Local infiltration course

Under what conditions may a dental hygienist in Texas administer local infiltration?

Under the direct supervision of a dentist and with a valid certificate

What is the minimum passing score for the didactic competency in a local infiltration course?

75%

Which of the following is not a required component of the didactic education for local infiltration?

a. TSBDE rules and regulations

b. pediatric behavior management

c. recognition of systemic toxicity

d. pharmacology of local anesthesia

B. pediatric behavior management

T/F: an RDH in Texas can provide local anesthesia for a patient younger than 18

FALSE

How many live patient experiences must the student complete to demonstrate clinical competence of local infiltration?

5 patients, with four different quadrants, affecting at least 3 teeth

What are the reporting requirements for if a patient dies possibly due to local anesthesia administration?

Within 72 hours or upon becoming aware.

Emergency management steps

1. call for help/AED

2. provide airway support, provide oxygen

3. Get vitals, remove allergens

Greatest chance for survivability:

1. early recognition

2. quality CPR

3. early defibrillation

What are the three branches of the trigeminal nerve?

1. ophthalmic

2. maxillary

3. mandibular

Where does the maxillary nerve enter and exit?

exits through the foramen rotundum and enters via infraorbital foramen

What areas does the maxillary nerve innervate?

nasal cavity/sinuses

max teeth and palate

midface below eye

Where does the mandibular nerve enter and exit?

exits through foramen ovale

What is unique about the mandibular nerve?

its is motor and sensory

What is the goal with local infiltration?

numb 1- 3 teeth at a time

What anesthetic can best diffuse through the bone to number nerve fibers?

Septocaine

What are the main branches of the mandibular nerve?

buccal.

lingual.

inferior alveolar

The IA nerve turns into the ________ and then ________

mental nerve, incisive nerve

What systems are affected by local anesthetic?

ALL

Describe the configuration of local anesthetic

-lipid soluble group

-ester amide group

-secondary amine group

What type of anesthetic class is local used in dentistry

Amides

Some common esters are:

-cocaine

-benzocaine

-procaine

-tetracaine

Some common amides are:

-lidocaine

-mepivacaine

-prilocaine

-articaine

-bupivacaine

potency

lowest concentration needed to block impulse conduction

What influences the potency of local anesthetic

-vasodilator activity

-tissue diffusion

-lipid solubility

Why are local anesthetics combined with hydrochloride salt?

they are weak bases, increases penetration and solubility and is more stable

Factors that affect the pH with injections:

-infections

-vasoconstrictors

-surgery or trauma

Name an advantage of having a vasoconstrictor?

less toxicity and less absorption of local anesthetic

Esters are metabolized by

plasma

amides are metabolized by

liver

what is the max dose you can give a healthy patient with no issues

11.5 of 1/100k

What is the max amount for a patient with mild cardiac disease

5.8 of 1/00k

How many carps can you give a patient who has severe cardiac disease

2.35

symptoms of vasoconstrictor toxicity

-anxiety

-agitation/confusion

-hypertension

What is the reason for using an aspirating syringe?

negative pressure is created to retract if the carp had been injected into a blood vessel

The higher the needle gauge the______ the needle is

smaller

In infiltration how much of the needle is inserted into the tissue?

only 2-3 mm

What is the purpose of a bevel on the needle?

angles for more comfortable insertion

A sharper, new needle leads to

better and more comfortable injections

Define a nerve block

local anesthesia is deposited close to main trunk near the site of operative intervention. ---Examples PSA, ASA, IO, IA

-affects larger areas of teeth and tissue

For infiltrations where are we going to insert the needle?

near the apex of the target tooth

-supraperiosteal, intraseptal, papillary infiltration

What are the implications for using a nerve block?

quadrant dentistry

What are the clinical applications for using infiltrations?

-periodontal procedures

-maxillary extractions

-maxillary restorations

Which technique is used for maxillary anterior teeth due to the porous nature of the bone?

infiltration anesthesia

What is the primary advantage of a nerve block over infiltration?

anesthetizes a larger area with one injection

Which anatomical structure makes infiltration less effective in the mandible?

dense cortical bone

what is common complication of a nerve block if improperly administered?

hematoma

The inferior alveolar nerve block anesthetizes what areas?

mandibular teeth on the same side

T/F: The dental hygienist can anesthetize the dentist's restorative patient for them

FALSE, they can only numb their own hygiene patients that are over the age of 18 and non-sedated

When administering anesthesia what is the best position to have our patients in?

supine and semisupine

(reduced chance of syncope)

Aspects of an atraumatic injection include:

-sharp needle

-topical

-slow injection

-use 27, 30-gauge needle

-N20

Injection techniques:

-dry tissue prior to topical

-pull tissue taut

-inject a few drops before advancing

-aspirate

for maxillary buccal and facial injections where is our target

the mucobuccal fold apical to the target tooth/area

What needs to be documented when administering local anesthesia?

-type of injection

-time and volume administered

What type of anesthetic diffused better into the bone with a mandibular injection?

articaine