This document discusses management of local anaesthesia in endodontics. It summarizes reported rates of profound anaesthesia from various studies ranging from 38-92%. It discusses reasons for mandibular anaesthesia failure including anatomical variations, maximum safe doses of local anaesthetics, and how pulpal inflammation can complicate achieving anaesthesia. Adjunctive strategies to improve mandibular anaesthesia outcomes are also reviewed such as additional injections, periodontal ligament injections, intraosseous injections, and alternative techniques like Gow-Gates or Akinosi.
Local & systemic Complications of Local AnesthesiaIAU Dent
This document discusses local anesthesia (LA), including its mechanism of action, factors influencing injection discomfort and techniques to reduce discomfort, testing the success of LA, causes and management of failed LA, complications of LA including local and systemic complications, and management of specific complications like needle breakage, pain/burning on injection, persistent anesthesia, and trismus. It provides anatomical and technical details related to achieving successful LA and avoiding complications.
This document discusses local anaesthesia complications including definitions, local complications like needle breakage, paresthesia, trismus, hematoma, pain on injection, infection, and ocular complications. It provides causes, prevention, and management strategies for each complication. Several case reports and studies are referenced that examine specific complications in more depth.
Local anaesthesia complications and their management was summarized in 3 sentences:
Local anaesthesia complications can include needle breakage, pain on injection, burning sensation, soft tissue injury, and prolonged numbness. Management involves reassurance, monitoring, and in some cases referral to specialist. Proper injection technique and use of buffers can help prevent complications from occurring.
Conduct Of Local Anesthesia Technique And ComplicationHusni Ajaj
This document discusses regional anesthesia techniques and their complications. It covers the advantages of regional anesthesia, how local anesthetics work, different types of regional blocks including spinal, epidural, brachial plexus and others. It describes the physiology of neuroaxial blocks and their effects. Complications of various blocks like hypotension, post dural puncture headache are explained. Contraindications and techniques for specific blocks are also outlined.
Local and systemic complications of local anesthesiamohamed ali
Local and systemic complications of local anesthesia administration in dentistry
contents :
Introduction
Types of complications
Localized complications with their management
Generalized complications with their management
This document outlines local and systemic complications that can occur from dental injections. It discusses various local complications including paresthesia, needle breakage, hematoma, pain on injection, facial nerve paralysis, infection, trismus, soft tissue injury, and edema. It also discusses rare ocular complications that can occur from inadvertent injection into blood vessels supplying the eye. Prevention and management strategies are provided for each complication. Systemic complications from overdose or allergy are also briefly covered. Predisposing factors that can increase risks of complications are outlined.
This document discusses complications associated with local anesthesia. It describes local complications such as needle breakage, persistent anesthesia, facial nerve paralysis, and trismus. It also covers systemic complications including allergic reactions, toxicity from overdose, and idiosyncratic reactions. Prevention and management strategies are provided for various complications. The document emphasizes the importance of proper technique and avoiding overdose when administering local anesthesia.
This document discusses local anesthesia used in dental procedures. It defines local anesthesia and describes the desirable properties of local anesthetic solutions. These include being non-irritating, not permanently altering nerve structures, having low systemic toxicity, and providing effective anesthesia regardless of injection site. The document outlines the electrophysiology of nerve conduction and how local anesthetics work by blocking sodium channels. It classifies local anesthetics and discusses vasoconstrictors used to prolong their effects. Complications of local anesthesia are described, including both local issues like needle breakage and hematoma, and systemic concerns like overdose and allergic reactions.
Local & systemic Complications of Local AnesthesiaIAU Dent
This document discusses local anesthesia (LA), including its mechanism of action, factors influencing injection discomfort and techniques to reduce discomfort, testing the success of LA, causes and management of failed LA, complications of LA including local and systemic complications, and management of specific complications like needle breakage, pain/burning on injection, persistent anesthesia, and trismus. It provides anatomical and technical details related to achieving successful LA and avoiding complications.
This document discusses local anaesthesia complications including definitions, local complications like needle breakage, paresthesia, trismus, hematoma, pain on injection, infection, and ocular complications. It provides causes, prevention, and management strategies for each complication. Several case reports and studies are referenced that examine specific complications in more depth.
Local anaesthesia complications and their management was summarized in 3 sentences:
Local anaesthesia complications can include needle breakage, pain on injection, burning sensation, soft tissue injury, and prolonged numbness. Management involves reassurance, monitoring, and in some cases referral to specialist. Proper injection technique and use of buffers can help prevent complications from occurring.
Conduct Of Local Anesthesia Technique And ComplicationHusni Ajaj
This document discusses regional anesthesia techniques and their complications. It covers the advantages of regional anesthesia, how local anesthetics work, different types of regional blocks including spinal, epidural, brachial plexus and others. It describes the physiology of neuroaxial blocks and their effects. Complications of various blocks like hypotension, post dural puncture headache are explained. Contraindications and techniques for specific blocks are also outlined.
Local and systemic complications of local anesthesiamohamed ali
Local and systemic complications of local anesthesia administration in dentistry
contents :
Introduction
Types of complications
Localized complications with their management
Generalized complications with their management
This document outlines local and systemic complications that can occur from dental injections. It discusses various local complications including paresthesia, needle breakage, hematoma, pain on injection, facial nerve paralysis, infection, trismus, soft tissue injury, and edema. It also discusses rare ocular complications that can occur from inadvertent injection into blood vessels supplying the eye. Prevention and management strategies are provided for each complication. Systemic complications from overdose or allergy are also briefly covered. Predisposing factors that can increase risks of complications are outlined.
This document discusses complications associated with local anesthesia. It describes local complications such as needle breakage, persistent anesthesia, facial nerve paralysis, and trismus. It also covers systemic complications including allergic reactions, toxicity from overdose, and idiosyncratic reactions. Prevention and management strategies are provided for various complications. The document emphasizes the importance of proper technique and avoiding overdose when administering local anesthesia.
This document discusses local anesthesia used in dental procedures. It defines local anesthesia and describes the desirable properties of local anesthetic solutions. These include being non-irritating, not permanently altering nerve structures, having low systemic toxicity, and providing effective anesthesia regardless of injection site. The document outlines the electrophysiology of nerve conduction and how local anesthetics work by blocking sodium channels. It classifies local anesthetics and discusses vasoconstrictors used to prolong their effects. Complications of local anesthesia are described, including both local issues like needle breakage and hematoma, and systemic concerns like overdose and allergic reactions.
This document summarizes various local complications that can occur from local anesthesia administration and their prevention and management. It discusses complications such as needle breakage, paresthesia, facial nerve paralysis, trismus, hematoma, infection, and post-anesthetic intraoral lesions. For each complication, it outlines potential causes, problems associated with the complication, ways to prevent the complication, and how to manage it if it occurs. The document emphasizes using proper techniques, aseptic protocols, and treating any issues that arise.
Complications of Local anesthesia (part I) for B.D.S & M.D.S bhavana valvi
This document discusses various local complications that can arise from local anesthetic injections. It describes complications such as needle breakage, prolonged anesthesia, facial nerve paralysis, trismus, soft tissue injury, hematoma, pain on injection, infection, and edema. For each complication, it discusses causes, problems associated with the complication, prevention strategies, and management approaches. The document provides detailed information on injection techniques and protocols to minimize risks of various local complications.
This document provides a history of local anesthetics from ancient times to modern drugs like lidocaine and bupivacaine. It discusses the definition and classification of local anesthetics, how they work, and their mechanisms of action. Examples of commonly used local anesthetics are presented, including details about their onset, duration, dosing, and metabolism. The document also covers local anesthetic administration techniques and necessary armamentarium. In summary, it provides a comprehensive overview of the development and use of local anesthetics in oral and maxillofacial surgery.
1. The document discusses local anaesthesia equipment and techniques used in dentistry. It describes the components of local anaesthesia syringes, needles, and cartridges.
