Chapter 10, 11, 12, 13, 14, 17 canvas and chapter quizzes
Local anesthetics are CNS stimulants and should be used with caution when patients have taken large doses of narcotics. True False
False Local anesthetics are CNS depressants. When patients have taken large doses of narcotics prior to anesthetic administrations, the local anesthetics can have a more profound effect on the CNS.
Atypical plasma cholinesterase is a relative contraindication to amide type anesthetics. False True
False Atypical plasma cholinesterase is a relative contraindication to ester-type anesthetics. Amide metabolism is not affected by the condition.
The two most important patient safety steps during an injection are locating the penetration site and deposition sites. True False
False The two most important patient safety steps of an injection are slow administration and aspiration.
Which of the following local anesthetic drugs is safest to use in the case of a known family history of methemoglobinemia? Prilocaine Tetracaine Benzocaine Lidocaine
Lidocaine
Which of the following local anesthetic drugs may represent a relative contraindication for patients with compromised liver function? Levonordefrin Lidocaine Epinephrine Benzocaine
Lidocaine
The field of anesthesia of an ASA nerve block includes each of the following except Upper lip, cheek, lower nose Lingual periodontium of central incisor through canine Pulps of the maxillary central incisor through canine Facial periodontium of central incisor through canine
Lingual periodontium of central incisor through canine
Which teeth and soft tissues are innervated by the inferior alveolar nerve? Mandibular molars and premolars, and buccal gingiva Mandibular teeth from the premolars to the incisors and buccal soft tissues Mandibular teeth to the midline and buccal soft tissue from premolars to the midline Mandibular teeth to the midline and the buccal soft tissues
Mandibular teeth to the midline and buccal soft tissue from premolars to the midline
Which one of the following is not anesthetized by a nasopalatine nerve block? Soft tissues of the anterior one third of the palate Incisive papilla Maxillary incisors and canines Lingual gingiva, canine to canine
Maxillary incisors and canines
Which of the following is not a helpful landmark to identify the penetration site for an inferior alveolar nerve block? Mandibular occlusal plane Internal oblique ridge Maxillary occlusal plane Pterygomandibular raph
Maxillary occlusal plane
Which of the following is the most important safety step following an injection? Recapping the needle with a one-handed technique Making a complete chart entry Assessing the patient for adverse reactions Rinsing the patient's mouth
Recapping the needle with a one-handed technique
Which statement describes the best management protocol for a suspected idiosyncratic reaction to a local anesthetic drug? Immediately stop procedures and transport the patient to ER Respond appropriately to whatever signs and symptoms develop No response will be adequate because the reaction to treatment will be idiosyncratic Respond the same as for an existing overdose of a drug
Respond appropriately to whatever signs and symptoms develop
What is the penetration site for a GP nerve block? Slightly distal to the greater palatine foramen Slightly anterior to the greater palatine foramen Greatest depression of the greater palatine foramen Junction of the maxillary and palatal bones medial to an imaginary line drawn between the maxillary first and second premolars
Slightly anterior to the greater palatine foramen
Which of the following is the most important consideration when preventing overdoses of local anesthetic drugs? Aspiration Slow administration Identifying allergies Calculating safe doses
Slow administration
What is the maximum recommended dose of epinephrine for patients in category ASA III with cardiovascular disease? 0.2 mg 0.4 mg 1.8 mg 0.04 mg
0.04 mg
What is minimum recommended volume of anesthetic solution administered for a lingual nerve block? 1.5 mL 0.2 mL 0.6 mL 0.9 mL
0.2 mL
What is minimum recommended volume of anesthetic solution administered for a buccal nerve block? 1.0 to 1.5 mL 0.2 to 0.3 mL 0.9 mL 0.6 mL
0.2 to 0.3 mL
Which of the following is the correct response for the management of a severe systemic allergic reaction? 100 mg oral Benadryl 1000 mg epinephrine IM or subcutaneous 0.3 mg epinephrine IM or subcutaneous 25 mg Benadryl IM
0.3 mg epinephrine IM or subcutaneous
What is the correct volume of anesthetic solution for a mental nerve block? 0.6 mL 0.2 mL 0.4 mL 1.0 mL
0.6 mL
Following a CVA, TIA, or RIND, how long should elective dental treatment be delayed? A minimum of 6 months, following appropriate consultation and risk analysis 1 to 6 months, following appropriate consultation and risk analysis A minimum of 12 months, following appropriate consultation and risk A minimum of 3 months, following appropriate consultation and risk analysis
1 to 6 months, following appropriate consultation and risk analysis
What is the minimum recommended rate of injection? 1.0 mL per two minutes 3.0 mL per minute 0.5 mL per minute 1.8 mL per minute
1.8 mL per minute
What is the optimum depth of penetration for a PSA nerve block? 16 mm 22 mm 9 mm 6 mm
16 mm
What is the insertion depth for a buccal nerve block? 6 mm 3 to 4 mm 4 to 8 mm 2 mm
3 to 4 mm
What is the depth of penetration for an ASA nerve block? 1 to 3 mm 3 to 6 mm 9 to 12 mm 6 to 9 mm
3 to 6 mm
Which of the following represents the recommended volume of anesthetic solution and depth of penetration for an incisive nerve block? 2 to 4 mm; 0.4 mL 6 to 10 mm; 0.9 mL 4 to 6 mm; 0.4 mL 4 to 6 mm; 0.6 mL
4 to 6 mm; 0.6 mL
What is the depth of penetration for a MSA nerve block? 5 to 8 mm 9 to 12 mm 3 to 6 mm 1 to 3 mm
5 to 8 mm
Studies have demonstrated the absence of the MSA nerve in: 50% to 72% of individual 15% to 50% of individuals 10% to 28% of individuals 28% to 52% of individuals
50% to 72% of individual
What is the correct depth of penetration for a mental nerve block? 2 to 4 mm 6 to 10 mm 4 to 6 mm 4 to 10 mm
6 to 10 mm
In a typical adult patient, the infraorbital foramen is approximately 8 to 10 mm below the infraorbital ridge. a. True b. False
: A—This range is considered normal for the av- erage adult
Which one of the following describes the target site for local anesthetic solutions? a. Needle pathway b. Deposition site c. Penetration site d. Aspiration site
: B—The deposition site is the anatomical loca- tion where drugs are deposited.
