Local Anesthesia
Dental
enters tooth through apical foramen and divide into many small branches within pulp provides pulp innervation
T/F a 27 gauge needle has smaller lumen than a 30 gauge?
false
T/F you can use the patient's arm for a hand rest
false, face or chest
T/F inferior alveolar nerve block has a low percentage of failures
fasle, high and lower success rate
What does the lingual nerve innervate?
floor of mouth and gingiva on lingual surface of mandible
Mandibular division exits skull through.....
foramen ovale- into infratemporal fossa
Maxillary division exits skull through.....
foramen rotundum- into pterygopalatine fossa
LA prevents both the ______ and _______ of a nerve impulse
generation and conduction
Palatal Anesthesia injections
greater palatine nasopalatine local infiltration
Greater/lesser palatine nerve
hard and soft palate, lingual gingiva
Saltatory conduction
impulse conduction occurs by leaps from node to node
At the mental foramen the inferior alveolar nerve branches into what 2 branches?
incisive nerve mental nerve
ASA teeth and tissues anesthetized?
incisors canines premolars facial soft tissue mesiobuccal root of 1st molar
Only want to use the method of LA that does what?
induces transient and completely reversible state of anesthesia
Lingual nerve parallels what nerve?
inferior alveolar anterior and medial
Which branch is the largest of V3?
inferior alveolar nerve
Mandibular injections
inferior alveolar nerve block buccal nerve block mental/incisive nerve block
Maxillary injections
infiltration PSA MSA greater palatine nasopalatine ASA
Myelin
insulating lipid layer
trigeminal nerve provides sensory innervation to all _____, ______, and _______ of the oral cavity
teeth, bone, and soft tissues
Interradicular
terminate in the PDL at root furcations
Ophthalmic has how many branches?
3
ASA
anterior teeth and facial tissues
Maxillary has how many branches?
4
Pterygopalatine fossa consists of how many nerves?
4
Rotate syringe how far before 2nd aspiration?
45 degrees
Most adverse reactions occur within.....
5-10 minutes
Patient position for LA
supine with feet slightly elevated
Topical provides anesthesia of outermost ______ mm of mucousa
2-3
1.8 ml cartridge should be administered in what amount of time?
1 minute
The mandibular division gives off branches in 3 areas....
1. from the undivided nerve 2. from anterior division 3. from posterior division
Infraorbital canal consists of how many nerve?
2
ASA anesthetizes what nerves?
ASA, MSA, and infraorbital
The neuron transmits message between what?
CNS and all parts of the body
T/F the posterior division is primarily motor with small sensory component
False, primarily sensory with small motor
Field block
LA deposited near the larger terminal branches
MSA
MB root of 1st molar, premolars, and buccal tissues
Nerves of infraorbital canal....
MSA and ASA
Does LA act on the PNS or the CNS
PNS, does not alter consciousness
Outermost layer of myelin consists of.....
Schwann cell
T/F mandibular division contains both sensory and motor roots
True, sensory is larger
3 branches of the trigeminal nerve
V1 - ophthalmic V2 - maxillary V3 - mandibular
In repolarization what is terminated?
action potential
PNS
afferent and efferent
Greater palatine nerve block
aka anterior palatine
Nerve block
anesthetic deposited close to main nerve trunk
The lingual nerve is sensory to.....
anterior 2/3 of tongue sensation and taste
Intravascular injection
aspirate to avoid this
Posterior division descends to what branches?
auriculotemporal nerve lingual nerve inferior alveolar nerve
CNS
brain and spinal cord
Buccal nerve provides sensory to ______ of mandibular molars and skin of cheek
buccal gingiva
sensory root makes up the ________ of the ganglion cells in the _______ganglion
central processes, trigeminal
Mental nerve divides into 3 branches that innervate skin of ______ and mucous membrane of _______ and buccal mucous membrane anterior to mental foramen from _________ to midline
chin lower lip second premolar
Peripheral process
composed of free nerve endings most distal segment of the neuron
Maxillary branches in what four areas?
cranium pterygopalatine fossa infraorbital canal face
Polarized
creates negative charge in cell and positive charge outside cell
What are the 3 types of nerves in the dental plexus?
