1. Armamentarium and Preparation
for basic injection
Dr. Hesham El-Hawary
www.elhawarydentalclinic.com
ELHAWARY

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