Ch. 9 local anesthesia

Bubbles in the cartridge that are larger than ____mm are a warning that the anesthetic cartridge has been frozen. They can be present in the cartridge with or without the rubber stopper extended beyond the glass rim. These cartridges should NOT be used and should be discarded because the ________ of the LA cannot be guaranteed

2, sterility

The _____ gauge needle is safer for the patient because the lumen is larger, providing easier access for blood to enter the cartridge during the aspiration procedure

25

Needles used for intraoral injections are available in gauge sizes ____, ___, ___,

25, 27, 30

Burning on injection This is a normal reaction to the LA agent having a lower pH (____-____) than the tissues ______ in which it is administered. This sensation only lasts a couple of _______ until the anesthetic takes effect and is noted primarily on _______ patients and when the anesthetic is deposited on _____ teeth

5-6, 7.4, seconds, sensitive, anterior

What are some needle problems that can occur during or after the injection?

Pain on insertion, pain on withdrawal, needle stick exposure to the clinician, and needle breakage

With the Wand STA or Wand CompuDent systems the patients typically experience _______ injections. Although there is still a minimal sensation of the needle insertion, the actual anesthetic administration is precisely controlled and ________

Painless

The Wand handpiece can be modified to any preferable length by snapping off portions of the plastic handpiece at any of the preformed indentions. This modification is particularly useful for clinicians with small hands and when administering ______ injections

Palatal

The manufacturer inserts product identification info in every local anesthetic container. This provides the clinician with important information concerning the anesthetic agent, including dosages, warnings, precautions, care, and handling, and more. Practitioner should review the product inserts _______ as this info can change

Periodically

The ________ passes through the finger grip and attaches to the thumb ring of the syringe.

Piston

Routine maintenance of reusable syringes To ensure reliable aspiration, the ______ and _______ should be replaced if the harpoon loses its sharpness and readily disengages from the rubber stopper of the cartridge or if the harpoon is bent.

Piston and harpoon

A _________ version of the cartridge-type aspirating syringe is available for intraoral administration of local anesthetics

Plastic

The _______ syringe adaptor is not pre-threaded, any dental hygienist must simultaneously push and screw the needle onto the syringe. The advantages of this adapter include easy adaptation and bevel alignment with most syringes

Plastic

The purpose of the ________ is to add control over the syringe and to advance or retract the piston.

Thumb ring

What are the two basic types of finger grips? These also may be _________ to aid in establishing a firm grip

Winged and wingless, silicone-coated

What is an example of the safety syringe?

Ultra Safety Plus XL

What are some (all) of the types of local anesthetic syringes?

-Reusable breech-loading metallic cartridge-type aspirating syringe -Reusable breech-loading metallic cartridge-type self-aspirating syringe -Reusable breech-loading plastic cartridge-type aspirating syringe -Pressure syringe for periodontal ligament injection -Jet injector -Computer-controlled local anesthetic devices -Disposable safety syringes

The jet injector syringe delivers the anesthesia in measured doses of ______ to _____ mL to the mucous membranes. Because of the _______ pressure associated with the anesthetic administration, the patient may be startled by the force by which the anesthetic is delivered

0.05 to 0.2, high

The advantage of a pressure syringe is that it administers a measured dose of ______ mL of anesthetic, making it easier to express the solution against a tissue resistance

0.2

The width of each rubber stopper expels approximately _____ mL of solution, providing a means to determine the amount of anesthetic deposited when an entire cartridge is not administered

0.2

30 gauge outside diameter & lumen?

0.31 mm, 0.15 mm

27 gauge outside diameter & lumen diameter?

0.41 mm, 0.20 mm

25 gauge outside diameter & lumen diameter?

0.51 mm, 0.25 mm

Topical anesthetics are most effective if applied to the dry mucous membranes for ____ to ____ mins

1 to 2

The extra short needle is ____ mm, the short needle is ____ mm, and the long needle is _____ mm, as measured from the hub to the top of the needle

12, 20, 32

The _____-gauge needle has the largest needle and lumen diameter, followed by the ______gauge. The needle with the smaller diameter and lumen is the ____gauge

25, 27, 30

The ______ gauge needle is recommended for areas of high risk of positive aspiration, such as the ______ block and _____ block

25, IA, PSA

The Onset Mixing Pen device dispenses a standard _____ mL cartridge of sodium bicarbonate 8.4% USP buffer solution to a standard 1.8 mL cartridge of anesthetic with vasoconstrictor to mix the solutions.

3.0

A ______ gauge needle has the smallest lumen diameter, causing more needle deflection during insertion, decreased reliability during aspiration test, and increase pressure needed to administer the anesthetic agent. It may cause increased pain and tissue trauma

30

Extra short needles are available only in a ____ gauge

30

The majority of needle breakage incidences have occurred with _____ gauge short or ultrashort needles. It is recommended that the dental hygienist use ____gauge needles for all injections that penetrate significant soft tissue

30, 25

Needles used with the Wand handpiece are also available in the standard lengths: _____ gauge 1/2 inch, ______ gauge 1 inch, and ______ gauge 1 1/4 inch lengths. Needles are Pre bonded into the handpiece for single use (per patient visit).

