Local Anesthesia Midterm

The mental foramen can be located as far posterior as the mandibular _______ or as far anterior as the mandibular _______.

1st molar, canine

What is the standard prophylaxis for an adult not allergic to amoxicillin?

2 g orally 1 hr prior to dental procedures.

Topical anesthesia will anesthetize the affected area _______ into the tissue.

2 to 3 mm

Topical anesthetics generally penetrate _____ into to the tissue.

2 to 3 mm.

What is the available concentration of Oraqix?

2.5% lidocaine and 2.5% prilocaine

What is the available concentration of Oraquix?

2.5% lidocaine and 2.5% prilocaine

Which of the following needle gauges has the largest lumen diameter?

25

Which gauge needle is recommended for use for areas where there is a high risk for a positive aspiration?

25 gauge

Which of the following is true regarding Oraquix?

-It is a micro-emulsion. -Does not provide pulpal anesthesia. -Applicator assembly is easy.

Which of the following are benefits of taut tissue retraction at the penetration site?

-Less traumatic needle insertion. -Easier needle insertion. -Increased visibility

Match the drug or medical condition in the left-hand column with the description of the significant concern in the right-hand column

-Life threatening syndrome caused by general anesthetics: pt with malignant hyperthermia. -Avoid use of vasopressors; may lead to myocardial infarction; cocaine abusers. -Completely inhibits PABA in microorganisms; pt's taking sulfonamides. -Will inhibit the reuptake of vasoconstrictor; pt's taking MAOI. -Frequently prescribed for the treatment of myasthenia gravis and glaucoma; pt taking cholinesterase inhibitors. -Increases effects of epi, avoid levonordefrin; pt's taking tricyclic antidepressants. -Use amides judiciously because they may increase risk of toxicity; pt's with liver disease. -Administer prilocaine or articaine because these drugs reduce liver capacity to metabolize amides; pt's taking cimetidine on a regular basis. -Administer prilocaine or articane because these drugs decrease hepatic blood flow; pt's taking beta blockers. -Limit amount of vasopressor because it can increase ocular pressure; pt's with glaucoma.

Your patient reports taking nonselective beta blockers. If vasoconstrictor is necessary, you should:

-Limit epi to 0.04mg per appointment. -Limit levonordefrin to 0.2mg per appointment. -Not use 1:50,000 epinephrine.

What does the collection of preanesthetic data guide the dental hygienist in determining?

-Modification of dental care plan. -Need for medical consultation. -Appropriateness of administrating a local anesthetic or vasoconstrictor.

What usually causes the discomfort associated with the IA injection?

-Needle close to the lingual nerve. -Lingual shock

Practices to avoid when administering local anesthetic include which of the following?

-Not using enough for pt comfort and hemostatic control. -Overadministering of anesthesia. -Administering anesthesia to a larger treatment area than can be completed in 1 visit.

Which of the following are signs of anxiety and fear?

-Paleness of skin -Cold sweats -Increased vital signs.

Which of the following properties are advantages of topical anesthetics being in a liquid form?

-Provides anesthesia to a widespread area. -Useful to decrease a pt's gag reflex. -Can be applied to site-specific areas with an applicator.

Successful delivery of local anesthetic agents depends on which of the following?

-Pt assessment -Safe administration of the drug. -Effective pt management

T or F: what is the maximum recommended dose of Oraqix at one dental treatment session?

5 cartridges

What is the USUAL approximate depth of needle insertion for the anterior superior alveolar local anesthetic block?

5mm

Due to a recent knee replacement, your patient must be medicated with an antibiotic before receiving periodontal therapy. If his care plan requires four appointments, each appointment should be scheduled at least ______ apart.

9 days

Of the following patients, which is most likely to have a negative reaction to topical anesthetic?

A child

What type of needle is recommended to safely and effectively administer the inferior alveolar nerve block?

A long, 25 gauge needle

List the specific local anesthetic information that should be included in the chart documentation

-drug used and concentration -vasoconstrictor used (if any), -amount administered in milligrams -the gauge and type of needle -the injections given -the time of administration -any patient reactions.

In which of the following patients is epinephrine a relative contraindication?

A pt taking digitalis glycosides.

In which of the following patients is the administration of an ester anesthetic NOT contraindicated?

A pt with a true sulfite allergy. (A pt taking sulfonamide drugs, a pt taking cholinesterase inhibitor drugs, a pt with atypical plasma cholinesterase)

What is one disadvantage of using a smaller syringe?

A small portion of the anesthetic remains in the cartridge and is not usable.

Which of the following local anesthetic blocks has the HIGHEST risk of hematoma for the pt after administration?

PSA block

Which of the following local anesthetic blocks requires the needle and syringe barrel angulation to be at 45 degrees within three separate planes during administration?

PSA block

When the middle superior alveolar nerve is missing, the tissues it usually innervates are innervated instead by the _______.

PSA nerve ASA nerve

Where is the recommended target area or deposit location for the posterior superior alveolar local anesthetic block?

PSA nerve entering the maxilla through the PSA foramina.

Which combination of injection techniques will ensure complete pulpal anesthesia of the maxillary molars as well as their associated periodontium and gingival tissue?

PSA, MSA, and GP blocks

When administering the inferior alveolar block, the syringe barrel in MOST cases should be in what relation to the mandibular occlusal plane?

Parallel plane

Which of the following is a sign that your patient is experiencing moderate anxiety?

Perspiration on forehead and hands. (red-toned complexion,bradycardia, hypotension)

After the patient has consented to treatment, when is a good time to communicate with the patient to alleviate fears of needle injection?

When preparing the tissue for injection

When are bilateral injections of the ASA block indicated?

When the ASA nerve crosses over the midline from the contralateral side.

ASA II describes a patient:

With a mild systemic disease that does not interfere with daily activity.

What should the clinician do if she accidently positions the anesthetic needle against the periosteum and bony contact is made?

Withdraw the needle and reinsert it farther away from the periosteum.

Best practices for administering the IA block injection include which of the following? (CHECK)

(After gently making contact with the bone, withdraw slightly and then begin the deposition of solution.) (All options listed) Deposition of solution at the target area will provide the most anesthetic power. (Deposit a small amount of the local anesthetic agent as the needle enters the tissue after each aspiration.)

In which of the following patients would a supraperiosteal injection be contraindicated?

-A pt requiring anesthesia for several teeth in the quad. -A pt with severe localized inflammation in the treatment area.

Which of the following influences the amount of local anesthetic agent in the systemic circulation?

-Ability of the body to metabolize the drug. -Administration technique. -Ability of kidneys to excrete any unmetabolized drug.

Drying the mucosa with 2 × 2 gauze, prior to the application of topical anesthesia, assists in _______.

-Accurate placement of the topical anesthetic. -Increasing visibility.

Which of the following are best practices to use to reduce a dental patient's level of anxiety about dental treatment?

-Administer adequate pain control during treatment and after the operation. -Telephone the pt after treatment. -Consider appointment length and time of day.

Following the local anesthetic procedure, what information is important to document?

-Anesthetic used and amount in mg. -Vasoconstrictor used and amount in cartridge.

Which patients may be more susceptible to adverse effects to topical anesthetic agents?

-Children -Elderly -Med compromised

List all the methods for delivery of topical anesthetic drugs

-Cotton tip applicators -Sprays -Brushes -Patches -Blunted cannulas and/or syringes -Single dose applicator swabs

What can the clinician do to prevent an emergency situation from occurring while administering local anesthesia?

-Do a thorough pt assessment. -Provide effective communication. -Offer psychological support.

List the specific local anesthetic information that should be included in the chart documentation.

-Drug used and concentration. -Vasoconstrictor used (if any) -Amount administered in mg. -The gauge and type of needle. -The injections given. -The time of administration. -Any pt reactions.

Which of the following are considerations the clinician must respect when choosing the appropriate administration technique?

-Duration of anesthesia needed. -Comfort needs of the patient. -Area to be treated.

Why does the local and systemic absorption of topical anesthetics increase the risk of toxicity?

-Formulated in high concentrations. -Do not contain vasoconstrictors. -Absorbed quickly into the tissue and blood stream due to vasodilation of the area.

Which of the following is a factor in determining which injection to administer?

-Hemostasis -Presence of infection -Treatment area

Match the name of the mandibular injection to the landmarks of the injection site and/or the area that receives the anesthesia?

-IA:Middle of pterygomandibular triangle at the height of the coronoid notch ,needle penetration depth is approximately 20 to 25 mm, or two thirds to three fourths of long needle. -Buccal block:Injection site is the alveolar mucosal tissue, distal and buccal to the most distal molar tooth in the arch. -Mental block:Does not massage anesthetic solution into foramen. -Incisive block:Massage anesthetic solution into foramen, anesthesia of the anterior teeth, premolar teeth, and associated periodontium as well as facial soft tissue anterior to the mental foramen. -Gow-Gates: A true man block because it anesthetizes almost the entire man nerve ,useful for extensive procedures during quadrant dentistry or with failure of IA block.