2. Various local anaesthesia techniques are covered, including infiltration, block, and topical anaesthesia. Infiltration anaesthetizes terminal nerve fibers, while block anaesthetizes the main nerve trunk.
3. Topical anaesthesia is described as surface anaesthesia for mucosa or skin using physical or chemical methods. Its effectiveness depends on the site of application and adequate time allowed.
Local anesthesia is defined as a transient reversible loss of sensation caused by blocking nerve conduction in a localized area. There are two types of local anesthetics: amides and esters. Amides such as lidocaine are preferred due to their longer duration of action and lower risk of allergic reactions. Local anesthetic solutions also contain vasoconstrictors to prolong the effects and buffering agents. The document discusses the mechanisms, uses, contraindications and toxicity of local anesthesia in detail. It provides classifications based on duration and vasoconstrictor types used. Potential adverse effects on the central nervous system, cardiovascular system and risks of methemoglobinemia are outlined.
This document discusses local anesthetic complications. It defines complications as any deviation from normal patterns during or after injection. Complications are classified as primary/secondary, mild/severe, and transient/permanent. Common complications include pain on injection, hematoma, infection, nerve injury, and syncope.
The document focuses on syncope, explaining that it is caused by cerebral ischemia from vasodilation or blood flow to muscles. Management includes placing the patient in a semi-reclined position. It also discusses factors affecting toxicity of local anesthetics, including rate of absorption, distribution, biotransformation, and excretion. Toxicity can produce cardiovascular effects like hypotension or central nervous effects like seizures. Proper management
1. Local anesthetic complications can arise from the drugs themselves or injection techniques. Soft tissue injury and sloughing of tissues from ischemia are complications of the drugs, while needle breakage, hematoma, and failure to achieve anesthesia can result from injection issues.
2. Proper administration techniques such as slow injection, aspiration, and choice of anesthetic agent and dose can help prevent complications. Monitoring for signs of excessive dosage or allergic reaction and having BLS protocols in place are also important for managing potential issues.
3. An understanding of anatomy, use of proper technique, and care in performing injections can help minimize risks. However, despite best efforts, complications may still occur rarely and require prompt treatment of symptoms
Local complications of LA injections include needle breakage, paresthesia, facial nerve paralysis, trismus, soft tissue injury, hematoma, pain on injection, and infection. Systemic complications include allergic reactions, toxicity, and methemoglobinemia. Proper injection technique and adhering to dosage guidelines can help prevent complications. Management involves reassurance, analgesics, antibiotics, and consultation with specialists if issues persist or worsen.
Local anesthesia is used to induce temporary loss of sensation in a specific area of the body without loss of consciousness. It works by blocking sodium channels and preventing nerve impulse propagation. Common local anesthetics used in dentistry include lidocaine and articaine. They are administered via injection using various needle sizes and lengths. The onset and duration of anesthesia is influenced by factors like pH, lipid solubility, and presence of vasoconstrictors. Local anesthetics provide a safe alternative to general anesthesia for minor dental procedures by restricting effects to localized areas.
This document discusses complications that can occur from regional anesthesia. It classifies complications as primary or secondary, mild or severe, transient or permanent. It also discusses specific complications that can occur from local anesthetic absorption (toxicity, idiosyncrasy, allergy), needle insertion (syncope, trismus, pain, edema, infection), or post-procedure (hematoma, sloughing of tissues, intraoral lesions). For each complication, it describes potential causes and treatments or methods for prevention. The document provides an overview of potential anesthetic complications and strategies to avoid or address issues.
Local anaesthesia for children (dentistry)jhansi mutyala
This document provides an overview of local anaesthesia techniques for children. It discusses definitions of local anaesthesia and various techniques including surface anaesthesia, infiltration, nerve blocks, and recent advances. It covers local anaesthetic solutions, pharmacological and non-pharmacological pain control methods, and complications of local anaesthesia such as allergic reactions and toxicity when using local anaesthetics in children. The goal is to provide effective pain control while minimizing risks for paediatric dental procedures.
Autoimmune Inner Ear Disease (AIED) refers to hearing loss or vestibular dysfunction caused by an immune-mediated process in the inner ear. It can be primary, restricted to the inner ear, or secondary to other autoimmune diseases. The cause is thought to be an immune response triggered by antigens in the inner ear. Common symptoms include progressive bilateral hearing loss over weeks to months. Treatment involves corticosteroids, with intratympanic injections as an alternative. Other immunosuppressants may be used if steroids are not effective. Systemic autoimmune diseases like Cogan syndrome, Granulomatosis with polyangiitis, and Systemic Lupus Erythematosus can also cause
This document provides information on various techniques for local anesthesia in dentistry. It discusses the mechanism of action, classifications, and maximum recommended doses of local anesthetics. It also describes in detail techniques for maxillary injections including inferior alveolar nerve block, Gow Gates, and Vazirani Akinosi techniques for mandibular anesthesia. Complications and contraindications of local anesthesia are mentioned.
Local anesthesia in dentistry /certified fixed orthodontic courses by Indian...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
00919248678078
This document provides an overview of different types of local and regional anesthesia techniques. It discusses local anesthesia, which involves infiltration or topical application of anesthetic to a specific body part. It also covers regional anesthesia techniques like spinal blocks, epidurals, and peripheral nerve blocks. The document describes different conduction anesthesia methods, including peripheral nerve blocks, plexus blocks, epidurals, and caudal blocks. It discusses intravenous regional anesthesia and local anesthetic agents and complications. In summary, the document is a comprehensive guide to local and regional anesthesia techniques.
Local anesthesia is used to induce numbness in a specific part of the body. This document discusses types of local anesthetics, their maximum doses, potential complications from local anesthesia administration including needle breakage, prolonged numbness, nerve injury, swelling, and allergic reactions. It provides guidance on managing these complications through reassurance, medication, heat/ice therapy, observation, and referral to a specialist if needed. Systemic toxicity is also addressed, with levels of severity and corresponding emergency treatment procedures.
local Anesthesia PPt for Dental students. In this presentation, we have explained the mechanism of action of local anesthetic drugs, types of local anesthesia, complications of local anesthesia , different clinical techniques of local anesthesia administration. This presentation was made from a local anesthesia book ( Handbook of local anesthesia / Stanley E Malamed )
This document discusses the use of dexmedetomidine (Dex) in neuroanesthesia. It describes how Dex leads to sedation, analgesia and decreases in heart rate and blood pressure through activation of α2 receptors. Studies show Dex causes a reduction in cerebral blood flow in animals but not cerebral metabolic rate of oxygen. In humans, Dex decreases mean cerebral blood flow velocity. Dex also has little effect on intracranial pressure and neurophysiological monitoring. The document reviews clinical experiences using Dex for craniotomies, spinal fusions and carotid endarterectomies. It suggests Dex may offer advantages over other sedatives due to its unique sedative properties and potential for
The document describes a panoramic anatomy presentation that identifies anatomical structures on panoramic radiographs. It includes slides labeling structures, describing different types of images (single real, double real, ghost), and providing an anatomical key. The slides provide examples of panoramic images labeling different structures and examples of positioning errors.
The document provides information about anatomical structures visible on panoramic radiographs. It includes descriptions of single real images, double real images, and ghost images produced in panoramic radiography. Various anatomical landmarks are labeled on diagrams of panoramic images and identified in a key. Test slides are included for students to identify anatomical structures and positioning errors.
This document summarizes various local complications that can occur from local anesthesia administration and their prevention and management. It discusses complications such as needle breakage, paresthesia, facial nerve paralysis, trismus, hematoma, infection, and post-anesthetic intraoral lesions. For each complication, it outlines potential causes, problems associated with the complication, ways to prevent the complication, and how to manage it if it occurs. The document emphasizes using proper techniques, aseptic protocols, and treating any issues that arise.
