Dental Anesthesia Techniques Quiz

Questions and Answers

What is a contraindication for a supraperiosteal injection?

Patient preference for sedation

Previous history of dental anxiety

Thick zygomatic buttress

Infection at the injection site (correct)

Which method is recommended when the risk of hemorrhage is high?

Supraperiosteal injection

PDL injection (correct)

Infiltration anesthesia

Intraosseous injection

What is the angle of needle orientation for the Posterior Superior Alveolar Nerve Block?

60 degrees to the long axis of the molar

90 degrees to the maxilla

45 degrees to the occlusal plane and long axis (correct)

30 degrees to the occlusal plane

What is the recommended needle length for the Posterior Superior Alveolar Nerve Block?

20 mm Signup and view all the answers

What should be done first when performing the Posterior Superior Alveolar Nerve Block technique?

Partially open the patient’s mouth Signup and view all the answers

Which of the following is NOT part of the armamentarium for the Posterior Superior Alveolar Nerve Block?

Surgical scalpel Signup and view all the answers

What should be done to minimize the risk of accidental needlestick injury during the PSANB procedure?

Retract the patient’s cheek with a mouth mirror Signup and view all the answers

What alternative injections can be utilized if supraperiosteal injection is ineffective?

Maxillary nerve block Signup and view all the answers

What is a primary advantage of the anterior superior alveolar nerve block compared to the infiltration technique?

It minimizes needle punctures and anesthetic volume. Signup and view all the answers

What is the aspiration rate associated with the anterior superior alveolar nerve block?

0.7% Signup and view all the answers

Which item is considered basic armamentaria for the anterior superior alveolar nerve block?

Aspirating Syringe Signup and view all the answers

At what anatomical landmark should the needle penetrate for the anterior superior alveolar nerve block?

Height of the mucobuccal fold Signup and view all the answers

What position should the dentist adopt if they are right-handed while performing this nerve block?

Standing on the right side of the chair Signup and view all the answers

Which of these is a disadvantage of the anterior superior alveolar nerve block?

It does not provide hemostasis in the operative field. Signup and view all the answers

Which step involves preparing the tissue at the injection site for the anterior superior alveolar nerve block?

Apply topical anesthetic for at least one minute Signup and view all the answers

What anatomical feature must be located before administering the anterior superior alveolar nerve block?

Infraorbital foramen Signup and view all the answers

What is the recommended needle insertion depth for the Posterior Superior Alveolar Nerve Block in average adults?

16 mm Signup and view all the answers

During the PSANB technique, how long is recommended for slow deposition of anesthetic solution?

30 – 60 seconds Signup and view all the answers

What subjective clinical finding might a patient report after a successful PSANB?

Tingling and numbness Signup and view all the answers

What is the ideal aspiration technique during the PSANB procedure?

Aspiration in two perpendicular planes Signup and view all the answers

What is the maximum volume of anesthetic solution recommended for a full PSANB cartridge?

1.8 mL Signup and view all the answers

Which of the following factors contributes to the low pain experience in the PSANB technique?

The target area is loose connective tissue Signup and view all the answers

What should be done immediately after withdrawing the needle in the PSANB technique?

Make the needle safe using the single hand scoop technique Signup and view all the answers

What is the success rate of the PSANB technique as indicated in the findings?

<blockquote> 95% </blockquote> Signup and view all the answers

What is the primary reason the anterior superior alveolar nerve block (ASANB) is less popular than other nerve blocks?

There is a general lack of experience and fear of eye injury. Signup and view all the answers

Which teeth are primarily anesthetized by the anterior superior alveolar nerve block?

Maxillary incisors, canines, premolars, and mesiobuccal root of the first molar. Signup and view all the answers

In what percentage of the population is the middle superior alveolar (MSA) nerve present?

30% Signup and view all the answers

What is the purpose of allowing the anesthetic solution to enter the infraorbital canal?

To ensure effective blockage of the infraorbital nerve. Signup and view all the answers

Which of the following is a contraindication for using the anterior superior alveolar nerve block?

Presence of cellulitis. Signup and view all the answers

Which branch of the infraorbital nerve primarily serves the upper lip?

Superior labial nerve. Signup and view all the answers

What type of dental procedures strongly indicate the use of the anterior superior alveolar nerve block?

Procedures involving multiple maxillary anterior teeth and their overlying buccal tissues. Signup and view all the answers

Which facial nerve branches are anesthetized during an anterior superior alveolar nerve block?

Inferior palpebral, lateral nasal, and superior labial nerves. Signup and view all the answers

What is a common subjective clinical finding following an Intra-Oral Anterior Superior Alveolar Nerve Block?

