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
We in Chinthamani Laser Dental Clinic & Implant Centre ,cover every speciality and subspeciality in dentistry so that all kind of your dental problems can be treated efficiently and effectively.
Contact us:
Chinthamani Laser Dental Clinic & Implant Centre
1/464,Mount Poonamallee High Road,
Iyyapanthangal,
Chennai-56
Phone no.044-43800059 , 92 83 786776
Email:
chinthamanidental@gmail.com,
dr_mrgvl@gmail.com
Website:
www.chinthamanilaserdentalclinic.com
Dr, Kathirvel Gopalakrishnan
M.D.S (OMFS)
Presentation on Maxillary nerve block which helps for a quick refresh.
Applied aspects described well and slides contains images for easy understanding of the subject.
We in Chinthamani Laser Dental Clinic & Implant Centre ,cover every speciality and subspeciality in dentistry so that all kind of your dental problems can be treated efficiently and effectively.
Contact us:
Chinthamani Laser Dental Clinic & Implant Centre
1/464,Mount Poonamallee High Road,
Iyyapanthangal,
Chennai-56
Phone no.044-43800059 , 92 83 786776
Email:
chinthamanidental@gmail.com,
dr_mrgvl@gmail.com
Website:
www.chinthamanilaserdentalclinic.com
Dr, Kathirvel Gopalakrishnan
M.D.S (OMFS)
Presentation on Maxillary nerve block which helps for a quick refresh.
Applied aspects described well and slides contains images for easy understanding of the subject.
Oral surgery
Mandibular nerve block.
Local anaesthesia.
Areas anaesthetised.
Technique
Placement of needle
advanatges and disadvantages of this technique
Complications
Failure of IANB
Anatomy
Technique of maxillary anesthesia which includes Greater Palatine Nerve Block and Incisive Nerve Block. The reference is of LA Book by Malamed.
Hope you find it useful.
Please like and share.
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.
Techniques of mandibular anesthesia new /certified fixed orthodontic cours...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
Oral surgery
Mandibular nerve block.
Local anaesthesia.
Areas anaesthetised.
Technique
Placement of needle
advanatges and disadvantages of this technique
Complications
Failure of IANB
Anatomy
Technique of maxillary anesthesia which includes Greater Palatine Nerve Block and Incisive Nerve Block. The reference is of LA Book by Malamed.
Hope you find it useful.
Please like and share.
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.
Techniques of mandibular anesthesia new /certified fixed orthodontic cours...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
Mandibular Nerve Block - By Dr Saikat Saha Dr Saikat Saha
Mandibular nerve block techniques in short for Dental Surgeons. Mandibular nerve blocks are very important for all dental surgeons as it becomes a part and parcel of all dental and oral surgeons. This presentation will be useful for students of dentistry and doctors.
We in Chinthamani Laser Dental Clinic & Implant Centre ,cover every speciality and subspeciality in dentistry so that all kind of your dental problems can be treated efficiently and effectively.
Contact us:
Chinthamani Laser Dental Clinic & Implant Centre
1/464,Mount Poonamallee High Road,
Iyyapanthangal,
Chennai-56
Phone no.044-43800059 , 92 83 786776
Email:
chinthamanidental@gmail.com,
dr_mrgvl@gmail.com
Website:
www.chinthamanilaserdentalclinic.com
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
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
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 .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
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.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
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
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.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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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
Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
4. Mandibular Anesthesia
Most commonly performed technique
Has highest failure rate (15-20%)
Success depends on depositing solution within 1 mm of
nerve trunk
5. Inferior Alveolar Nerve Block
Not a complete mandibular nerve block.
Requires supplemental buccal nerve block
May require infiltration of incisors or
mesial root of first molar
7. Inferior Alveolar Nerve Block
Areas Anesthetized
Mandibular teeth to midline
Body of mandible, inferior ramus
Buccal mucosa anterior to mental foramen
Anterior 2/3 tongue & floor of mouth
Lingual soft tissue and periosteum
13. Inferior Alveolar Nerve Block
Technique
Apply topical
Area of insertion:
medial ramus, mid-coronoid notch,
level with occlusal plane (1 cm above),
3/4 posterior from coronoid notch to
pterygomandibular raphe
advance to bone (20-25 mm)
14. Inferior Alveolar Nerve Block
Target Area
Inferior alveolar nerve, near mandibular foramen
Landmarks
Coronoid notch
Pterygomandibular raphe
Occlusal plane of mandibular posteriors
15. Inferior Alveolar Nerve Block
Precautions
Do not inject if bone not contacted
Avoid forceful bone contact
23. a) Halstead method
b) Gow-Gates method
c) Akinosi method
1. Inferior Alveolar Nerve Block
a) Individual variations in the locations of the
mandibular foramen
b) Be aware of the proximal extremity of the
maxillary artery. Aspiration !
24. a) The finger in the retromolar fossa with the
fingernail poiting backward
a) A line is sighted from occlusal surfaces of the
premolars of the opposite side to the midpoint of
the fingernail
b) Inject 0,5 - 1ml solution
c) Continue to inject 0,5ml on removal from
injection site to anesthetize the lingual branch
a) Halstead Open-Mouth method
25.