Complications of Local anesthesia (part I) for B.D.S & M.D.S bhavana valvi
This document discusses various local complications that can arise from local anesthetic injections. It describes complications such as needle breakage, prolonged anesthesia, facial nerve paralysis, trismus, soft tissue injury, hematoma, pain on injection, infection, and edema. For each complication, it discusses causes, problems associated with the complication, prevention strategies, and management approaches. The document provides detailed information on injection techniques and protocols to minimize risks of various local complications.
This document provides a history of local anesthetics from ancient times to modern drugs like lidocaine and bupivacaine. It discusses the definition and classification of local anesthetics, how they work, and their mechanisms of action. Examples of commonly used local anesthetics are presented, including details about their onset, duration, dosing, and metabolism. The document also covers local anesthetic administration techniques and necessary armamentarium. In summary, it provides a comprehensive overview of the development and use of local anesthetics in oral and maxillofacial surgery.
1. The document discusses local anaesthesia equipment and techniques used in dentistry. It describes the components of local anaesthesia syringes, needles, and cartridges.
2. Various local anaesthesia techniques are covered, including infiltration, block, and topical anaesthesia. Infiltration anaesthetizes terminal nerve fibers, while block anaesthetizes the main nerve trunk.
3. Topical anaesthesia is described as surface anaesthesia for mucosa or skin using physical or chemical methods. Its effectiveness depends on the site of application and adequate time allowed.
Local anesthesia is defined as a transient reversible loss of sensation caused by blocking nerve conduction in a localized area. There are two types of local anesthetics: amides and esters. Amides such as lidocaine are preferred due to their longer duration of action and lower risk of allergic reactions. Local anesthetic solutions also contain vasoconstrictors to prolong the effects and buffering agents. The document discusses the mechanisms, uses, contraindications and toxicity of local anesthesia in detail. It provides classifications based on duration and vasoconstrictor types used. Potential adverse effects on the central nervous system, cardiovascular system and risks of methemoglobinemia are outlined.
This document discusses local anesthetic complications. It defines complications as any deviation from normal patterns during or after injection. Complications are classified as primary/secondary, mild/severe, and transient/permanent. Common complications include pain on injection, hematoma, infection, nerve injury, and syncope.
The document focuses on syncope, explaining that it is caused by cerebral ischemia from vasodilation or blood flow to muscles. Management includes placing the patient in a semi-reclined position. It also discusses factors affecting toxicity of local anesthetics, including rate of absorption, distribution, biotransformation, and excretion. Toxicity can produce cardiovascular effects like hypotension or central nervous effects like seizures. Proper management
1. Local anesthetic complications can arise from the drugs themselves or injection techniques. Soft tissue injury and sloughing of tissues from ischemia are complications of the drugs, while needle breakage, hematoma, and failure to achieve anesthesia can result from injection issues.
2. Proper administration techniques such as slow injection, aspiration, and choice of anesthetic agent and dose can help prevent complications. Monitoring for signs of excessive dosage or allergic reaction and having BLS protocols in place are also important for managing potential issues.
3. An understanding of anatomy, use of proper technique, and care in performing injections can help minimize risks. However, despite best efforts, complications may still occur rarely and require prompt treatment of symptoms
Local complications of LA injections include needle breakage, paresthesia, facial nerve paralysis, trismus, soft tissue injury, hematoma, pain on injection, and infection. Systemic complications include allergic reactions, toxicity, and methemoglobinemia. Proper injection technique and adhering to dosage guidelines can help prevent complications. Management involves reassurance, analgesics, antibiotics, and consultation with specialists if issues persist or worsen.
Local anesthesia is used to induce temporary loss of sensation in a specific area of the body without loss of consciousness. It works by blocking sodium channels and preventing nerve impulse propagation. Common local anesthetics used in dentistry include lidocaine and articaine. They are administered via injection using various needle sizes and lengths. The onset and duration of anesthesia is influenced by factors like pH, lipid solubility, and presence of vasoconstrictors. Local anesthetics provide a safe alternative to general anesthesia for minor dental procedures by restricting effects to localized areas.
This document discusses complications that can occur from regional anesthesia. It classifies complications as primary or secondary, mild or severe, transient or permanent. It also discusses specific complications that can occur from local anesthetic absorption (toxicity, idiosyncrasy, allergy), needle insertion (syncope, trismus, pain, edema, infection), or post-procedure (hematoma, sloughing of tissues, intraoral lesions). For each complication, it describes potential causes and treatments or methods for prevention. The document provides an overview of potential anesthetic complications and strategies to avoid or address issues.
Local anaesthesia for children (dentistry)jhansi mutyala
This document provides an overview of local anaesthesia techniques for children. It discusses definitions of local anaesthesia and various techniques including surface anaesthesia, infiltration, nerve blocks, and recent advances. It covers local anaesthetic solutions, pharmacological and non-pharmacological pain control methods, and complications of local anaesthesia such as allergic reactions and toxicity when using local anaesthetics in children. The goal is to provide effective pain control while minimizing risks for paediatric dental procedures.
Autoimmune Inner Ear Disease (AIED) refers to hearing loss or vestibular dysfunction caused by an immune-mediated process in the inner ear. It can be primary, restricted to the inner ear, or secondary to other autoimmune diseases. The cause is thought to be an immune response triggered by antigens in the inner ear. Common symptoms include progressive bilateral hearing loss over weeks to months. Treatment involves corticosteroids, with intratympanic injections as an alternative. Other immunosuppressants may be used if steroids are not effective. Systemic autoimmune diseases like Cogan syndrome, Granulomatosis with polyangiitis, and Systemic Lupus Erythematosus can also cause
This document provides information on various techniques for local anesthesia in dentistry. It discusses the mechanism of action, classifications, and maximum recommended doses of local anesthetics. It also describes in detail techniques for maxillary injections including inferior alveolar nerve block, Gow Gates, and Vazirani Akinosi techniques for mandibular anesthesia. Complications and contraindications of local anesthesia are mentioned.
Local anesthesia in dentistry /certified fixed orthodontic courses by Indian...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
00919248678078
This document provides an overview of different types of local and regional anesthesia techniques. It discusses local anesthesia, which involves infiltration or topical application of anesthetic to a specific body part. It also covers regional anesthesia techniques like spinal blocks, epidurals, and peripheral nerve blocks. The document describes different conduction anesthesia methods, including peripheral nerve blocks, plexus blocks, epidurals, and caudal blocks. It discusses intravenous regional anesthesia and local anesthetic agents and complications. In summary, the document is a comprehensive guide to local and regional anesthesia techniques.
Local anesthesia is used to induce numbness in a specific part of the body. This document discusses types of local anesthetics, their maximum doses, potential complications from local anesthesia administration including needle breakage, prolonged numbness, nerve injury, swelling, and allergic reactions. It provides guidance on managing these complications through reassurance, medication, heat/ice therapy, observation, and referral to a specialist if needed. Systemic toxicity is also addressed, with levels of severity and corresponding emergency treatment procedures.
local Anesthesia PPt for Dental students. In this presentation, we have explained the mechanism of action of local anesthetic drugs, types of local anesthesia, complications of local anesthesia , different clinical techniques of local anesthesia administration. This presentation was made from a local anesthesia book ( Handbook of local anesthesia / Stanley E Malamed )
This document discusses the use of dexmedetomidine (Dex) in neuroanesthesia. It describes how Dex leads to sedation, analgesia and decreases in heart rate and blood pressure through activation of α2 receptors. Studies show Dex causes a reduction in cerebral blood flow in animals but not cerebral metabolic rate of oxygen. In humans, Dex decreases mean cerebral blood flow velocity. Dex also has little effect on intracranial pressure and neurophysiological monitoring. The document reviews clinical experiences using Dex for craniotomies, spinal fusions and carotid endarterectomies. It suggests Dex may offer advantages over other sedatives due to its unique sedative properties and potential for
The document describes a panoramic anatomy presentation that identifies anatomical structures on panoramic radiographs. It includes slides labeling structures, describing different types of images (single real, double real, ghost), and providing an anatomical key. The slides provide examples of panoramic images labeling different structures and examples of positioning errors.