The AMSA technique can provide anesthesia for areas traditionally anesthetized by which one of the following groups of injections? a. ASA, MSA, PSA, NP, and GP b. ASA, MSA, NP, and GP c. PSA and GP d. NP and MSA
: B—This is the best answer. The AMSA tech- nique provides anesthesia for structures traditionally anesthetized by the ASA, MSA, NP, and GP injections.
Which one of the following techniques is an alternative to nearly all mandibular anesthetic techniques? a. Gow-Gates b. Vazirani-Akinosi c. PDL d. Infiltrations
: C—The periodontal ligament injection (PDL), although providing only limited areas of anesthesia, is an alternative to nearly all other techniques, mandibu- lar and maxillary.
A field block injection is also called: A periodontal ligament injection An interpapillary injection A nerve block injection A superperiosteal injection
A superperiosteal injection
An injection that deposits anesthetic solution near a major nerve trunk is called: A. A nerve block injection B. A field block injection C. A supraperiosteal injection D. A periodontal ligament injection
A. A nerve block injection
A patient is experiencing moderate signs and symptoms of an overdose of a local anesthetic drug and office emergency protocol has been activated. Which of the following correctly describes the next step? Administer diazepam to prevent seizures Perform CPR Reassure, observe, and monitor the patient Administer oxygen
Administer oxygen
A patient is experiencing initial signs and symptoms of a mild overdose of a local anesthetic drug. Which of the following correctly describes the next step? Administer oxygen, then dismiss the patient and refer to a physician for follow-up evaluation Administer oxygen, observe, and monitor Adminsiter oxygen, then dismiss the patient and reschedule the appointment Administer oxygen and diazepam to prevent seizures
Administer oxygen, observe, and monitor
Which one of the following is the most important consideration for palatal local anesthetic procedures? Withdraw the needle if swelling and ischemia occur Administer solution slowly Use ester topical anesthetic drug Apply topical anesthetic for one to two minutes
Administer solution slowly
Which of the following patient factors is not a predisposing factor in overdose reactions? Concomitant medications Disease status Allergy Age
Allergy
An injection technique that deposits anesthetic solution near terminal nerve endings is called: A periodontal ligament injection An infiltration injection A field block injection A nerve block injection
An infiltration injection
The most common adverse events related to local anesthetic include all of the following except Postoperative discomfort Syncope Anaphylaxis Self-injury
Anaphylaxis
What is the position of the lingual nerve in relation to the inferior alveolar nerve? Inferior and lateral Anterior and medial Anterior and lateral Posterior and medial
Anterior and medial
In the absence of an MSA nerve, which of the following two nerves may innervate the premolars and the mesiobuccal root of the first molar? Anterior superior alveolar and greater palatine Infraorbital and posterior superior alveolar Infraorbital and anterior Superior alveolar Anterior superior alveolar and posterior superior alveolar
Anterior superior alveolar and posterior superior alveolar
The day after a dental hygiene procedure, a patient calls to report the right side of his mouth is sore and he is having difficulty opening. Which of the following should be recommended first? Monitor for increased discomfort and call again if pain worsens Apply hot, moist towels for 20 minutes every hour Recommend an analgesic for discomfort Open and close the mouth to regain flexibility of the muscles
Apply hot, moist towels for 20 minutes every hour
Allergies to topical anesthetic drugs that manifest in mucosal signs and symptoms hours or days after application: Are usually an indication of allergy to amide type anesthetics and all amide drugs should be avoided in the future Have a high potential to progress to anaphylaxis Are considered delayed hypersensitivity reactions however the drug type should be avoided in the future Usually occur due to secondary infections from needle penetrations
Are considered delayed hypersensitivity reactions however the drug type should be avoided in the future
During an inferior alveolar block, a patient makes a sudden movement in response to needle contact with bone. The needle bends and breaks off at the hub. The broken shank of the needle is visible. Which of the following is a recommended first response? Ask the patient to keep the mouth open and attempt to remove the needle with a hemostat Take a radiograph to determine if the needle remains in contact with bone. If not, remove the needle with a sterile hemostat Gently remove the needle with gloved fingers Contact an oral surgeon and transport the patient to the oral surgeon's office
Ask the patient to keep the mouth open and attempt to remove the needle with a hemostat
The mental foramen can typically be palpated It is best to identify the location on a radiograph as it is difficult to palpate Between the facial apices of the mandibular first molar and second premolar At the facial apices of the mandibular first or second premolar Between the apices of the mandibular first premolar and the canine
At the facial apices of the mandibular first or second premolar
Which of the following is the most important precaution in order to avoid hematoma formation? Avoid using large gauge needles that are flexible and can unknowingly pierce vessels Avoid PSA nerve blocks because infiltrations are safer injections Never inject before carefully assessing the anatomy in the area of the injection Avoid multiple needle penetrations
Avoid multiple needle penetrations
1. Which one of the following statements best describes the needle pathway for an infiltration injection technique? a. The needle is parallel to the long axis of the tooth, passing through thin mucosal tissues to superficial fas- cia containing loose connective tissue, and past small vessels and microvasculature, and nerve endings. b. The needle is distal to the long access of the tooth, passing through thin mucosal tissue to deep fascia of connective tissues, and past small vessels, alveolar bone, and nerve endings. c. The needle is parallel to the long axis of the tooth, passing through thin mucosal tissues to superficial tissue, and past small vessels, nerves, and bone d. The needle is perpendicular to the long axis of the tooth, passing through thick mucosal tissue, dense connective tissues, muscle, and vessels, and past microvasculature and nerve endings.
