dose calculation

what do u need to calculate?

-amount given in volume

-volume is in ml

-how much drug is in each ml given

-expressed as mg/ml

-whats the max amount of drug u can give (MRD)

1 entire cart = ____ ml

1.8

½ cart = ____ ml

0.9ml

¼ cart = _____ ml

0.45ml

1/3 cart = ____ ml

0.6ml

2/3 cart = ____ ml

1.2ml

how big is the rubber stopper?

0.2ml

if u get 3 stoppers of solution so 3 × 0.2ml = _____

0.6ml of solution

2% concentration = ____ mg/ml

3% concentration = ____ mg/ml

4% concentration = ____ mg/ml

20, 30, 40

Whats the MRD for 0.5% Bupivacaine?

0.9mg/lb oe 2.0mg/kg (Canada only, none listed in USA)

Absolute maximum: 90mg

Whats the MRD for 4% Articaine?

3.2mg/lb or 7.0mg/kg

Absolute maximum: none currently listed

Whats the MRD for 4% Prilocaine?

3.6mg/lb or 8.0mg/kg

Absolute maximum: 600mg

Whats the MRD for 2% and 3% Mepivicane?

3.0mg/lb or 6.6mg/kg

Absolute maximum: 400mg

Whats the MRD for 2% Lidocaine?

3.2mg/lb or 7.0mg/kg

Absolute maximum: 500mg

when are supraperiosteal injections recommended?

when pulpal anesthesia is needed on a limited # of teeth or when anesthesia of the periodontium is needed in a localized area, (a single tooth)

which maxillary block should be given first

PSA (to let the larger molars fully anesthetize)

what teeth/structures does the PSA anesthetize?

third, second, first molars, and periodontium (completely anesthetized in 72% of population)

what area is not always anesthetized during the PSA block?

mesiobuccal root of maxillary first molar (28% of the population), as well as soft tissue of maxillary molar region

what is the landmark for the PSA injection?

height of the mucobuccal fold above the MB cusp of 2nd molar, if they have a small mouth its closer to the distal of the 1st molar

whats the needle, length of needle inserted, insertion location, amount of anesthetic, and length of time to deposit for the PSA block?

Needle: 27 gauge, short needle (25mm)

Length of Needle Inserted: 5-10mm or ¼

insertion Location: Superior to apex of max 2nd molar, at height of mucobuccal fold

Amount of Anesthetic: approx 0.9 to 1.8ml

Length of time to Deposit: approx 60 to 90 seconds

Who should the PSA block not be used on? What is recommended instead?

Children, due to risks (pterygoid plexus may be closer due to child still developing), use of supraperiosteal injections are recommended instead

What teeth are anesthetized w/ the MSA block?

max 1st and 2nd premolars, (also mesiobuccal root of max 1st molar in 28% of population)

Does the MSA block anesthetize the lingual tissue of the premolars and first molar?

No, use the GP block

what should you do if one of the premolars has been removed, such as you would find in an orthodontically treated patient?

use your critical thinking skills and estimate the target area by having the injection site halfway in the dental arch

whats the needle, length of needle inserted, insertion location, amount of anesthetic, and length of time to deposit for the MSA block?

Needle: 27 gauge, short (25mm)

Length of Needle Inserted: 5mm or ¼

insertion Location: height of mucobuccal fold above apex of max 2nd premolar

Amount of Anesthetic: approx 0.9ml

Length of Time to Deposit: 30 to 40 seconds

Will the ASA anesthetize the lingual tissue of the maxillary anterior teeth?

No, use the nasopalatine injection for the lingual tissue

whats the needle, length of needle inserted, insertion location, amount of anesthetic, and length of time to deposit for the ASA block?