The document provides information about anatomical structures visible on panoramic radiographs. It includes descriptions of single real images, double real images, and ghost images produced in panoramic radiography. Various anatomical landmarks are labeled on diagrams of panoramic images and identified in a key. Test slides are included for students to identify anatomical structures and positioning errors.
This document discusses various techniques for preserving vital primary and young permanent teeth, including indirect pulp therapy, direct pulp capping, pulpotomy, and pulpectomy. It provides details on the indications, contraindications, techniques, and success rates of each procedure. Formocresol pulpotomy continues to be widely used for treating carious exposures in primary teeth, though alternatives like glutaraldehyde are discussed. Successful endodontic treatment of primary teeth requires an understanding of their complex root canal anatomy and the effects of physiologic root resorption.
The document describes several anatomical landmarks of the maxilla and mandible that are visible on dental radiographs. Key maxillary landmarks include the median palatine suture, nasal fossa, nasal septum, anterior nasal spine, incisive foramen, maxillary sinus, malar bone, maxillary tuberosity, hamular process, and nasolacrimal duct. Mandibular landmarks include the lingual foramen, genial tubercles, mental ridge, mental foramen, mental fossa, external and internal oblique lines, mylohyoid line, mandibular foramen, inferior dental canal, and submandibular gland fossa. These landmarks appear as radiopaque or
The document identifies common errors that can occur when taking panoramic dental x-rays. These include the teeth being positioned too far anterior or posterior to the focal trough, the patient's head being turned or tipped in various directions, issues with the placement of the lead apron, and other errors like patient movement, double exposures, or using incorrect exposure settings. Proper patient positioning and technique are necessary to avoid these errors and ensure diagnostic quality panoramic dental x-rays.
This document provides information on local anesthesia. It begins by defining local anesthesia and classifying local anesthetics. It then discusses the pharmacokinetics and mechanisms of action of local anesthetics. Factors that affect the efficacy of local anesthetics like pH, inflammation, dosage, and vasoconstrictors are covered. Potential adverse effects and allergic reactions are described. Guidelines for administering local anesthesia to special patient populations like children, handicapped patients, and those on anticoagulants are provided. The document concludes by discussing dosing considerations and choices of local anesthetic for different procedures.
This document contains summaries of several pediatric OSCE stations, including:
- A station counseling a parent on their child's dyslexia diagnosis.
- Taking a history from the mother of a 2-year-old presenting with severe pallor.
- Examining the blood pressure of a 10-year-old child.
- Administering the MMR vaccine to a 17-month-old child.
- Taking a history of an 18-month-old boy presenting with fever and rash for 8 days.
- Performing a musculoskeletal exam on an 8-year-old boy.
- Counseling parents about the treatment and prognosis of their 29-week
This document contains an outline of 6 chapters covering general principles of pharmacology and various classes of drugs. Chapter 1 discusses pharmacokinetics, including absorption, distribution, metabolism and excretion of drugs. Chapter 2 covers agents that control the peripheral nervous system, including local anesthetics, cholinergic drugs, anticholinergic drugs, adrenergic drugs and antagonists. Subsequent chapters address agents controlling the central nervous system, organ-specific drugs, metabolic profile drugs, and chemotherapeutic drugs.
This document provides information on mandibular anesthesia techniques. It discusses:
1. The lower success rate of mandibular anesthesia compared to maxillary anesthesia, around 80-85%, due to bone density and less access to nerve trunks.
2. The various mandibular nerve blocks including inferior alveolar, mental, buccal, lingual, and Gow-Gates techniques. The inferior alveolar nerve block is the most commonly performed but has the highest failure rate of 15-20%.
3. Details of performing the inferior alveolar nerve block including target area, landmarks, technique, areas anesthetized, indications, contraindications, and complications.
4
Endolymphatic Hydrops Surgery talk NOTSA 2022 (FINAL) .pptxKristyRae1
Endolymphatic hydrops, or excess fluid buildup in the inner ear, can cause Meniere's disease which features episodes of vertigo, hearing loss, and tinnitus. Surgical interventions aim to reduce these symptoms by addressing the endolymphatic sac, but their efficacy compared to placebo is unclear due to the natural fluctuations of the disease. A landmark 1981 sham study found that a simple mastoidectomy was as effective as endolymphatic sac surgery, casting doubt on surgeries' benefits. However, advocates argue surgeries still help when medical options fail, though more research is needed to prove their efficacy while avoiding harm.
This document provides an overview of local anaesthesia presented by Dr. Yugal Kishor. It discusses the history, definition, classification and agents of local anaesthesia. It describes newer local anaesthetic drugs like articaine and centbucridine. It also discusses local anaesthetic solutions, delivery systems like computer-controlled syringes and jet injectors. The document outlines techniques for maxillary and mandibular nerve blocks including posterior superior alveolar, infraorbital and mental nerve blocks. It provides details on the anatomy, techniques, effectiveness and precautions for different nerve block procedures.
This document provides an overview of local anesthesia techniques for pediatric dental patients. It defines pain and local anesthesia, and describes topical anesthetics and the components of local anesthetic solutions. Techniques for mandibular and maxillary anesthesia are outlined, including nerve blocks and infiltration. Supplemental injection methods and maximum recommended doses are also discussed. Potential complications of local anesthesia are reviewed. Finally, some new techniques are mentioned, such as jet injection and computer-controlled delivery systems.
Papini Enrico. L'alcolizzazione del nodulo cistico. ASMaD 2011Gianfranco Tammaro
This document discusses techniques for ablating benign thyroid nodules using laser and percutaneous ethanol injection (PEI). It presents results from studies on using PEI to sclerose thyroid cysts and ablate solid nodules, showing reductions in cyst volume of over 75% and improvements in local symptoms. Laser ablation is also discussed as an alternative minimally invasive technique, with results from a randomized trial showing a 42.7% decrease in nodule volume compared to no significant change with medication alone. Both techniques are presented as less invasive options than surgery for selected patients.
This case report describes performing a superficial parotidectomy under local anesthesia for a patient with uncontrolled hypertension and a difficult airway. Nerve blocks were used to anesthetize the maxillary nerve, superficial cervical plexus including the greater auricular nerve, as well as incision site infiltration. The surgery was performed successfully using these nerve blocks with mild sedation. Local anesthesia allowed preservation of the facial nerve and avoidance of risks from general anesthesia for this high risk patient.
Local anesthesia is the most widely used method of pain control in dental practice. It involves injecting local anesthetic drugs near nerves to reversibly block nerve conduction and sensation in a specific part of the body. The first local anesthetic used was cocaine, extracted in 1859. Modern local anesthetics like lidocaine and bupivacaine reversibly block sodium channels, preventing nerve impulse propagation. They are metabolized in the liver and may cause minor complications like pain on injection or transient numbness, but rarely major issues. Proper dosage and technique help ensure safe and effective local anesthesia for dental procedures.
The document provides an overview of local anesthetics. It defines local anesthesia as the loss of sensation in a circumscribed area caused by depression of nerve endings or inhibition of nerve conduction. Local anesthetics reversibly block action potentials in excitable membranes. They are classified based on their chemical structure and duration of action. Properties, composition, indications, contraindications and mechanisms of action are described. The calcium displacement theory and specific receptor theory are discussed in relation to the mechanism by which local anesthetics block nerve conduction.
1) The document describes two cases of laryngeal dysfunction in horses. Case 1 involves left laryngeal hemiplegia, while Case 2 involves epiglottic entrapment.
2) For Case 1, a prosthetic laryngoplasty surgery was performed under general anesthesia to create abduction of the left arytenoid cartilage using sutures. For Case 2, a standing laser surgery was used to perform an axial excision of thickened aryepiglottic tissue causing the entrapment.
