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Anesthesia
temporary loss of feeling or sensation
Anesthetic
medication that produces the temporary loss of feeling or sensation
Induction
time from injection, to effective anesthesia
the length of time from injection to complete conduction blockage
Innervation
supply or distribution of nerves to specific body part
Topical Anesthesia
provides a temporary numbing effect on nerve endings located near the surface of the oral mucosa, the drugs in _____ are concentrated to allow penetration of the mucous membranes and action at the nerve endings.
Local Anesthetic
most frequently used form of pain control in dentistry. It is safe, dependable, effective, and suitable for virtually all forms of dental treatment and it is not irritating to tissues. It has minimal toxicity, rapid onset, and eliminates pain during a procedure.
Local anesthesia
is obtained by injecting an anesthetic solution near a nerve where treatment is to take place
Electronic Anesthesia
non invasive form
blocks pain using a low current of electricity
contact pads targeted directly to the nerve bundle at the root of the tooth
hand pads on backs of hands and third pad placed intra-orally
area is isolated and dried, pad attached to the lingual side 3-5mm from the gingival margin
client has control in activating the unit and gradually increasing the level of the pain-blocking signal
Inhalation sedation
nitrous oxide/oxygen analgesia
may be the safest type of sedation in dentistry
produces a Stage 1 anesthesia/analgesia by using a combination of nitrous oxide and oxygen gases
client inhales these gases through a nosepiece and feels the effect almost immediately
produces a pleasant, relaxing experience
easy onset, minimal side effects and rapid recovery
tasteless, sweet-smelling, colourless gas in a blue cylinder
nose piece
nasal inhalers through which client breathes (rubber can be sterilized)
scavenger system
reduces the amount of N2O releases into treatment room
antianxiety agents
in large doses these can produce sleep, sedation, and anesthesia
can be administered orally, intravenously, or by inhalation
this is used for clients who are nervous, long/difficult procedures, mentally challenged, and for very young children that need extensive treatment
Intravenous sedation - Conscious sedation IV
Results in a minimally depressed level of consciousness.
Client can maintain an open airway
only given and monitored by someone who is trained and certified (Oral surgeon or Periodontist)
Have registered nurse to administer
Feels the effect almost immediately
General Anesthesia
A controlled state of unconsciousness
loss of protective reflexes ie. lose ability to maintain an airway independently
Stage III
(Stage one is induction, stage two is excitement and possible uncontrolled movements)
Anesthesiologist
are physicians who specialized in general anesthesia
Local anesthetic with epinephrine
cannot be used with patients who have heart disease, hypertension, and hyperthyroid disease
Local anesthetic amide
cannot be used for patients who have impaired liver function
Topical anesthetic
cannot be used for patients who have open lesions and certain food allergies
15 seconds to 1-2 minutes
for effectiveness of topical anesthetic ointments, these must remain on the site of injection for how long?
Liquid and spray topical anesthetic
are applied to larger surfaces of the mouth. For example, back of the throat to desensitize gag reflex
Topical patch
new product that works within 10 seconds, used for injections and alleviates discomfort from denture sores and ulcers
vary in concentrations of 5-20% of active ingredients
Esters
are usually used as topical anesthetics
an alcohol based and soluble in water
have a greater potential of adverse allergic reaction
are metabolized in plasma
quickly absorbed
Benzocaine
active ingredient of esters
Lidocaine
active ingredient of amides
Amides
absorbed slowly
low incidence of allergic reaction
metabolized in the liver
cannot be used for clients with impaired liver function
white, sloughing mucosa
seizures, CNS depression, increased BP and pulse
overdose to anesthetic agents
Trigeminal nerve
primary source of innervation for the oral cavity, it has three divisions: ophthalmic, maxillary, and mandibular
Maxillary division
supplies the maxillary teeth, periosteum, mucous membrane, maxillary sinuses, and soft palate.
Maxillary division subdivides into
Nasopalatine nerve
greater palatine nerve
anterior superior alveolar nerve
middle superior alveolar nerve
posterior superior alveolar nerve
Nasopalatine nerve
Passes through the incisive foramen
supplies the mucoperiosteum palatal to the maxillary anterior teeth
Greater palatine nerve
Passes through the posterior palatine foramen and forward over the palate
Supplies mucoperiosteum, intermingling with the nasopalatine nerve
Anterior Superior Alveolar nerve
Supplies the maxillary central, lateral and cuspid teeth (canines) and their periodontal membranes and gingiva
Also supplies the maxillary sinus
Middle Superior Alveolar nerve
Supplies the maxillary first and second premolars, the mesiobuccal root of the maxillary first molar, and the maxillary sinus.