Which of the following describes the maxillary intraceptal injection?

-IO injection -Useful for homeostasis -Usually administered after nerve block. -Can use higher concentration of vasoconstrictor.

The body's response to fear provokes symptoms that could include:

-Increased BP -Irritability -Muscular tension

Which of the following are symptoms of a localized reaction to topical anesthetic?

-Irritation, burning and stinging at the site of application. -Tissue sloughing or discoloration and temporary change in taste perception.

What is the recommended patient position when administering anesthesia?

Supine

What is the weakest part of the needle?

The hub

Why is the slow depositing of the anesthetic solution important?

-It improves pt comfort. -It prevents tearing of tissue. -It is a safety factor.

The ____________ will provide the hygienist with a comparable baseline, in the event that an emergency situation should arise during treatment.

vital signs

Which of the following are best practices to follow when administering local anesthesia of any kind in the dental office?

-Review the pt's health and dental history at all appointments. -Use the lowest concentration of anesthesia to satisfy clinical requirements. -Limit the area of application. -Know the concentration of the drug being used.

Match the name of the maxillary injection to the landmark of the injection site and/or the area that receives the anesthesia.

-Slightly mesial to the canine eminence and at the height of the mucobuccal fold: ASA injection -Hard palate and overlying soft tissue of the maxillary anterior teeth: NP -Foramen located at the junction of the maxillary alveolar process and palatine bone distal to the maxillary 2nd molar: GP -Pulpal anesthesia of 1st and 2nd maxillary premolars in a small percentage of the population: MSA injection -Lateral to the incisive papilla: NP -Pulpal anesthesia of the distobuccal root of the max 1st molar: PSA injection -Height of mucobuccal fold above the 1st premolar: IO -Pulpal anesthesia of the mesiobuccal root of the max 1st molar in 28% of the population: MSA injection -Hard palate and overlying tissue of max 3rd molar to the first premolar: GP -Bone overlying incisors, canine, premolars, and sometimes mesiobuccal root of the 1st molar, as well as upper lip, lower eyelid, and lateral aspect of the nose: IO -Upward 45 degrees to occlusal plane, inward and backward 45 degrees to the midsagittal plane: PSA injection -Pulpal anesthesia of max dental incisors: ASA injection

What should the clinician do if she notices excessive blanching of the palatal tissue during the AMSA block administration?

-Slow down the deposition of anesthetic solution. -Stop the deposition of anesthetic solution for a few seconds.

Why is it important to slowly deposit the anesthetic solution?

-Slowly depositing improves pt comfort. -Slowly depositing prevents tissue damage.

Possible localized adverse effects of topical anesthetics could include which of the following?

-Stinging at the site of application. -Tissue discoloration -Sloughing

Best practices include which of the following?

-Take preanesthetic vital signs to identify diagnosed or undiagnosed conditions. -Take preanesthetic blood pressure readings to determine whether to use a local anesthetic with a vasoconstrictor. -Take preanesthetic vital signs to provide a standard of comparison in the event of an emergency. -Take preanesthetic blood pressure readings to provide baseline information.

Best practices for increasing patient comfort during the administration of maxillary injections include which of the following?

-The needle should not be moved within the tissue. -There is no bony contact of the overlying sensitive periosteum with the needle. -The patient's upper lip should not be slightly jiggled for distraction.

A thorough health history guides the clinician in determining?

-The pt's physical ability to tolerate a vasoconstrictor. -Anestetic hypersensitivity. -Current medications that may interact with an administered anesthetic agent.

Name the four anesthetic administration techniques.

-Topical -Infiltration injection -Field block -Nerve block

Why does the local and systemic absorption of topical anesthetics increase the risk of toxicity?

-Topical anesthetics do not contain vasoconstrictors. -Topical anesthetics are formulated in high concentrations. -Topical anesthetics are absorbed quickly into the tissue and blood stream due to vasodilation of the area.

Which of the following conditions are absolute contraindications for vasoconstrictors?

-Uncontrolled high BP. -Myocardial infarction within 6 months. -Coronary bypass surgery within 6 month.

Which of the following describes digitalis glycosides?

-Used for the treatment of congestive heart failure. -When combined with epi, the potential for cardiac arrhythmias increases.

During the preanesthetic assessment, what are appropriate clinical considerations?

-Vital signs -Length of appointment -Anticipated postoperative pain control

Which of the following should you consider regarding the use of vasoconstrictors for patients who present with hypothyroidism?

-When controlled, cardiac dose of vasoconstrictors is permitted. -Patients may be at risk of developing thyrotoxicosis. -Uncontrolled hyperthyroidism is an absolute contraindication to vasoconstrictors.

Supraperiosteal injections are NOT recommended when there is (are):

-close proximity to inflammation. -several teeth to be anesthetized. -close proximity to infection.

Match the parts of the anesthetic armamentarium with their function or main purpose.

-syringe barrel: has a large window and a small window for visibility of cartridge. -harpoon: the sharp tip of an aspirating syringe that allows for aspiration. -finger grip: utilized to give clinician added support of the syringe. -thumb ring: used to advance or retract the piston. -breechloading syringe: allows for insertion of the cartridge through the side of the barrel. -bevel:the point or tip of the needle. -shaft:the length of the needle composed of long tubular metal extending from the tip of the needle to the cartridge penetrating end. -syringe adaptor: the metal or plastic hub that attaches the needle to the syringe. -gauge: the size of the lumen of the needle. -diaphragm: the semipermeable material located at the top of the anesthetic cartridge.

A deposition rate of _______ is recommended to maximize patient comfort when administering the Gow-Gates nerve block.

1 to 2 mins

To achieve the optimal anesthetic effect, topical anesthesia should remain at the site of application for _______.

1 to 2 mins.

Where should the site for the MSA injection be if the patient is missing one of his premolars due to orthodontic treatment?

1/2 way in the dental arch

What is the average needle penetration depth for the PSA block?

16mm

A patient who has just been administered Oraqix gel (2.5% lidocaine and 2.5% prilocaine) can expect a comfortable duration of anesthesia of approximately _______.

20 mins

What is the approximate needle insertion depth into soft tissue in MOST cases for the inferior alveolar local anesthetic block?

20 mm

What are the two commonly used needle lengths for intraoral injections?

25mm 32mm

The needle penetration site for the MSA block is at the height of the mucobuccal fold, at the apex of the _______.

2nd premolar

To maximize patient comfort and minimize tissue trauma, the needle should be changed after _______ injections on the same patient.

3 to 4

Which statement describes the P-ASA block?

3 to 4 minute deposition period. -anesthesia for the max anterior teeth of 1 sextant. -no anesthesia of upper lip and face.

Which of the following intraoral needle gauges used in dentistry are listed from smallest to the largest?

30 27 25

According to Malamed, what kinds of needles are most likely to break?

30 gauge short or ultrashort needles.

Oraqix gel (2.5% lidocaine and 2.5% prilocaine) produces an anesthetic effect within ____________.

30 secs

Which identifying mark is required by the ADA for all local anesthetic cartridges?

A standardized color-coded band on the plastic label.

Which injection is commonly used when performing cosmetic dentistry on the maxillary anterior teeth?

AMSA block

The IO block anesthetizes both the _________________ with one injection.

ASA and MSA nerves

Established local anesthetic syringe criteria include which of the following?

Able to withstand repeated use and sterilization. Disposable and packaged in sterile containers. Lightweight and simple to use.

What is the term that describes a situation in which a drug should not be administered to an individual under any circumstances?

Absolute contraindication

After administering an IA block to your patient and shortly after you begin instrumentation, you begin to suspect a crossover of the contralateral incisive nerve. Which of the following is the most appropriate response?

Administer an incisive block on the opposite side to anesthetize the contralateral incisive nerve.

Before injecting a patient with a local anesthetic with or without a vasoconstrictor, the dental hygienist should perform all of the following EXCEPT one. Which one is the EXCEPTION?

Administer nitrous oxide

Which of the following treatment modifications are important for pt's with alcoholism?

Administer the minimal effective dose of lidocaine, mepivacaine, or bupivacaine.

Which of the following techniques is recommended in the administration of the IA block?

Administer the solution at the deposition site after gentle boney contact.

When does the needle become dull?

After 3 to 4 needle penetrations.

The intraseptal injection is usually administered ___________ the nerve block for the region and with a concentration of epinephrine ________ that used for the block.

After, higher than

Patients with atypical plasma cholinesterase should not receive which classification of drugs?

All esters

Which topical anesthetic has the most rapid onset of action?

Benzocaine

Which of the following is/are true regarding topical anesthetics?

Allergic reactions can occur up to 2 days after the anesthetic is given.

Which of the following characteristics could contribute to the properties of an ideal intraoral topical anesthetic?

