Local Anesthetics Quiz

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Questions and Answers

What characteristic primarily differentiates local anesthetics based on their duration?

Their method of administration

Their duration of pulpal anesthesia (correct)

Their chemical composition

Their effect on systemic conditions

Which type of local anesthetic provides over 90 minutes of pulpal anesthesia?

Short duration anesthetics

Long duration anesthetics (correct)

Rapid onset anesthetics

Intermediate duration anesthetics

Which factor may influence the effectiveness of the inferior alveolar nerve block?

Anatomical variations of the mandible (correct)

Time of day the procedure is performed

Patient's age

Type of local anesthetic used

What is the primary class of the most common injectable local anesthetics?

Amide class Signup and view all the answers

Which of the following is NOT a reason to select a specific local anesthetic for a procedure?

Patient's preference for taste Signup and view all the answers

Which local anesthetic is classified as category B by the US FDA?

Lidocaine Signup and view all the answers

What is the primary method recommended to avoid inadvertent intravascular injection when using local anesthetics in pregnant women?

Utilizing the aspiration technique Signup and view all the answers

Which of the following factors most commonly leads to the failure of an inferior alveolar nerve block?

Inappropriate volume of anesthetic used Signup and view all the answers

What is the most reliable method to confirm pulpal anesthesia?

Cold refrigerant use Signup and view all the answers

How is anesthetic success for nerve blocks typically defined in clinical studies?

Two consecutive nonresponsive readings on electric pulp testing within 15 minutes Signup and view all the answers

Under what condition is it useful to repeat an initial injection?

When the classic signs of soft-tissue anesthesia are absent Signup and view all the answers

Which injection techniques are included as supplemental injections?

Infiltration, Intra-Osseous, Intraligamentary, Intraseptal, and Intrapulpal injections Signup and view all the answers

What is a significant advantage of the Intraosseous injection technique?

It shows a quicker onset and shorter duration compared to infiltrations Signup and view all the answers

What is the first step in the Intraosseous injection technique?

Anesthesia of the attached gingiva Signup and view all the answers

What outcome is expected when using a buccal infiltration injection alone?

Ineffective for achieving anesthesia Signup and view all the answers

What equipment is specifically used for cortical plate perforation in the Intraosseous technique?

A low speed handpiece Signup and view all the answers

Which combination of supplemental injections is effective in the mandible?

Buccal plus lingual infiltrations of articaine Signup and view all the answers

Which injection method allows deposition of anesthetic directly into the cancellous bone?

Intraosseous injection Signup and view all the answers

What is the purpose of the 'rule of 25' proposed by Finder and Moore?

To determine the maximum dosage of local anesthetic based on patient weight. Signup and view all the answers

Which local anesthetic is classified as a long-acting agent but has a shorter duration for infiltration compared to 2% lidocaine?

Bupivacaine Signup and view all the answers

Which of the following is a possible adverse effect of local anesthesia?

Methemoglobinemia Signup and view all the answers

What systemic effect may occur due to local anesthesia?

Acute toxicity Signup and view all the answers

What should always be reviewed before administering local anesthetics to a patient?

Patient's medical history and current medications Signup and view all the answers

Which local anesthetic solution is a reasonable alternative for patients who cannot use vasoconstrictors?

3% mepivacaine Signup and view all the answers

What is a significant factor that may influence the effectiveness of local anesthesia?

Systemic diseases or conditions Signup and view all the answers

Which of the following is NOT a common cardiovascular reaction to local anesthesia?

Bradycardia Signup and view all the answers

What is a major disadvantage of intrapulpal injection?

It usually lasts only 15–20 minutes. Signup and view all the answers

How long does pulpal anesthesia typically last for anterior maxillary teeth?

30 minutes Signup and view all the answers

To significantly extend the duration of pulpal anesthesia for maxillary teeth, what is the recommended action?

Add another cartridge of 2% lidocaine at specific intervals. Signup and view all the answers

What is the primary reason for achieving infiltration during maxillary anesthesia?

To achieve high incidences of successful pulpal anesthesia. Signup and view all the answers

When should a second cartridge of lidocaine be added for anterior teeth anesthesia?

At 30 minutes Signup and view all the answers

What effect does infiltration with epinephrine have in maxillary anesthesia?

Enhances the success rate of pulpal anesthesia. Signup and view all the answers

Which of the following is a method of supplemental anesthesia for vital pulp in the mandible?

Intrapulpal injection Signup and view all the answers

What is the expected onset time for pulpal anesthesia using infiltration?

3-5 minutes Signup and view all the answers

Where is it generally better to inject local anesthesia in relation to the tooth, with the exception of certain molars?

Distal to the tooth Signup and view all the answers

What should be the perforation site for the intraosseous injection?

Equidistant between the teeth in attached gingiva Signup and view all the answers

How long does the anesthesia from a supplemental intraosseous injection typically last in patients with irreversible pulpitis?

45 minutes Signup and view all the answers

What is one noted complication when using certain systems with anesthetic solutions containing epinephrine?

Transient increase in heart rate Signup and view all the answers

What is a key factor for achieving a successful periodontal ligament injection?