A—A is the correct choice. B is incorrect be- cause the needle is not oriented distal to the long axis of the tooth. C is incorrect because the needle does not pass through bone. D is incorrect because the mu- cosa and connective tissue in this area are not typi- cally thickened
A primary benefit of orienting needle bevels toward bone during injections is that it: a. Reduces trauma to the periosteum when bone is contacted. b. Deflects the needle away from the bone during penetration. c. Prevents false negative aspirations within a vessel. d. Reduces discomfort from the advancing needle.
A—Orienting the bevel toward bone reduces discomfort and trauma to periosteum when bone is contacted. In the event of inadvertent contact, the needle tends to glance off the bone rather than pierce the periosteum. Although reducing discomfort is important (Answer D), many other aspects of injections which decrease discomfort have nothing to do with bevel orientation. Option A is the better answer because bevel orientation specifically reduces trauma to the periosteum in addition to providing for more comfort
Which one of the following is most likely to increase the risk of hematoma following a PSA nerve block? a. The needle is inserted too deep or too posterior to the deposition site on the posterior surface of the maxilla. b. The needle is inserted too inferior to the posterior surface of the maxilla. c.The porous bony surface of the maxilla allows the needle to penetrate the maxilla-piercing blood vessels. d. A long needle is inserted, contacting the bony periosteum on the surface of the maxilla.
A—Overinsertion of needles increases the risk of hematoma formation in PSA blocks. This can oc- cur both by deeper insertion into the pterygopalatine fossa or by location too posteriorly initially.
Allergiestotopicalanestheticdrugsthatcausemucosal signs and symptoms hours to days after exposure are explained best by which one of the following reactions? a. Delayed hypersensitivity b. Anaphylaxis c. Angioedema d. Immunopathology
A—Reactions with signs and symptoms occur- ring many hours to days after contact with a drug are characterized as delayed sensitivities.
Following a myocardial infarction, what is the current guideline recommended when considering elective dental treatment? A. A minimum of 12 months delay, following appropriate consultation and risk analysis B. A minimum of 4 weeks delay, following appropriate consultation and risk analysis C. A minimum of 3 months delay, following appropriate consultation and risk analysis D. A minimum of 6 months delay, following appropriate consultation and risk analysis
B. A minimum of 4 weeks delay, following appropriate consultation and risk analysis
Which of the following local anesthetic drugs is a concern for patients with atypical plasma cholinesterase? Dyclonine hydrochloride Benzocaine Prilocaine Lidocaine
Benzocaine
The ASA (American Society of Anesthesiologists) Physical Status Classification System categorizes patients based on their overall health. Classification P3 describes which one of the following? a. Normal Healthy Patient b. Severe Systemic Disease c. Moribund Patient d. Severe Systemic Disease (constant threat to life)
B—ASA Classification P3 is defined as "Severe Systemic Disease."
The delivery of local anesthesia requires both medical and technical skills. Which one of the following is not one of the six elements of the ASA Medical Components of Care associated with regional anesthesia? a. Preanesthetic evaluation of the patient b. Comprehensive tooth charting c. Remain present during the course of the anesthesia d. Providing indicated postanesthesia care
B—Although useful for planning a course of anesthesia, tooth charting is not one of the ASA Med- ical Components of Care.
For which one of the following medical conditions is it unnecessary to obtain a medical consultation from the patient's physician before dental treatment? a. Significant liver disease b. Myocardial infarction within 3 weeks c. Kidney dialysis patients d. Organ transplant patients
B—Myocardial infarction within 3 weeks is an absolute contraindication to care.
Palpating anatomy before all mandibular anesthetic procedures is: a. An unnecessary step in anesthesia techniques b. Helpful in some techniques and useless in others c. The least important aspect of anesthetic assessment d. Critical to the success of these techniques
B—Palpating anatomy is essential to some techniques and not very helpful in others. While the statement that it is an unnecessary step is obviously false, palpation is not even possible in lingual nerve blocks, for example.
What is the MOST likely cause of a patient giving a sudden jump and complaining of a tingling sensation shooting downward in the jaw and tongue during an inferior alveolar nerve block? Contacting the mental/incisive nerve Contacting the lingual nerve Injecting too rapidly for the situation Injecting into the inferior alveolar artery
Contacting the lingual nerve
Considering all of the following measures for pre- venting overdose, which one is most important? a. Calculating doses b. Slow administration c. Aspiration d. Reassuring patients
B—Slow administration is the most impor- tant safety factor in local anesthetic drug administra- tion and increases the safety margins of all the other preventive strategies mentioned. Aspiration is critical but not always completely reliable. Cal- culating appropriate maximum doses is also critical but hyper-responders may react adversely to doses which are carefully calculated and considered to be appropriate. Reassurance does not even address this issue
AMSA nerve blocks provide bilateral anesthesia of palatal tissues at least 20% of the time. a. True b. False
B—Solution in AMSA blocks does not cross the midline and provides same-side anesthesia only.
. The middle superior alveolar nerve is absent in approximately 28% - 50% of individuals. a. True b. False
B—The MSA nerve is present in somewhere between 28% and 50% of individuals.
Which one of the following is the correct order, from inferior to superior location, of the mandibular techniques listed in relation to the pterygomandibular space? a. IA, Gow-Gates, Akinosi b. IA, Akinosi, Gow-Gates c. Gow-Gates, IA, Akinosi d. Akinosi, IA, Gow-Gates
B—The correct order from inferior location to superior location in the pterygomandibular space is IA, Akinosi, Gow-Gates.