Allow pain-free application

Which of the following characteristics could contribute to the properties of an ideal introral topical anesthetic?

Allow pain-free application.

The penetration site for the long buccal block is located _______.

Along the alveolar mucosal tissue distal and buccal to the last molar.

On what factor should the clinician base the choice of the needle length?

Amount of tissue that needs to be penetrated.

Which of the following defines paresthesia?

An abnormal burning or prickling sensation resulting from nerve damage.

The color-coded band on the anesthetic cartridges identifies what?

Anesthetic drug inside the cartridge.

Which of the following structures does the infraorbital local anesthetic block USUALLY anesthetize?

Anterior and middle superior alveolar nerves within 1 max quadrant.

Where is the recommended injection site or needle insertion point for the middle superior alveolar local anesthetic block?

Apex of the max 2nd premolar

Where is the greater palatine foramen usually located?

Approx. 10mm medial and directly superior to the palatal gingival margin.

Which of the following actions is a preventive measure to ensure the needle has not entered a blood vessel?

Aspirate

Which aspiration technique is recommended for the IA block?

Aspirate on three planes and after every one fourth of a deposited cartridge.

Cartridges of local anesthetics contain 1.8 mL of solution—except articaine, which contains 1.7 mL of solution. How fast should articaine be injected?

At a rate of 1.8mL per 2 mins.

Where is the injection site for the local anesthesia of the mylohyoid nerve?

At the apex of the mesial root of the man 1st molar

Which of the following techniques will enhance patient comfort?

Avoid boney contact when administering local anesthesia.

Which of the following can cause a false high BP reading?

BP cuff is too narrow

The bevel of the needle should?

Be turned toward the bone.

The sphenomandibular ligament may block the diffusion of anesthetic to the mandibular foramen if the deposition of anesthetic occurs _______.

Before bone is contacted

Which of the following is likely to increase the incident of needle breakage?

Bending the needle Changing the direction of the insertion of the needle. Forcing the needle against resistance.

What is the name of a common ester topical anesthetic?

Benzocaine

Which of following topical anesthetics do not always require a prescription?

Benzocaine

What is the best reason for the relative contraindication to amide local anesthetics for patients with liver disease?

Biotransformation of the amides occurs primarily in the liver.

Which of the following is NOT true regarding the Vazirani-Akinosi mandibular block?

Bone should be contacted prior to deposition.

Which of the following supplemental injections are also intraosseous injections?

Both the intraseptal and periodontal ligament injections.

A toxic overdose of topical anesthetic may result in which of the following?

Bradycardia

The needle is advanced and gentle bone contact is made for which injection?

Buccal IA IA and Gow-Gates Gow-Gates

What injection, in addition to the IA block, should be considered if the clinician will be performing nonsurgical periodontal therapy on the mandibular molars?

Buccal block

Which injection is USUALLY administered along with the inferior alveolar block to provide complete anesthesia of a mandibular quadrant on a patient before nonsurgical periodontal therapy WITHOUT any overlapping coverage?

Buccal block

Which of the following local anesthesia blocks will NOT provide pulpal anesthesia to tooth #23 (#3.2) before restorative dental procedures?

Buccal block

T or F: patients who report an allergy to sulfites should be given the vasoconstrictor levonordefrin.

False

All of the following cause a burning sensation when the anesthetic is injected into just tissue EXCEPT one. Which one is the EXCEPTION?

Buffered anesthetic (The anesthetic is more acidic than the tissue The low pH Vasoconstrictors)

Pulling the tissue taut before needle insertion helps all of the following EXCEPT one. Which one is the EXCEPTION?

Burning sensation felt by the pt. (visibility, ease of needle insertion, ease of needle penetration through tissue)

If plasma concentrations in the body become too high, the most prominent systemic effect will occur in which of the following systems?

CVS CNS

All of the following EXCEPT one are considered advantages for the use of topical anesthetic agents. Which one is the EXCEPTION?

Can be purchased OTC. (minimize pain associated w needle insertion, useful in treatment of minor oral injuries, reduce gag reflex during radiographic procedures)

What FDA Category does Oraqix fall into?

Category B

What FDA Category does Oraquix fall into?

Category B

What is the injection site or needle insertion point for an intraseptal injection within the maxillary arch?

Center of the interdental papilla

Which of the following is a way to decrease pain during injections?

Change needle after 3 to 4 tissue penetrations.

Which patients may be more susceptible to adverse effects of topical anesthetic agents?

Children Elderly Med compromised

Best practices to alleviate a patient's anxiety about local anesthetic include:

Communication

What technique is best when administering the AMSA block?

Computer-controlled delivery device

Which anatomic variation is least likely to affect the success of an IA block?

Congenitally missing man 3rd molars.

Placing the local anesthetic cartridge in alcohol or sterilization solution can cause?

Contamination of the local anesthetic solution Corrosion of the aluminum cap A burning sensation during the injection

T or F: patients with an artificial heart valve need premedication before a local anesthetic injection.

False

All of the following are advantages of purchasing a single-dose unit of a topical anesthetic EXCEPT one. Which one is the EXCEPTION?

Cost-effective (dose manageable, less cross contamination, less messy)

The ____________ can assist the clinician in visualizing access to the injection site, especially when the patient presents with a bulky alveolar ridge or bony exostosis.

Cotton-tipped applicator

Which of the following are reasons for inadequate anesthesia?

Dense bone covers the apices of the teeth as seen in children.

Best practices for administering the IA block injection include which of the following?

Deposition of solution at the target area will provide the most anesthetic power.

What is the injection site or needle insertion point for a periodontal ligament injection within the mandibular arch?

Depth of the gingival sulcus

After a few minutes following the administration of a mental local anesthetic block, a patient reports that some of her contralateral mandibular anterior teeth feel numb. What caused the patient's contralateral mandibular anterior teeth to become anesthetized?

Diffusion of the anesthetic agent to the incisive nerve.

Which of the following is NOT a recommended procedure prior to administering anesthesia?

Document the injection in the pt's chart. (expel a few drops of anesthetic to check the cartridge flow, check the orientation of the needle's beveled tip, pull back on the thumb ring to ensure harpoon is embedded)

Why might the harpoon of the syringe become disengaged during aspiration?

Dullness Improper syringe setup Clinician technique

What is the name of a common ketone topical anesthetic?

Dyclonine hydrochloride

Which of the following topical anesthetic agents is considered a ketone?

Dyclonine hydrochloride

Which topical anesthetic is NOT classified as an ester or an amide, but as a ketone?

Dyclonine hydrochloride

Generally speaking, the administration of a local anesthetic will _________ blood pressure.

Elevate

The volume of anesthetic required to achieve profound pulpal anesthesia in a restorative procedure is often __________ the amount required for nonsurgical periodontal therapy.

Equal to

All of the following are true regarding maximum recommended doses for topical anesthesia EXCEPT one. Which one is the EXCEPTION?

Exact doses can be measured using a cotton tip applicator. (it is difficult to monitor exact doses being given, patches are a good way to monitor exact doses,MRD does not exist for all topical anesthetics)

Harpoon disengagement may occur due to which operator error?

Excessive pull during aspiration. Failure to properly engage the harpoon during setup.

After receiving an infraorbital local anesthetic block, the patient reports slight numbness of the lower eyelid. What should the clinician do next?

Explain to the patient that this is usual reaction to the block.

After administering a mental local anesthetic block, the patient reports slight numbness of the chin. What should the clinician do next for the patient?

Explain to the pt that this is the usual reaction and continue with treatment.

What is the likelihood that your patient will experience a true allergic reaction to an amide local anesthetic?

Extremely unlikely

The mental block effectively anesthetizes the _______.

Facial gingiva of the mandibular anterior teeth and premolars.

When administering the IA block injection, what other nerve may inadvertently be anesthetized?

Facial nerve

Once the penetration site has been determined, the clinician should pick up the prepared anesthetic syringe, making certain the large window is _______ and the clinician's hand is _______.

Facing up, Palm up

Which of the following is the most common medical emergency observed in the dental office?

Fainting

T or F: Following a positive aspiration, the dental hygienist must always change the cartridge and redo the procedure.

False

T or F: The over-the-counter product Anbesol with benzocaine can be safely used by all family members.

False

T or F: a bubble in the cartridge that is larger than 2 mm is harmlessly produced by nitrogen gas during the manufacturing process. A cartridge with a large bubble (>2 mm) can be used without complication.

False

T or F: a patient is considered to have tachycardia if beats per minute are greater than 80.

False

T or F: a patient presents to your dental office the day after her dental appointment complaining of swelling and itching on the right side of her face. You should reassure the patient that it is not possible that her symptoms are related to dental anesthesia.

False

T or F: a patient who had heart bypass surgery 1 year ago should not have local anesthetics with vasoconstrictors.

False

T or F: anesthesia of the lingual nerve requires a separate technique and/or injection.