Needle: 27 gauge, short (25mm)

Length of Needle Inserted: 5mm or ¼

insertion location: height of mucobuccal fold above apex of max canine

Amount of Anesthetic: approx 0.6 to 0.9ml

Length of time to Deposit: approx 30-40 seconds

What injection is recommended when there is a need for additional hemostatic control with the interdental periodontium and gingiva, or two adjacent teeth?

intraosseous injection

whats the needle, length of needle inserted, insertion location, amount of anesthetic, and length of time to deposit for the IO block?

Needle: Long needle

Length of needle inserted: approx 16mm or ½

insertion Location: height of mucobuccal fold above max 1st premolar, superior rim of infrorbital foramen until bone is gently contacted

Amount of Anesthetic: approx 0.9 to 1.2ml

Length of Time to Deposit: approx 60 to 90 seconds

What teeth/structures are anesthetized with the IO block?

max central, lateral, canine, first and second premolars, and MB root of max first molar in some pts

Periodontium of anesthetized teeth, facial soft tissue of max arch (except molar region), upper lip to midline, medial part of cheek, side of nose, and lower eyelid

will the IO injection take care of all max anterior teeth if there is a crossover of the contralateral ASA nerve?

no, use supraperiosteal injection over the contralateral teeth if necessary and depending on extent of procedures to be performed.

will the IO injection anesthetize the lingual tissue of the maxillary anteriors and premolars?

no, use GP and NP injections

what is the important technique for the IO?

Massage the IO foramen for approx 2 mins to enhance anesthetic diffusion

what is the important technique for the mandibular incisive nerve block?

Massage the mental foramen for approx 2 mins to enhance anesthetic diffusion

whats the needle, length of needle inserted, insertion location, amount of anesthetic, and length of time to deposit for the GP block?

Needle: 27 gauge, short (25mm)

Length of Needle Inserted: approx 3-6mm or just until bevel is covered

insertion location: GP foramen, slight depression at junction of max alveolar process and posterior hard palate, at the apex of of the max 2nd molar, about 10mm medial and directly superior to the lingual GM

Amount of Anesthetic: approx 0.45 to 0.6ml

Length of time to Deposit: minimum of 30 seconds

In pts w/ a vaulted palate, the GP formaen will appear ______ to the dentition. In pts w/ a shallow palate, the foramen will appear _____ to the midline.

closer

Both the right nasopalatine nerve and the left nasopalatine nerve are anesthetized by this block, so only one injection is needed for both sides of the palate. Does the NP provide pulpal anesthesia of the maxillary anterior teeth?

No, Additional anesthesia such as the MSA and ASA or the IO block may be needed, it anesthetizes lingual soft tissue from canine to canine

whats the needle, length of needle inserted, insertion location, amount of anesthetic, and length of time to deposit for the NP block?

Needle: 27 gauge, short (25mm)

Length of Needle Inserted: approx 3 to 6mm

insertion location: at incisive foramen slightly lateral, use qtip to apply pressure to papilla

Amount of Anesthetic: approx 0.45 or ¼

Length of Time to Deposit: minimum of 30 seconds

whats the needle, length of needle inserted, insertion location, amount of anesthetic, and length of time to deposit for the AMSA block?

needle:CCDD w/ short needle

insertion location: apices of maxillary premolars on hard palate, midway between lingual GM and median palatal raphe

Amount of Anesthetic: approx 1.4 to 1.8ml until blanching of tissue

Length of Time to Deposit: approx 0.5ml per minute

What does the AMSA anesthetize?

ASA, MSA, GP, and NP nerve

covers all maxillary anterior teeth in one quadrant

how much is 0.5% in 1 mL and 1.8mL?

5 and 9

how much is 2% in 1 mL and 1.8mL?

20 and 36

how much is 3% in 1 mL and 1.8mL?

30 and 54

how much is 4% in 1 mL and 1.8mL?

40 and 72

What is the formula for calculating the healthy patient’s MRD in mg?

Multiply the patient’s weight in pounds or kilograms by the absolute MRD per appointment for healthy patients

What is the formula for calculating the milligrams of anesthetic drug in 1 mL of the selected anesthetic?

Multiply the percent concentration of local anesthetic by 10 mg.

