This document discusses local complications and systemic effects that can occur from the use of local anesthetics in dentistry. It describes various local complications including needle breakage, prolonged anesthesia, facial nerve palsy, trismus, soft tissue injury, hematoma, pain on injection, and infection. It then discusses signs and symptoms of local anesthetic overdose as well as factors that can contribute to overdose. Lastly, it provides guidance on controlling complications for special patient populations such as uncooperative children, pregnant women, and those receiving anticoagulation therapy.
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
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
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
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Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
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Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
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Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
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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.
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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.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
4. Local Complications
1) Needle breakage
2) Prolonged Anesthesia or Paresthesia
3) Facial Nerve palsy
4) Trismus
5) Soft tissues injury
6) Hematoma :
7) Pain on injection
8) Burning on Injection
9) Infection :
10) Edema
11) Postanesthetic Intra-oral lesion:
12) Sloughing of tissue
5. Needle breakage
Prevention
• Do not use short needles for inferior alveolar nerve
block in adults or larger children.
• Do not use 30-gauge needles for inferior alveolar nerve
block in adults or children.
• Do not bend needles when inserting them into soft
tissue.
• Do not insert a needle into soft tissue to its hub, unless
it is absolutely essential for the success of the injection.
• Observe extra caution when inserting needles in
younger children or in extremely phobic adult or child
patients.
6. Prolonged Anesthesia or Paresthesia
• Strict adherence to injection protocol
• Most paresthesias resolve within approximately 8
weeks to 2 months without treatment.
• Determine the degree and extent of paresthesia.
• Explain to the patient that paresthesia
• Record all findings
• Second opinion
• Examination every 2 months
• It would be prudent to contact your liability insurance
carrier should the paresthesia persist without evident
improvement beyond 1 to 2 months.
7. Facial Nerve palsy
• Reassure the patient
• Contact lenses should be removed until muscular
movement returns.
• An eye patch should be applied to the affected eye
until muscle tone returns
• Record the incident on the patient's chart.
• Although no contraindication is known to
reanesthetizing the patient to achieve mandibular
anesthesia, it may be prudent to forego further
dental care at this appointment.
8. Trismus
• Prescribe heat therapy, warm saline rinses,
analgesics (Aspirin 325 mg)
• If necessary, muscle relaxants to manage the
initial phase of muscle spasm - Diazepam
(approximately 10 mg bid)
• Initiate physiotherapy
• Antibiotics should be added to the treatment
regimen described and continued for 7 full days
• Patients report improvement within 48 to 72 hours
9. Soft tissues injury
• Analgesics, antibiotics, lukewarn saline rinse,
petroleum jelly
• Cotton roll placed between lips and teeth,
secured with dental floss, minimizes risk of
accidental mechanical trauma to anesthetized
tissues.
10. Hematoma
• Hematoma is not always preventable. Whenever a
needle is inserted into tissue, the risk of inadvertent
puncturing of a blood vessel is present.
• When swelling becomes evident during or immediately
after a local anesthetic injection, direct pressure should
be applied to the site of bleeding.
• For most injections, the blood vessel is located between
the surface of the mucous membrane and the bone;
localized pressure should be applied for not less than 2
minutes. This effectively stops the bleeding.
• Ice may be applied to the region immediately on
recognition of a developing hematoma.
11. Pain on injection
• Adhere to proper techniques of injection, both anatomic
and psychological.
• Use sharp needles.
• Use topical anesthetic properly before injection.
• Use sterile local anesthetic solutions.
• Inject local anesthetics slowly.
• Make certain that the temperature of the solution is
correct
• Buffered local anesthetics, at a pH of approximately
7.4, have been demonstrated to be more comfortable on
administration
12. Burning on Injection
• By buffering the local anesthetic solution to a
pH of approximately 7.4 immediately before
injection, it is possible to eliminate the burning
sensation that some patients experience during
injection of a local anesthetic solution
containing a vasopressor.
• Slowing the speed of injection also helps
13. Edema
If edema occurs in any area where it compromises breathing, treatment consists of the
following:
• P (position): if unconscious, the patient is placed supine.