False

T or F: because the bone is denser on the mandibular anterior teeth than on the mandibular posterior teeth, a supraperiosteal injection may be less successful than a supraperiosteal injection on the posterior teeth.

False

T or F: benzocaine topical anesthetic exists almost entirely in its base form, making absorption into circulation high.

False

T or F: depositing anesthetic agent should be done quickly to promote pt comfort.

False

T or F: if anesthesia of the lingual periodontium and gingiva is required for #25-27 (#4.1-4.3), an incisive block is clinically effective BECAUSE it anesthetizes both the associated facial and lingual periodontium and gingiva of the mandibular anterior teeth.

False

T or F: if two quadrants are to be completed in a single visit, anesthesia should be administered to the upper right and left quadrants or to the lower right and left quadrants.

False

T or F: in order to safely and effectively anesthetize the PSA nerve, the hygienist should direct the needle at a 90-degree angle to the occlusal plane and a 90-degree angle to the long axis of the second maxillary molar. Bending the needle shank may be necessary to accomplish these needle angulations.

False

T or F: in patients who have a vaulted palate, the GP foramen appears closer to the midline. Conversely, in patients with a more shallow palate, the foramen appears closer to the dentition.

False

T or F: it is ALWAYS important for the clinician to orient the needle as close as possible to the periosteum. This is to ensure the needle glides along the periosteum allowing for more stability.

False

T or F: lingual shock may occur as the needle passes by the inferior alveolar nerve during the IA block.

False

T or F: local anesthetics are teratogenic and pose a moderate risk to the unborn fetus. The administration of all local anesthetic agents is an absolute contraindication in the first and second trimesters of pregnancy.

False

T or F: local anesthetics containing a vasoconstrictor are relative contraindications for a patient who reports experiencing an allergic reaction to local anesthetics in the past.

False

T or F: needles should be carefully bent before disposing of them in the sharps container.

False

T or F: prior to providing an injection, the topical agent should remain at the site of penetration for about 4 minutes. Anesthesia should be achieved to a depth of approximately 5-6 mm into the tissue.

False

T or F: pulpal anesthesia can be achieved using 2.5% lidocaine and 2.5% prilocaine gel mixture.

False

T or F: suggested safety controls for needles and other sharps include placing used disposable syringes and needles, scalpel blades, and other sharp items in appropriate puncture-resistant containers.

False

T or F: the dental hygienist should practice the local anesthetic technique until it becomes routine.

False

T or F: the incidence of occupational exposures is reduced for the experienced clinician.

False

T or F: the most common procedure for assessing the pulse rate is to palpate the brachial artery. Bradycardia is an abnormally elevated heart rate and may be a sign of cardiovascular disease or anxiety.

False

T or F: the most commonly found form of lidocaine is in base form because it is water soluble and can easily penetrate and be absorbed into the tissues.

False

T or F: the published maximum dosage recommendation for topical anesthetic benzocaine is 200mg.

False

T or F: there is NO need to palpate for the mental foramen prior to administering the mental local anesthetic block because the mental foramen is USUALLY in the same location on all patients

False

T or F: to provide safe and comfortable injections, the clinician should administer the anesthetic solution quickly.

False

T or F: topical anesthetics have a lower concentration of anesthetic than their injectable counterparts. This is necessary because some topical anesthetics contain a vasoconstrictor.

False

T or F: when administering the buccal block and the tissue balloons up, the clinician should correct this by deeper penetration of the bevel of the needle.

False

T or F: while at room temperature, Oraqix is in gel form in the cartridge. It will liquidate as it reaches body temperature in the periodontal pocket.

False

T or F: a child can grant informed consent for dental work. The written agreement of the care plan becomes a legal contract between the patient and the dental hygienist.

False, True

T or F: a greater degree of variation exists in the maxilla than in the mandible. Maxillary injections are generally more successful than mandibular injections.

False, True

T or F: numbness or tingling of the lower lip is a good indication that profound anesthesia has occurred. It is also an indicator that the inferior alveolar nerve has been initially anesthetized.

False, True

T or F: patient comfort is minimized through the use of a sharply beveled needle. When administering local anesthesia, the bevel of the needle should face bone.

False, True

T or F: the care plan should be developed by the dental hygienist and presented to the patient. Local anesthesia should be administered in the areas that can be completed in one appointment.

False, True

T or F: there is less variation in the anatomy of the mandibular anesthetic landmarks than there is in similar maxillary structures, thus making the mandibular injections more routine. Anesthesia in the maxillary arch usually does not require any troubleshooting of failure cases.

False, True

T or F: to obtain the most benefit from the use of topical anesthetics, a fairly substantial amount of topical should be placed on the cotton tip applicator. This amount mixes with the saliva and may numb the tongue, soft palate, or pharynx.

False, True

T or F: to prevent accidental needle stick exposures to the clinician, the clinician should wear thick utility gloves to protect herself. Needle stick injuries typically occur from inattention by the clinician or unexpected patient movement.

False, True

T or F: it is safe to insert the needle to the hub. The hub of the needle is the strongest part of the needle.

False, neither the statement nor the reason is correct

T or F: warming the anesthetic agent is recommended for patient comfort because it can activate the vasoconstrictor. This can cause an increase in the duration of action.

False, neither the statement nor the reason is correct.

What area should the clinician palpate in order to determine the location of the mental foramen?

From the man 1st molar to the distal surface of the canine.

In which of the following cases is the long buccal block indicated?

Furcation debridement of a mandibular molar.

Pressure anesthesia to control patient discomfort upon injection with the needle can be used during which of the following local anesthetic blocks?

GP and NP local anesthetic blocks

List common forms of topical anesthetics used in dentistry

Gel Spray Liquid Ointment One patch form

What injection uses the mesiolingual cusp of the maxillary second molar as a landmark during administration?

Gow-Gates mandibular block

Which of the following local anesthetic blocks anesthetizes the mylohyoid, mental, and the auriculotemporal nerves?

Gow-Gates mandibular block

Larger gauge needles have what advantages over smaller gauge needles?

Greater accuracy Increased injection success

The _________ is a sharp tip attached to the internal end of the piston that embeds into the cartridge's rubber stopper.

Harpoon

Which of the following is an absolute contraindication to the use of vasoconstrictors?

Heart attack 5 months ago.

Where is the recommended injection site or needle insertion point for local anesthetic deposition of the agent located when administering a supraperiosteal injection on the surface of the maxilla?

Height of the max mucobuccal fold

What is the recommended injection site or needle insertion point for the infraorbital block?

Height of the max mucobuccal fold of the max 1st premolar.

When half-mouth periodontal treatment with anesthesia is required, it is best to begin with which injection?

IA

Which is the correct order for the administering of injections?

IA B PSA MSA ASA

Which of the following local anesthetic blocks uses BOTH the mandibular occlusal plane and pterygomandibular raphe as landmarks for administration?

IA block

Which mandibular local anesthetic blocks require the clinician to gently contact the mandible with the anesthetic needle?

IA block and Gow-Gates mandibular block

Long needles are required for which of the following?

IA block injection Gow-Gates mandibular block injection IO block injection

If half-mouth treatment is necessary, the _______ block is given first. Once the anesthetic has taken effect, instrumentation should proceed on the _______ first.

IA, max arch

If the clinician wanted to anesthetize teeth #9 to #11 (#2.1 to #2.3) and associated facial and palatal periodontium and gingiva for a limited procedure, it would be BEST to administer which of the following local anesthetic blocks?

IO NP blocks

When performing maxillary nerve anesthesia, which is the ONLY local anesthetic block that requires the clinician to gently contact bone with the needle to ensure clinically effective outcome?

IO block

Which of the following techniques can be used to reduce the risk of injecting into a blood vessel when administering a PSA block?

If injecting a child, administer a supraperiosteal injection instead of a PSA block.

A patient presents to your dental office with a toothache. His blood pressure is 200/116. What should you do?

Implement anxiety control measures, including the use of nitrous oxide/oxygen analgesia.

Field block injections are most effective _______.

In the maxillary arch

After administering the IA block, which injection should the clinician consider administering if one of the lateral incisors fails to achieve pulpal anesthesia?

Incisive block

Which mandibular injection has the highest VAS number or is rated as the most uncomfortable for the dental patient?

Incisive block

What is the most common technique error associated with supraperiosteal, ASA, and MSA injections?

Incorrect angulation of the syringe barrel and needle.

What is the most common technique error associated with the infraorbital injection?

Incorrect angulation of the syringe barrel and the needle.

All of the following are possible localized adverse reactions associated with topical anesthesia EXCEPT one. Which one is the EXCEPTION?

Increased heart rate (burning or stinging, sloughing, tissue discoloration)

Which of the following is NOT a disadvantage associated with the Gow-Gates mandibular block?

Increased risk of hematoma

Which of the following are important criteria for an acceptable local anesthetic syringe?

