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Questions and Answers
What is the maximum dose of epinephrine for a cardiac patient?
What is the maximum dose of epinephrine for a cardiac patient?
What is the indication for the Gow-Gates technique?
What is the indication for the Gow-Gates technique?
What is the purpose of the 4 Cs in atraumatic injection?
What is the purpose of the 4 Cs in atraumatic injection?
What is the indication for the nasopalatine nerve block?
What is the indication for the nasopalatine nerve block?
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What is the recent trend in local anesthesia?
What is the recent trend in local anesthesia?
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What is the mechanism of action of local anesthetics?
What is the mechanism of action of local anesthetics?
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What is one of the reasons why local anesthetics may fail to work effectively?
What is one of the reasons why local anesthetics may fail to work effectively?
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What is the importance of vasoconstrictors in local anesthetics?
What is the importance of vasoconstrictors in local anesthetics?
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Which of the following is an example of an amide-type local anesthetic?
Which of the following is an example of an amide-type local anesthetic?
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What is the purpose of using a carpule with a needle and syringe in local anesthetics?
What is the purpose of using a carpule with a needle and syringe in local anesthetics?
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Study Notes
Local Anesthesia (L.A.)
- Used for pain control
- Mechanism of Action: binds to specific receptor on the sodium channel, blocking sensation transmission
Causes of Failure of L.A.
- Inflamed tissue with acidic pH decreases dissociation of local anesthesia
- Nerves in inflamed tissue are sensitized with decreased excitability threshold
- Patient in pain have lower pain threshold
L.A. Armamentarium
- Needle (short – long)
- Carpule (ester – amide)
- Syringe
Classification of L.A. Types
Ester Group
- Cocaine
- Tetracaine
- Procaine
Amide Group
- 2% Lidocaine
- 2 or 3% Mepivacaine
- 4% Prilocaine
- 4% Articaine
- 0.5% Bupivacaine
L.A. with or without Vasoconstrictor
- For pain control and haemostasis
- Concentrations: 1:50,000, 1:80,000, 1:100,000, 1:200,000
- Vasoconstrictor Importance:
- Decrease blood flow and bleeding
- Decrease L.A. toxicity
- Increase duration of L.A.
Classification of Vasoconstrictors
Catecholamines
- Epinephrine
- Norepinephrine
Noncatecholamines
- Amphatemine
- Methamphetamine
Max L.A. Dose (Rule 25)
- Safe to use 1 cartridge for every 25 pounds of patient weight
- Max dose for cardiac patient: 0.04 mg of epinephrine (2-3 cartridges)
Atraumatic Injection
- Technical aspect:
- Use topical anesthesia
- Stretch the tissue
- Use sharp needle
- Use warm anesthesia
- Inject few drops slowly
- Psychological aspect (4 Cs with the patient):
- Control
- Concern
- Confidence
- Communicate
Testing Effectivity of L.A.
- Numbness
- Probe pricking Soft tissue
- Pulp testing
- Innervation of teeth: Trigeminal nerve
Local Anaesthetic Techniques
Infiltration
- Buccal Infiltration:
- Indication: All upper teeth, Lower anterior teeth
- Palatal infiltration:
- Indication: During surgical procedure, to control pain in divergent palatal roots
Nerve Block
- Mandibular teeth nerve block:
- Inferior alveolar nerve block:
- Indication: Multiple mandibular posterior teeth
- The Gow-Gates technique:
- Indication: Inferior alveolar nerve block is unsuccessful
- Vazirani-akinosi closed mouth technique:
- Indication: Limited mouth opening
- Mental nerve block:
- Indication: Lower premolars teeth
- Inferior alveolar nerve block:
- Maxillary teeth nerve block:
- Posterior superior alveolar nerve block:
- Indication: Upper molar teeth
- Middle superior alveolar nerve block:
- Indication: Upper Premolars
- Anterior superior alveolar nerve block:
- Indication: Anterior maxillary teeth
- Greater palatine nerve block:
- Indication: For surgical procedure
- Nasopalatine nerve block:
- Indication: Surgical procedure
- Posterior superior alveolar nerve block:
Supplemental Anesthesia
- Periodontal ligament technique:
- Indication: After failure of standard injection and no pulp exposure
- Intraosseous injection technique:
- Indication: Pain control for single tooth
- As stabident, X-Tip
- Intrapulpal injection technique:
- Indication: Pulp extirpation
Complications of L.A.
- Systemic action of L.A.:
- Stimulatory phase (Convulsions – tachycardia)
- Depressive phase
- Circulatory collapse
- Vasoconstriction
- CNS depression
- Respiratory arrest
- Overdose Metheamoglubinemia
- Allergy
- Local tissue toxicity
- Nerve parasthesia
Recent Trends in Local Anesthesia
- Delivering of LA without need of needle injection through different forms as discs, tablets, patches, hydrogels, sprays or microspheres
- Nanotechnology in anesthesia: Nanobots
- L.A. reversal:
- Phentolamine mesylate (0.4 mg in 1.7 ml cartridge, oraverse)
- Decreases effect of vasoconstrictor leading to rapid absorption of L.A.
Isolation in Endodontics
- The use of rubber dam in root canal treatment is mandatory
- Advantages of Rubber Dam:
- Clean and dry field
- Improves visibility
- Retracts and protects soft tissues
- Less need for frequent rinsing
- Avoids aspiration
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Description
This quiz covers the mechanism of action of local anesthesia, causes of failure, and the armamentarium used in local anesthesia. It also discusses the importance of pH levels and nerve sensitivity in relation to local anesthesia.