Which one of the following statements best describes the deposition site for a nasopalatine nerve block? a. The deposition site is within the nasopalatine canal. b. The deposition site is near the wall of the incisive canal. c. The deposition site is anterior to the opening of the anterior palatine foramen. d. The deposition site is near the junction between the vertical alveolar process and the horizontal palatal process.
B—This is correct compared with A because al- though deposition is at the incisive foramen, the nee- dle is not advanced into the nasopalatine canal. C is incorrect because the nasopalatine nerve block is not performed at the anterior palatine foramen. D does not describe a location at the incisive foramen.
Which one of the following is an important consideration in all palatal LA procedures? a. Always apply topical anesthetic for 1 to 2 minutes. b. Always administer solutions slowly. c. Always use patch anesthetics.
B—This is the best answer. Applying topical for 1-2 minutes is typical of many injections. Using patch topicals in the palate is helpful but not necessary. Slow deposition of solution is important to avoid damage to tissue, which has difficulty accommodat- ing the volumes of solution necessary in many palatal techniques. Pain is reduced with slow administration and safety is enhanced.
When infiltration injections are unsuccessful, it may be helpful to: a. Change the length of the needle and repeat the injection. b. Visualize, palpate, check radiographs, and reassess the technique. c.Establish contact with bone before administering one cartridge of anesthetic solution. d.Repeat the same injection and deposit more solution.
B—This is the correct answer. Visualization, palpation, and reassessment of available landmarks are most useful. A is incorrect in most instances unless the wrong size was used in the first place, such as an ultrashort needle. C is incorrect because contact with bone results in pain and trauma, not increased suc- cess. D is incorrect because the patient is not the one responsible for the injection parameters.
Which one of the following drugs is absolutely contraindicated for patients with bisulfite sensitivity? A.All injectable local anesthetics with amides B. All topical anesthetics C. All injectable local anesthetics with vasoconstrictors D All injectable local anesthetics with esters
C. All injectable local anesthetics with vasoconstrictors
Which of the following is an anatomical landmark for an ASA injection? Mucobuccal fold superior to the canine eminence Canine fossa distal to the canine eminence Canine fossa anterior to the canine eminence Mucobuccal fold mesial to the first premolar
Canine fossa anterior to the canine eminence
For an uncontrolled diabetic patient, which factor is the most critical to consider when planning to use a local anesthetic with epinephrine? Appointment time Blood sugar level Meal time Cardiac compromise
Cardiac compromise
The PSA injection technique may be contraindicated in patients with: Clotting disorders due to risk of hematoma TMD because of difficulty opening the mouth wide Diabetes due to high risk of infection Missing maxillary second molars due to difficulty locating the posterior aspect of the tuberosity
Clotting disorders due to risk of hematoma
Which is the best explanation for incomplete anesthesia of the central incisor following an ASA nerve block? Poor angulation of the needle Cross-innervation from the opposite side of injection Inadequate depth of penetration Accessory innervation of the MSA nerve
Cross-innervation from the opposite side of injection
Which of the following correctly describes the buccal nerve pathway? Crosses the coronoid notch and innervates the medial pterygoid and buccinator muscles Crosses at the height of the coronoid notch and divides into several branches that innervate the buccal mucosa and gingival Divides into several branches and crosses the coronoid notch and innervates the buccinators muscle, mucosa and gingiva of the mandibular molars Crosses the coronoid notch at the level of the mandibular occlusal plane
Crosses the coronoid notch at the level of the mandibular occlusal plane
1. A technique that deposits anesthetic solution near larger terminal nerve branches for treatment near the site of an injection is called: a. An infiltration injection. b. A ligamental injection. c. A field block injection. d. A nerve block injection.
C—A field block injection deposits local anes- thetic solution near larger terminal nerve branches for treatment near the site of injection.
Your patient has identified or you suspect that your patient has used methamphetamines approximately 20 hours ago. Which of the following would be the most appropriate action when considering the use of local anesthetics? a. Continue with procedures, as it has been more than 12 hours since the use. b. Restrict the dose of vasoconstrictors to 20% of standard dose. c. Consider postponing care for a full 24 hours. d. Use only bupivacaine as the local anesthetic agent.
C—Administration of vasoconstrictors may result in hypertensive crisis, stroke, or myocardial in- farction. It is recommended that you not administer local anesthetics with vasoconstrictors for a minimum of 24 hours after methamphetamine use.
Which of the following is not considered a main tool for patient assessment when planning for local anesthesia? a. The medical/dental questionnaire b. The clinical examination c. Drug MRDs d. Medical consultation
C—Although important when monitoring total doses of drug delivered, this is not considered a main tool for patient assessment.
Which one of the following drugs is an absolute contraindication for patients with poorly controlled or uncontrolled hyperthyroidism? a. Lidocaine b. Bupivacaine c. Epinephrine d. Felypressin
C—Epinephrine and Felypressin are both vaso- constrictors; however, Felypressin has no adrenergic effects and is therefore safe to use for patients with hyperthyroidism.
Upon completion of an injection, the most important subsequent step is to: a. Rinse the patient's mouth. b. Calculate the volume of drug delivered. c. Make the needle safe with a one-handed technique. d. Determine if the patient experienced discomfort.
C—Make the needle safe with a one-handed technique. This optimizes safety for all personnel. Once this has been done, attend to the patient.
Of the following possible adverse reactions, which one occurs most frequently? a. Allergy b. Idiosyncratic response c. Overdose
C—Of the three, overdose is the most frequent systemic complication.