Inexpensive, self-contained, and able to withstand repeated sterilization without damage. (Able to withstand repeated sterilization, lightweight, and expensive Not self-contained, inexpensive, and able to withstand repeated sterilization without damage Not self-contained, heavy in weight, and able to withstand repeated sterilization without damage)

Where should the injection site for an IA block injection be located if the clinician notices a double mandibular canal on dental images?

Inferior to the usual anatomic landmarks for the IA block

What can the clinician safely do if a patient is experiencing excessive bleeding while undergoing root planing?

Infiltrate 1:50,000 in small amounts directly into the area of bleeding.

Benzocaine is available in all of the following preparations EXCEPT one. Which one is the EXCEPTION?

Injectable (cream, gel, spray, patch)

What is the most commonly cited error contributing to missed IA blocks?

Injection being too low

Surface anesthesia can be achieved by all of the following EXCEPT one. Which one is the EXCEPTION?

Injections (gels, creams, sprays)

What is a possible disadvantage of using the self-aspirating syringe?

Insecurity of the clinician accustomed to the harpoon-type syringe.

Routine maintenance of a reusable syringe includes?

Inspection and replacement of a dull or bent harpoon

EMLA is approved by the U.S. Food and Drug Administration for use on which of the following areas?

Intact skin

Which of the following injections is usually provided after a regional nerve block in order to facilitate hemostasis?

Intraseptal

Which of the following supplemental injections increase hemostasis when used with a higher level of vasoconstrictor upon instrumenting within the maxillary arch?

Intraseptal injection

What is an advantage of using the pressure-type syringe over the conventional type of syringe?

It administers a 0.2-mL dosage of anesthetic.

Why is the pterygoid venous plexus an area of concern when administering the PSA?

It is a highly vascular area.

What is a possible advantage of using a computer-controlled syringe?

It offers precise control of anesthetic flow and pressure. It has automatic aspiration. The rotational needle insertion minimizes needle deflection.

What is a possible advantage of using the computer-controlled syringe?

It offers precise control of anesthetic flow and pressure. It has automatic aspiration. The rotational needle insertion minimizes needle deflection.

Which of the following is NOT an ideal property of an oral topical anesthetic?

It produces dependency on repeated use. (it remains at the site of application, it has an acceptable taste, it permits a comfortable application)

When comparing large-gauge numbers to smaller-gauge numbers, what does the larger-gauge number of the needle mean?

It refers to the smaller diameter of the needle.

All of the following are considered ideal properties of a topical anesthetic EXCEPT one. Which one is the EXCEPTION?

It should be allergenic (it should produce no damage to the tissue, it should have an acceptable taste, it should not induce systemic toxicity)

Where is the pterygomandibular fold located?

It turns superior to the junction of hard and soft palates.

A patient presents to your office asking for a needleless injection. What anesthetic method is the patient referring to?

Jet injector syringes

Where is the recommended injection site or needle insertion point for the nasopalatine block?

Lateral to the incisive papilla

Which anesthetic falls under the pregnancy risk category B?

Lidocaine

Which of the following topical anesthetics is classified as an amide?

Lidocaine

Which of the following topical anesthetics has a U.S. Food and Drug Administration pregnancy category B?

Lidocaine/prilocaine

When breach-loading a cartridge into the syringe, the rubber stopper should _______.

Load 1st

Anesthesia deposited near the smaller terminal nerve endings, providing soft tissue anesthesia in a limited area, is defined as (a)

Local infiltration

When soft tissue anesthesia is needed in a limited area, it is best to perform a:

Local infiltration

What is the main difference in the MOA between topical anesthetics and injectable anesthetics?

Location of the blocking of nerve conduction.

Which of the following are the MAIN disadvantages of the Gow-Gates block?

Longer onset time and numbness to lower lip and temporal region.

Which of the following is an advantage of the plastic breech-loading aspirating syringe?

Lower cost Less threatening appearance Lighter weight

Which block is MOST appropriate to administer so as to allow for clinically effective anesthesia of the associated buccal periodontium and gingiva of the maxillary premolars?

MSA block

Which of the following local anesthetic blocks anesthetizes the mesiobuccal root of tooth #3 (#1.6) in ONLY approximately 28 per cent of the population?

MSA block

What is an important post-infraorbital injection procedure?

Maintain pressure and massage the solution into the infraorbital foramen for approximately 2 mins to enhance anesthetic diffusion.

What is the name of the inherited syndrome that is triggered by the exposure to certain drugs used for general anesthesia and the neuromuscular blocking agent succinylcholine?

Malignant hyperthermia

Which of the following is true?

Malignant hyperthermia can be fatal if not treated quickly. (Malignant hyperthermia occurs more frequently in adults than it does in children, Amide local anesthetics are absolutely contraindicated for patients with a history of malignant hyperthermia,Malignant hyperthermia is a hereditary condition characterized by the inability of blood to bind to oxygen)

When administering the PSA injection, what other nerve may inadvertently be anesthetized?

Mandibular nerve

Where is the recommended injection site or needle insertion point for the anterior superior alveolar local anesthetic block?

Max mucobuccal fold superior to the apex of the maxillary canine.

Which of the following describe topical antiseptic placement?

May be useful for immunosuppressed pt's. Screen pt for allergy to iodine. Optional procedure

All of the following are true regarding phenothiazines EXCEPT one. Which one is the EXCEPTION?

May increase the risk of hypertension. (May reverse the pressor effect of vasoconstrictors,Alpha blocker that antagonizes the beta effects of epinephrine,When epinephrine is needed, the minimum effective dose should be administered)

In most cases, patients with cardiovascular involvement

May receive vasoconstrictors, but only in limited doses.

What has the combined lidocaine/prilocaine cream been approved and effectively used for?

Medical procedures

Which mandibular injection has the second highest rate of developing the complication of a hematoma?

Mental block

Which method of delivery is recommended to decrease the risk of methemoglobinemia?

Metered spray with disposable nozzle.

What is a good reason not to use distracters when administering maxillary facial anesthesia?

Movement may cause the anesthetic not to be placed at the target area.

Which of the following maxillary blocks will anesthetize bilaterally (both the left and right), with only one injection?

NP block

What is the name of the component of the syringe that can easily be unscrewed and inadvertently disposed of during needle removal?

Needle adaptor

What term describes the injection site where the bevel of the needle is covered with tissue?

Needle insertion point

What is the correct dental term for the presence of a clear air bubble, or no return after definite movement backward of the rubber stopper?

Negative aspiration

Pulling back on the thumb ring provides ____________ and produces an aspiration.

Negative pressure

What is produced when the thumb ring of a syringe is pulled back by the clinician, causing retraction of the rubber stopper?

Negative pressure

The dental hygienist will provide nonsurgical periodontal therapy of teeth #18 to 24. Which injection administration technique should the dental hygienist use?

Nerve block

What is the name of the type of injection that anesthetizes a larger area than the local infiltration because the local anesthetic agent is deposited near large nerve trunks?

Nerve block

Which of the following injection techniques can provide profound soft tissue and pulpal anesthesia over a large area?

Nerve block

A patient who presents for dental treatment with uncontrolled hyperthyroidism should receive

No vasoconstrictors until the hyperthyroidism is under control.

Which of the following drugs is the BEST choice to administer when a patient has a history of hepatitis B?

Nonselective

It is recommended to monitor a patient's blood pressure throughout treatment for symptoms of altered (increased) blood pressure when a patient is taking which of the following medications?

Nonspecific beta blockers

When the vasoconstrictor is absolutely contraindicated, the dental hygienist should

Not under any circumstance, administer vasoconstrictors.

What are characteristics of topical anesthetics?

Provide soft tissue anesthesia.

What should the clinician do while waiting for local anesthetic to take effect for her patient?

Observe the pt for possible signs of an adverse reaction.

A tingling sensation in the lower lip after an IA block injection is a good indication _______.

Of initial anesthesia in the IA nerve

What is the most common topical preparation for lidocaine?

Ointment

Which of the following is a eutectic mixture that will thicken into a gel once inserted into a periodontal pocket, relieving pain associated with nonsurgical periodontal therapy?

Oraquix; 2.5% lidocaine/ 2.5% prilocaine gel

Methemoglobinemia is caused by the metabolite?

Orthotoluidine

What is a common mistake that beginners tend to make when first learning to give local anesthesia, especially if they do not have a firm fulcrum?

Overexaggerating the pulling back motion of the thumb ring, pulling the needle away from the proper depth of penetration.

Which of the following injections is used when pulpal anesthesia as well as anesthesia of the associated periodontium and gingiva are indicated on a single tooth?

PDL

Which of the following mandibular supplemental injections enters the alveolar bone?

PDL

Which of the following supplemental injections increase hemostasis when used with a LESS diluted vasoconstrictor upon instrumenting within the mandibular arch?

PDL injection

Which of the following supplemental injections is MAINLY used within the mandibular arch?