30, 30, 27

The Dentapen permits three injection speeds: Fast (____secs/mL), medium (_____secs/mL), and slow (____secs/mL)

30, 50, 90

The standardized color coded bands are required by the ______ for all LA cartridges to receive the _______ Seal of Approval

ADA

_________ the piston allows the clinician to embed the harpoon into the silicone rubber stopper at the bottom of the cartridge

Advancing

The silver-colored ___________ fits securely around the rubber diaphragm, keeping it in place

Aluminum cap

The ______ of the bevel in relation to the long axis of the needle may have an effect on the amount of needle deflection when significant tissue is penetrated, such as which the ____ block

Angel, IA

There are three main components to the __________ of anesthetic equipment and supplies: The aspirating syringe, the disposable hypodermic needle, and single-dose anesthetic cartridge

Armamentarium

The first intraoral local anesthetic syringe was introduced by Cook Laboratories in 1921, and considerable improvements have been made since then, with the most important improvement being the addition of the ________

Aspirating harpoon

There are three main components to the armamentarium of anesthetic equipment and supplies: _________, _________, and the _______

Aspirating syringe, disposable hypodermic needle, single dose anesthetic cartridge

__________ _______ are accomplished by pulling back on the thumb ring of the syringe to create negative pressure within the cartridge. This action determines whether the needle tip rest within a blood vessel, as observed by the absence or entry of blood into the cartridge

Aspiration tests

Certain criteria have been developed by the Council in Dental Material and Devices of the American Dental Association for the acceptance of LA syringes that include the following. -Syringes should provide for effective ________ and be constructed so that blood may be easily __________ in the cartridge

Aspiration, observed

A plastic version of the cartridge-type aspirating syringe is available for intraoral administration of local anesthetics. The syringe is ______ and _________ _________. This also applies for the metallic version.

Autoclavable, chemically sterilizable

If the injection is administered properly, there is no need to ______ the needle to reach the target location. ______ the needle compromises the integrity of the needle and increases the risk of breakage. Therefore the needle should never be ______ by the clinician.

Bend, bending, bent

Although needle breakage is rare when needles are properly used, the incidence of needle breakage is increased by?

Bending needle before injection, sudden direction changes, forcing needle against resistance, inserting the needle to the hub, or using 30 gauge needles

The dental hygienist may observe a corroded aluminum cap (white debris) if it has been immersed in quaternary compounds such as ________ used for "cold sterilization ". Disinfection of the cartridge can be accomplished by using an approved ADA disinfectant lightly applied to a gauze square.

Benzalkonium chloride

Topical antiseptics?

Betadine or Merthiolate

The ______ of the needle is the angled surface of the needle tip that is directed into the tissue providing a cutting surface that offers little resistance to mucosa as the needle penetrates and withdraws from the tissue

Bevel

What are the components of a needle?

Bevel, shaft, hub, cartridge-penetrating end, syringe adaptor

An injection technique to help reduce needle deflection is called ______. This technique, which is similar to acupuncture, uses a back-and-forth rotational movement of the handpiece or needle to advance the needle into the tissue. This technique can completely eliminate needle deflection regardless of needle length or gauge

Birotational insertion technique (BRIT)

Local anesthetic cartridges are packaged in boxes containing ___________ of 5 or 10 units of 10 sealed cartridges

Blister packs

Commercially available cartridge warmers keep the LA agent at _____ temp. It has been reported by many dental professionals that this promotes patient ______ during the administration of the LA. Overheating the LA can cause a _______ sensation during injection and destroy the heat-sensitive vasoconstrictor drug and ________ duration of action

Body, comfort, burning, decrease

To increase patient comfort during injections that are administered in close proximity to the periosteum, the bevel of the needle should be turned toward the ____

Bone

because the shaft Of the 25 gauge needle is significantly stronger than it's dinner counterparts, needle _______ is considered minimized

Breakage

a broken cartridge can be a result of 2 things

Breakage during shipping and handling, excessive force during harpoon engagement

Problems with cartridges are _____ observed; however the dental hygienist may encounter the following:

Bubbles, extruded or sticky stopper, burning on injection, corroded cap, rust on cap, leakage during injection or broken cartridge

The ________ was designed to improve ergonomics and precision of local anesthetic delivery

C-CLAD

This Device was designed to replace the standard breech-loading aspirating syringe that requires the clinician to attempt to control the variables of drug infusion and needle movement in soft tissue

C-CLAD

This model is no longer marketed by Milestone scientific

C-CLAD

The __________ is the part of the shaft that passes through the hub and penetrates the rubber diaphragm of the cartridge, lying within the anesthetic aging of the cartridge

Cartridge penetrating end

The Wand STA unit accommodates any local anesthetic _________, a _________ patient use disposable handpiece, and a variety of needle ________ and ________

Cartridge, single, sizes and gauges

The glass local anesthetic ______ contains the sterile LA drug and other contents in a convenient single use dose. The glass tube allows the dental hygienist adequate ______ of delivered doses and aspiration tests.

Cartridge, visibility

Certain criteria have been developed by the Council in Dental Material and Devices of the American Dental Association for the acceptance of LA syringes that include the following. -syringes should be capable of accepting a wide variety of _______ and ________ of different manufacturers and permit related use

Cartridges, needles

Routine maintenance of reusable syringes Reusable syringes should be thoroughly ______ and _________ using appropriate infection control guidelines after each patient.