Tingling and numbness of the ipsilateral lower eyelid Signup and view all the answers

What does a positive response to the Electric Pulp Tester indicate?

Healthy pulp response Signup and view all the answers

Which of the following corrections should be made if the needle contacts the bone inferior to the infraorbital foramen?

Keep the needle in line with the infraorbital foramen Signup and view all the answers

Which alternative technique can be used if the Intra-Oral Anterior Superior Alveolar Nerve Block fails?

Maxillary Nerve block Signup and view all the answers

What is one possible complication resulting from an Intra-Oral Anterior Superior Alveolar Nerve Block?

Hematoma across the lower eyelid Signup and view all the answers

What is indicated by an absence of pain during a probing test of the anterior and premolar teeth?

Successful anesthesia of the roots Signup and view all the answers

What adjustment is necessary if the needle is deviated medial or lateral to the infraorbital foramen?

Adjust the needle orientation toward the foramen Signup and view all the answers

What is a proper depth of penetration to ensure effective anesthesia during the procedure?

1.2 ml medium penetration Signup and view all the answers

Study Notes

Supraperiosteal Injection

Ineffective in cases with thick zygomatic buttress over the apices of first molar.
Contraindicated with infection or acute inflammation at the injection site.
Contraindications include infection, risk of hemorrhage (e.g., in hemophiliacs or patients on anticoagulants like Coumadin, Plavix).

Posterior Superior Alveolar Nerve Block (PSANB) Technique

Positive aspiration rate is high at 3%.
Alternatives include supraperiosteal infiltrations and maxillary nerve block.
Required armamentarium: short needle (20 mm, 25- or 27-gauge), aspirating syringe, local anesthetic cartridge (with or without vasoconstrictor).

Technique for PSANB

Point of insertion is at the height of the mucobuccal fold above the maxillary second molar.
Target area is PSAN entering the posterior surface of the maxilla.
Needle orientation: advance needle upward, inward, and backward in one motion.
- Upward at 45-degree angle to occlusal plane.
- Backward at 45-degree angle to long axis of second molar.
- Inward at 45-degree angle toward midline and occlusal plane.

Needle Insertion Depth

Average adults: ¾ of the short needle length (16 mm).
Smaller adults and children: ½ of the short needle length (10 mm).

Injection Technique

Perform aspiration tests in two planes.
Deposit anesthetic solution slowly (0.9 mL to 1.8 mL) over 30-60 seconds, with aspirations during injection.
Remove needle and recap using single hand scoop technique.
Begin dental treatment after a wait of 3 to 5 minutes.

Clinical Findings

Subjective: Tingling and numbness noted; patients may report numbness of buccal mucosa opposite maxillary molars.
Objective tests: absences of pain during probing; electric pulp tester shows no response (80/80); freezing spray results in no response; absence of pain during treatment.

Advantages and Disadvantages of PSANB

Advantages: High success rate (>95%), atraumatic technique with minimal pain due to loose connective tissue and no bone contact.
Disadvantages: Limited hemostasis and potential complications.

Anterior Superior Alveolar Nerve Block (ASANB)

Recommended for procedures involving multiple maxillary anterior teeth and associated tissues.
Contraindications include localized treatment areas and situations requiring hemostasis.
Advantages: Minimizes anesthetic volume and punctures compared to infiltration; longer anesthetic effect.

ASANB Technique and Armamentarium

Requires long needle, aspirating syringe, local anesthetic cartridge, optional topical antiseptic and anesthetic.
Patient should be positioned supine or semisupine with slight neck extension.

Infraorbital Foramen Location

Identify infraorbital notch, apply pressure to locate the foramen which is slightly inferior to the notch.

Clinical Findings for ASANB

Subjective: Tingling and numbness in lower eyelid, side of nose, upper lip, and corresponding teeth.
Objective: Absence of pain during probing, no response to electric and thermal tests, absence of pain during treatment.

Causes for ASANB Failure

Contacting bone during injection; correction involves keeping needle aligned with foramen.
Needle deviation medial or lateral; correction is maintaining appropriate orientation toward foramen.

Alternative Techniques

Basic injection techniques: infiltration technique and maxillary nerve block.
Supplementary techniques: periodontal ligament injection.

Complications of ASANB

Possible outcomes include hematoma across lower eyelid and temporary double vision (horizontal diplopia).

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Description

Test your knowledge on dental anesthesia, focusing on supraperiosteal injections and their contraindications. Understand when this technique may be ineffective and the specific scenarios where it should not be used. This quiz is essential for dental students and professionals.