PDL injection

Which of the following supplemental injections is RARELY used within the maxillary arch before nonsurgical periodontal therapy?

PDL injection

In what order would you administer the maxillary injections?

PSA MSA ASA

In which order would you administer the maxillary injections?

PSA MSA ASA

When administering local anesthesia to the maxillary arch for extensive root planing procedures, what is the correct order of the injections?

PSA MSA ASA

Which local anesthetic block listed below requires the recommended injection site or needle insertion point to be at the height of the maxillary mucobuccal fold superior to the apex of the maxillary second molar?

PSA block

When selecting an anesthetic, which of the following factors should be considered?

Postoperative pain control.

When administering the inferior alveolar block, the syringe barrel in MOST cases should usually be superior to which mandibular tooth?

Premolar on contralateral side

A _______ syringe is primarily used for PDL injections of single mandibular teeth where tissue resistance is pronounced.

Pressure

Gauze 2×2 squares are a helpful supplement to the anesthetic armamentarium. Which of the following is NOT a function of a gauze 2×2?

Pressure anesthesia

Which of the following anesthetics should be avoided if a patient has methemoglobinemia?

Prilocaine

Which of the following local anesthetic agents is found in Oraqix?

Prilocaine

Which of the listed local anesthetics could produce an emergency situation characterized by the inability of the blood to bind to oxygen?

Prilocaine

Select the local anesthetic that is most likely to inhibit the antibacterial activity of sulfonamides.

Procaine

Each of the following is a descriptiono f the AMSA injection EXCEPT one. Which one is the EXCEPTION?

Provides anesthesia to the anterior teeth of one sextant.

Each of the following is a descriptionof the AMSA injection EXCEPT one. Which one is the EXCEPTION?

Provides anesthesia to the anterior teeth of one sextant. (provides soft tissue anesthesia, provides pulpal anesthesia, palatal nerve block)

What is the main advantage of the nerve block over other types of anesthesia?

Provides profound pulpal and soft tissue anesthesia over a larger area.

All of the following describe why aspiration is a necessary part of administering local anesthesia EXCEPT one. Which one is the EXCEPTION?

Pt comfort (To dramatically decrease the incidence of an intravascular injection, To ensure that the needle has not entered a blood vessel)

Which of the following situations is NOT related to incomplete anesthesia on the usual areas of the mandible on an adult patient after administering an inferior alveolar local anesthetic block?

Pt experiencing "lingual shock" during the injection.

Which of the following is a relative contraindication to the use of an amide local anesthetic?

Pt taking Tagamet

Allergic reactions to topical anesthetic are _______.

Rare

The manifestation of a hematoma is ______ with supraperiosteal injections.

Rare

As you are about to administer an injection, your needle tip inadvertently touches the patient's disposable bib (clean but not sterile). What should you do next?

Recap the needle with the one-hand scoop method, discard it and replace it with a new, sterilized needle. Proceed in administering the local anesthesia.

After removing the needle, what is the immediate next step?

Recapping the needle

How should a clinician properly dispose of anesthetic needles?

Recapping using the scoop method and disposal in an approved sharps container.

Patients taking Elavil should:

Receive lowest effective dose of epinephrine similar to that recommended for cardiovascularly involved patient

When comparing large-gauge numbers to smaller gauge numbers, what does the larger-gauge number of the needle mean?

Refers to the smaller diameter of the needle.

If the harpoon disengages during an aspiration, the clinician should?

Remove the syringe from the pt's mouth, remove the needle, and reengage the harpoon into the rubber stopper.

What should the clinician do if the harpoon becomes disengaged during aspiration?

Remove the syringe, remove the needle, reengage the harpoon, reattach the needle, and then continue with the procedure.

All of the following describes advantages of single unit-dose applications of topical anesthetics EXCEPT one. Which one is the EXCEPTION?

Requires less administration time. (prevent cross-contamination, doses administered can be monitored, less messy)

What is the name of a plastic, single-use or partially disposable syringe that utilizes a retractable plastic sheath that locks over the needle upon removal from tissue?

Safety syringe

Which of the following is NOT an effective stress reduction measure?

Schedule the appointment in the afternoon.

Which of the following are considered advantages of the application of dental topical anesthetics in a patch form?

Site-specific

The ability of the clinician to properly aspirate can be affected by the _______.

Size of the anesthetic syringe

The pulse rate of a school-aged child is ______________ than that of an adult.

Slightly faster

Which of the following indicates that the cartridge should be used?

Small bubbles less than 2mm.

Following the administration of a local anesthetic with a vasoconstrictor, the patient experiences mild itching and a slight rash. This is most likely caused by:

Sodium bisulfite

Topical anesthetics are available in a variety of forms. Which method of delivery is most likely to produce a toxic reaction?

Spray

T or F: anesthesia of the maxillary teeth is MORE clinically effective than the mandibular teeth BECAUSE the bone of the maxillae overlying the teeth is denser and less porous.

Statement is correct, reason is not

Which of the following guidelines should be followed in order to correctly store local anesthetic cartridges in the dental office?

Store @ room temp in a dark place.

Which of the following is the most effective patient positioning for the administration of local anesthesia?

Supine positioning

If the dental hygienist wants to anesthetize tooth #12, which injection administration technique should the clinician use?

Supraperiosteal

What is the name of the type of injection that anesthetizes a small area of one or two teeth and the associated structures when the local anesthetic agent is deposited near the terminal nerve endings?

Supraperiosteal

What type of injection administration technique is the anterior superior alveolar (ASA)?

Supraperiosteal

Which of the following supplemental injections within the mandibular arch is palpated to ensure soft tissue entry before the needle is inserted?

Supraperiosteal injection

Which of the following supplemental injections within the maxillary arch is palpated before administration to ensure soft tissue entry before the needle is inserted?

Supraperiosteal injection

Which of the following supplemental injections are NOT intraosseous injections?

Supraperiosteal injection (intraseptal, PDL)

Mild allergic reactions to topical anesthetic can include _______, _______, and _______.

Swelling Raised welts Itching

Patients with bleeding disorders will most likely be susceptible to:

Technique of anesthetic administration.

What is the name of the most potent ester topical anesthetic ?

Tetracaine hydrochloride

What is the name of the most potent ester topical anesthetic?

Tetracaine hydrochloride

Which topical anesthetic has the longest average duration?

Tetracaine hydrochloride

Select the true statement

The Gow-Gates block has a higher success rate than the IA block.

Which of the following statements is true according to the IA ?

The IA block is the most frequently administered injection in dentistry.

Your patient requires local anesthesia for periodontal therapy of a maxillary quadrant. Which injection should be administered first?

The PSA block

Since the syringe was introduced in 1921, what has been the single most important improvement in dental local anesthetic?

The addition of the aspirating harpoon.

What is the most important improvement that has been made to the local anesthetic syringe?

The addition of the aspirating harpoon.

What does the presence of an extruded anesthetic cartridge stopper w/o a large bubble mean?

The anesthetic cartridge has been placed in disinfecting solution.

What does the presence of an extruded anesthetic cartridge stopper without a large bubble mean?

The anesthetic cartridge has been placed in disinfecting solution.

What is indicated by the presence of bubbles LARGER than 2mm in diameter and located within the anesthetic cartridge?

The anesthetic has been frozen.

What is indicated by the presence of bubbles larger than 2 mm in diameter and located within the anesthetic cartridge?

The anesthetic has been frozen.

What is the definition of the needle bevel?

The angled point or tip of the needle.

Which of the following is true according to the blocks?

The anterior middle superior alveolar (AMSA) block will effectively anesthetize the pulpal tissue, periodontium, and gingival tissue usually innervated by the ASA, MSA, GP, and NP blocks.

Which of the following is an important consideration when selecting a technique to administer local anesthesia?

The comfort of the pt.

In the interest of patient comfort, the dental hygienist should effectively anesthetize the treatment area with _______.

The fewest possible tissue penetrations.

Which of the following modifications would apply when administering anesthesia to a patient with thrombophilia (clotting disorder)?

The hygienist should administer infiltration anesthesia in place of block injections, which pose a greater risk of puncturing a blood vessel (PSA, IA, and so on).

What part of the syringe must be pulled back when inserting the anesthetic cartridge?

The internal end of the piston with the harpoon.

Which part of the syringe must be pulled back when inserting the anesthetic cartridge?

The internal end of the piston with the harpoon.

Which of the following is an important feature of the syringe barrel?

The large window provides DIRECT vision of the cartridge during anesthetic administration.

All of the following statements are true EXCEPT one. Which one is the EXCEPTION?

The more topical placed at the site of needle penetration the better. (allergic reactions associated with topical anesthetic are rare, topical anesthetics are made available OTC, tetracaine hydrochloride is considered the most potent of the topical anesthetics)

Your patient complained that the injection that you just administered was very painful as you withdrew the needle. What do you think happened to cause this pain?