What is the formula for calculating the milligrams of solution in one cartridge of the selected anesthetic?

Multiply the number of mg in one mL by either 1.8 or 1.7.

What is the formula for converting the MRD to number of cartridges?

Divide the MRD in milligrams by the number of milligrams per cartridge of anesthetic.

What is the formula for converting the maximum number of cartridges to milliliters?

Multiply the number of cartridges by 1.8 (or 1.7 for articaine)

What is the is ratio of 1:20,000 EPI in mg/mL and mg/cart (1.8ml) ?

0.05mg/ml and 0.09mg/cart

What is the is ratio of 1:50,000 EPI in mg/mL and mg/cart (1.8ml) ?

0.02mg/ml and 0.036mg/cart

What is the is ratio of 1:100,000 EPI in mg/mL and mg/cart (1.8ml) ?

0.01mg/ml and 0.018mg/cart

What is the is ratio of 1:200,000 EPI in mg/mL and mg/cart (1.8ml) ?

0.005mg/ml and 0.009mg/cart

Whats the MRD of EPI in a healthy patient?

0.2mg per appointment

whats the MRD of EPI in a cardiovascular/medically compromised patient?

0.04mg per appointment

Whats the MRD of Levonordefrin in a healthy patient?

1mg per appointment

whats the MRD of Levonordefrin in a cardiovascular/medically compromised patient?

0.2mg per appointment

With the 1:50,000 concentration of EPI what MRD of # of cartridges per appointment for healthy and CV patients?

5 (healthy) and 1(CV)

With the 1:100,000 concentration of EPI what MRD of # of cartridges per appointment for healthy and CV patients?

11 (healthy) and 2 (CV)

With the 1:200,000 concentration of EPI what MRD of # of cartridges per appointment for healthy and CV patients?

22 (healthy) and 4 (CV

what drug and concentration of EPI is an exception to the rule that the anesthetic is the limiting drug?

Lidocaine 2% 1:50,000 (meaning the vasoconstrictor limits amount of drug/carts we can use before the anesthetic in this case)

whats the needle, length of needle inserted, deposit location, amount of anesthetic, and length of time to deposit for the IA block?

Needle: 25 gauge long (32mm)

Depth inserted: 20-25mm until bone is contacted

insertion location: intersection of imaginary horizontal and vertical lines, approx 6-10mm superior to mandibular molar occlusal plane, place syrine barrel over contralateral premolars of side u are injecting

Amount:1.8 to 3.6ml

Deposit time: 60-120secs

whats the needle, length of needle inserted, deposit location, amount of anesthetic, and length of time to deposit for the LONG BUCCCAL block?

Needle: 25 gauge long (32mm) (bc its done right after IA injection, use 27 gauge short if given alone)

Depth inserted: 1-4mm

insertion Location: vestibule, distal and buccal to most distal molar at height of occlusal plane

Amount: approx 0.3ml (1/8 to 1/4 of solution)

Deposit time: 10 secs

whats the needle, length of needle inserted, deposit location, amount of anesthetic, and length of time to deposit for the MENTAL block?

Needle: 27 gauge short (25mm)

Depth inserted: not specified (approx 5mm like the ASA)

insertion location: apex of tooth at mucobuccal fold anterior to mental foramen (xrays are helpful, feel for depression from 1st molar to canine in 1 quad)

Amount: 0.6ml

Deposit time: 20 sec

whats the needle, length of needle inserted, insertion location, amount of anesthetic, and length of time to deposit for the INCISIVE block?

Needle: 27 gauge short (25mm)

Depth inserted: not specified (approx 5mm like the ASA)

Insertion location: apex of tooth at mucobuccal fold anterior to mental foramen (xrays are helpful, feel for depression from 1st molar to canine in 1 quad)

Amount: 0.6ml

Deposit time: 20 sec

SPECIAL TECHNIQUE FOR INCISIVE IS THE APPLY PRESSURE/MASSAGE FORAMEN FOR 2 MINS AFTER INJECTION TO ENCOURAGE DIFFUSION

whats the needle, length of needle inserted, insertion location, amount of anesthetic, and length of time to deposit for the GOW-GATES block?