Cleaned and sterilized

The shield that covers the cartridge penetrating end is _____

Clear

In 1997, milestone scientific Inc. introduced the first __________ System as the __________

Computer controlled local anesthetic delivery (C-CLAD), CompuDent wand system

The Mylar plastic label on the body of the glass cylinder contains:

Contents, trade and generic drug names, drug concentrations, vasoconstrictor dilutions, expiration date, and manufacturers name

The Dentapen offers two modes of flow: ________ flow or gradual ________

Continuous, increase

The first intraoral local anesthetic syringe was introduced by __________ __________ in 1921, and considerable improvements have been made since then, with the most important improvement being the addition of the aspirating harpoon

Cook Laboratories

The following should be followed by the dental hygienist to minimize the risk of cross contamination: Needles should be immediately ____ by the protective shield, using the ________ method with a needle sheath prop or other recapping aids after the administration of the injection to prevent accidental needle stick with the contaminated needle

Covered, one-handed scoop

The greater the angle of the bevel, the greater the degree of the needle ________

Deflection

Because of the rigidity of the larger gauge needles, less ___ Occurs during significant tissue penetration. This provides greater _______ to the target location and increases the likelihood of _______ of the injection. This is a particular importance for the _____ block

Deflection, accuracy, success, IA

The administration of safe and effective local anesthesia depends on the anesthetic —— ——-

Delivery devices

The ________ is a battery operated, handheld C-CLAD device for the routine administration of local anesthesia. It allows the clinician the option of two different handles to be used either as a ________ syringe or as a ___________.

Dentapen, traditional, pen-style grasp

The gauge selection is determined by the ______ of the tissue being penetrated and the risk of _______ injection

Depth, intravascular

The needle is attached by passing it through the needle adaptor to the barrel and properly screwing it to the adaptor. The needle then penetrates the _______ at the top of the LA cartridge

Diaphragm

The rubber ______ is made of semipermeable material and is located at the top of the cartridge where the needle is inserted into the center of the rubber. Because the rubber is semipermeable, if the cartridge is improperly stored (ex. In disinfecting solution) the anes agent can be ________ by diffusion of the disinfecting solution into the cartridge

Diaphragm, contaminated

Needle breakage can occur if sudden ____ changes are made during the administration of the anesthetic especially when the needle is deeply embedded in tissue. If the needle must be redirected during the injection, the needle should be _______ almost completely from the tissue and the change in the direction can be safely made. The needle can then be readvanced to the target location.

Direction, withdrawn

____________ of the harpoon during injection can occur when the clinician retracts the thumb ring to achieve aspiration.

Disengagement

The Wand STA system incorporates ____________ Technology to provide real time continuous pressure feedback during the injection. _________ pressure at the tip of the needle is used to identify location or specific tissue type.

Dynamic pressure sensing (DPS), fluid

With the Wand STA, The clinician holds the feather light "Wand" Handpiece as if holding a pan, which gives SUPERIOR _______ control

Ergonomic

The burning sensation from LA agents, especially in those that contain a vasoconstrictor, is enhanced when an _______ agent is used. This can be avoided by carefully checking the expiration date before use

Expired

The thumb ring is attached to the ________ end of the piston

External

The _________ attaches to the barrel of the syringe and allows the piston to pass through and attach to the thumb ring.

Finger grip

The Wand STA and Wand CompuDent systems are activated by ___________, allowing the clinician to delicately hold the Wand handpiece. The rate of flow can be set as precisely as _____ drop every other ______ (slow rate, or the clinician can use the foot pedal to set the control rate at carious settings, including "cruise control".

Foot control, one, second

Cartridges arriving in damaged containers should be examined carefully for possible _____ or _____ in the cartridges.

Fractures or chips

Needle stick injuries typically occur how?

From inattention by the clinician or unexpected patient movement

The ______ is the diameter of the needle, and the______ is the hollow portion of the needle

Gauge, lumen

The needle length selection is based on the ______ needed and the amount of _______ that needs to be penetrated to reach the target location and to deposit the anesthetic successfully.

Gauge, tissue

Other methods to reduce surface bacteria before the injection include wiping the surface with ______ or having the patient preprocedural rinse with ________

Gauze, 0.2% chlorhexidine

The harpoon should be ______ engaged into the rubber stopper during syringe setup. Exerting excessive force may fracture the cartridge.

Gently

The ________ is the body of the cartridge and contains the anesthetic agent. It is capable of containing ____ mL of agent. However, once the rubber stopper is added, the net volume of anesthetic is reduced to a maximum ___ mL for all local anesthetic agents.

Glass cylinder, 2.0, 1.8

What are the cartridge components?

Glass cylinder, cartridge labeling, silicone rubber stopper, diaphragm, and aluminum cap

With the Dentapen, the _________ flow is excellent for PDL injections where the anesthetic flow will _______________ to provide a more painless PDL injection

Gradual increase, gradually increase

_______ fractures may not be easily identified.

Hairline

The _______ of the aspirating syringe is embedded into the rubber stopper, providing the clinician a means to aspirate.

Harpoon

The ________ of the aspirating syringe is a sharp tip attached to the internal end of the piston.

