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.
Dental Management of a Medically Compromised Patients - Presented by Dr. Shweta and Parray as a part of Dhaka Dental COllege OMS Department Weekly Presentation Program
Apexogenesis & apexification in pediatric dentistryDr. Harsh Shah
SDDCH Parbhani
Presented by : Vipul GIratkar
Dept. of Pediatric dentitstry
Guided by . Dr. Rehan Khan
DIscussion regarding apexification and apexogenesis
brief description on posterior superior alveolar nerve block.
its uses in dentistry, technique and action. locating PSA nerve is easy and this is the most used nerve block in dentistry.
This presentation specifically deals with the maxillary and mandibular Major connectors used in a cast partial denture. it also mentions the uses, advantages and disadvantages of each,
Dental Management of a Medically Compromised Patients - Presented by Dr. Shweta and Parray as a part of Dhaka Dental COllege OMS Department Weekly Presentation Program
Apexogenesis & apexification in pediatric dentistryDr. Harsh Shah
SDDCH Parbhani
Presented by : Vipul GIratkar
Dept. of Pediatric dentitstry
Guided by . Dr. Rehan Khan
DIscussion regarding apexification and apexogenesis
brief description on posterior superior alveolar nerve block.
its uses in dentistry, technique and action. locating PSA nerve is easy and this is the most used nerve block in dentistry.
This presentation specifically deals with the maxillary and mandibular Major connectors used in a cast partial denture. it also mentions the uses, advantages and disadvantages of each,
Classification & management of zygomatic complex fractures including lateral ...Indian dental academy
Welcome to Indian Dental Academy
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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.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
2. Lecture Outline:
- Definition of Pain and Anesthesia.
- Topical Anesthesia.
- Content of L.A Solution.
- Metabolism of L.A.
- Anesthesia of Mandibular Teeth and Soft Tissue.
- Anesthesia of Maxillary Teeth and Palatal Tissue.
- Supplemental Injection Technique.
- Maximum Recommended Dose.
- Complications of L.A.
- New Techniques in L.A.
3. Pain:
It is defined as an unpleasant sensational experience initiated
by noxious stimulus & transmitted over a specialized neural
network to CNS where it is interpreted as such feeling.
4. Local Anesthesia:
Transient loss of sensation in a circumscribed area of the body
caused by a depression of excitation in nerve endings or an
inhibition of the conduction process in peripheral nerves.
5. Topical Anesthesia
Available in different forms:
- Gel ( most effective type).
- Liquid
- Spray.
- Technique:
• The mucosa at the site of the intended needle insertion is dried with
gauze.
• A small amount of the topical anesthetic agent is applied to the tissue
with a cotton swab.
• Topical anesthesia should be produced in 30 seconds.
• The dentist should prepare the child for the injection ( tell the patient :
the tooth is going to sleep so that the treatment can proceed without
discomfort).
6. • Effective to a depth of 2-3 mm .
• Effective in reducing the discomfort of the initial penetration
of the needle into the mucosa.
• It’s disadvantages are the taste may be disagreeable to patient
and the length of application time may increase apprehension
in the pediatric patient.
• When applying topical anesthetics to the soft tissue use the
smallest effective amount to avoid anesthetizing the
pharyngeal tissues ( cause gaging).
• Not known to produce systemic toxicity in adults but can
produce local allergic reactions.
7. Content of L.A. Solution:
1. Local anesthetic agent.
2. Vasoconstrictors.
3. Reducing agents.
4. Preservatives.
5. Fungicide.
6. Vehicle.
8. Reducing Agent
Sodium metabisulphite.
Preservative
Methylparaben.
It increases the shelf life of the anesthetic solution.
Acts as a bacteriostatic agent.
Fungicide
Thymol.
Vehicle
Modified Ringer’s solution / Distilled Water to give volume.
9. Local anesthetic agent
Esters
Esters of Benzoic Acid
Cocaine, Butacaine, Benzocaine, Tetracaine
Esters of Para Aminobenzoic Acid
Procaine, Chloroprocaine, propoxycaine
Amides
Bupivacaine, lidocaine, articaine, prilocaine
Quinolones ( not used anaymore)
Centbucridine
10. - Lidocaine hydrochloride (Xylocain) 2 % is most commonly
used local anesthetic agent.
- 2% mean…….
2 mg in 100 ml
or
20mg in 1 ml
11. Vasoconstrictors
Adrenaline in the concentration of 1:50000 to 1:200000 is
commonly used.
1:200000 means….