26. a) Inject remaining anesthetic into coronoid notch
region in the mucous membrane distal and buccal
to most distal molar to perform a long buccal
nerve block
27. a) Field block anesthesia
b) The injection site is higher than Halstead
c) Below the insertion of the lateral pterygoid
muscle at the anterior side of the condyle at
maximal opening in relatively avascular area
d) The injection line is parralel with the external
line from the intertragal notch to the angle of the
mouth
b) Gow-Gates method
28. a) The diffusion of the anesthetic solution reach all
three oral sensory portion of mandibular branch
V.n. and other sensory nerves in this region
b) High success rate, fewer complication x slower
rate of onset
29.
30. a) Field block anesthesia
b) For patient with limited opening due trismus,
ankylosis, fracture
The gingival margin above the maxillary 2nd and
3rd molars and the pterygomandibular raphae
serve as landmarks for this technique
c) Vazirani-Akinosi
closed mouth method
31. a) The needle is advanced through the mucous
membrane and buccinator muscle to enter the
pterygomandibular space
b) Penetrate to a depht 25mm
a) Remaining
anesthetic in long
buccal nerve area
32. 2. Mental Nerve Block
a) Terminal branch of the inferior alveolar
nerve, exits the mandible via the mental
foramen
b) The position of this foramen is most
frequently near the apex of the mandibular 2nd
premolar
c) The foramen open upward and slightly
posteriorly!
33. a) Anesthetized lower lip, chin, labial gingiva,
alveolar mucosa, pulpal/periodontal tissue for the
canine, incisors and premolars on side blocked
Technique
The tip of needle be directed or anterior to
approximate the position of the foramen, but not
enter the foramen !
Penetrate to a depth 5 mm, inject 0,5 - 1,0 ml
To provide incisive nerve anesthesia via the
application of finger pressure over the foramen
after local anesthetic solution is deposited there
36. 3. Lingual Nerve Block
a) Nerve passes from the infratemporal fossa into
the floor of the mouth, in the vicinity of the 2nd and
3rd molars, is quite vulnerable
b) Is anesthetizes during the inferior alveolar
nerve block or with a bolus of anesthetic solution
injected after an inferior alveolar nerve block
a) Anesthetized anterior ⅔ of the tongue, lingual
gingiva and adjacent mucosa
38. 4. Buccal Nerve Block
a) Arises in the infratemporal fossa and crosses
the anterior border of the ramus to give multiple
branches
b) Supplies buccal gingiva and mucosa of the
mandible for a variable length, from the vicinity of
the 3th molar to the canine
39. Technique - anterior ramus of the mandible at the
level of the mandibular molar occlusal plane in
the vicinity of the retromolar fossa
52. Reported Reasons for Mandibular
Anaesthesia Failure
1. Operator Inexperience
2. Armamentarium: Deflection of the needle tip
3. Patient factors:
1. Variations in anatomy
2. Accessory innervation
3. Unpredictable spread of LA
4. Local infection
5. Pulpal inflammation
6. Psychological issues
53. Reported Reasons for Mandibular
Anaesthesia Failure
1. Operator Inexperience
2. Armamentarium: Deflection of the needle tip
3. Patient factors:
1. Variations in anatomy
2. Accessory innervation
3. Unpredictable spread of LA
4. Local infection
5. Pulpal inflammation
6. Psychological issues
54. ■ 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
55. Reported Reasons for Mandibular
Anaesthesia Failure
1. Operator Inexperience
2. Armamentarium: Deflection of the needle tip
3. Patient factors:
1. Variations in anatomy
2. Accessory innervation
3. Unpredictable spread of LA
4. Local infection
5. Pulpal inflammation
6. Psychological issues
56. 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
57. Adjunctive Strategies
■ Additional Anaesthetic
■ PDL Injection
■ Intraosseous Injection
■ Intrapulpal Injection
■ Different anaesthetic
■ Retest using the CC
61. 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
62. 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
63. Maximum Doses LA
■ Lidocaine 2%
■ Max dose = 7 mg/kg
■ 7mg/kg X 88=616 mg
■ 36 mg/1.8 mL
■ 616mg/36mg/cart.=
■ 17 cartridges **
■ Articaine 4%
■ Max dose 7 mg/kg
■ 7 X 88 = 616 mg
■ 72 mg/1.8mL
■ 616 mg/72 mg/cart. =
■ 9 cartridges
64. 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)
69. 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
70. 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
71. 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
72. 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
73.
74.
75. 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
76.
77.
78. 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
80. 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
83. 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)
90. Intrapulpal Anaesthesia
■ VanGheluwe and Walton 1997:
■ under back-pressure, efficacy of LA=saline
injection
■ Conclusion: back-pressure is the key to
intrapulpal anaesthetic success
93. 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)
94. 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)
95. 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)
96. 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”
97. Articaine
■ Paraesthesia?
■ Dower 2003 (Dentistry Today)
■ Review article
■ Paraesthesia rates up to 2-4% when using
articaine for lingual blocks or IANBs
98. 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.
99. 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
100. Reported Reasons for Mandibular
Anaesthesia Failure
1. Operator Inexperience
2. Armamentarium: Deflection of the needle tip
3. Patient factors:
1. Variations in anatomy
2. Accessory innervation
3. Unpredictable spread of LA
4. Local infection
5. Pulpal inflammation
6. Psychological issues