Harpoon

The _________ allows the anesthetic syringe to engage the silicone rubber stopper of the anesthetic cartridge. This addition introduced the important concept of aspirating before injecting local anesthetic agents to assess whether the location of the needle tip is within a blood vessel

Harpoon

This addition of part of the syringe ntroduced the important concept of aspirating before injecting local anesthetic agents to assess whether the location of the needle tip is within a blood vessel

Harpoon

________ or ________ should be part of the LA armamentarium in the rare incidence of a needle breakage. They aid in the retrieval of the needle fragment

Hemostat or cotton pliers

The disadvantage of the pressure syringe is the ________, and it may cause ________ to surrounding tissues when anesthetic is delivered under pressure

Higher cost, trauma

The ______ of the needle is The point where the shaft of the needle joins and secures the needle to the syringe adapter

Hub

The syringe adaptor and hub are frequently referred to as the _____

Hub

To assist a clinician in determining the location of the bevel, several manufactures are placing indicators of the bevel location on the _____ of the needle

Hub

The ______ and _________ are made of plastic or metal and provide a means to attach the needle to the syringe.

Hub and syringe adaptor

Breakage of the needle is most likely to occur at the ______ (weakest portion of the needle) if sudden movement of the syringe or patient occurs. The likelihood of needle breakage increases when the needle is inserted into tissue all the way to the ______. Moreover, if the needle breaks at the hub during the injection, the needle fragment will be embedded in tissue and _____ to retrieve

Hub, hub, impossible

For safety reasons, the needle should never be inserted to the ____. Although needle breakage is rare, a sufficient length of the shaft for any length must be _______ in the oral cavity during insertion to permit retrieval of the needle fragment in case of breakage.

Hub, visible

Long needles are required for the ______ block, the _________ mandibular block, and the _____ block, and they are preferred for the _______ block. This allows for adequate tissue penetration to reach the target and for sufficient length of the shaft to be visible.

IA, Gow-Gates, VA, infraorbital

It is recommended that the dental hygienist use a 25 gauge needle for injections that pose an increased risk for positive aspiration such as the _______, _______, and _________ and _______ blocks. However, the 27 gauge needle may be more readily available and is also acceptable. The 30 gauge needle is not recommended.

IA, PSA, mental and incisive

The use of a topical antiseptic before administration should be considered for patients who are _______

Immunosuppressed

Although it is possible to aspirate with smaller gauge needles (30), The smaller lumen does significantly _____ flow into the cartridge. It also requires more _________ by the clinician to adequately aspirate through the narrow lumen of smaller gauge needles. This makes it difficult to achieve a reliable aspiration, ________ The possibility of needle movement away from the target location, and _________ The likelihood that the harpoon will disengage from the rubber stopper during aspiration

Impede, pressure, increases, increases

Cartridges that have rubber stoppers that are not _______ slightly should be discarded because sterility of the anesthetic agent cannot be guaranteed.

Indented

Clinicians hold the syringe using the finger grip with the _____ and ______ fingers, providing the clinician stability and control of the syringe

Index, middle

Certain criteria have been developed by the Council in Dental Material and Devices of the American Dental Association for the acceptance of LA syringes that include the following. Syringes should be ________, ________, ______, and ______ to use with one hand.

Inexpensive, self-contained, lightweight, simple

Difficulty in controlling the variables of drug ______ and __________ utilizing the standard syringe can compromise the injection technique and patient comfort

Infusion, needle movement

The type of ________, how much _______ needs to be penetrated, and individual _______ will determine whether an extra-short, short, or long needle should be used and which gauge is appropriate.

Injection, tissue, preference

Patients may complain of pain during needle ______, this is usually caused by ______ needles after repeated needle penetrations. To prevent this problem, the dental hygienist should change the needle after _____ to _____ needle penetrations

Insertion, dull, three to four

Cartridges contaminated with disinfection solution and subsequently injected into the mucous membranes can produce an _______ burning sensation. This can also cause other problems such as _________ and tissue ________. Cartridges should NEVER be placed in disinfecting solution.

Intense, paresthesia, edema

The Wand STA system guides the clinician by the fluid exit pressure with spoken and/or audible sounds and visual feedback, enabling the clinician to identify accurate needle placement in the PDL space for _______________ injections

Intraligamentary

The dental hygienist should never bend the needle before use except for _________ injections

Intraligamentary

Pressure Syringes can also be used for _____ injections

Intraseptal

There are three main components to the armamentarium of anesthetic equipment and supplies: The aspirating syringe, the disposable hypodermic needle, and the single dose anesthetic cartridge. When handled correctly, this equipment will ensure that the dental hygienist can precisely administer the local anesthetic agent to the patient without risk of ____________ and __________

Intravascular injection and cross contamination

The dental hygienist may encounter the _________ syringe, which is used primarily for topical anesthetic of soft tissues before needle insertion or mucosal anesthesia of the palate

Jet injector

The ______ window should ALWAYS be in view of the clinician during administration of local anesthetics

Large

The smaller the gauge number, the __________ The diameter of the needle and the lumen.

