la midterm

17. How many cartridges of prilocaine 4% with epinephrine can a 130-lb patient with significant cardiovascular disease receive?

C. Priliocaine formulation with 4% is 1:200,000 Cardiac patient max Epi = 0.04. 1 carp 1:200,000 = 0.005mg in 1 ml x 1.7 ml = 0.0085mg epi in 1 carp (0.04/.0085 = 4.7carps) closest is 4.4carps (max carps for cardiac pt is 4.4)

calculating MRD in mg, cartridges, mL

(1) % of solution times 10 (2) multiply by 1.7 = mg of anesthetic per cartridge (3) multiply lb by mg/lb (4) divide (total form answer 3) by (total answer from answer 2) = maximum number of cartridges (5) multiply (total from answer 4) by 1.7 = maximum number of mL

Positive aspiration

Blood entering the cartridge following an aspiration test indicating the needle tip is within a blood vessel.

2. What does 2% local anesthetic solution mean?

D. A 2% solution contains 2 g (2000mg) of anesthetic per 100 ml of solution or 20 mg per 1 ml solution.

Jet injector

Needleless syringe that delivers anesthesia to mucous membranes at high pressure.

16. What is the absolute maximum dose of bupivacaine?

D. MRD bupivacaine = 90mg in one appt. (0.9 mg/lb) Max dose per weight = 100lbs x 0.9 = 90mg

20. What is the MRD for 0.5% bupivacaine for a 102-lb patient?

D. MRD for 0.5% Bupivacaine = 0.9mg x 102 mg = 91.8mg which exceeds the absolute max of 90mg.

4. Where is the target area for local anesthetic deposition of the agent located when administering a supraperiosteal injection? A. Cervix of the tooth B. Height or depth of the mucobuccal fold C. Between the mucoperiosteum and bone D. Between the gingival tissue and bone

Height or depth of the mucobuccal fold

MRD mg/lb

Lidocaine: 3.2 mg/lb (500 mg max) Mepivacaine: 3.0 mg/lb (400 mg max) Prilocaine: 4.0 mg/lb (600 mg max) Articaine: 3.2 mg/lb (500 mg max) Bupivacaine: 0.9 mg/lb (90 mg max)

Armamentarium

Local anesthetic supplies, materials, and devices needed to successfully administer a local anesthetic.

When soft tissue anesthesia is needed in a limited area, it is best to preform a what? A. Supraperiosteal B. Local Infiltration C. Nerve Block D. Surface anesthesia

Local infliltration

Silicone rubber stopper

Located at the bottom of the anesthetic cartridge, where the harpoon is embedded.

10. How many more milligrams of mepivacaine can be administered to this patient?

MAX MRD for Lidocaine = 448. MAX MRD for Mepivacine = 400mg. Already gave 85 mg. (1.7ml x 20mg lido = 34mg lido in one carp x 2.5carps) 400-85 = 315mg of Mepivicaine can be given

This part of the anesthetic carpule is penetrated by the harpoon: A. The diaphragm B. The rubber stopper C. The yellow platerm-53stic cap D. The needle shield

the rubber stopper

All of the following are the benefits of establishing a fulcrum during the administration of local anesthetic, except one A. To ensure safe comfortable injections B. To ensure proper aspiration without needle movement C. to provide more stability D. To clearly see a positive aspiration

to clearly see a positive aspiration

Intraosseous (Intraseptal) injection

used when there is a need for additional hemostatic control with the interdental periodontuim and gingiva higher levels of vasoconstrictor can be used can use in either dental arch

2% solution

20 mg/1 mL

Visual analog scale (VAS)

An instrument used to measure pain.

Depositing anesthetic agent should be done quickly to promote patient comfort. A. True B. False

False

Bevel

The angled surface of the needle tip.