The needle had a barb from manufacturing.

Your pt complained that the injection that you just administered was very painful as you withdrew the needle.What do you think happened to cause this pain?

The needle had a barb from manufacturing.

Which of the following are best practices for the maxillary supraperiosteal injection technique?

The needle should be inserted parallel with the long axis of the tooth.

Which of the following is NOT true?

The needle should not come in contact with bone during the administration of the IO block.

In which scenario is antibiotic premedication recommended?

The placement of a dental implant. ( placement of rubber dam, placement of ortho brackets, postop suture removal)

On receiving the maximum recommended dose of prilocaine, the patient's lips and mucous membranes turn blue. Which of the following is a possible explanation?

The pt has methamoglobinemia.

Which of the following statements is the correct consideration regarding the use of amide local anesthetic plus vasoconstrictor in treating a patient with a known bleeding disorder?

The risk of a positive aspiration is the greatest concern.

The American Dental Association has set forth criteria for the acceptance of local anesthetic syringes. Which of the following is NOT consistent with the ADA's standards?

The syringe must be disposable

How can the clinician correct the problem of hitting bone while administering the PSA injection?

The syringe needs to be closer to the occlusal plane, thereby reducing the angle to less than 45 degrees.

What is a noticeable difference between the mental block and the incisive block?

There is pulpal anesthesia of the involved teeth with an incisive block.

What is the reason that concentrations of topical anesthetic agents are higher than those of their injectable counterparts?

They facilitate diffusion of the topical anesthetic agent through the mucous membranes.

Manufacturer recommendations for the routine maintenance of reusable syringes include?

Thorough cleaning and sterilization after use on each pt.

Which of the following is NOT an appropriate use for topical anesthesia?

To achieve pulpal anesthesia prior to restorative dental procedures. (to increase comfort during minor dental hygiene procedures, to reduce a pt's gauge reflex while taking dental impressions, to minimize the pain associated with needle insertion)

All of the following are the benefits of establishing a fulcrum during the administration of a local anesthetic EXCEPT one. Which one is the EXCEPTION?

To clearly see a positive aspiration. (to ensure safe, comfortable injections, to ensure proper aspiration w/o needle movement, to provide stability)

What is the main goal of aspirating on two planes?

To determine if the bevel of the needle is abutting against a blood vessel providing a false negative aspiration on the first aspiration test.

When checking the armamentarium, why is it important to expel a few drops of the anesthetic agent?

To ensure a free flow of anesthetic through the needle.

What is the purpose of applying negative pressure to the harpoon?

To evaluate whether the needle is within a blood vessel.

Which of the following would be an indication for use of a topical anesthetic?

To minimize pt's gag reflex.

It is recommended that the clinician know the location of the uncovered needle tip at all times. Why?

To prevent accidental needle contamination. To prevent needle injury to the pt. To prevent needle injury to the clinician.

Why should the clinician avoid administering local anesthetics to both the mandibular right and left quadrants during a single treatment?

To prevent the inability of the pt to control his/her mandible.

Because of the cost of the "needleless" injection, what is an alternative cost-effective anesthetic that will produce results similar to those of the needleless injection?

Topical anesthetic

What is optional when preparing to give an intraoral injection?

Topical antiseptic

T or F: adequate pain control is essential l to provide thorough nonsurgical periodontal therapy. Thorough pain control is best accomplished by the administration of local anesthetics.

True

T or F: adequate pain control is essential to provide thorough nonsurgical periodontal therapy. Thorough pain control is best accomplished by the administration of local anesthetics.

True

T or F: although topical anesthetics are generally regarded as safe, if used improperly they can produce adverse reactions that are fatal.

True

T or F: both the right nasopalatine nerve and the left nasopalatine nerve are anesthetized by the nasopalatine block. Only one injection is needed for both sides of the palate.

True

T or F: concentrations available in over-the-counter products can be as high as those administered professionally in the dental office.

True

T or F: few health conditions absolutely contraindicate the administration of vasoconstrictors. Patients with uncontrolled systemic disease are not normally seen for nonsurgical periodontal therapy.

True

T or F: field blocks are injections in which the local anesthetic is deposited near large terminal nerve branches.

True

T or F: following the initial negative aspiration, the dental hygienist should rotate the barrel of the syringe about 45 degrees and aspirate a second time. This ensures that the needle is not located within a blood vessel and possibly abutting the blood vessel wall, providing a false-negative aspiration.

True

T or F: if the blood of a positive aspiration does not completely fill the cartridge, the clinician can slightly reposition the needle and attempt a second aspiration.

True

T or F: if the harpoon disengages during an aspiration, the clinician must remove the needle from the tissue and re-embed the harpoon into the rubber stopper.

True

T or F: in dentistry, the pressure-type syringe is used for providing anesthetic for periodontal ligament injections. It provides reliable anesthesia for one tooth in the mandible.

True

T or F: in most cases, paresthesia occurs due to problematic surgical extraction of impacted molars.

True

T or F: informed consent is when the pt gives the clinician permission to perform the dental procedure.

True

T or F: lidocaine is metabolized in the liver and excreted via the kidneys with less than 10% remaining unchanged.

True

T or F: local anesthesia is best administered by quadrants or sextants. It is an effective patient management strategy.

True

T or F: local anesthetics administered during pregnancy are not teratogenic and pose little danger to the fetus. Pregnant women can receive dental hygiene care with anesthesia in any trimester, in consultation with the patient's physician.

True

T or F: local anesthetics containing a vasoconstrictor are an absolute contraindication for a patient who reports being allergic to wine and dried fruits.

True

T or F: methemoglobinemia has been reported following topical anesthesia use of benzocaine, particularly with higher concentrations of 14%-20% spray applications applied to the mouth and mucous membrane. An advisory statement informing the public of the association between benzocaine and methemoglobinemia has been released by the Institute of Safe Medication Practices and the U.S. Food and Drug Administration.

True

T or F: nerve block anesthesia provides profound anesthesia over a larger area with fewer injections needed.

True

T or F: patient comfort can be increased by the sharpness of the bevel. The bevel of the needle should be turned toward the bone.

True

T or F: patient t comfort can be increased by the sharpness of the bevel. The bevel of the needle should be turned toward the bone.

True

T or F: periodontal ligament injections are utilized when pulpal anesthesia is indicated on a single tooth in the mandibular arch.

True

T or F: tetracaine hydrochloride has a rather slow onset of action; however, it can last approximately 45 minutes.

True

T or F: the IA has the highest positive aspiration rate of all block injections of either dental arch. If hematoma occurs in the area of the pterygomandibular space, it is important to let the patient see the bruising when the treatment is finished and discuss that it is a basic risk of anesthesia and is temporary.

True

T or F: the PSA injection can be useful during maintenance or recare appointments. Many times the maxillary molars are the first teeth involved in periodontal disease.

True

T or F: the Vazirani-Akinosi block is useful when soft tissue structures such as the tongue or buccal fat pad persistently obstruct the view of the intraoral landmarks used in the IA block. The mylohyoid nerve is anesthetized during the Vazirani-Akinosi block.

True

T or F: the cartridge silicone rubber stopper is slightly indented from the rim of the glass barrel. Cartridges that have rubber stoppers that are not indented slightly should be discarded.

True

T or F: the concentrations of topical anesthetics are greater than those of their injectable counterparts. Topical anesthetics do not contain vasoconstrictors.

True

T or F: the hub of the needle is the point where the shaft of the needle joins and secures the needle to the syringe adaptor. The needle shank should never be inserted into tissue up to the hub of the needle.

True

T or F: the onset of action for benzocaine is rapid. The duration of action for benzocaine is 5-15 minutes.

True

T or F: the operator does not need to insert the needle in the mental foramen when administering the mental block to achieve effective anesthesia. However, returning the patient to an upright position after the injection will promote the diffusion of the anesthetic agent into the foramen.

True

T or F: the periodontal ligament injection is administered directly into the periodontium of the tooth, providing pulpal anesthesia along with the lingual and buccal mucosa.

True

T or F: the potentially adverse action of the released catecholamines on cardiovascular function in the patient with clinically significant heart or blood vessel disease warrants the inclusion of vasoconstrictors in the local anesthetic solution. Without adequate control of pain, sedation and stress reduction are impossible to achieve; however, use of local anesthetic plus a vasoconstrictor will help to ensure adequate pain control.

True

T or F: the self-sheathing anesthetic needle is an engineering design that reduces the clinician's exposures to blood and other potentially infectious material.

True

T or F: the use of amide local anesthetic agents, not prilocaine or topical benzocaine, is recommended for a patient with methemoglobinemia.

True

T or F: there is more variation in the anatomy of the mandibular anesthetic landmarks than in similar maxillary structures. Lack of consistent success with the IA block injection is due in part to anatomic variations.