Larger

__________ during injection is caused by a bent needle or the off center perforation of the needle penetrating end into the rubber diaphragm of the anesthetic cartridge, producing an oval puncture. When the anesthetic agent is administered, ________ through the diaphragm may occur. Dental hygienist should carefully examine the needle before syringe set up and insert the needle straight into the diaphragm to avoid this problem

Leakage

The significant components of the shaft are the ________ and the ______. The _______ is the diameter of the needle, and the size tubular _______(channel) of the needle is related to the gauge.

Length, gauge, gauge, lumen

Because conventional dental Syringes must be held with a palm thumb grasp, A ______ insertion technique is necessary and it's not permitted for the BRIT technique. However, the ________ system works ideally for the BRIT as the handpiece is lightweight and held with a pen like grasp that can be easily rotated

Linear, C-CLAD

The following should be followed by the dental hygienist to minimize the risk of cross contamination: The dental hygienist should know the ______ of the uncovered needle tip at all times, whether inside or outside of the patients mouth. If needle contamination occurs, the dental hygienist should _____ the needle using the method described and ____ it in the appropriate sharps container. A new sterilized needle should be placed to complete the injection

Location, recap, discard

________ needles are required for injections that require significant needle penetration of thick tissues to reach the nerve, such as the IA block, Gow-Gates mandibular block, VA block, and infraorbital block

Long

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

Long, short, extra short

The use of a vasoconstrictor and the sodium bisulfite preservative ______ the pH or the anesthetic even further than the anesthetic without a vasoconstrictor to between _____ and ______, which causes a burning sensation

Lowers, 3.0 to 5.5

Routine maintenance of reusable syringes After repeated autoclave by, the dental hygienist should dismantle and _______ all the threaded joints with a light oil

Lubricate

In addition to the Pre bonded Wand handpieces , Milestone Scientific also offers Wand handpieces without Pre attached needles. This handpiece requires ________ needles to be attached to the handpiece.

Luer-Lok

Routine _______ of reusable syringes is REQUIRED to ensure the long term efficiency of the device.

Maintenance

The jet injection technology is based on the principle of using a ___________ Energy source to create a release of pressure sufficient enough to push a liquid medication through very small orifices called _____, Creating enough force (2000 psi) that it can penetrate into the subcutaneous tissue without a needle

Mechanical, jets

The _________ syringe adaptor has a pre-threaded interior that allows for easy attachment to the syringe. A disadvantage of this adapter is that it can easily be unscrewed and when fully screwed is seated in one position, securing the bevel of the needle in One Direction and making it difficult to properly align the bevel toward the bone.

Metal

When the dental hygienist exerts pressure on the thumb ring, the entire cartridge moves forward, causing the elasticity of the rubber diaphragm to come in contact with the _________ and stretch the diaphragm. When the thumb ring is released, the cartridge springs back slightly, producing _________ pressure within the cartridge to achieve aspiration (self aspirating syringe)

Metallic sleeve, negative

The ________ is designed to be used with an Onset Cartridge Connector for the transfer of sterile fluids from one sealed container into a second sealed container. The connector provides a reservoir for collecting waste fluid displaced from the second container during the transfer process.

Mixing Pen

Although several bevel configurations are available for use in dentistry, the ________ point is considered to produce the most effective puncture while eliciting the least amount of tissue trauma

Multibeveled

The _______ also serves as protection to the patient and administrator in the event of glass breakage during the administration of anesthetic

Mylar plastic label

On the body of the glass cylinder, a _______ plastic label is applied by the manufacturer that lists the contents of the cartridge, trade and generic drug names, drug concentrations, vasoconstrictor dilutions, expiration date, and manufacturers name. Some manufacturers may include _______ indicators on the label to assist in determining the amount of agent deposited.

Mylar, volume

The ________ delivers the anesthetic agent from the cartridge to the surrounding tissues through its lumen.

Needle

What are the components of an anesthetic syringe?

Needle adaptor, syringe barrel, harpoon, piston, finger grip, thumb ring, guide gearing, spring

The __________ is located at the top of the syringe and is attached to the barrel of the syringe. The ________ tip allows the attachment of the needle to the barrel of the syringe.

Needle adaptor, threaded

_________ have an important role in protecting the clinician from needlestick injuries

Needle shields

___________ protect the needle that is inserted into the tissue, as well as the cartridge penetrating end of the needle

Needle shields

Aspirating tests are accomplished by pulling back on the thumb ring of the syringe to create __________ pressure within the cartridge. This action determines whether the needle tip rest within a blood vessel, as observed by the absence or entry of blood into the cartridge

Negative

Pulling back on the thumb ring provides ________ _____ by retracting the silicone rubber stopper and producing an aspiration

Negative pressure

The advantage and purpose of the harpoon is to provide ____________ inside the anesthetic cartridge when the thumb ring is pulled back, causing the rubber stopper to retract and produce an aspiration test.

Negative pressure

For complete pulpal anesthesia, _________ or ______ must be administered after the jet injector is used

Nerve blocks or supraperiosteal injections

Recently many manufacturers have been using ________ materials for the rubber stoppers and rubber diaphragms because latex allergies are becoming more common

Nonlatex

The following should be followed by the dental hygienist to minimize the risk of cross contamination: The dental hygienist should scoop the contaminated needle into the shield using ______ hand

One

What are the two types of thumb rings available?