Which of the following responses is most appropriate after rapid tissue swelling is noticed after a PSA block? a. Get an ice pack and then place pressure on the area with the ice pack. b. Place pressure on the area for 10 minutes and then continue working. c. Place pressure on the area while someone else looks for ice; terminate procedure. d. Reassure the patient and continue with planned therapy once numb.
C—Place pressure over the area as quickly as possible and then apply ice, when available. Advise the patient regarding the development of discolor- ation. Instruct the patient to apply ice intermittently for the next 6 hours and to avoid aspirin for pain. Advise the patient to notify you immediately of any change, especially the development of signs and symp- toms of infection or limited jaw opening
The rate of positive aspiration in the inferior alveolar nerve block is the highest of all techniques and approximates which one of the following? a. 2%-5% b. 5%-10% c. 10%-15% d. 15%-20%
C—The rate of positive aspiration in alveolar nerve blocks is 10% to 15%. This is the highest rate of all techniques described in this text. In practical terms, this means anticipating a positive aspiration in 1 to 2 out of every 10 inferior alveolar blocks.
A patient calls several days after an IA block and reports that numbness is still present along with some annoying, occasional sharp pains. Which of the fol- lowing terms best describes what is occurring? a. Paresthesia, anesthesia b. Paresthesia, hypoesthesia c. Paresthesia, dysesthesia d. Anesthesia, hyperesthesia
C—These symptoms are consistent with pares- thesia (prolonged numbness) and dysesthesia (sharp pains).
The first step in the administration of local anesthetic solutions is to: a. Assemble the armamentarium. b. Obtain informed consent. c. Assess the patient before proceeding. d. Make sure that solution is able to exit the needle.
C—Thorough patient assessment is critical to safe local anesthetic administration. Patient assess- ment must precede all other steps.
A second cartridge of 2% lidocaine has been admin- istered for an IA nerve block when the 160-lb patient becomes anxious and states that she doesn't feel well, even a little nauseous. She becomes less anxious as she becomes increasingly fatigued, her speech be- comes slurred, and she reports a numb feeling all around her mouth. Which one of the following state- ments best describes these observations? a. The patient is likely suffering from severe anxiety and fatigue b. The patient is likely suffering from a drug overdose due to excessive administered doses. c. The patient is likely suffering from a drug overdose due to intravascular administration. d. The patient is likely suffering from an allergy to lidocaine.
C—Two cartridges is not an overdose in a healthy 160-lb adult unless intravascularly adminis- tered or the patient is a hyper-responder. The progres- sion of signs and symptoms to slurring of speech and perioral numbness is not consistent with anxiety. As- suming the patient has no history of hyper-response, the likely mechanism for overdose is intravascular administration.
Which of the following procedures represents the correct response following a positive aspiration when a small wormlike thread enters the cartridge? A. Rotate the syringe a quarter turn, reaspirate and continue to deposit solution B. Withdraw the syringe and reinject C. Withdraw the syringe, change the cartridge, clear the needle of blood and reinject D. Reposition the syringe away from the area of the positive aspiration, and deposit solution following a negative aspiration
D. Reposition the syringe away from the area of the positive aspiration, and deposit solution following a negative aspiration
What is the most common cause of failure of a PSA nerve block? Inadequate volume of solution Deposition of solution too far away from the PSA foramina Incorrect needle length and gauge Intravascular injection
Deposition of solution too far away from the PSA foramina
The most important safety step(s) during a local anes- thetic injection is/are: a. To aspirate before depositing. b. To administer local anesthetics slowly. c. To direct the bevel away from bone. d. To aspirate before depositing and to administer drugs slowly.
D— It is not only critical to determine if a needle lumen lies within a vessel before deposition but also critical to administer drugs slowly in case the needle lumen lies within the vessel despite negative aspiration test results.
When administering a Gow-Gates mandibular nerve block, all of the following are essential, except: a. Performing one or more aspirations b. Meeting bony resistance c. Determining the site, height, and depth of penetration as well as the syringe barrel orientation d. Having the client remove all ear jewelry before administering
D—Even though there are both extraoral and intraoral landmarks for the Gow-Gates nerve block, it is not necessary to remove jewelry before administer- ing it
When is it safe to deposit local anesthetic solution? a. After a negative aspiration, where no blood is drawn into the cartridge. b. After a negative aspiration, following a positive aspiration where blood was visible in the cartridge only as a small trickle of blood or "worm like" thread. c. Following a positive aspiration that obscures the results of subsequent aspirations. d. A & B.
D—It is safe to deposit the anesthetic solu- tion once a negative aspiration is confirmed, includ- ing when there is no preceding positive aspiration; when previous positive aspiration does not obscure subsequent aspirations; and only when the clinician essentially starts fresh with a new cartridge and new aspiration, not after a positive aspiration that obscures the results.
Which one of the following result(s) in pulpal anesthesia? a. Buccal nerve block b. Mental nerve block c. A and B d. Neither A nor B
D—Neither the buccal nor the mental nerve blocks provide pulpal anesthesia to the mandibular teeth.
A clinician is administering an IA nerve block be- fore therapy when the patient suddenly jerks and the needle breaks. The embedded portion is not visible. What should the clinician do? a. Attempt removal b. Refer for removal c. Reappoint to remove once the needle has developed a fibrous cocoon around it d. Refer for evaluation
D—Some embedded needles are retained in tissue after evaluation. Evaluation by an oral surgeon may result in a decision to retain the needle versus the greater damage that might occur with attempted removal. Even though needle fragments are typically removed today, referring for removal may make the patient believe that either the referring clinician or the surgeon is acting inappropriately if the decision is made to retain the embedded fragment. Refer for evaluation.