3) Both surgeries aimed to improve airflow and resolve the underlying laryngeal issues. Post-operative care and monitoring was provided for several weeks to manage pain and ensure healing. The prognosis
This document discusses local anesthesia techniques for pediatric dental patients. It defines pain and local anesthesia, and describes the components of local anesthetic solutions. It provides details on topical anesthetics and various injection techniques for mandibular and maxillary teeth, including inferior alveolar nerve block, mental nerve block, and local infiltration. Supplemental techniques like periodontal ligament injections are also covered. The document discusses metabolism of local anesthetics, maximum recommended doses, and potential complications. It concludes by mentioning new techniques like jet injection and computer-controlled delivery systems.
Stroke prevention in patients with atrial fibrillationMgfamiliar Net
This document summarizes a webinar on stroke prevention in patients with atrial fibrillation. It reviews the evidence for using novel oral anticoagulants (NOACs), provides a clinical guide on how to use NOACs in practice, and discusses strategies to reduce ischemic and bleeding risks using real-world cases. The document also includes a quiz on the clinical use of NOACs and summarizes key advantages of NOACs over warfarin. Real-world cases demonstrate the impact of NOAC introduction on optimizing anticoagulation and reducing strokes in atrial fibrillation patients.
This document summarizes recent advances in local anesthesia for dentistry. It discusses newer local anesthetic drugs like articaine and centbucridine that are equally or more effective than lignocaine. It also describes new delivery systems for local anesthesia like computer-controlled local anesthesia delivery systems, jet injectors, and iontophoresis that reduce injection pain and improve patient comfort. Devices like CCLADs allow controlled infusion of anesthetic for more precise needle insertion and placement.
The document describes a case where a 58-year-old woman underwent phenol sclerotherapy for hemorrhoids. The phenol solution used was 80% aqueous rather than the usual 5% oily solution, resulting in necrosis of tissue around the anus requiring surgery. The patient eventually recovered fully after months of treatment including a temporary colostomy.
This document summarizes various treatments for chronic rhinitis. It defines chronic rhinitis and discusses its causes such as allergies, vasomotor rhinitis, and infections. It then examines the physiology behind nasal congestion and various assessment techniques. It provides details on medical therapies like steroids, antihistamines, and immunotherapy. Surgical treatments covered include inferior turbinate procedures like outfracture, resection, and laser/cautery techniques. Overall, the document provides an in-depth overview of chronic rhinitis diagnoses and both medical and surgical management options.
Atrophic rhinitis is a chronic inflammatory disease characterized by crusting, fetor, and atrophy of the nasal structures. It is most commonly caused by complications from prior sinus surgery. On physical exam, patients typically have extensive nasal crusting and anosmia. Radiographic findings include mucosal thickening and bone resorption in the paranasal sinuses. Treatment options aim to restore nasal hydration and minimize crusting, using topical therapies like saline irrigations and systemic antibiotics. Surgical therapies include closure of the nostrils or implantation of materials to increase nasal volume.
The document summarizes potential complications from local anesthetic administration, including both local and systemic complications. Local complications include needle breakage, facial nerve paralysis, and soft tissue injury. Systemic complications can include adverse drug reactions such as overdose, allergy, or idiosyncrasy. Overdose is the most common adverse reaction and can cause signs like talkativeness or hypotension. Allergic reactions range from mild skin issues to life-threatening laryngeal edema. Proper patient evaluation, slow injection, and immediate treatment of reactions can help manage complications.
The document discusses oral cancer and its management. It covers the molecular changes involved in carcinogenesis including mutations in proto-oncogenes and tumor suppressor genes. Treatment options for oral cancer depend on the tumor stage and site and may involve surgery, radiation therapy, chemotherapy, or palliative care. Complications of cancer therapy include acute reactions like mucositis as well as chronic issues involving fibrosis, vascular changes, and loss of salivary gland function. Pain management is important and involves a multimodal approach.
This document discusses the use of radiation therapy in the treatment of head and neck cancers. It notes that radiation therapy is often used alone or in combination with surgery and chemotherapy to treat cancers in areas like the nasopharynx, base of tongue, and soft palate. It also discusses how certain cancer types, like those of the salivary gland and alveolar ridge, are best treated with surgery followed by radiation. The document outlines the goals of radiation therapy and techniques like conventional fractionation, hypofractionation and brachytherapy. It also discusses the use of positioning devices and shields to optimize radiation delivery and reduce side effects.
Similar to Local anaesthesia 07 03 22 compressed (20)
The document discusses techniques for shaping root canals including the foramen last technique, apical control zone, and apical gauging. It emphasizes cleaning the coronal 2/3 of canals before reaching the apical 1/3 to minimize complications. The apical control zone is described as an enhanced taper in the apical third that provides resistance against obturation. Literature references typical canal diameters of 1mm from the apex across different tooth types. Electric foramenal locators and establishing working length are also covered.
This document discusses endodontic diagnosis and treatment planning. It begins with an introduction to endodontics and causes of pulpitis. Signs and symptoms of pulpitis are then outlined. The diagnostic process involves subjective history, objective examination, and tests like percussion, palpation, thermal sensitivity, electric pulp testing, and radiographs. Based on the diagnosis, a treatment plan is formulated which may involve root canal treatment, referral, or extraction. The document provides details on diagnosing and treating different pulpal and periapical conditions like reversible/irreversible pulpitis, abscesses, cysts, and necrosis.
The document discusses strategies for restoring teeth that have undergone root canal treatment. It notes that while root canal treatment has high success rates, teeth remain vulnerable after treatment until permanently restored. Key points emphasized include minimizing removal of further tooth structure, avoiding stress-generating restorations, and providing ferrule protection of remaining tooth structure with crowns or onlays when possible. Strategies like custom posts, diaphragm cores, and conservative cavity preparations are also recommended to maximize tooth reinforcement and strength.
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Chapter wise All Notes of First year Basic Civil Engineering.pptxDenish Jangid
Chapter wise All Notes of First year Basic Civil Engineering
Syllabus
Chapter-1
Introduction to objective, scope and outcome the subject
Chapter 2
Introduction: Scope and Specialization of Civil Engineering, Role of civil Engineer in Society, Impact of infrastructural development on economy of country.
Chapter 3
Surveying: Object Principles & Types of Surveying; Site Plans, Plans & Maps; Scales & Unit of different Measurements.
Linear Measurements: Instruments used. Linear Measurement by Tape, Ranging out Survey Lines and overcoming Obstructions; Measurements on sloping ground; Tape corrections, conventional symbols. Angular Measurements: Instruments used; Introduction to Compass Surveying, Bearings and Longitude & Latitude of a Line, Introduction to total station.
Levelling: Instrument used Object of levelling, Methods of levelling in brief, and Contour maps.
Chapter 4
Buildings: Selection of site for Buildings, Layout of Building Plan, Types of buildings, Plinth area, carpet area, floor space index, Introduction to building byelaws, concept of sun light & ventilation. Components of Buildings & their functions, Basic concept of R.C.C., Introduction to types of foundation
Chapter 5
Transportation: Introduction to Transportation Engineering; Traffic and Road Safety: Types and Characteristics of Various Modes of Transportation; Various Road Traffic Signs, Causes of Accidents and Road Safety Measures.
Chapter 6
Environmental Engineering: Environmental Pollution, Environmental Acts and Regulations, Functional Concepts of Ecology, Basics of Species, Biodiversity, Ecosystem, Hydrological Cycle; Chemical Cycles: Carbon, Nitrogen & Phosphorus; Energy Flow in Ecosystems.
Water Pollution: Water Quality standards, Introduction to Treatment & Disposal of Waste Water. Reuse and Saving of Water, Rain Water Harvesting. Solid Waste Management: Classification of Solid Waste, Collection, Transportation and Disposal of Solid. Recycling of Solid Waste: Energy Recovery, Sanitary Landfill, On-Site Sanitation. Air & Noise Pollution: Primary and Secondary air pollutants, Harmful effects of Air Pollution, Control of Air Pollution. . Noise Pollution Harmful Effects of noise pollution, control of noise pollution, Global warming & Climate Change, Ozone depletion, Greenhouse effect
Text Books:
1. Palancharmy, Basic Civil Engineering, McGraw Hill publishers.
2. Satheesh Gopi, Basic Civil Engineering, Pearson Publishers.
3. Ketki Rangwala Dalal, Essentials of Civil Engineering, Charotar Publishing House.
4. BCP, Surveying volume 1
বাংলাদেশের অর্থনৈতিক সমীক্ষা ২০২৪ [Bangladesh Economic Review 2024 Bangla.pdf] কম্পিউটার , ট্যাব ও স্মার্ট ফোন ভার্সন সহ সম্পূর্ণ বাংলা ই-বুক বা pdf বই " সুচিপত্র ...বুকমার্ক মেনু 🔖 ও হাইপার লিংক মেনু 📝👆 যুক্ত ..