True

T or F: there is no need for the clinician to shake or vibrate the tissue of the cheek to distract the patient. This action would move the needle and its bevel out of the correct pathway to the target area, causing less effective administration, possible trauma, and then pain to the patient.

True

T or F: topical anesthesia is available in many different forms: liquid, gel, spray, and patch. Topical anesthesia distributed in single dose applications decreases the possibility of cross-contamination.

True

T or F: topical anesthetic should be applied after the application of a topical antiseptic. Topical antiseptic can be used to decrease infection.

True

T or F: topical anesthetics are available in concentrations ranging from 0.2% to 20%. Products available over the counter can have concentrations just as high as those used professional in the dental office.

True

T or F: usual doses of amide local anesthetic do not pose any additional risk for patients with renal dysfunction.

True

T or F: vasoconstrictors are an absolute contraindication for a patient with uncontrolled diabetes.

True

T or F: vasoconstrictors can increase a pt's BP.

True

T or F: when a patient is taking a tricyclic antidepressant and is also given levonordefrin, blood pressure enhancement is fivefold greater than with levonordefrin alone.

True

T or F: when administering the Gow-Gates block, initially the vertical location for the injection is just inferior to the mesiolingual cusp of the maxillary second molar; the needle is then placed distal to the maxillary second molar.

True

T or F: when half-mouth treatment is planned, the inferior alveolar and buccal blocks are given first, then the maxillary facial, and then palatal injections follow with instrumenting proceeding first on the maxillary arch. This allows time for the entire mandibular arch to become completely anesthetized.

True

T or F: when the anesthetic solution has expired, the pH of the anesthetic solution will decrease when the preservative sodium bisulfate is oxidized to sodium bisulfate. This can be avoided by checking the expiration date printed on the Mylar label.

True

T or F: with the PDL injection, multirooted teeth require an injection for each root.

True

T or F: allergic reactions associated with topical anesthetics are rare. It is not necessary to review a patient's medical history before applying a topical anesthetic agent.

True, False

T or F: in the event of advanced periodontal disease, you may only realistically complete a few teeth each visit. When this is the case, the care plan should propose dividing the mouth by the arch (maxillary or mandibular) for treatment.

True, False

T or F: the importance of aspirating prior to anesthetic deposition and the potential hazards associated with intravascular injections are widely known and accepted. The self-aspirating syringe achieves the positive pressure for an aspiration without a harpoon.

True, False

T or F: the target area for the incisive block is the same as the mental block, but after administering the mental block, the clinician MUST place pressure to the injection site following the injection for clinically effective local anesthesia.

True, False

T or F: various colors are used by manufacturers to indicate the gauge and length of needles. There are no uniform guidelines for the color of needle shields.

True, False

T or F: administering the PSA block first is a good way to introduce the patient to less discomfort with local anesthesia because the injection does not contact bone and there is a relatively small area of soft tissue into which the local anesthetic is deposited.

True, False; statement correct, reason is not

T or F: the 25-gauge needle is safer for the patient because the smaller lumen provides ease of aspiration.

True, False; the statement is correct but the reason is not.

T or F: if repeated positive aspirations are observed at the same injection site, it may be necessary for the dental hygienist to consider postponing treatment because repeated penetrations in the same area can cause bleeding at the target location and increase risk of hematoma, trismus, postoperative pain, and infection.

True, both statement and reason are correct and related.

T or F: larger-gauge needles provide less tissue deflection during significant needle penetration because of the greater rigidity of larger gauge needles.

True, both the statement and reason are correct and related

T or F: the use of pressure anesthesia before, during, and after palatal injections to blanch the tissue is recommended to reduce patient discomfort. The overlying palatal tissue is dense and adheres firmly to the underlying bones of the palate.

True, both the statement and reason are correct and related

T or F: supraperiosteal injections are not recommended when several teeth in the quadrant need to be anesthetized because larger volumes of anesthetic would be provided and there is increased patient discomfort due to multiple penetrations.

True, both the statement and reason are correct and related.

T or F: unmetered sprays are not recommended because they do not allow control of the amount of anesthetic dispensed, nor are they easily contained at a specific site.

True, both the statement and reason are correct and related.

T or F: the FDA has released a Public Health Advisory alerting consumers to the potential risk of life-threatening or fatal reactions to over-the-counter topical anesthetics. Some of these over-the-counter topical anesthetics are available in concentrations twice the strength of those used in the dental office.

True,False

T or F: the administration of topical antiseptic is optional. Patients with an iron allergy should not be administered a topical antiseptic.

True,False

T or F: the most common cause of failed IA anesthesia is a deposition below the target area. The target area of the IA block is 8 to 12 mm above the mandibular occlusal plane.

True,False

T or F: the posterior mandibular sextant is denser and less porous than the mandibular anterior sextant, which allows for MORE clinically effective molar anesthesia

True,False

T or F: various colors are used by manufacturers to indicate the gauge and length of needles. There are no uniform guidelines for the color of the needle shields.

True,False

T or F:computer-controlled anesthetic devices are beneficial because they deliver exact amounts of anesthetic at a controlled rate. They are less ergonomic for the clinician.

True,False

T or F: since the greater palatine block does NOT provide pulpal anesthesia, the use of the middle superior alveolar block and/or posterior superior alveolar block is also indicated when instrumenting on the maxillary premolars.

True,false; statement is correct but reason is NOT.

T or F: Small bubbles (1-2 millimeters) trapped in the anesthetic cartridge are harmless because they are produced by nitrogen gas bubbled into the solution during the manufacturing process.

True; both the statement and reason are correct and related.

T or F: small bubbles (1-2 millimeters) trapped in the anesthetic cartridge are harmless because they are produced by nitrogen gas bubbled into the solution during the manufacturing process.

True; both the statement and reason are correct and related.

T or F: when infection is present, it is recommended to administer nerve blocks away from the area of infection because the acidic nature of the anesthetic deposited into acidic tissue from an infection decreases the ability of the anesthetic to readily dissociate for nerve penetration.

True; both the statement and reason are correct and related.

Which drug is most likely to exhibit a drug interaction with epinephrine?

Trycyclinc antidepressants

What is the minimum number of times a clinician should aspirate before administering the anesthetic solution?

Twice

The pulse rate is an important vital sign with respect to local anesthesia because it can identify a patient with ___________________.

Uncontrolled cardiac dysrhythmias.

In the administration of the greater palatine (GP) block, the needle is advanced _______.

Until the palatine bone is contacted

When the care plan involves anesthetizing two quadrants in a single visit, it is best to treat _______.

Upper and lower quads on the same side.

Each of the following is true regarding establishing a fulcrum while administering local anesthesia EXCEPT one. Which one is the EXCEPTION?

Use of the pt's arm to rest the syringe holding arm is acceptable. (a fulcrum must always be used, extraoral fulcrums are acceptable, if finger placement is not possible; arm to body support is acceptable)

All are ways that increase the risk of needle breakage EXCEPT one. Which one is the EXCEPTION?

Using a 25-gauge needle (Inserting into the hub Bending the needle Sudden directional changes)

All are acceptable ways to recap a needle EXCEPT one. Which one is the EXCEPTION?

Using fingers to recap the needle when the needle has not entered the pt's mouth. (The use of recapping devices Single-handed scoop method Using cotton pliers to recap the needle)

All of the following are strategies for when the clinician encounters bulky maxillary facial alveolar ridges EXCEPT one, which one is the EXCEPTION?

Utilize the palatal injections

All of the following are strategies for when the clinician encounters bulky maxillary facial alveolar ridges EXCEPT one. Which one is the EXCEPTION?

Utilize the palatal injections

The mandibular nerve or third division is a branch of which cranial nerve?

V

Which of the following is the appropriate action with a patient who has a true sulfite allergy?

Vasoconstrictors should not be administered to this patient.

What is the most common medical emergency observed in the dental office?

Vasodepressor syncope

While administering the inferior alveolar block, the clinician contacts bone at a depth of approximately 10 millimeters on an average size adult patient. What should the clinician do next?

Withdraw the needle and reinsert with the syringe barrel more anteriorly.

While administering the inferior alveolar block, the clinician does NOT contact bone. What should the clinician do?

Withdraw the needle and reinsert with the syringe barrel more posteriorly.

After arriving at the deposition site, you decide to redirect your needle to achieve effective anesthesia. Which of the following is an appropriate action?

Withdraw the needle completely, change the direction of the needle, penetrate, and readvance to the target location.

When do most reactions or dental emergencies associated with the administration of local anesthetic happen?

Within 5 minutes of the procedure.

The syringe designed to deliver a "virtually painless" injection of local anesthesia is the

computer-controlled anesthetic delivery device (CCLAD).

A needle with a ____________ is recommended for its ability to provide less deflection, greater accuracy, less needle breakage, and a more accurate aspiration.

larger gauge; 25

Surface anesthesia is _______ and limited to _______.

short lasting, the area of application.