Which one of the following statements is true of NP nerve blocks? a. They have the highest rate of positive aspiration in the palate. b. They have the second-highest rate of positive aspiration in the palate. c. They provide more durable anesthesia compared with other palatal techniques. d.They provide bilateral anesthesia.
D—This is the best answer. The aspiration rate is similar to other palatal techniques. NP blocks do not provide more durable anesthesia compared with other palatal techniques. When performed as recom- mended, they provide bilateral anesthesia.
The most common cause of failure for palatal injection techniques is: a. Solution is deposited too far from the associated bone or foramen. b. Inadequate volumes of solution are deposited. c. B only. d. Both A and B.
D—This is the correct answer. Both failure to deposit the solution close to the bone or foramen and insufficient volumes deposited reduce the amount of drug that diffuses through the bone to the nerves.
Which one of the following provides the most accurate description of the field of anesthesia in a PSA injection? a. Pulps of the maxillary premolars and molars, and their facial gingiva, periodontal ligament, and alveolar bone on the side injected b. Pulps of the maxillary and mandibular molars on the side injected c. Pulps of the maxillary teeth to the midline, and their facial gingiva, periodontal ligament, and alveolar bone on the side injected d. Pulps of the maxillary molars, except sometimes the mesiobuccal root of the first molar, and their facial gingiva, periodontal ligament, and alveolar bone on the injected side
D—This is the only accurate description. A, B, and C are incorrect. The premolars are not anes- thetized by a PSA injection nor are the mandibular molars or the maxillary teeth to the midline.
Which one of the following is the most appropriate local anesthesia patient record entry? a. 10/21/2015: Review Health History. BP 120/80. 2 car- tridges 2% lidocaine, 1:100,000 epi, no complications b. Review Health History. BP 120/80. 2 cartridges 2% lidocaine, 1:100,000 epi, Rt IA, LB, (+) aspiration c. Review Health History. BP 120/80. 72 mg of 2% li- docaine, 0.036 mg 1:100,000 epi, IA, LB d. 10/21/2015: Review Health History. BP 120/80. 2 cartridges (3.6 mL) 2% lidocaine (72 mg), 1:100,000 epi (0.036 mg), Rt IA, LB, (-) aspiration. No adverse reactions.
D—This is the only sample that has all compo- nents: date, drug(s), total drug volume(s), injection(s) or sites, results of aspiration test(s), a notation on ad- verse events, and clinician signature.
Which of the following best explains why infiltration techniques are highly successful in the maxilla? Volumes of anesthetic delivered Minimal penetration depths Multiple nerves in the dental plexus Ease of diffusion through bone
Ease of diffusion through bone
Which of the following reasons best describes why it is advantageous to use a 25 gauge long needle for an IA nerve block? Greater depth of penetration, greater accuracy of aspiration outcomes, less needle deflection Comfort level during penetration, greater depth of penetration, low risk of negative aspiration Ease of penetration through fibrous submucusal tissues, greater depth of penetration, low risk of positive aspiration Greater depth of penetration, less needle flexibility when contacting bone to determine deposition site, high risk of positive aspiration
Ease of penetration through fibrous submucusal tissues, greater depth of penetration, low risk of positive aspiration
Which of the following vessels is not located within the infratemporal and pterygomandibular spaces? Facial artery and vein Middle meningeal artery and vein Maxillary artery and vein Inferior alveolar artery and vein
Facial artery and vein
Which of the following describes the field of anesthesia for the buccal nerve block? Facial and lingual mucosa and gingiva of mandibular molars Facial mucosa, gingiva and pulps of mandibular molars Facial soft tissue and periodontium of mandibular molars to the midline Facial soft tissue and periodontium of mandibular molars
Facial soft tissue and periodontium of mandibular molars
Avoiding PSA nerve blocks is a prudent practice For patients with diabetes Because they require a high degree of clinical skill to administer without causing hematoma formation For patients on anticoagulant therapy Because infiltrations are always much safer
For patients on anticoagulant therapy
Which of the following are initial signs and symptoms of methemoglobinemia? Flushed, clammy skin Dizziness and headache Gray cyanosis of mucous membranes, lips, nail beds CNS depression and seizures
Gray cyanosis of mucous membranes, lips, nail beds
According to the 2007 American Heart Association guidelines, which of the following conditions does not require antibiotic premedication for the prevention of infective endocarditis? Prosthetic heart valve Congenital heart disease Previous endocarditis Hemophilia
Hemophilia
The incisive nerve is a terminal branch of the Mental nerve Cervical nerve Mylohyoid nerve Inferior alveolar nerve
Inferior alveolar nerve
The mental nerve is a terminal branch of the Inferior alveolar nerve Cervical nerve Mylohyoid nerve Incisive nerve
Inferior alveolar nerve
Which of the following signs and symptoms should alert the clinician to a potential vasoconstrictor overdose? Intense anxiety and nausea Bradycardia and hypotension Itching and hives Visual hallucinations and confusion
Intense anxiety and nausea
Which of the following correctly describes the needle pathway for an IA nerve block? Lateral to the pterygomandibular raphe, into the pterygomandibular space; passing medial to the medial pterygoid muscle; posterior and medial to the lingual nerve, lateral to the sphenomandibular ligament; and superior to the lingula and mandibular foramen Medial to the pterygomandibular raphe, into the pterygomandibular space; passing lateral to the medial pterygoid muscle, lingual nerve, and sphenomandibular ligament; and superior to the lingula and mandibular foramen Medial to the pterygomandibular raphe, into the infratemporal space; passing lateral to the medial pterygoid muscle, lingual nerve, and sphenomandibular ligament; and superior to the lingula and mandibular foramen Lateral to the pterygomandibular raphe, into the pterygomandibular space; passing lateral to the medial pterygoid muscle, lingual nerve, and sphenomandibular ligament; and superior to the lingula and mandibular foramen
Lateral to the pterygomandibular raphe, into the pterygomandibular space; passing lateral to the medial pterygoid muscle, lingual nerve, and sphenomandibular ligament; and superior to the lingula and mandibular foramen
Which of the following muscles experiences trismus more frequently? Lateral pterygoid Masseter Medial pterygoid Buccinator
Medial pterygoid
Which of the following initial signs and symptoms should alert the clinician to a potential overdose reaction? Metallic taste and circumoral tingling/numbness Tremors and seizures Visual hallucinations and confusion Itching and hives
Metallic taste and circumoral tingling/numbness
Terminal fibers of the GP nerve overlap the: Lesser palatine nerves Opposite greater palatine nerve Anterior superior alveolar nerves Nasopalatine nerves
Nasopalatine nerves
Which of the following describes the penetration site? Anesthetic solution is deposited Needle pierces the muscle Needle pierces a vessel Needle pierces mucosa
Needle pierces mucosa
Which of the following statements is true when considering hematoma formations following inferior alveolar nerve blocks? Outward signs of hematoma are uncommon during or immediately following injection because the pterygomandibular space accommodates large quantities of blood medial to the ramus. Hematoma is very rare following inferior alveolar nerve blocks because the venous plexus is located superior to the IA nerve. Outward signs of hematoma are immediately noticeable under the mandible due to the large unrestricted areas of soft tissue. Outward or intraoral signs of hematoma occur immediately during or following injections because the blood leakage quickly follows the facial planes.