Needle: 25 gauge long (32mm)

Depth inserted: approx 25mm (3/4 of needle) until bone is contacted

insertion location: oral mucosa at mesial aspect of ramus, just distal to the height of the mesiolingual cusp of max 2nd molar

Amount: 1.8ml

Deposit time: 60-90 secs

whats the needle, length of needle inserted, insertion location, amount of anesthetic, and length of time to deposit for the VAZIRANI-AKINOSI block?

Needle: 25 gauge long (32mm)

Depth inserted: approx 25mm WITHOUT contacting bone

Insertion Location: closed mouth approach, w/ syrine up ending opposite the mesial aspect of max 2nd molar

Amount: 1.8ml

Deposit time: 60-90 secs

whats the needle, length of needle inserted, insertion location, amount of anesthetic, and length of time to deposit for the PDL INJECTION?

Needle: 27 gauge or 30 gauge extra short

Depth inserted: 1-2mm into alveolar bone proper after contact

Insertion location: into PDL region toward ABP near selected tooth

Amount: 0.2ml

Deposit time: 20 secs

What teeth/structures does the IA block anesthetize?

• Inferior alveolar nerve, Lingual nerve, Mental nerve, Incisive nerve

Areas Anesthetized:

• All mandibular teeth on the injected side to the midline

• Periodontium and facial gingiva anterior to the mental foramen and at the first molar, as described in your PPT

• Lingual soft tissues to the midline

• Lower lip to the midline

• Anterior ⅔ of the tongue

• Floor of the mouth

DOES NOT RELIABLY ANESTHETIZE BUCCAL GINGIVA OF MOLARS (WHY BUCCAL BLOCK IS OFTEN NEEDED)

What teeth/structures does the LONG BUCCAL block anesthetize?

• long buccal nerve

Areas Anesthetized:

• Buccal gingival tissues of mandibular molars

• Buccal soft tissues associated with mandibular molars

What teeth/structures does the MENTAL NERVE block anesthetize?

• mental nerve

Areas Anesthetized:

• Facial gingival tissue anterior to the mental foramen, usually around mandibular anterior teeth and premolars

• Lower lip to the midline

• Skin of the chin to the midline

What teeth/structures does the INCISIVE NERVE block anesthetize?

• incisive nerve and mental nerve

Areas Anesthetized:

• Mandibular anterior teeth and premolars

• Periodontium associated with these teeth

• Facial gingival tissues anterior to the mental foramen

• Lower lip and chin to the midline

What teeth/structures does the GOW-GATES NERVE block anesthetize?

NERVES Anesthetized:

• Inferior alveolar nerve

• Lingual nerve

• Mental nerve

• Incisive nerve

• Mylohyoid nerve

• Long buccal nerve

• Auriculotemporal nerve

Areas Anesthetized:

• All mandibular teeth on the injected side to the midline

• Associated periodontium

• Buccal and lingual gingiva of the mandibular teeth, including molars

• Lower lip to the midline

• Anterior ⅔ of the tongue

• Floor of the mouth

• Skin over the zygoma

• Posterior cheek and temporal regions

What teeth/structures does the VAZIRANI-AKINOSI NERVE block anesthetize?

NERVES Anesthetized:

• Inferior alveolar nerve

• Lingual nerve

• Mental nerve

• Incisive nerve

• Mylohyoid nerve

Areas Anesthetized:

• Long buccal nerve (approximately 75% of the time)

• Mandibular teeth on the injected side to the midline

• Associated periodontium

• Lingual gingiva and soft tissues

• Lower lip and chin

• Anterior ⅔ of the tongue

• Floor of the mouth

• Buccal gingiva of mandibular molars when the long buccal nerve is successfully anesthetized