Posterior Superior Alveolar nerve
Supplies the other roots of the maxillary first molar and the maxillary second and third molars
Branches forward to serve the lateral wall of the maxillary sinus
Buccal nerve
supplies branches to the _______ mucous membrane and to the mucoperiosteum of the mandibular molars
Lingual nerve
supplies the anterior two thirds of the tongue and gives off branches to supply the _____ mucous membrane and mucoperiosteum.
Inferior alveolar nerve
divides into mylohyoid nerve, small dental nerve, mental nerve, and incisive nerve
mylohyoid nerve
supplies ______ muscles and the anterior belly of the digastric muscle
small dental nerve
supply the molar and premolar teeth, alveolar process & periosteum
mental nerve
moves outward and anteriorly through the ____ foramen and supplies the chin and mucous membrane of the lower lip
incisive nerve
continues anteriorly within the bone and gives off small branches to supply the _____ teeth
Vasoconstrictors
function is to slow down the intake of an anesthetic agent and increase the duration of the action
prolongs the effect of the anesthetic by decreasing blood flow in the area of injection
the smaller the ratio, the higher the percentage of _______ in the anesthetic agent.
duration
is the time from induction until the reversal is complete
60-180 minutes
short acting
120-240 minutes
intermediate acting
240-540 minutes
long acting
nerve block
anesthetic deposited close to main nerve trunk for quadrant dentistry
palatal anesthesia
common ____ injections if necessary, are the anterior or greater palatine nerve block (post palate) or the nasopalatine nerve block (ant palate)
these injections can be particularly sensitive for the client.
Infiltration Anesthesia
Solution is injected directly into the tissue at the site of the dental procedure
Generally used for maxillary teeth because of the porousnature of the alveolar cancellous bone – solution can diffuse through bone and reach apices
May be used as a secondary injection to block gingival tissues surrounding the mandibular teeth
________ of anesthetic with a vasoconstrictor is used to minimize bleeding
Field Block
injection of anesthetic near a major nerve
usually involves deposit of anesthetic at the apex of a tooth when only one tooth and the surrounding area need to be anesthetized (could involve 2-3 teeth)
most commonly used in maxilla or in the mandibular anterior
Block Anesthesia
Mandibular bone is compact and dense and therefore, anesthetic doesn’t diffuse as easily through it
usually required for most mandibular teeth
method of injection that would provide anesthesia to an entire quadrant
incisive nerve block
If anterior teeth or premolars require anesthesia, an __________ is given at the mental foramen
Periodontal Ligament Injection
This is an alternative infiltration technique that involves injection of the anesthetic solution under pressure directly into the _____________ and surrounding tissues
Used as an addition to other techniques
Thumb Ring, Finger Grip, and Finger Bar
allows the dentist to control the syringe firmly and aspirate with one hand
Harpoon
a sharp hook that locks into the rubber stopper of the anesthetic cartridge so the stopper can be retracted by pulling on the piston rod
this makes aspiration possible
Piston Rod
pushes the rubber stopper of the cartridge and forces solution out through the needle
Barrel of the Syringe
firmly holds cartridge in place – loaded through open side, window on other side allows dentist to watch for blood during aspiration
Threaded Tip
needle is attached to syringe on the _______
cartridge end of needle passes through the small opening in the centre of the _________, puncturing the rubber diaphragm of anesthetic cartridge
rubber or silicone
Anesthetic Cartridge/ Carpule have a ______ stopper at one end and an aluminum cap with a rubber diaphragm at the other end
blister packs
Anesthetic Cartridge/ Carpule are supplied in _______ sterilized and sealed.
two-part plastic covering
disposable needles are sterile, protected by a ________________
cartridge end
is the shorter end – it fits through the threaded tip of the syringe and punctures the rubber diaphragm
Needle Hub
made of self-threading plastic or pre-threaded metal
attaches needle to the threaded tip of syringe
Injection End
protected by the needle guard and is either 1 inch or 1 and 5/8 inches in length
usually, the short (1 inch) is used for infiltration and the long (1 5/8) is used for block anesthesia
Lumen
hollow centre of the needle
Gauge
thickness/size of needle
larger the number, the thinner the needle
the smaller the number, the thicker the needle
alter the function of vital organs, notably, the heart
If local anesthetic is injected directly into a blood vessel it can
Paresthesia
a condition in which numbness lasts after the effects of the local anesthetic solutions should have worn off
use of contaminated anesthetic solution
trauma to nerve sheath during injection or surgery
hemorrhage (bleeding) into or around the nerve sheath