Outward signs of hematoma are uncommon during or immediately following injection because the pterygomandibular space accommodates large quantities of blood medial to the ramus.
Which of the following best describes the correct syringe position for an IA nerve block? At the labial commissure over the molars on the contralateral side of the mouth Over the premolars on the contralateral side of the mouth above and parallel to the occlusal plane Over the premolars on the contralateral side of the mouth angled 45 degrees from the occlusal plane Over the canine on the contralateral side of the mouth above the occlusal plane
Over the premolars on the contralateral side of the mouth above and parallel to the occlusal plane
Which of the following local anesthetic complications occurs most frequently? Idiosyncratic reaction Dysesthesia Overdose Allergy
Overdose
Which of the following injection technique errors can cause facial nerve paralysis following an IA nerve block? Penetration into the medial pterygoid muscle An overdose of anesthetic drug Overinsertion into the capsule around the deep lobe of the parotid gland Overinsertion into the capsule around the TMJ
Overinsertion into the capsule around the deep lobe of the parotid gland
Which of the following maxillary injection techniques has the highest risk of hematoma? ASA AMSA PSA IO
PSA (Which of the following maxillary injection techniques has the highest risk of hematoma?)
Which one of the following injections is the best alternative for an unsuccessful infiltration of a maxillary first molar? AMSA IO PSA MSA
PSA (Which one of the following injections is the best alternative for an unsuccessful infiltration of a maxillary first molar?)
Which location represents the correct penetration site for a nasopalatine nerve block? Palatal mucosa at the base of the incisive papilla on the right or left side of the incisive papilla Palatal mucosa lateral to the widest anteroposterior dimension of the incisive papilla Perpendicular to the incisive papilla at the widest dimension Midline in the incisive papilla at the widest anteroposterior dimension of the incisive papilla
Palatal mucosa lateral to the widest anteroposterior dimension of the incisive papilla
Three days after receiving an inferior alveolar block, a patient calls and complains that the numbness has not worn off and she is experiencing sharp pains in her lower jaw on the same side as the numbness. Which of the following describes what she is experiencing? Persistent anesthesia and hypoesthesia Paresthesia and dysesthesia Paresthesia and anesthesia Paresthesia and an idiosyncratic reaction
Paresthesia and dysesthesia
What is the best correction to make during an IA injection when premature bony contact is met at less than one half of the penetration depth? Withdraw the syringe to minimize tissue trauma and reinject. Partially withdraw the needle, reposition syringe over the contralateral canine and re-advance the needle until bony contact is met. Reposition syringe toward the contralateral canine and re-advance the needle until bony contact is met. Partially withdraw the needle, reposition syringe over the contralateral canine, advance needle to clear resistance, then reposition the syringe over the premolars, and re-advance the needle until bony contact is met.
Partially withdraw the needle, reposition syringe over the contralateral canine, advance needle to clear resistance, then reposition the syringe over the premolars, and re-advance the needle until bony contact is met.