• A-B-C (airway, breathing, circulation): basic life support is administered, as
needed.
• D (definitive treatment): emergency medical services (e.g., 9-1-1) is summoned.
• Epinephrine is administered: 0.3 mg (0.3 mL of a 1:1000 epinephrine solution)
(adult), 0.15 mg (0.15 mL of a 1:1000 epinephrine solution) (child [15 to 30 kg]),
intramuscularly (IM) or 3 mL of a 1:10,000 epinephrine solution intravenously (IV-
adult), every 5 minutes until respiratory distress resolves.
• Histamine blocker is administered IM or IV.
• Corticosteroid is administered IM or IV.
• Preparation is made for cricothyrotomy if total airway obstruction appears to be
developing. This is
• extremely rare but is the reason for summoning emergency medical services early.
• The patient's condition is thoroughly evaluated before his or her next appointment
to determine the cause of the reaction.
14. Infection
• Use sterile disposable needles.
• Properly care for and handle needles.
• Properly prepare the tissues before penetration.
• Prescribe 29 (or 41, if 10 days) tablets of
penicillin V (250-mg tablets).
• Erythromycin may be substituted if the patient
is allergic to penicillin.
15. Sloughing of tissue
• Usually, no formal management is necessary
for epithelial desquamation or sterile abscess.
Be certain to reassure the patient of this fact.
• For pain, analgesics such as aspirin or other
NSAIDs and a topically applied ointment
(Orabase)
• The course of a sterile abscess may run 7 to 10
days
16. Postanesthetic Intra-oral lesion:
• Primary management is symptomatic
• No management is necessary if the pain is not severe
• Topical anesthetic solutions (e.g., viscous lidocaine)
• A mixture of equal amounts of diphenhydramine
(Benadryl) and milk of magnesia rinsed in the mouth
effectively coats the ulcerations and provides relief
from pain.
• Orabase, a protective paste, without Kenalog can
provide a degree of pain relief.
• A tannic acid preparation (Zilactin) can be applied
topically to the lesions extraorally or intraorally (dry
the tissues first).
19. • Toxicity Caused by Direct Extension of the Usual Pharmacologic Effects
of the Drug:
1) Side effects
2) Overdose reactions
3) Local toxic effects
• Toxicity Caused by Alteration in the Recipient of the Drug:
1) A disease process (hepatic dysfunction, heart failure, renal dysfunction)
2) Emotional disturbances
3) Genetic aberrations (atypical plasma cholinesterase, malignant hyperthermia)
4) Idiosyncrasy
• Toxicity Caused by Allergic Responses to the Drug
Adverse drug reaction
20. Signs and Symptoms – Toxic Reaction
to Local Anesthesia
• Talkativeness
• Slurred speech
• Dizziness
• Nausea
• Depression
• Euphoria
• Excitement
• Convulsions
21. حسی بی داری اوردوز واکنش
Clinical signs and symptoms that
develop as a result of an
over-administration of a drug
24. Drug Factors
• Vasoactivity
• Concentration
• Dose
• Route of administration
• Rate of injection
• Vascularity of the injection site
• Presence of vasoconstrictors
25. حسی بی اوردوز کلینیکی عالیم
LOW TO MODERATE OVERDOSE LEVELS:
Confusion
Talkativeness
Apprehension
Excitedness
Slurred speech
Generalized stutter
Muscular twitching, tremor of face and
extremities
Elevated BP, heart rate and respiratory rate
26. حسی بی اوردوز کلینیکی عالیم
MODERATE TO HIGH BLOOD LEVELS:
Generalized tonic clonic seizure, followed by
Generalized CNS depression
Depressed BP, heart rate and respiratory rate
SYMPTOMS:
Headache
Light headedness
Auditory distrurbances
Dizziness
Blurred vision
Numbness of tongue and perioral tissues
Loss of consciousness
27. سیستمیک عوارض کنترل
1) Basic emergency management : A-B-C-D
approach
2) Allergy : Medical history questionnaire is
important.