dental, interdental, interradicular
Inside of cell is positively charged, outside is negatively charged
depolarization
Primary effect of LA occurs during what?
depolarization
Sodium channels open during _______ and close during _______
depolarization, repolarization
The posterior division descends _______ and _______ to external pterygoid muscle and branches
downward and medially
2 ganglia of the trigeminal nerve innervate what?
each side of the face
Infiltration anesthetizes....
large terminal branches of dental plexus, pulp and root area of tooth, buccal periosteum, connective tissue, mucous membrane
What gauge needles are recommended when greater risk for positive aspiration?
larger gauge
Buccal nerve gives off branches to _____ and _____ muscles
lateral pterygoid, masseter
The inferior alveolar nerve parallels ________, then descends posterior to _______ and enters the mandibular canal
lingual nerve, lingual nerve
Nerve membrane consists of 2 layers of....
lipid molecules
Definition of LA
loss of sensation in a circumscribed area of the body caused by the depression of excitation in the nerve endings OR inhibition of conduction process in the peripheral nerves
Superior Dental Plexus
made up of smaller nerve fibers from the 3 superior alveolar nerve (PSA, MSA, ASA)
Which nerve is the largest of the three divisions
mandibular nerve, V3
Anterior division provide motor to _______ and sensory to ______ of cheek and ________ of mandibular molars
mastication, mucous membrane, buccal mucous membrane
Posterior superior alveolar nerve
maxillary molars and buccal tissues except mesiobuccal root of 1st
Mental nerve exits the mandibular canal through what?
mental foramen
The inferior alveolar nerve travels to ________ and gives off dental branches along the way
mental foramen
Impulses
messages or action potentials
Inferior Alveolar Nerve block
most frequently used in dentistry
trigeminal nerve is made up of small ________ root and larger _______ root
motor, sensory
Nerve conduction
nerves carry message from one part of the body to another
Gaps between schwann cells are called what?
nodes of ranvier
Depolarization
occurs in response to stimulus
Greater palatine nerve block anesthetizes.....
palatal hard and soft tissues distal to the canine and medially to midline
Nasopalatine nerve
palatal mucosa for canines through central incisors
Deposit several drops of anesthetic before touching what?
periosteum
What are the 3 major portions of the sensory neuron?
peripheral process axon cell body
Incisive nerve stays in canal and forms a _______ that innervates pulp of ______, ______, _____
plexus incisors, canines, premolars
Resting state
polarized- no stimulus to nerve
The nerve membrane is selectively permeable via.....
pores and channels
Blood in cartridge is a.....
positive aspiration
Cell body
provides metabolic support for entire neuron
Repolarization
return to resting state
What type of technique is used for capping the needle
scoop technique
Sensory transmits what?
sensation of pain the the brain
What are the 2 basics types of neurons?
sensory and motor
PNS is mechanism through which _________ about ______ state and _______ environment is relayed to the _______ and _______
sensory information internal and external brain and spinal cord
Afferent is ______, Efferent is _______
sensory, motor
Zygomatic nerve
skin on side of forehead, skin on prominence of cheek
infiltration
small terminal nerve endings in the dental tx. area are flooded with L.A.
LA sets up a chemical roadblock between what?
source of the impulse and the brain
Neuron
structural unit of the nervous system
Ophthalmic division exits skull through....
superior orbital fissure
Length of the needle depends on what?
the injection
Axon
thin cable-like structure transmits impulses to CNS
Action potential
transient depolarization of membrane which leads to brief increase in permeability of membrane to Na+
Nasopalatine has a reputation for being what?
traumatic
Interdental
travel in radicular bone between teeth to provide sensory innervation to PDL
What is the largest cranial nerve?
trigeminal nerve
T/F maxillary nerve blocks have a better success rate versus mandibular nerve blocks
true
T/F myelinated nerves conduct impulses faster than unmyelinated nerves
true
T/F we want to prevent depolarization?
true
Nerve membrane blocks diffusion of what?
water soluble molecules
Nerves of pterygopalatine fossa....
zygomatic nasopalatine greater/lesser palatine posterior superior alveolar