Which one of the following conditions does not indicate the need to limit the dose of vasoconstrictors? Patient with cardiovascular disease and controlled hypothyroidism Patient taking digitalis gylcosides for heart failure Patient taking nonselective beta-blockers Patient prone to arrhythmia
Patient with cardiovascular disease and controlled hypothyroidism
Which of the following statements best describes the technique error(s) that results in premature contact with bone immediately after penetration for an IA nerve block? Penetration too medial to the internal oblique ridge in relationship to the pterygomandibular raphe Penetration too low and too lateral to pterygomandibular raphe Penetration too high and too lateral to pterygomandibular raphe Angle of the syringe was anterior to the premolars
Penetration too low and too lateral to pterygomandibular raphe
Which of the following is a possible complication of an IA nerve block when penetration is too deep? Piercing the parotid gland and numbing the facial nerve Piercing a vessel in the pterygoid plexus increasing potential of hematoma Piercing the external carotid artery causing a severe hematoma Piercing the parotid gland and numbing the hypoglossal nerve
Piercing the parotid gland and numbing the facial nerve
Which of the following procedures would not require a buccal nerve block? Placement of a rubber dam on #31 Periodontal surgical procedure for teeth #27 to 29 Root planning of teeth #18 to 20 Crown preparation of tooth #30
Placement of a rubber dam on #31
Which of the following nerve blocks is most frequently associated with hematoma formation? Greater palatine Gow-Gates Posterior superior alveolar Inferior alveolar
Posterior superior alveolar
What is the correct deposition site for a PSA nerve block? Posterior to the zygomatic bone of the maxilla Anterior to the zygomatic process of the maxilla Superior to the apex of the mesial buccal root of the maxillary second molar Posterior surface of the maxillary tuberosity
Posterior surface of the maxillary tuberosity
Which of the following statements is true of the NP nerve block? Provides highest rate of positive aspiration of palatal injections Provides more durable anesthesia than other palatal injections Contact with bone should be avoided Provides bilateral anesthesia
Provides bilateral anesthesia
The PSA nerve branches from the maxillary nerve within the: Infraorbital canal Temporomandibular fossa Maxillary tuberosity Pterygopalatine fossa
Pterygopalatine fossa
Which of the following statements is the most accurate description of the field of anesthesia for a greater palatine nerve block? Soft and hard palatal tissues unilaterally from the midline Soft and hard palatal tissues unilaterally distal to the canine Soft and hard palatal tissues bilaterally from the midline Soft and hard palatal tissues unilaterally from the canine to the molars
Soft and hard palatal tissues unilaterally distal to the canine
he recommended first step in paresthesia management is Speak personally with and reassure the patient Explain that most paresthesias resolve over time Schedule an appointment to evaluate the paresthesia Diagram the extent and degree of sensory deficit
Speak personally with and reassure the patient
Which anatomical structure should be medial to the needle at the IA deposition site? Pterygomandibular raphe Hylomandibular ligament Sphenomandibular ligament Stylomandibular ligament
Sphenomandibular ligament
What is the main cause of hematoma? Tearing a blood vessel Poor operator technique Failure to aspirating Anatomical anomalies
Tearing a blood vessel
Which of the following describes the ASA nerve? Descends through anterior wall of the maxillary sinus to supply sensation to the dental plexus of the premolars, canine, lateral and central incisors Terminal branch of the maxillary nerve exiting the infraorbital foramen to supply sensation to the upper lip, lower side of the nose, and dental plexus of the canine and incisors Descends along the external surface of the maxilla and supplies sensation to the dental plexus of the canine, central and lateral incisors Terminal branch of the maxillary nerve branching from the infraorbital nerve within the infraorbital canal 6 to 10 mm prior to the infraorbital foramen to supply sensation to the dental plexus of the canine, central and lateral incisors
Terminal branch of the maxillary nerve branching from the infraorbital nerve within the infraorbital canal 6 to 10 mm prior to the infraorbital foramen to supply sensation to the dental plexus of the canine, central and lateral incisors
Which of the following correctly describes the needle pathway for an MSA injection? The needle advances parallel to the long axis of the first premolar through thin mucosal tissue to superficial fascia consisting of loose connective tissue, microvasculature, and nerve endings. The needle advances parallel to the long axis of the second premolar through thin mucosal tissue to superficial fascia consisting of loose connective tissue, microvasculature, and nerve endings. The needle advances distal to the second premolar through thin mucosal tissue to superficial fascia consisting of dense connective tissue, microvasculature, and nerve endings. The needle advances perpendicular to the long axis of the second premolar at the height of the mucobuccal fold through thin mucosal tissue to superficial fascia consisting of loose connective tissue, microvasculature, and nerve endings.
The needle advances parallel to the long axis of the second premolar through thin mucosal tissue to superficial fascia consisting of loose connective tissue, microvasculature, and nerve endings.
Which statement describes the correct positioning of the long window of the syringe? Away from the patient to block visibility throughout the injection Toward the clinician to permit visibility throughout the injection Toward the patient to permit assessment of the duration of the injection Either toward or away from the clinician because both sides of the syringe have an opening
Toward the clinician to permit visibility throughout the injection
Articaine may be the anesthetic drug of choice for a patient with liver dysfunction because only 5 to 10 % is metabolized in the liver. False True
True (Articaine may be the anesthetic drug of choice for a patient with liver dysfunction because only 5 to 10 % is metabolized in the liver.)
The most stable position when using a syringe is palm up. True False
True (The most stable position when using a syringe is palm up.)
Epinephrine is an absolute contraindication for patients with poorly controlled or uncontrolled hyperthyroidism. True False
True (Epinephrine is an absolute contraindication for patients with poorly controlled or uncontrolled hyperthyroidism)
If there are repeated positive aspirations at the same injection site, rescheduling should be considered. True False
True (If there are repeated positive aspirations at the same injection site, rescheduling should be considered.)
Epinephrine is contraindicated in a patient with: Heart disease Uncontrolled hyperthyroidism Diabetes Asthma
Uncontrolled hyperthyroidism
A clinician has administered an injection for a restorative procedure. The patient immediately becomes anxious and restless, clutching his chest. The clinician reassures the patient in a calm voice after which the patient's breathing slows and he feels calmer. Which of the following describes what has likely occurred? Hypersensitivity reaction to the sulfite preservative Vasoconstrictor overdose Local anesthetic overdose Mild myocardial infarction
Vasoconstrictor overdose
What anatomical feature may restrict the penetration site for an MSA injection? Maxillary tuberosity Low mucogingival junction Canine eminence Zygomaticoalveolar crest
Zygomaticoalveolar crest
What is the best correction to make during an IA injection when no bony contact is met at target depth? Withdraw the needle and select an alternate technique. Aspirate in two plane to assure negative aspiration and inject 1.8 mL. Reposition the syringe over the contralateral canine and re-advance the needle until bony contact is met. Withdraw the needle at least half way, reposition the syringe over the molars, re-advance the needle until bone is met.
Withdraw the needle at least half way, reposition the syringe over the molars, re-advance the needle until bone is met.