3) Elective dental care
4) Emergency dental care:
- Protocol no.1 : no treatment of an invasive nature
- Protocol no.2 : use general anesthesia
- Protocol no.3: Histamine blockers
- Protocol no.4 : Electronic dental anesthesia/hypnosis
28. خاص بیماران کنترل
• Uncooperative child
The maximum safe dose of lidocaine for a
child is 4.5 mg/kg per dental appointment.
Local infiltration of anesthesia is sufficient for
all dental treatment procedures in 90% of cases
even in the mandible.
29. خاص بیماران کنترل
• Handicapped Patient
• retarded patients
choose a shorter needle and/or a larger
gauge needle which is less likely to be
bent or broken.
better to use general anesthesia
30. خاص بیماران کنترل
Patients receiving anticoagulation or suffering from bleeding
disorders
Oral procedures must be done at the beginning of the day & must be
performed early in the week, allowing delayed re-bleeding episodes,
usually occurring after 24-48 h, to be dealt with during the working
weekdays.
Local anesthetic containing a vasoconstrictor should be
administered by infiltration or by intraligamentary injection
wherever practical.
Regional nerve blocks should be avoided when possible.
Local vasoconstriction may be encouraged by infiltrating a small
amount of local anesthetic containing adrenaline (epinephrine) close
to the site of surgery.
31. خاص بیماران کنترل
PREGNANCY
• Lidocaine + vasoconstrictor: most common
local anesthetic used in dentistry extensively
used in pregnancy with no proven ill effects,
Esters are better to be used.
• Accidental intravascular injections of lidocaine
pass through the placenta but the
concentrations are too low to harm fetus.
32. FDA Category of Prescription
Drugs
Drug Category Use During
Pregnancy
Risk
Lidocaine B Yes -
Prilocaine B Yes -
Mepivacaine C Use with caution-
Consult physician
Fetal
bradycardia
Bupivacaine C Use with caution-
Consult physician
Fetal
bradycardia
33. خاص بیماران کنترل
GERIATRIC PATIENT
– When choosing an anesthetic, we are largely
concerned with the effect of the anesthetic agent upon
the patient's cardiovascular and respiratory systems.
– increased tissue sensitivity to drugs acting on the CNS
– Decreased hepatic size and blood flow may reduce
hepatic metabolism of drugs
– hypertension is common and can reduce renal function
– Same prevention procedures used with children
34. خاص بیماران کنترل
LIVER DISORDERS
– Advanced liver diseases include:
Liver cirrhosis - Jaundice
- Potential complications:
1 . Impaired drug detoxication e.g. sedative, analgesics,
general anesthesia.
2. Bleeding disorders ( decrease clotting factors, excess
fibrinolysis, impaired vitamin K absorption).
3. Transmission of viral hepatitis.
Management
– Avoid LA metabolized in liver: Amides (Lidocaine,
Mepicaine), esters should be used
36. آلرژی
• Incidents of allergy are low
• Often allergic reaction is to one of the
ingredients within the cartridge, not the
local anesthesia itself
37. • Hypersensitive state as a result of
exposure to an allergen
• Re-exposure can heighten the initial
reaction
40. کنیم جلوگیری آلرژی بروز از چگونه
• Take a thorough medical history
• Dialogue the medical history with the
patient
41. رایج سواالت
• Allergic to any medications?
• Have you ever had a reaction to local
anesthesia?
• If yes, describe what happened
• Was treatment given? If so, what?
48. Asthma Patient
• Thorough medical and dental history
• Avoid use of anesthesia that contain
epinephrine or levonordefrin because of
sulfites (may cause wheezing)
• Asthma patient that is steroid dependant
may develop brochospasms
• Establish rapport and calm environment
49. خون فشار
• Stress and anxiety may raise the patient’s blood
pressure (>160/100)
• Thorough medical, dental and patient history
• Norepinephrine and levonordefrin should not be
used because of alpha1 stimulation
(2% Mepivacaine with 1:20,000 levonordefrin)
• Up to two cartridges of 2% lidocaine with
1:100,000 epinephrine is safe