Failure to Obtain Anesthesia in Dentistry
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Questions and Answers

What is the primary cause of trismus after a local anesthetic injection?

  • Excessive volume of local anesthetic solution deposited into a restricted area
  • Infection after injection
  • Hematoma in or around the muscles
  • Trauma to the muscles due to the injection of local anesthetics (correct)

    • How can trismus be prevented after a local anesthetic injection?

  • By using a non-sterile needle
  • By using a sharp, sterile, disposable needle and practicing atraumatic insertion and injection technique (correct)
  • By injecting the local anesthetic solution into multiple areas
  • By using a large volume of local anesthetic solution

    • What is the recommended treatment for trismus after a local anesthetic injection?

  • Applying hot and moist towels to the affected area (correct)
  • Prescribing antibiotics
  • Applying cold packs to the affected area
  • Injecting additional local anesthetic solution

    • What is the main reason why patients experience soft tissue injury after a local anesthetic injection?

    <p>The patient bites or chews the anesthetized soft tissue</p> Signup and view all the answers

    What is the result of hematoma in or around the muscles after a local anesthetic injection?

    <p>The blood is slowly resorbed over approximately 2 weeks</p> Signup and view all the answers

    What is the recommended way to initiate physiotherapy to manage trismus after a local anesthetic injection?

    <p>By opening and closing the mouth as well as lateral excursions of the mandible</p> Signup and view all the answers

    Why should contact lenses be removed during a local anesthetic injection?

    <p>Until the muscular movement retunes</p> Signup and view all the answers

    What is the relationship between soft tissue anesthesia and pulpal anesthesia?

    <p>Soft tissue anesthesia lasts longer than pulpal anesthesia</p> Signup and view all the answers

    What is the primary goal when managing an allergic reaction to local anesthesia?

    <p>Determining the actual cause of the allergy</p> Signup and view all the answers

    What is the characteristic of a true allergic response to local anesthesia?

    <p>It can be localized or generalized</p> Signup and view all the answers

    What is the primary medication used to manage anaphylaxis?

    <p>Epinephrine</p> Signup and view all the answers

    What is the consequence of inadequate diagnosis and treatment of an allergic reaction?

    <p>Life-threatening reactions</p> Signup and view all the answers

    What is the purpose of a proper pre-anesthetic evaluation?

    <p>To identify potential allergies to the local anesthetic agent</p> Signup and view all the answers

    What is the characteristic of anaphylactic shock?

    <p>It is a life-threatening hypersensitivity reaction</p> Signup and view all the answers

    What is the response to an anaphylactic reaction?

    <p>Giving epinephrine and seeking medical help</p> Signup and view all the answers

    What is the purpose of substituting the local anesthetic agent with another type?

    <p>To avoid allergic reactions to ester-type anesthetics</p> Signup and view all the answers

    What is the most common cause of insufficient anesthesia in inferior alveolar nerve block?

    <p>Poor technique</p> Signup and view all the answers

    Which of the following is NOT a cause of failure to obtain anesthesia?

    <p>Sedation</p> Signup and view all the answers

    What is the result of injection of anesthesia too soon on the anterior ascending ramus?

    <p>Insufficient anesthesia</p> Signup and view all the answers

    What is the primary reason for the need to use a combination of block, infiltration, and supplemental intraligamentary injections in some cases?

    <p>To overcome the effects of inflammation and low pH</p> Signup and view all the answers

    What is the potential consequence of persistent anesthesia or paraesthesia?

    <p>Self-inflicted injury or trauma</p> Signup and view all the answers

    What is the primary reason for the use of sedatives like benzodiazepine in some cases?

    <p>To reduce anxiety and fear</p> Signup and view all the answers

    What is the common anatomical cause of failure to obtain anesthesia?

    <p>All of the above</p> Signup and view all the answers

    What is the primary characteristic of Paraesthesia?

    <p>Altered sensation beyond the expected duration of anesthesia</p> Signup and view all the answers

    What is the primary goal of administering oxygen to a patient experiencing a toxic reaction to local anesthesia?

    <p>To improve breathing</p> Signup and view all the answers

    What is the primary factor that influences the dose necessary to induce toxicity in patients?

    <p>The patient's general health and liver function</p> Signup and view all the answers

    What is the best method to avoid toxic reactions when administering local anesthesia?

    <p>Use the smallest possible volume and lowest effective concentration</p> Signup and view all the answers

    What is the first step in managing a patient who has stopped breathing due to a toxic reaction to local anesthesia?

    <p>Start cardiopulmonary resuscitation (CPR) immediately</p> Signup and view all the answers

    What is the primary effect of rapid injection of local anesthesia into a highly vascular area?

    <p>Increased risk of toxicity</p> Signup and view all the answers

    What is the primary reason for using antihistamine in a patient experiencing a toxic reaction to local anesthesia?

    <p>To contract the effect of histamine</p> Signup and view all the answers

    What is the most common sign of toxicity in a patient who has received local anesthesia?

    <p>Restlessness and agitation</p> Signup and view all the answers

    What should be done if a patient fails to recover from a toxic reaction to local anesthesia?

    <p>Transfer the patient to the hospital</p> Signup and view all the answers

    What is the primary goal of CPR in a person who is in cardiac arrest?

    <p>Maintain intact brain function</p> Signup and view all the answers

    What is the recommended depth of chest compressions for adults during CPR?