1 gm in 200000 ml
Or
1mg in 200 ml (0.02 mg/ml)
Function of Vasoconstrictors:
1. Delays absorption of LA from the site.
2. Provides blood less field.
3. Prolongs the action .
4. Reduces the systemic toxicity.
Contraindication: Thyrotoxicity, Asthma and haypertension
12. Metabolism of LA:
Ester Group:
They are hydrolyzed in the plasma by the enzymes
pseudocholinesterase .
Amide Group:
Primary site of biotransformation is in liver.
Excretion: from kidney.
13. Points to be Kept in Mined Regarding the
Difference between Child and Adult Patient:
1.Density and calcification of maxillary and mandibular bone.
2.Anatomic structures.
3.Penetration of the needle.
4.Depth of needle penetration.
5.Emotional aspect.
14. Types of Injection Procedures:
1.Nerve block: depositing the LA solution within close
proximity to a main nerve trunk.
2.Field block: depositing a in proximity to the larger nerve
branches.
3.Local infiltration: small terminal nerve endings are
anaesthetized.
15. Anesthesia of Mandibular Teeth and Soft Tissue:
1) Inferior Alveolar Nerve Block + Lingual Nerve Block:
- The mandibular foramen is situated at a level lower than the occlusal plane of the
primary teeth of the pediatric patient.
- The injection must be made slightly lower and more posteriorly than for an adult
patient.
BELOW 6 YEARS 6 – 12 YEARS ABOVE 12 YEARS
16. Landmarks
1. Coronoid notch
2. Pterygomandibular raphe
3. Occlusal plane of the mandibular posterior teeth.
17. Area anesthetized
Mandibular teeth of the injected side.
Body of the mandible, inferior portion of the ramus.
Buccal mucoperiosteum, mucous membrane anterior to the
mandibular 1st molar.
Anterior 2/3rd of tongue and floor of the mouth.
Lingual soft tissue and periosteum.
Used for more than 1 tooth filling, extraction, pulp therapy and if
can’t apply mental block due to infection.
19. 3) Long Buccal Nerve Block
Site of injection
Mucous membrane distal and buccal to the most distal molar
tooth in the arch.
Area Anesthetized
Soft tissue and periosteum buccal to the mandibular molar
teeth.
20. 4) Infiltration For Mandibular Incisors:
The terminal ends of the inferior alveolar nerves cross over the
mandibular midline slightly and provide conjoined innervation
of the mandibular incisors.
The labial bone overlying the mandibular incisors is usually thin
enough for supraperiosteal anesthesia techniques to be effective.
21. Gow Gates Mandibular Block ( Not for childeren)
This approach uses external anatomic landmarks ( Intertragel
notch) to align the needle.
A nerve block procedure that anesthetizes the entire
distribution of the fifth cranial nerve in the mandibular area.
22. Anesthesia of Maxillary Teeth and Soft Tissue:
1) Supraperiostial Technique (Local Infiltration)
Most frequently used for obtaining pulpal anesthesia in
maxillary teeth.
Indicated whenever dental procedures are confined to only one
or two teeth.
Landmark: insertion 45 to
Long acsses of the tooth
1. Mucobuccal fold.
2. Crown of the tooth.
3. Root contour of the tooth.
23. Areas Anesthetized
1. Pulp and root area of the tooth.
2. Buccal periosteum.
3. Connective tissue.
4. Mucous membrane.
26. 4) Palatal Anesthesia:
a) Nasoplatine Nerve Block:
Blocking the nasopalatine nerve anesthetizes the palatal tissues
of the six anterior teeth.
This technique is painful and is notroutinely used before
operative procedures. ( apply pressure to decrease pain).
27. b) Greater Palatine Nerve Block:
Anesthetizes the mucoperiosteum of the palate from the
tuberosity to the canine region and from the median line to the
gingival crest on the injected side.
28. Supplemental Injection Technique:
1) Periodontal Ligament Injection
The needle is placed in the gingival sulcus, and advanced along
the root surface until resistance is met.
Then approximately 0.2 mL of anesthetic is deposited into the
periodontal ligament.
Pressure is necessary ( by the injection) to express the
anesthetic solution.
29. Advantages of Periodontal Ligament Anesthesia:
1. It provides reliable pain control rapidly and easily.
2. It provides pulpal anesthesia for 30 to 45 minutes.
3. It is no more uncomfortable than other local anesthesia
techniques.
4. It is completely painless if used adjunctively.
5. It requires very small quantities of anesthetic solution.
6. It does not require aspiration before injection.
7. It may be performed without removal of the rubber dam.
8. It may be useful in patients with bleeding disorders that
contraindicate use of other injections.