Attainment of back-pressure during injection Signup and view all the answers

Which type of anesthesia is reported to have an immediate onset due to its delivery method?

Intraosseous anesthesia Signup and view all the answers

What is a characteristic of the intraosseous injection technique compared to traditional methods?

Injects directly into cancellous bone Signup and view all the answers

Which syringe is mentioned as being used in high-pressure injections for local anesthesia?

Citoject syringe Signup and view all the answers

Study Notes

Pain Control & Anesthesia in Endodontics

The presentation covers pain control and anesthesia techniques, specifically for endodontic procedures.
A key figure in the early use of ether in dentistry is Robert Liston.
Local anesthesia is classified based on the route of administration, duration, and mode of action.
Local anesthetics are categorized into injectable and surface anesthetics. Injectable anesthetics are further categorized into low, intermediate, and high potency, with various sub-types.
The amide group of anesthetics includes lidocaine, mepivacaine, and articaine, known for their potency and duration.
The ester group of anesthetics includes cocaine, procaine, and chloroprocaine, but has limited use.
The "rule of 25" suggests one cartridge of local anesthetic for every 25 pounds of body weight.
Clinically, anesthesia does not always fit into the defined guidelines; it depends on whether it is used for a block or infiltration.
Possible adverse reactions to local anesthesia include cardiovascular effects (e.g., tachycardia), systemic effects (e.g., acute toxicity), methemoglobinemia(issues with anesthetic metabolism), allergic reactions( to components such as latex or additives like sulfites) and peripheral nerve paresthesia.
Systemic diseases can affect anesthetic response, necessitating a thorough patient history.

Local Anesthesia

Clinically available local anesthetics includes various types for different uses.
Factors affecting local anesthesia selection include systemic conditions/diseases, and clinical factors.
Common causes of failure of inferior alveolar nerve block include accessory/cross innervation.
Possible adverse effects of local anesthesia: Cardiovascular reactions (e.g., tachycardia), systemic (acute toxicity), methemoglobinemia, peripheral nerve paresthesia, allergic reactions (latex or additives like sulfites).
Systemic conditions or medications can interact with local anesthetics.

Mandibular Anesthesia (inferior alveolar nerve block)

1-2% lidocaine with 1:100,000 epinephrine is a common choice.
Success of the block is measured by consecutive non-responsive electrical pulp test readings within 15 minutes, and maintained for 60 minutes.
Alternative anesthetic solutions include those without epinephrine, articaine with varying epinephrine concentrations, long-acting anesthetics (bupivacaine), and buffered lidocaine.

Alternative Injection Sites and Techinques

Several alternative mandibular block injection techniques/sites are presented, including Gow-gates and Vazirani-Akinosi.
Articaine infiltrations are noted to be generally more effective for buccal infiltration of mandibular first molars compared to infiltrations with lidocaine.
Buccal plus lingual infiltration using articaine may provide better pulpal anesthesia compared to buccal infiltrations alone.

Volume and Concentration of Local Anesthetics

Increasing injection volume of 2% lidocaine with epinephrine does not increase pulpal anesthesia incidence; same for concentration.
Inadequate anesthesia in endodontic therapy is frequently observed in lower molars with irreversible pulpitis.

Causes of Failure of Inferior Alveolar Nerve Block

Accessory/cross-innervation (mylohyoid nerve most commonly implicated).
Injection inaccuracies, including needle beveling or deflection.

Supplemental Anesthesia for Vital Pulp in the Mandible

Supplemental injections are used if the primary injection proves insufficient.
These methods include infiltrations, intraosseous (IO), intraligamentary, and intraseptal injections.
Intrapulpal (IP) injection is considered when previous methods are ineffective, requiring an exposed pulp in a controlled manner. Surgical exposure of the pulp usually must take place before intrapulpal injection is performed with good back-pressure.

Maxillary Anesthesia

Infiltration with 2% lidocaine and 1:100,000 epinephrine is common.
Infiltration anesthesia is typically successful in approximately 87-92% of maxillary tooth cases.
The onset of anesthesia is typically between 3 and 5 minutes for maxillary teeth
Two cartridges of 2% lidocaine and epinephrine are often used to augment anesthetic duration.

Intraligamentary Anesthesia

The success of this method depends on achieving back-pressure within the periodontal ligament.
This method works well with injection delivered under pressure, and thus it is often coupled with the use of a computer-assisted delivery/pressure system.
This method generally does not lead to significant postoperative discomfort.

Intraseptal Anesthesia

Anesthetics are injected into the dental papilla distal to the intended tooth.
Only a minimal amount of anaesthetic is required for this technique

Intrapulpal Anesthesia

Injection is given under strong back-pressure to promote efficient anesthesia.
This can be a very painful technique.
This method requires initial exposure of the pulp tissue to administer the anesthetic.

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Description

Test your knowledge on local anesthetics, their classifications, and factors influencing their effectiveness. This quiz covers various aspects including duration, categories, and clinical techniques associated with local anesthesia. Perfect for dental students and professionals looking to refresh their understanding.