আমাদের সবার জন্য খুব খুব গুরুত্বপূর্ণ একটি বই ..বিসিএস, ব্যাংক, ইউনিভার্সিটি ভর্তি ও যে কোন প্রতিযোগিতা মূলক পরীক্ষার জন্য এর খুব ইম্পরট্যান্ট একটি বিষয় ...তাছাড়া বাংলাদেশের সাম্প্রতিক যে কোন ডাটা বা তথ্য এই বইতে পাবেন ...
তাই একজন নাগরিক হিসাবে এই তথ্য গুলো আপনার জানা প্রয়োজন ...।
বিসিএস ও ব্যাংক এর লিখিত পরীক্ষা ...+এছাড়া মাধ্যমিক ও উচ্চমাধ্যমিকের স্টুডেন্টদের জন্য অনেক কাজে আসবে ...
This slide is special for master students (MIBS & MIFB) in UUM. Also useful for readers who are interested in the topic of contemporary Islamic banking.
A workshop hosted by the South African Journal of Science aimed at postgraduate students and early career researchers with little or no experience in writing and publishing journal articles.
Reimagining Your Library Space: How to Increase the Vibes in Your Library No ...Diana Rendina
Librarians are leading the way in creating future-ready citizens – now we need to update our spaces to match. In this session, attendees will get inspiration for transforming their library spaces. You’ll learn how to survey students and patrons, create a focus group, and use design thinking to brainstorm ideas for your space. We’ll discuss budget friendly ways to change your space as well as how to find funding. No matter where you’re at, you’ll find ideas for reimagining your space in this session.
Main Java[All of the Base Concepts}.docxadhitya5119
This is part 1 of my Java Learning Journey. This Contains Custom methods, classes, constructors, packages, multithreading , try- catch block, finally block and more.
it describes the bony anatomy including the femoral head , acetabulum, labrum . also discusses the capsule , ligaments . muscle that act on the hip joint and the range of motion are outlined. factors affecting hip joint stability and weight transmission through the joint are summarized.
How to Setup Warehouse & Location in Odoo 17 InventoryCeline George
In this slide, we'll explore how to set up warehouses and locations in Odoo 17 Inventory. This will help us manage our stock effectively, track inventory levels, and streamline warehouse operations.
Leveraging Generative AI to Drive Nonprofit InnovationTechSoup
In this webinar, participants learned how to utilize Generative AI to streamline operations and elevate member engagement. Amazon Web Service experts provided a customer specific use cases and dived into low/no-code tools that are quick and easy to deploy through Amazon Web Service (AWS.)
How to Fix the Import Error in the Odoo 17Celine George
An import error occurs when a program fails to import a module or library, disrupting its execution. In languages like Python, this issue arises when the specified module cannot be found or accessed, hindering the program's functionality. Resolving import errors is crucial for maintaining smooth software operation and uninterrupted development processes.
Strategies for Effective Upskilling is a presentation by Chinwendu Peace in a Your Skill Boost Masterclass organisation by the Excellence Foundation for South Sudan on 08th and 09th June 2024 from 1 PM to 3 PM on each day.
Your Skill Boost Masterclass: Strategies for Effective Upskilling
Local anaesthesia 07 03 22 compressed
1. Management of Local
Anaesthesia in Endodontics
Halton-Peel Dental Association
Andrew Moncarz
BSc, DDS, Dip. An, MSc, FRCD(C)
March 22, 2007
2. Objectives
Review of:
Reported rates of profound anaesthesia
Anatomical variations
Maximum doses of local anaesthetics
Pulpal inflammation as a complicating factor
Adjunctive strategies for profound mandibular
LA
3.
4. Reported Reasons for
Mandibular Anaesthesia Failure
1. Operator Inexperience
2. Armamentarium: Deflection of the needle tip
3. Patient factors:
Variations in anatomy
Accessory innervation
Unpredictable spread of LA
Local infection
Pulpal inflammation
Psychological issues
5. Reported Reasons for
Mandibular Anaesthesia Failure
Operator Inexperience
Armamentarium: Deflection of the needle tip
Patient factors:
Variations in anatomy
Accessory innervation
Unpredictable spread of LA
Local infection
Pulpal inflammation
Psychological issues
7. Effectiveness of Conventional
IANB as measured by EPT
Childers et al. 1997 lido 2% 1:100K 63%
Clark et al. 1999 lido 2% 1:100K 73%
Dunbar et al. 1996 lido 2% 1:100K 43%
Guglielmo et al. mepiv 2%
80%
1999 1:20K
Reitz et al. 1998 lido 2% 1:100K 71%
8. Reported Reasons for
Mandibular Anaesthesia Failure
Operator Inexperience
Armamentarium: Deflection of the needle tip
Patient factors:
Variations in anatomy
Accessory innervation
Unpredictable spread of LA
Local infection
Pulpal inflammation
Psychological issues
9. Always use a long 25 gauge needle (the
red one)
2 reasons:
1. Less deflection
2. Less false negative aspiration
10. Reported Reasons for
Mandibular Anaesthesia Failure
1. Operator Inexperience
2. Armamentarium: Deflection of the needle tip
3. Patient factors:
Variations in anatomy
Accessory innervation
Unpredictable spread of LA
Local infection
Pulpal inflammation
Psychological issues
11.
12.
13. Ultrasound Guidance
Hannan et al. 1999:
Repeated-measures design
40 subjects injected twice at separate
appointments—once with landmarks, once with
ultrasound guidance
EPT after profound lip numbness reported
Anaesthetic success 38%-92%, no difference
between the techniques
Conclusion: accuracy of needle placement is not
the primary reason for failure of IANB
14. Reported Reasons for
Mandibular Anaesthesia Failure
1. Operator Inexperience
2. Armamentarium: Deflection of the needle tip
3. Patient factors:
Variations in anatomy
Accessory innervation
Unpredictable spread of LA
Local infection
Pulpal inflammation
Psychological issues
16. Reported Reasons for
Mandibular Anaesthesia Failure
1. Operator Inexperience
2. Armamentarium: Deflection of the needle tip
3. Patient factors:
Variations in anatomy
Accessory innervation
Unpredictable spread of LA
Local infection
Pulpal inflammation
Psychological issues
17. Berns et al. 1962: injected radiopaque
material into pterygomandibular space
Spread is unpredictable
Suggestion: inject more LA
18. Reported Reasons for
Mandibular Anaesthesia Failure
1. Operator Inexperience
2. Armamentarium: Deflection of the needle tip
3. Patient factors:
Variations in anatomy
Accessory innervation
Unpredictable spread of LA
Local infection
Pulpal inflammation
Psychological issues
19. Decrease in the pH locally
Can influence the amount of LA available
in the lipophilic form to diffuse across the
nerve membrane
Result is less drug interference of sodium
channels
Less likely to influence mandibular block
anaesthesia
20. Reported Reasons for
Mandibular Anaesthesia Failure
1. Operator Inexperience
2. Armamentarium: Deflection of the needle tip
3. Patient factors:
Variations in anatomy
Accessory innervation
Unpredictable spread of LA
Local infection
Pulpal inflammation
Psychological issues
21. Pulpal Inflammation
Causes activation and sensitization of
peripheral nociceptors
Causes sprouting of nerve terminals in the
pulp
Causes expression of different sodium
channels: TTX-resistant class of sodium
channels are 4 times as resistant to
blockade by lidocaine and their expression
is doubled in the presence of PGE2
22. Effectiveness of Conventional
IANB: Irreversible Pulpitis
100% lip anaesthesia
Reisman et al. 1.8 mL lido 2%
25%
1997 1:100K epi
Nusstein et al. 1.8 mL lido 2%
19%
1998 1:100K epi
Cohen et al. 1.8 mL lido 2%
50%
2000 1:100K epi
1.8 mL lido 2%
Claffey et al. 1:100K epi 23%
2004
23. Adjunctive Strategies
Additional Anaesthetic
PDL Injection
Intraosseous Injection
Intrapulpal Injection
Different anaesthetic
Retest using the CC
27. Maximum Doses LA
A cartridge contains 1.8 mL
Therefore a cartridge of 2% local
anaesthetic contains 20 mg/mL X 1.8 mL =
36 mg of local anaesthetic
28. Maximum Doses LA
How much LA can you give?