One with a half moon and one with a thumb ring

The buffering process uses a sodium bicarbonate solution that is mixed via the _______ device with the cartridge of LA. This is a dispensing device used for mixing two solutions together during the buffering process.

Onset Mixing Pen

Intravascular injections rapidly produce high blood levels of drugs, potentially resulting in an anesthetic _________, but can be prevented by performing an __________

Overdose, aspiration test

The large window provides adequate room for breech loading cartridges to be inserted into the syringe and provides the clinician with direct vision of the cartridge during anesthetic administration. This is an important feature Bc any ________ aspiration that occurs during the injection can be seen

Positive

If the tip of the needle is within a blood vessel, blood will enter the cartridge , signaling a __________ to the clinician

Positive aspiration

When performing STA PDL injections, _________ needles are recommended because of the pressure involved with these injections.

Pre attached

With the C-CLAD, The drug is administered at a _________ flow rate, allowing the clinician to focus on the needle ___________ and _________ While providing the injection of local anesthetic

Preprogrammed, positioning and insertion

For added patient comfort, Milestone Scientific has developed a three stage technique known as ________, ________, and ________

Prepuncture, penetration, and delivery

Applying ______ to the thumb ring advances the piston to embed the harpoon into the silicone rubber stopper and pushes the anesthetic agent out of the cartridge through the needle.

Pressure

Injection _______ is created when the rubber stopper in the cartridge is depressed, creating a flow of anesthetic agent into the tissue. Injection ________ has been found to directly influence of patients perceived pain and anxiety level

Pressure

The correlation between the lumen size and patient comfort is related to the amount of ________ Needed to inject the anesthetic agent into the tissue.

Pressure

The lumen of the 30 gauge needle is smaller when compared to the lumen of a 25 gauge needle and therefore requires MORE ________ to be placed on the rubber stopper to inject the anesthetic agent into the tissue, causing tissue injury and pain. In contrast, it has been demonstrated that a needle with a LARGER lumen such as the 25 gauge needle, will ______ pain and tissue injury during anesthetic administration due to _________ pressure necessary to depress the rubber stopper

Pressure, reduce, decreased

The __________ syringe is used for the PDL or intraligamentary injections, and it provides reliable anesthesia for one tooth in the mandible

Pressure-type

The following should be followed by the dental hygienist to minimize the risk of cross contamination: Needles are ________ by the manufacturer and are _________. They should never be used on more than one person.

Presterilized, disposable

Needle breakage is _______; however, needle breakage usually occurs when the entire shaft of the needle is inserted up to the _____. This primarily occurs from exerted _________ pressure against the shank or sudden movement of the syringe or patient

Rare; hub, lateral

Disengagement of the harpoon during aspiration frequently produces a popping noise. Should this occur, the dental hygienist must ______, ______, ________

Remove needle from tissue, reengage the harpoon and redo the procedure

What is the most commonly used syringe for the administration of intraoral local anesthetics?

Reusable breech loading metallic cartridge-type aspirating syringe

LA cartridges should be stored in their original container at _______ temp in a _____ place. This keeps the cartridges clean and uncontaminated and prevents premature deterioration of the solution, particularly the oxidation of the ___________ drug caused by prolonged exposure to heat or direct sunlight

Room, dark, vasoconstrictor

The local anesthetic training needle known as the ________ was developed as a simple, safe, effective teaching aid for clinical instruction of local anesthesia. It is available in short and long needle lengths and resembles a standard dental LA needle with a safety ball tip that can be set up on a standard syringe. These needles are for single use and should be discarded in the sharps container utilizing usual protocol

Safe-D-Needle

Because of concerns regarding the risk of accidental exposure to the clinicians from contaminated needles after the administration of local anesthetics, the _______ syringe was developed as an alternative to the standard breech loading aspirating syringe

Safety

The _____ syringe is designed as a single use item that allows for reinjection using the same cartridge and reloading the syringe for additional anesthetic cartridges if needed. This provides an added advantage over standard syringes by _________ the risk or accidental exposure.

Safety, decreasing

The _____ syringe is a plastic, single use, or partially disposable syringe with short and long needle lengths. A plastic sheath on the syringe is retracted when the clinician is ready to administer an injection, and the sheath _____ over the needle upon removal of the tissue; the mechanism is easily activated by the clinician with one hand

Safety, locks

topical anesthetics can accomplish the ________ result as the jet injector at a fraction of the cost

Same

The _____ design of the bevel, similar to a surgical scalpel, has been reported to allow for needle insertion with less tissue displacement, thus requiring less force to penetrate the mucosa

Scalpel

The newer _______ design of the bevel can only be used for maxillary and PDL injection and is not recommended for any injection procedures in which a nerve may be directly contacted

Scalpel

The ——— of the needle is the length of the needle that consist of long tubular metal extending from the tip of the needle through the hub to the piece (cartridge-penetrating end) that penetrates the diaphragm of the cartridge

Shaft

The ______ the bevel, the less tissue resistance to the needle, and patient discomfort can be minimized.

