The document discusses the preparation and procedures for dental injections. It covers taking a case history, examining the patient, grouping patients based on their health status, and performing sensitivity tests. It then describes the proper positioning of the patient and operator for different procedures. The document outlines the sterilization of equipment and infection control practices. It provides details on the types of syringes, needles, and local anesthetics used. Finally, it discusses the steps for preparing the injection site and properly inserting the needle.

1. Armamentarium and Preparation
for basic injection
Dr. Hesham El-Hawary
www.elhawarydentalclinic.com
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2. Pre-anesthetic evaluation of
the patient
1. Case History
2. Local Examination
3. Patient Grouping and sensitivity test
4. Discussing with the patient the Treatment Plan
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3. Case History
• Personal data
name, age, sex, occupation, etc
• History of chief complaint
• Past medical history
• Past dental history
• Family history
• Review Of systems
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4. Case History Cont.
• Advantages of taking Case history:
– Establishing a diagnosis
– Establishing the patient’s general condition and
hence his ability to withstand the procedure and
the kind of anesthesia
– Establishing sound doctor-patient relationship
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5. Local Examination
• The region to be operated on
• Evaluation of the surgical work to be done
– Severity
– Time required
• Evaluation of any obstacles in the site of
injection
– Anatomical
– Septic
– Mechanical
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6. Patients grouping
• Group I:
Completely fit for Local Anesthesia
• Group II:
II:
Patients who need medical consultation
with specialist and/or physician
• Group III:
III:
Patients who are contraindicated for local
anesthesia
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7. Group I: Fit for local anesthesia
1. Receive injection without premedication
2. Premedicated before injection:
1. Allergic patients →Sensitivity test
2. Nervous patients →Tranquilizer (Atarax)
3. Toxicity → Barbiturates
4. Infection → Antibiotics
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8. Skin Sensitivity Test
• Depositing 0.1 ml of the test solution into the
patients forearm
• The area to be injected is first wiped with an
alcohol pad
• A small intradermal wheel about 5 mm in
diameter is raised with saline injection
• A similar wheel 3 or 4 cm away is also raised
with the local anesthetic to be tested
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9. • After 5 minutes, both wheels are
examined
• Results:
– Negative Sensitivity: Both alike
– Positive sensitivity: Erythema
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11. Intranasal Sensitivity Test
• This test should supplement the skin
test
• Place the patient in supine position
• Record the blood pressure and pulse
every 3 minutes
• One drop of the local anesthetic
solution to be tested is placed in each
nostril while recording the blood
pressure and pulse
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12. Intranasal Sensitivity Test Cont.
• After 3 minutes 2 drops are placed
minutes,
in each nostril
• This procedure is repeated every 3
minutes increasing the number of
drops placed in each nostril until
reaching 4 drops / nostril
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13. Intranasal Sensitivity Test Cont.
• Then the blood pressure and pulse
is recorded for the next 15 minutes
• Sensitivity is manifested by
significant lowering of the blood
pressure and pulse
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14. Discussing with the patient the
Treatment Plan
• Explain your treatment plan in a simple way
• No
– Scary
– scientific words
• Never deny a procedure
• Never lie to a child patient
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15. Precautions for Infection
Control
Barrier technique
Care of the hands
Handling of sharp instruments and needles
Disinfection and Sterilization of the armamentarium
Disinfection and Sterilization of the dental unit
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16. Barrier technique
• Gloves
• Face protection
• Clothes protection
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18. Care of the hands
• Visibly dirty
• After touching contaminated
objects with bare hands
• Before and after patient
treatment (before glove
placement and after glove
removal)
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19. • Handwashing
Washing hands with plain soap and water
• Antiseptic handwash
Washing hands with water and soap or other
detergents containing an antiseptic agent
• Alcohol-based handrub
Rubbing hands with an alcohol-containing
preparation
• Surgical antisepsis
Handwashing with an antiseptic soap or an
alcohol-based handrub before operations by
surgical personnel
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20. Good Better Best
Plain Soap Antimicrobial Alcohol-based
soap handrub
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21. Handling of sharp
instruments and needles
• The needle must be recovered before
removal from the syringe
• Don’t recap the needle of the cartilage
syringe, by its plastic cover using your two
hands
• Recap the needle by one hand using the
table technique
• All sharp disposable instruments must be
discarded in a puncture resistance
container or in the incinerator
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23. Handling of sharp
instruments and needles Cont.
