DH 128 Basic Injection Tech, Trigeminal Nerve, & Supra Injection

Penetration site

initial insertion site (where you initially 'poke' the patient)

Pathway of insertion

direction the needle follows

Target site

the location where the LA will be delivered

True or false: Always believe the injection you are giving will NOT be painful.

True; be confident in your technique

What are the components of atraumatic injections?

technical aspect & communicative aspect (iatrosedation)

How often should you change the needle?

every 3-4 penetrations

True or false: Keep the assembled syringe on the bracket table & always use a needle recapper.

False; Keep the assembled syringe on the side table, NOT the bracket table & always use a needle recapper.

How deep into the mucosa does the topical penetrate?

2 mm

True or false: Your hand should be in the palm UP hand position.

True

Aspiration

critical safety factor to prevent intravascular injection

create negative pressure in carpule by retracting piston

What rate should you be depositing solution?

one mL/60 seconds

What should be recorded in the patient chart?

LA drug used

Vasoconstrictor name & concentration

Volume of solution

Injections given

Patient reaction

What are the 3 branches of the Trigeminal Nerve

Ophthalmic branch (sensory)

Maxillary branch (sensory)

Mandibular branch (mixed but mainly sensory)

What nerves make up the Maxillary nerve branch?

PSA, MSA, ASA, GP, NP, IO, AMSA

What nerves make up the Mandibular nerve branch?

Auriculotemporal, Buccal, IA, Mental, Incisive, Lingual

What are the 4 categories of injections?

Local infiltration

Field block

Nerve block

Topical

Local infiltration

affects small terminal nerve endings in the area of treatment

ex. papillary injection

Field block

deposit solution near larger terminal nerve branches

treatment area away from site of deposition

ex. Supraperiosteal injection

Nerve block

deposit solution close to a main nerve trunk

usually a distance from site of treatment

involves larger area of numbness

used in quadrant tx

ex. ASA nerve block

Topical

liquid or ointment

affects terminal nerve endings in area of direct contact

2-3mm deep of penetration

used for pain control preceding injection

What type of injection is the supraperiosteal injection?

field block

What is the supra injection most commonly used for?

pulpal anesthesia in maxillary teeth

For a mandibular supra injection, what anesthetic would likely be used?

Articaine bc it has a higher concentration

What areas are anesthetized by a supra?

pulp; buccal periosteum, lip & mucous membrane; buccal bone

NO palatal tissue or bone anesthesia

Indications for supra

pulpal anesthesia of 1 or 2 teeth in the maxillary arch or mandibular anteriors

soft tissue anesthesia

Contraindications for supra

infection at site of deposition

dense cortical bone covering the apices of teeth

Advantages of a supra

>95% success rate

technically easy

usually atraumatic

<1% positive aspiration

Disadvantages of a supra

not suitable for large areas

too. many pokes

large volume of solution required

larger volume of solution = greater risk of systemic complications

What gauge and length needle is used for a supra?

25-27 gauge short needle

What is the point of insertion for supra?

*height of the mucobuccal fold

*above tooth to be anesthetzed

*close to buccal bone

Path of insertion for supra

parallel to long axis of tooth & follow contour of bone

Target area for supra

buccal to bone, at or just apical to the tooth to be anesthetized

Landmarks for supra

*mucobuccal fold

*crown of tooth

*contour of root

Bevel orientation for supra

faces bone, prevents tearing of periosteum, not critical with this injection, do not overly manipulate the needle with supra

Spread of solution for supra

quick onset & one injection may cover several adjacent teeth

Signs & symptoms of supra

no pain, maybe pressure sensation

(show pt the difference, go to an unanesthetized area & test first)

absence of pain during treatment

Failures of supra anesthetic

needle tip below apex (will have soft tissue anes but not pulpal)

needle too far away from buccal plate of bone (inadequate diffusion of solution)

Complications of supra

pain on insertion (needle against periosteum)

withdraw & redirect away from bone