193 lb 33 yo male
Lidocaine 2% 1:100K
Articaine 4% 1:200K
2.2 lbs = 1 kg
193 lbs = 88 kg
29. Maximum Doses LA
Lidocaine 2% Articaine 4%
Max dose = 7 mg/kg Max dose 7 mg/kg
7mg/kg X 88=616 mg 7 X 88 = 616 mg
36 mg/1.8 mL 72 mg/1.8mL
616mg/36mg/cart.= 616 mg/72 mg/cart. =
17 cartridges ** 9 cartridges
30. Maximum Doses Epi
% = 1/100 = g/dL
Therefore:
1/100 = 1% = 1g/dL = 10 mg/mL
1/1000 = 0.1% = 0.1 g/dL = 1 mg/mL
1/10000 = 0.01% = 0.01 g/dL = 0.1 mg/mL
1/100000 = 0.001% = 0.001 g/dL = 0.01mg/mL
A cartridge contains 1.8 mL
Therefore a cartridge of 1:100 000 epi contains
0.01 mg/mL X 1.8 mL = 0.018 mg
(or about 0.02 mg)
35. FDA categories (based on risk of
fetal injury)
A: controlled studies in humans—no risk to
fetus demonstrated
B: animal studies show no risk, no human
studies; or animal studies have shown a
risk but human studies have shown no risk
C: animal studies show risk, no human
studies; or no animal or human studies
36. Pregnant Patients
Which Local Anaesthetic to use?
Articaine 4% 1:200 000 FDA category C
Lidocaine 2% 1:100 000 FDA category B
Mepivacaine 2% 1:20 000 FDA category C
Mepivacaine 3% plain FDA category C
37. Advantages of Injecting
“Higher”
Failure to achieve profound local
anaesthesia attributed to being “too low”
and “too far forward”
Injecting superiorly and more distally may
block accessory innervation
3 nodes of Ranvier may not be true
38. Gow-Gates Technique
Landmarks:
Corner of the mouth (contralateral side)
Tragus of the ear
Disto palatal cusp of the maxillary second
molar
AIMING FOR THE NECK OF THE CONDYLE
39.
40.
41. Efficacy of the Gow-Gates
Technique
Author Year GG (%) IANB (%)
Watson and Gow-Gates 1976 98.4 85.4
Gow-Gates and Watson 1977 96.2 85.5
Levy 1981 96 65
Malamed 1981 97.5
Montagnese et al. 1984 35 38
42. Akinosi Technique
Closed-mouth technique
Does not rely on a hard-tissue landmark
Parallel to occlusal plane, height of the
mucogingival junction
Advanced until hub is level with distal
surface of maxillary second molar
Delayed onset of anaesthesia
43.
44.
45. Akinosi Technique
Martinez Gonzalez et al. 2003
Pain to puncture less with Akinosi
Onset slower
17.8% failure vs. 10.7% IAB/LB
BUT-incomplete LB considered failure
Cruz et al. 1994
Gow Gates more effective, but Akinosi most
acceptable to patients
46. Nerve to Mylohyoid
Deposit ¼ cartridge of LA on lingual
surface of tooth in alveolar mucosa
Goal is to bathe the nerve as branches of it
enter the lingual surface of the mandible
48. PDL Injection
Technique:
needle inserted into the gingival sulcus at a 30
degree angle towards the tooth
bevel placed towards bone
advanced until resistance felt
anaesthetic injected with continuous force for
about 15 seconds.
approx. 0.2 mL of solution
25 vs. 30 gauge needle
49.
50. PDL Injection
Conventional vs. specific PDL syringes:
Malamed (1982):
similar rates of success
D’Souza et al (1987):
no sig. difference in anaesthesia achieved.
using the pressure syringe resulted in more spread
of anaesthetic to adjacent teeth
51. PDL Injection: Primary
Technique
Melamed 1982: 86% overall
Faulkner 1983: 81% overall
White 1988: variable, short duration esp.
md. molars
Walton 1990: “In reviewing the clinical and
experimental literature…the periodontal
ligament injection does not meet all of the
necessary requirements for a primary
technique.”
52. PDL Injection: Supplemental
Technique
Walton and Abbott 1981:
Inadequate pulpal anaesthesia following IAB
92% overall
included situations where multiple PDL
injections required
most critical factor was to inject under strong
resistance
Smith, Walton, Abbott 1983:
83% overall with high pressure syringe
53. PDL Injection: Anaesthetic
Distribution
Garfunkel et al 1983, Smith and Walton
1983, Tagger et al 1994, Tagger et al
1994*
spread along path of least resistance
influenced by anatomical structures and fascial
planes
through marrow spaces
avoided PDL route
appears to be a form of intraosseous injection
54. PDL Injection: Effects on the
Periodontium
Animal histological studies
Most studies: no long term evidence of
tissue disruption or inflammation
Roahen and Marshall 1990: evidence of
localized external resorption
56. Intraosseous Injection
Technique for mandibular infiltration
Perforate the cortical plate to introduce LA
in medullary bone
Bathes the periradicular region in LA
2 commercial systems available:
Stabident (Patterson)
X-Tip (Tulsa Dentsply)
65. Intrapulpal Anaesthesia
VanGheluwe and Walton 1997:
under back-pressure, efficacy of LA=saline
injection
Conclusion: back-pressure is the key to
intrapulpal anaesthetic success
68. Articaine
Reputation for improved local anaesthetic
effect—short linear molecule
Amide local, contains a thiophene ring
instead of a benzene ring
Partial hydrolysis by plasma esterases
4% solution—concern with toxicity
Potential for methemoglobinemia (like
prilocaine)
69. Articaine
More effective than other local
anaesthetics?
No difference found:
Haas et al. 1990 (vs. prilocaine)
Vahatalo et al. 1993 (vs. lidocaine)
Malamed et al. 2000 (vs. lidocaine)
Donaldson et al. 2000 (vs. prilocaine)
Claffey et al. 2004 (vs. lidocaine)
Mikesell et al. 2005 (vs. lidocaine)
70. Articaine
Claffey et al. 2004:
Articaine vs. lidocaine IANB for irreversible
pulpitis of mandibular teeth
Articaine 9/37 (24%)
Lidocaine 8/35 (23%)
(all subjects had subjective lip anaesthesia)
71. Articaine
Paraesthesia?
Haas and Lennon 1995: higher incidence of
paraesthesia associated with prilocaine and
articaine. Attributed to the higher
concentration of drug required for comparable
clinical effect
14/11 000 000 injections
Statistically higher
Clinical relevance? Claffey et al 2004 “clinically
rare event”
72. Articaine
Paraesthesia?
Dower 2003 (Dentistry Today)
Review article
Paraesthesia rates up to 2-4% when using
articaine for lingual blocks or IANBs
73.
74. RCDSO Dispatch
Summer 2005 pg. 26
“Until more research is done, it is the
College’s view that prudent practitioners
may wish to consider the scientific
literature before determining whether to
use 4% local anaesthetic solutions for
mandibular block injections.”