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24. Disinfection and Sterilization
of the armamentarium
• All contaminated instruments
– Handled with the general purpose utility gloves
– Cleaned to remove debris and blood, then dried,
wrapped and autoclaved
• Anesthetic carpule sterilized from outside by
insertion in colored antiseptic solution so that if
any leakage occurred the anesthetic solution
color will be changed
• The handpiece must be cleaned, lubricated and
wrapped then autoclaved between patients
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25. Disinfection and Sterilization
of the armamentarium
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26. Disinfection and Sterilization of
the dental unit
• Cover the head rest with disposable towels
• The light handles, the control buttons, and
the handles of the saliva ejectors and
suctions must be covered with aluminum
foils or plastic covers
• A chemical germicidal spray is used to
spray the dental chair and the practice
table between patients
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27. Disinfection and Sterilization of
the dental unit
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29. The patient position
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30. • The patient is seated comfortably in the
dental chair
• The back and the head rest are adjusted
so that the patient’s head, neck and
trunk are at straight line
• The light is adjusted to illuminate the
operating field
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31. For working in maxillary teeth
• The chair is tilted backward so that the
maxillary occlusal plane would be at 45º
angle to the floor
• The chair is raised up so that the maxillary
occlusal plane is two inches below
operator shoulder level
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32. For working in mandibular teeth
• The chair is tilted backward so that the
mandibular occlusal plane would be
parallel to the floor when the patient opens
his mouth widely
• The chair is raised up so that the
mandibular occlusal plane should be about
two inches above the elbow joint
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33. For working in lower right posterior
teeth the chair is lowered and tilted
enough to enable the operator to have
a clear view to the field from behind
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34. The operator’s position
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35. • For anesthesia and extraction of all teeth the
operator stands infront and to the right to the
patient except in three situations
• where he stands from behind and to the right:
– Lingual infiltration of lower anterior teeth.
– Right handed operator giving left side inferior
alveolar nerve block from behind technique.
– Extraction of lower right posterior teeth.
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36. Armamentarium used in
dental Anesthesia
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38. Dental Carpule
• Glass tube sealed from both ends
– One end by a rubber stopper
– The other end by a metal cap with rubber diaphragm that is
punctured by the needle
• Carefully sterilized from outside by keeping them in a
colored antiseptic solution
• The carpule contains the following:
– The anesthetic agent
– Vasoconstrictor
– Vehicle to make solution isotonic
– Preservative
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40. Dental Syringe
• Types:
– According to material
• Plastic
• Metalic
– According to aspiration
• Aspirating
• Non-Aspirating
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43. Dental Syringe Cont.
• The dental syringe consists of:
– Syringe barrel
– Finger grip
– Thumb ring
– Piston
– Harpoon
– Needle adaptor
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44. Dental Syringe Cont.
• There are two types
of metallic dental
syringes
– Basal loading
– Lateral loading
metal syringe
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45. Dental Syringe Cont.
• In the lateral loading dental syringes
The piston is retracted to allow space for
insertion of the carpule laterally into the syringe
barrel
• In the basal loading dental syringes
The syringe piston is retracted and rotated
around the syringe barrel
• The needle is then inserted into the threaded
part of the syringe barrel (needle adaptor)
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46. Disposable Dental Needle
• The dental needle consists of:
– Syringe adaptor
– Hub
– Syringe penetrating end
– Needle shank
– Needle bevel
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47. Disposable Dental Needle Cont.
• There are two types of needles:
– Long needles
Used during the block injections.
– Short needles
Used during the infiltration anesthesia.
• Once the needle introduced into the tissues
never change its direction
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48. Preparation of the site of
injection and Needle
insertion
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49. • Syringes and Needles:
– Chose suitable type syringe and needle should be
– The syringe and needle should be carefully sterilized
• Hands of the operator:
– Washed thoroughly with soap and water
– Dried with a sterile towel
– Wiped with 70% alcohol
• Anaesthetic carpules:
– Carefully sterilized
– Warmed to body temperature
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51. • Patient's mouth:
– Scaling if needed
– Rinsing with good antiseptic mouthwash
– Draping in the regular manner
• Site of injection:
– Dried from saliva by a pellet of sterile cotton
– Wiped with a disinfectant as 5% tincture iodine
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54. • Insertion of the needle:
– The patient should be aware that he is going to
have the injection but not exactly when
– stretched as much as possible to facilitate
insertion of the needle
– The syringe is held in a pen grasp
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56. • Insertion of the needle Cont.:
– The needle’s bevel of the needle should be
directed towards bone or the site of operation
– The prick is then made as quickly as possible
while guarding with the mirror or fingers of the
left hand against any sudden movement of the
patient
– While starting to inject, try to direct the patient's
attention to something else
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57. • Insertion of the needle Cont.:
– The needle should not be bent to change its
direction inside the tissues, it should rather be
withdrawn first and then reinserted in the desired
direction
– The needle should always follow the simplest
way inside the tissues to reach its target
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58. • Insertion of the needle Cont.:
– After insertion of the needle, aspirate a little, if an
aspirating syringe is used, to be sure that the
needle is not within a blood vessel, so as to
prevent toxicity from the local anaesthetic.
– The anaesthetic solution is then deposited at a
rate of not more than 2 ml/min, meanwhile the
patient should be watched carefully for any
adverse reaction
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59. THANK YOU
www.elhawarydentalclinic.com
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