Sharper

The following should be followed by the dental hygienist to minimize the risk of cross contamination: Contaminated needles should be properly disposed of after use in an approved _________. The sharps container should be properly disposed of according to _____, _____, and ______ regulations

Sharps container, federal, state, and local

The ______ (or plunger) is located at the bottom of the anesthetic cartridge and is slightly indented from the rim of the glass barrel. This is an important feature for the dental hygienist to observe when examining the cartridges before syringe setup.

Silicone rubber stopper

The pressure type syringe allows the clinician to achieve anesthesia of a ________ tooth in the _______ where supraperiosteal injections are unsuccessful because of the bone density, and IA block, or Gow Gates mandibular block, anesthetizes _______ teeth than needed for this procedure

Single, mandible, more

Because of the "________" design of the Wand hand piece, dental hygienists find it easy to grasp and handle during the injection. In addition, the hand piece can be modified to any preferable ________ by snapping off portion of the plastic hand piece at any of the preformed indentions

Slim line, length

The syringe barrel has ___________ and a _________ on opposite sides. The _____ window provides adequate room for breech loading cartridges to be inserted into the syringe and provides the clinician with direct vision of the cartridge during anesthetic administration

Small window, large window, large

The _______ allows the piston to be pulled back during the insertion of the cartridge and during appreciations aspiration tests.

Spring

All needed manufactured for dentistry are _________, __________, and _______

Stainless steel, presterilized, and disposable

The _________ syringe is held with a palm up grasp that is not designed for needle control during tissue penetration and proper ergonomics

Standard

With the pressure type syringe that allows the clinician to achieve anesthesia of a single tooth in the mandible, a _________ syringe can be used for this injection, but the tissue resistance necessitates more __________ strength to administer

Standard, muscle

Certain criteria have been developed by the Council in Dental Material and Devices of the American Dental Association for the acceptance of LA syringes that include the following. -syringes must be durable and able to withstand repeated _________ without damage (if the unit is disposable, it should be packaged in a ________ container)

Sterilization, sterile

A __________ stopper is caused by paraffin being employed during manufacturing. This has become less a problem because most manufacturers are currently treating the rubber stopper with ________. Storing cartridges at room temp can minimize this problem.

Sticky, silicone

Short needles are preferred for injections that require less soft tissue penetration to reach the target location, such as _________ injections

Supraperiosteal

The breech loading ___________ allows the glass anesthetic cartridge to be inserted into the syringe through the side of the barrel.

Syringe barrel

The following should be followed by the dental hygienist to minimize the risk of cross contamination: For patient comfort, the needle should be changed after approximately ____ to _____ injections in the same patient. The stainless steel becomes dull after ______ to _______ needle penetrations, causing tissue trauma and pain on insertion with each subsequent injection. The patient may also experience soreness when sensation returns.

Three to four

An alternative method, using a self aspirating syringe, uses a __________that, when pressed and released, produces negative pressure in a similar fashion as the thumb ring

Thumb disk

Each cartridge consists of a glass cylinder with a rubber diaphragm enclosed in a metal cap at the _____ of the cartridge and a silicone rubber stopper at the ______ of the cartridge

Top, bottom

A __________ may be applied to the tissue to reduce the possibility of surface microorganisms from entering the soft tissue, which could result in a post injection infection. This step is optional, & before application the patient must be first screen for possible ______ to iodine.

Topical antiseptic, allergy

In addition to the syringe, needle, and cartridge, supplemental equipment includes 7 things?

Topical antiseptic, topical anesthetic, applicator sticks, gauze, hemostat or cotton pliers, and needle capping aids

In addition to the syringe, needle, and cartridge, supplemental equipment includes _________, _____________, __________, __________, __________ or _________, & _________, all of which are also important to the effective delivery of local anesthetic agents

Topical antiseptic, topical anesthetic, applicator sticks, gauze, hemostat or cotton pliers, and needle capping aids

The bevel of the needle should be _______ the bone when administering injections in close proximity to the periosteum

Toward

A color-coded band in the Mylar plastic label on the glass cylinder also identifies the anesthetic drug container in the cartridge.

True

A common belief among practitioners is that the 30 gauge needle causes less needle insertion discomfort to the patient than the 25 gauge needle. However, numerous comparisons over the years have demonstrated that patients cannot discern the difference between a 25 gauge needle and a 30 gauge needle

True

Cotton-tipped applicator sticks are sued in the application of topical antiseptics and anesthetics. They are also recommended to provide pressure anesthesia during palatal injections.

True

It is critical for the dental hygienist to administer local anesthetics with an aspirating syringe. If the tip of the needle is within a blood vessel, blood will enter the cartridge through the lumen of the needle after a successful aspiration, informing the dental hygienist of a positive aspiration

True

Jet injector is not intended to replace the needle and syringe

True

Larger gauge needles (25) have several significant advantages over smaller gauge needles (30)

True

Needles are not designed to penetrate bone and should never be forced against resistance

True

Overheating of cartridges causes burning sensations upon administration. Warmers are NOT recommended, and LA agents should be kept at room temp

True

Red rust on the cartridge is an indication that a cartridge contained in the metal container has broken, depositing the anesthetic agent on the other cartridges within the container. This cartridge should not be used and should be discarded, and all other cartridges within the same container should be evaluated for rust

True

Some manufacturers are providing thumb ring designs with a textured silicone coating to enhance the clinicians grip and to prevent slipping