9. It may be useful in young or disabled patients in whom the
possibility of postoperative trauma to the lips or tongue is a
concern.
30. 2)Intrapulpal Injection: ( not used for deciduous teeth)
Local anesthetic solution is delivered directly to the pulp using a
bent needle.
Advantages:
Requires minimum volumes of LA solution
Immediate onset of action
Very few post operative complications
31. 3)Intraosseous Injection:( not used for deciduous teeth)
Require the deposition of local anesthetic solution in the porous
alveolar bone.
By forcing a needle through the cortical plate and into the
cancellous alveolar bone
or
a small, round bur may be used to make an access in the bone
for the needle.
32. Maximum Recommended Doses:
4.4 mg/kg body weight with vasoconstrictor.
Dose Calculation:
2% lidocaine = 20 mg/ ml
1 carpule = 1.8ml
Amount of LA in 1 carpule = 20X 1.8 = 36mg/carpule.
Example:
20 Kg child can tolerate a maximum dose of 2% lidocaine with
vasoconstrictor of LA ----------
4.4 X 20= 88 mg = 2.4carpules.
34. Manifestation Of Toxicity
Cardiac Depression
Coma
Convulsions
Unconsciousness
Muscular twitching
Visual and auditory disturbances, light
headedness, numbness of tongue
Concentration of LA in Plasma
35. Syncope:
Most common cause : Vasovagal attach
Signs and Symptoms:
• Child become pale and cold .
• Pulse is rapid.
• The pupils are dilated or constricted.
• Drop of blood pressure.
36. Allergic Reaction:
• Uncommon.
• Manifestations: edema, eczema or ertecharia.
• Anaphylactic shock : more sever form of allergy >> Med.
Emergency.
• Tx: .1-.5 ml of 1:1000 epinephrine injection >> the base of
the tongue.
37. Vasoconstrictors Effects:
Patients with ischemic heart diseases and hypertension are at
high risk of toxicity if LA administrated intravascularly.
38. 2) Local Complications:
Broken needle.
Hematoma.
Trauma of the nerve causing Paresthesia.
Sloughing .
Truisms.
Soft tissue injury.
40. 2)Computer Controlled Anesthesia Delivery System
(WAND) :
Administers local anesthetic at two specific rates of delivery.
The slow rate is 0.5ml/min
and
fast rate is 1.8ml/min .
41. • The CompuDent instrument eliminates the pain associated
with single tooth, palatal, mandibular block and all other
injections.
• these eliminate unnecessary collateral numbness of the
tongue, lips and facial muscles.
• Rapid onset of anesthesia in mandibular block injections.
• The use of the sterile single-use disposable Wand hand piece
minimizes the risk of cross contamination.
• The CompuDent/Wand system's ergonomic design makes an
injection easier and less stressful to administer, lowering the
risk carpal tunnel syndrome.
42. 3)EMLA (Eutectic Mixture of LA) Not for pedo
Mixture of Lidocaine & Prilocaine.
EMLA cream is used for numbing the skin before inserting
the needle.
It is designed to go through intact skin. ( used extraoral)
Potential for toxic effects of L.A. is minimal.
Use in children under 6 months is contraindicated due to
the possibility for developing methemoglobinemia due to
prilocaine .
43. 4)Intraoral lidocaine patch (Topical Anesthesia)
Contains 10% or 20% lidocaine.
Placed for 15 minutes on the buccal mucosa of the maxillary
or mandibular premolar area, 2 mm apical to the
mucogingival junction.
44. 5)Electronic Dental Anesthesia
Uses the principle of Transcutaneous Electrical Nerve
Stimulation (TENS).
Requires good patient co-operation.
It increases salivary blood flow.
45. Principles of Atraumatic Injection:
• Check the flow of LA solution.
• Use Anesthetic cartilage and siring at
temperature close to room temperature.
• Proper positioning for the patient and doctor.
• Apply topical anesthesia.
• Always communicate with the pt.
• Keep syringe out of pt site.
• Don’t inject subperiosteally.
• Always aspirate.
• Slowly deposit LA solution.
• Bevel of the needle facing the bone.
• Never leave pt unattended.
CAUSES OF TOXICITY
Use of excessive dose of LA
Inadvertent intravascular injection
Slow detoxification or biotransformation
Slow elimination or redistribution
Majority of the toxic reactions to LA are immediate, mild and transient
They can be avoided by closely monitoring during the injection, injecting slowly and withdrawing the needle at the first signs of an adverse response