75.
76.
77. College Registrar Replies
Dispatch Fall 2005 vol. 19, #4
“This college received legal advice from our
general counsel, and from outside counsel,
before publishing what we did…The advice
we received was that it was certainly within
our obligation to advise members to be
aware of the literature…”
78. Articaine
Hillerup and Jensen 2006:
Danish population—all cases in Denmark
referred to authors for evaluation
54 injection injuries in 52 patients
54% of all nerve injuries associated with
articaine
Substantial increase in number of injection
injuries following introduction of articaine to
Danish market in 2000.
79. Articaine
What about a mandibular infiltration?
Recommended by Steve Buchanan
Kanaa et al. 2006
Cross-over design comparing articaine and
lidocaine for mandibular infiltration for first
molars
Anaesthesia measured by maximal EPT X2
Lidocaine 38% effective
Articaine 65% effective
80. Reported Reasons for
Mandibular Anaesthesia Failure
1. Operator Inexperience
2. Armamentarium: Deflection of the needle tip
3. Patient factors:
Variations in anatomy
Accessory innervation
Unpredictable spread of LA
Local infection
Pulpal inflammation
Psychological issues
81. Kleinknect and Bernstein 1978: positive
correlation between anxiety and reported
pain during dental treatment
82. Topical Anaesthetic
Benzocaine or Lidocaine
Effectiveness?
Gill and Orr 1979: 15
second application no
more effective than
placebo
Stern and Giddon 1975:
2-3 minutes=profound
soft tissue anaesthesia
83. Topical Anaesthetic
Recommendations:
Dry mucous membranes first
2-3 minutes, but concern with tissue sloughing
Tip of the tongue
85. Topical Anaesthetic
Benzocaine spray/Methemoglobinemia
Recommendations:
Avoid in patients with a history of MHb
Consider lidocaine as an alternative
Broken/inflamed tissue may promote uptake
Use only amount deemed necessary
If suspicious, send patient to hospital for
methylene blue tx
O2 won’t help, but give it anyways
86. Methemoglobinemia
Fe2+ ion of the heme group of the
hemoglobin molecule is oxidized to Fe3+
Hemoglobin converted to methemoglobin,
a non-oxygen binding form of hemoglobin
that binds a water molecule instead of
oxygen.
87. Conclusions:
1. Consider topical anaesthetic
2. Re-test using patient’s chief complaint
2. Inject again
Higher
More Local Anaesthetic
Nerve to Mylohyoid
3. Consider PDL/Intraosseous Anaesthesia
4. Consider Intrapulpal Anaesthesia
5. If they say it hurts, it hurts
88. Thank you
Questions?
Please feel free to contact me:
416-223-1771
andrew_moncarz@yahoo.com
www.endoasleep.ca
Editor's Notes
Vital asymptomatic md. 6s: no response to max. EPT, 2 tests within 1 hour Subjective report of lip numbness at baseline Wong 2001: 69% weighted success rate
Arises within the middle cranial fossa from the trigeminal ganglion—large relay station. Mostly sensory, some motor. Nerve drops down through foramen ovale and enters the infratemporal region and divides into multiple branches: Branches from the stem: 3 motor: medial pterygoid, tensor tympani (middle ear), tensor palati (soft palate) 1 sensory: nervus spinosus (sensory): dura of the middle cranial fossa Branches from the anterior division: 3 motor: masseter, temporalis, lateral pterygoid 1 sensory: buccal branch (long buccal nerve) Branches from the posterior division: 1. auriculotemporal nerve—mostly sensory but carries autonomic info from the otic ganglion. Auricular, articular, temporal all sensory. Secretory fibres with ANS info. Otic ganglion: sensory, sympathetic and parasympathetic innervation. Only parasympathetic synapses in the ganglion. Post synaptic sympathetic and parasympathetic fibres hitchhike with the auriculotemporal nerve to the parotid gland. 2. lingual nerve—sensory 3. Inferior alveolar nerve—sensory and motor: Passes downward along the medial side of the mandibular ramus to the mandibular foramen. The mandibular foramen lies at the centre point of the internal face of the ramus. Just about the same height as the occlusal plane. At that point, the nerve to mylohyoid branches off. Nerve to mylohyoid: motor: passes to the submandibular region. Supplies the mylohyoid muscle and the anterior belly of the digastric. Intramandibular portion: passes downward and anteriorly through the mandibular canal. Sends small branches to supply the pulps of the teeth. Mental nerve is a branch that emerges from the mental foramen. Sensory for skin and mucous membrane of the lower lip, skin of the chin, and vestibular gingiva of the mandibular incisors.
Theoretically, local anaesthetic deposited at the mandibular foramen should provide anaesthesia to: all mandibular teeth of that side, the vestibular gingiva anterior to the mental foramen, the lower lip, and the chin.
Lingula and mandibular foramen
Inferior alveolar nerve, before entering md. foramen branches into mylohyoid nerve. Mylohyoid nerve runs along medial ramus in mylohyoid groove to provide motor function to mylohyoid muscle. Foramina found in pm region of md. associated with the mylohyoid. 1972—study—able to elicit pain response by stimulating nerve. Not anaesthetized by block because of branching—classically thought to be 5 mm above mandibular foramen. Wilson 1984—mean 14.7 mm, range 5 to 23 mm. LA may not bathe critical length of axon.
Complaint of pain in time with the heartbeat Potentially need 4 times as much LA to block nerve conduction
Felt pain at any time during the procedure Clinical diagnosis of irreversible pulpitis based on prolonged response to EndoIce. After injection, 15 minute wait. Asked pt. about subjective lip numbness. If not present, pt. Excluded. Therefore, 100% of patients used for data analysis had profound lip anaesthesia.
Hargraves: bathe more than the 3 nodes of ranvier. May be advantageous to give a gow gates or a high standard block.
Montagnese et al. 1984 Repeated measures design 40 subjects injected twice at separate appointments—once with GG, once with conventional IANB EPT after profound lip numbness reported Results: Higher reports of tongue numbness with GG EPT: GG: 35% no response to maximal stimulation Conventional IANB: 38% no response to maximal stimulation No significant difference
To overcome the high pressures necessary for the technique using a standard syringe, can use either a short 25 gauge needle (recommended by Melamed OOO 1982) or an ultrashort 30 gauge needle (recommended by Branstromm et al J Dent Child 1982). This will help minimize bending of the needle when it’s driven into the sulcus.
White 1988: White et al (JOE 1988) found that duration and depth of anaesthesia was widely variable (PDL injection, primary technique). Adequate anaesthesia time was sometimes was as little as 10 minutes. With mandibular molars for example, 80 % were adequately anaesthetized after 2 minutes, but only 20% were still adequately frozen at 10 minutes. With maxillary lateral incisors, only 39% had adequate anaesthesia after 2 minutes, and then rates dropped.
Tagger E, Tagger M, Sarnat H, Mass E. (Int J Paediatr Dent 1994) Dog study, primary dentition: Similar protocol to above. The solution usually reached the alveolar bone crest, seeped under the periosteum and alongside vascular channels into bone marrow, reaching natural cavities such as the crypts of tooth buds and the mandibular canal. The ink did not penetrate into the enamel organ or contact the permanent tooth buds. The solution appeared to spread along the path of least resistance, governed by the intricacies of anatomical structures and fascial planes. Therefore the risk of mechanical damage to permanent tooth germs appears to be minimal.
Solid 27 gauge wire with a beveled end. Used in a slow speed handpiece to perforate the cortical plate.
Most apical extent of attached gingival margins of adjacent teeth used as landmark for locating appropriate perforation point (cortical bone in mandibular molar region is thinnest within crestal third of alveolar process); after application of topical anesthetic and infiltration of local anesthetic into gingival mucosa, perforation is performed mesial or distal to tooth; after removal of perforator, injection needle is introduced to deliver local anesthetic into periradicular medullary bone
Abstract JDR 1994: Miller and Lennon. 5X greater incidence