, and patient selection criteria. Test your knowledge on short, intermediate, and long-acting anesthetics.