    <p>5 cm deep</p> Signup and view all the answers

    What is the probability of hypersensitivity reaction to local anesthesia?

    <p>Less than 1% of all complications</p> Signup and view all the answers

    What is the recommended compression to ventilation ratio for CPR in adults?

    <p>30:2</p> Signup and view all the answers

    What is the primary cause of hypersensitivity reaction to local anesthesia?

    <p>All of the above</p> Signup and view all the answers

    What is the first step in the treatment of a vasovagal attack?

    <p>Lower the head of the patient</p> Signup and view all the answers

    What is the minimum rate of chest compressions recommended for CPR in adults?

    <p>100 per minute</p> Signup and view all the answers

    What type of local anesthetic agent is more commonly associated with hypersensitivity reaction?

    <p>Ester type</p> Signup and view all the answers

    Study Notes

    Failure to Obtain Anesthesia

    • Failure to obtain anesthesia is the most common problem seen during the use of local anesthesia, especially with block anesthesia in the lower jaw.
    • Causes of failure to obtain anesthesia: • Poor technique: injecting anesthesia too soon on the anterior ascending ramus, giving the solution inferior to the mandibular foramen. • Anatomical causes: accessory nerve supply, abnormal course of the nerve, variation in the foramen location, and innervation of the tooth by more than one nerve. • Pathological causes: trismus, infection, and inflammation affecting the pulp and nerve. • Psychological causes: fear and anxiety, requiring relaxation of the patient and sometimes the use of a sedative like benzodiazepine.

    Persistent Anesthesia or Paraesthesia

    • Defined as altered sensation beyond the expected duration of anesthesia or prolonged loss of sensation.
    • Common in dental practice, with potential for self-inflicted injury, biting, thermal, or chemical trauma.
    • Patients should remove contact lenses until muscular movement returns.

    Trismus

    • Defined as a prolonged spasm of the jaw muscles, restricting normal mouth opening.
    • Causes: • Trauma to the muscles due to local anesthetic injection. • Muscle irritation by local anesthetic solution contaminated with alcohol. • Hematoma in or around the muscles. • Infection after injection. • Excessive volume of local anesthetic solution deposited into a restricted area.
    • Prevention: • Use sharp, sterile, disposable needles. • Practice atraumatic insertion and injection technique. • Avoid repeated injections and multiple insertions into the same area. • Use the minimum effective volume of local anesthetic solution.
    • Management: • Heat therapy. • Analgesic and muscle relaxant. • Physiotherapy: opening and closing the mouth, lateral excursions of the mandible, and chewing gum.

    Soft Tissue Injury

    • Soft tissue anesthesia lasts longer than pulpal anesthesia.
    • Trauma to anesthetized soft tissue can lead to swelling, pain, and infection.
    • Causes: Self-inflicted trauma to the lips and tongue when the patient bites or chews these tissues while still anesthetized.
    • Management: • First aid treatment should be started immediately. • Spontaneous recovery is usual, and it is often possible to complete the treatment at the same visit.

    Cardiopulmonary Resuscitation (CPR)

    • An emergency procedure combining chest compressions with artificial ventilation to manually preserve intact brain function until further measures are taken to restore spontaneous blood circulation and breathing in a person who is in cardiac arrest.
    • Recommended in those who are unresponsive with no breathing or abnormal breathing.
    • CPR involves chest compressions for adults of about 5 cm deep and at a rate of at least 100 per minute with a universal compression-to-ventilation ratio of 30:2.

    Hypersensitivity or Allergy to Local Anesthesia

    • More commonly seen with ester-type agents than amide-type agents.
    • Causes: • Local anesthetic agent. • Vasoconstrictor. • Additives like bisulfite used as a preservative.
    • Prevention: • Proper pre-anesthetic evaluation, including a personal history and past dental history, particularly history of allergy to the local anesthetic agent or any other drug.
    • Management: • Antihistamine injection. • Epinephrine 0.5 ml of 1:1000 IM. • Administer O2 if necessary. • Substitution of the local anesthetic agent.

    Anaphylactic Shock

    • A rare, life-threatening hypersensitivity reaction to an antigen, developing fast and causing death within a few minutes.
    • Characterized by: • Profound fall in blood pressure. • Dyspnea and respiratory embarrassment. • Facial and laryngeal edema. • Loss of consciousness.
    • Management: • Epinephrine is the most important medication. • Oxygen should be given to improve breathing. • Intravascular (IV) fluid may be necessary to restore adequate blood pressure. • Antihistamine should be given to contract the effect of histamine. • If the patient stops breathing, start CPR immediately.

    Overdosage and Toxicity

    • Relatively rare, occurring when the concentration of local anesthesia in circulation increases too rapidly within a short period of time.
    • The toxic effect is primarily directed to the CNS and CVS.
    • Signs and symptoms: • Restlessness, agitation, convulsion. • Increased blood pressure, heart rate, and respiratory rate.
    • Prevention: • Use the smallest possible volume and lowest effective concentration. • The local anesthetic solution should be injected slowly. • Avoid intravascular administration by using an aspirating syringe.
    • Management: • Stop the dental procedure. • Position the patient supine with legs elevated. • Reassurance of the patient. • Administer O2, IV anticonvulsant, and monitor vital signs.

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    Description

    Learn about the common causes of failure to obtain anesthesia, including poor technique and anatomical factors, and how to overcome them in dentistry practices.

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