True

Syringes are available with different sizes of thumb ring to accommodate varying hand sizes

True

The LA cartridge should never be placed in alcohol or sterilizing solutions because the rubber diaphragm is permeable. This can cause contamination of the LA agent and corrode the aluminum cap

True

The local anesthetic does not need to be prepared before use if stored properly

True

There are no uniform guidelines for the color of needle shields. However, manufactures are consistent for their own color coding system

True

With needle shields, various Colors are used by manufactures to determine the Designated length and gauge of the needle that is inserted into the tissue

True

Clinicians with small hands may find the ______ hand piece easier to use because of the design and ultra lightweight features

Wand

Milestone scientific Inc. introduced the next generation to C-CLAD Systems as the ________

Wand STA

This handpiece can be less intimidating for the patient and can help alleviate the patients fear associated with the standard large metal syringe

Wand STA

The _________ and _________ systems precisely regulate the flow rate of the local anesthetic agent administered via a computer controlled module. In addition, the _________ technology regulates and monitors the pressure of the anesthetic agent.

Wand STA and Wand CompuDent, DPS

The ___________ can be used to perform all the standard dental injections for all routine dental treatments, including Nonsurgical periodontal therapy and newer described injections such as the AMSA, P-ASA, and STA-intraligamentary

Wand STA system

Currently, there are several C-CLAD Systems available in North America, including the: ________, ______, ________, _______, & _____

Wand STA, Calaject, EZ flow, Dentapen, and Anaeject

The patient may complain of pain when the needle is _______ from the tissue. This is usually caused by ______ on the needle tip, these can occur during manufacturing but are most likely to occur if the needle contacts bone forcefully during the injection. To prevent this, the needle should never be forced against any _____ surface during the injection.

Withdrawn, barbs, hard

the importance of _________ before anesthetic deposition and the potential hazards associated with ____________ injections are widely known and accepted

aspirating, intravascular

the importance of aspirating before anesthetic deposition and the potential hazards associated with intravascular injections are widely known and accepted. the ______ aids the clinician in performing this procedure without difficulty.

breech loading metallic cartridge type self aspirating syringe

with the smaller syringes made for smaller handed clinicians, the contoured thumb rings maximize _____ during aspiration

control

With the Wand STA, a pen like grasp allows clinicians to rotate the hand piece back and forth, using birotational insertion technique that eliminates needle ______ during needle penetration into tissue, resulting in accurate needle ________

deflection, placement

disengagement of the harpoon during injection can occur when the clinician retracts the thumb ring to achieve aspiration. this can be caused by a _____ harpoon, excessive pull on the ____, or _______ engagement of the harpoon during syringe setup

dull, thumb ring, improper

The dental hygienist should make certain that the _______ is fully engaged during aspiration to ensure that the proper technique has been accomplished

harpoon

Single use cartridges of anesthetic are inserted into the syringe through the ______ _________

large window

to help accommodate the differences in hand sizes, newer syringes have been manufactured to include choices of smaller syringes with smaller contoured thumb rings to facilitate the smaller handed clinician in performing sufficient aspirating techniques. the advantages of these syringes are that they are _______ and made of surgical grade ________ and ________, which REDUCES weight and hand stress, providing better ergonomic control during injection without compromising durability.

lightweight, aluminum, stainless steel

the self aspirating syringe achieves the negative pressure necessary for an aspiration without a harpoon. instead, the negative pressure is achieved by a ____ _____ at the base of the syringe that surrounds the needle penetrating end and rests on a rubber diaphragm in the cartridge.

metallic sleeve

During manufacturing, bubbles can be trapped in the cartridge that are either small or large. _______ is used during manufacturing of the LA to prevent oxygen from being trapped in the cartridge, potentially destroying the vasoconstrictor. ______ bubbles (1-2 mm) are harmless and produced by nitrogen gas bubbles into the solution during this process.

nitrogen gas, small

Why would burning on injection occur?

pH of the drug, cartridge contains a vasoconstrictor, overheated cartridge, expired agents, cartridge containing disinfecting solutions

the disadvantage of the smaller syringe is that the entire cartridge of anesthetic CANNOT be deposited because of the shorter length of the ___________. A small portion of the anesthetic remains in the cartridge and is ___________

piston, unusable

disengagement of the harpoon during injection can occur when the clinician retracts the thumb ring to achieve aspiration. this can be caused by a dull harpoon, excessive pull on the thumb ring, or improper engagement of the harpoon during syringe setup. this frequently produces a "________" noise, alerting the clinician of the disengagement.

popping

smaller syringes contain NO ________, so the needle adaptor cannot be loosened or removed

removable parts

if the harpoon becomes disengaged during the aspiration, the negative aspiration cannot be guaranteed and the dental hygienist must ______, _________, and ________. The needle must be placed back on the syringe, and the injection repeated.

remove the syringe from the patient's mouth, remove the needle, reengage the harpoon into the silicone rubber stopper

The gauze squares can assist in ____, _____, and _____

retraction, visibility, and stabilization

the _______ syringe achieves the negative pressure necessary for an aspiration without a harpoon.

self aspirating

the harpoon is embedded into the syringe through the __________, and the needle is affixed to the ____________

silicone rubber stopper, needle adaptor