1 cc

1 mL

Vasoconstrictor Dosage Volume

1:20,000 = 1/20 = 0.05 mg/mL x 1.7 = 0.085 mg/carp 1:00,000 = 1/100 = 0.01 mg/mL x 1.7 = 0.017 mg/carp 1:200,000 = 1/200 = 0.005 mg/mL x 1.7 = 0.0085 mg/carp 1:50,000 = 1/50 = 0.02 mg/m: x 1.7 = 0.034 mg/carp

MRD mg vasoconstrictor

1:50,000 Epi: 0.2 mg, cardio pt 0.04 mg 1:100,000 Epi: 0.2 mg, cardio pt 0.04 mg 1:200,000 Epi: 0.2 mg, cardio pt 0.04 mg 1:20,000 Levo: 1 mg, cardio pt 0.2 mg

14. What is the cardiac dose for levonordefrin?

A. The cardiac dose of levonordefrin is 0.2 mg per appointment.

Cardiac dose

A vasoconstrictor dose that can be administered safely to patients with ischemic heart disease.

13. Assuming the maximum dose was administered, how many milligrams of epinephrine were administered to this patient?

A. 0.017mg lidocaine in one carp x 2.5 = 0.0425 mg 1:100,000 = 0.01 mg/ml x 1.7 (1 cartridge) = 0.017 mg epi in 1 carp 0.017 (epi per 1 carp) x 2.5 carps used = 0.0425 mg epi administered There is no epi. In the Mepivicaine.

9. What is the MRD for mepivacaine?

A. 140 lbs x 3 = 420 mg MRD.****** (Absolute MRD for Mepivacaine for one appointment = 400) SO THE ACTUAL CORRECT ANSWER TO THIS QUESTION IS 400mg!

12. How many more milliliters of mepivacaine can be administered?

A. 6.2 carps x 1.7ml (in one carp) = 10.5 mL (usually not significant to know ml totals)

During the pre-anesthetic assessment, what are appropriate clinical considerations? A. Vitals sings B. Length of appt C. Anticipated postoperative pain control D. All are important considerations

All are important considerations

Breech-loading

Allows the glass anesthetic cartridge to be inserted into the syringe through the side of the barrel.

Cartridge

Contains the sterile local anesthetic drug and other contents.

Needle shields

Covers that protect the needle that is inserted in the tissue, as well as the cartridge penetrating end of the needle.

6. How many cartridges of prilocaine 4% can a healthy 150 pound patient receive?

D. 150 lbs x 4 = 600mg MRD. Cartridges = 1.7 x 40mg in 1 carp = 68mg in 1 carp. 600/68 = 8.8 carps.

5. How many cartridges of lidocaine 2% 1 : 100,000 epinephrine can be safely administered to a 120 pound patient taking tricyclic antidepressants?

B. A patient taking tricyclics is a relative contraindication to the use of epinephrine. It is recommended that the patient receive a lower dose of epinephrine similar to the cardiac dose. Therefore, for a a 1:100,000 dilution of epi. The patient can safely receive 2.2 cartridges of 2% lidocaine.

11. How many more cartridges of mepivacaine can be administered to this patient?

B. 315 mg mepivacaine can be given divided by 51mg (amt of mepivacaine in 1 carp) Mepivacaine 3% = 30mg/ml 1.7 x 30 = 51mg 315 mg (already given) divided by 51 mg (in 1 cart) = 6.17 or about 6.2 carps maximum (select 6 carps as answer)

1. The cardiac dose of epinephrine is:

B 0.04 mg

Following the local anesthetic procedure, what information is important to document? A. Anesthetic used and amount in cartridge B. Anesthetic used and amount in mg C. Vasoconstrictor used and amount in cartridge D. Vasoconstrictor used and amount in mg E. B and C only F. B and D only

B and D only

15. How many milligrams are in one cartridge of 4% articaine?

B. 1.7 ml x 40mg (4% x 10 = 40mg) = 68 mg

7. What is the MRD for lidocaine?

B. 140 lbs x 3.2 = 448 mg (USE 1.7 ml in cartridge) Max is 500 mg

8. How many milligrams of lidocaine did the dental hygienist administer?

B. 2.5 cartridges x 34 mg (in one cartridge 1.7 x 20mg (2% lidocaine)) = 85 mg

19. What is the absolute number of milligrams of epinephrine 1 : 50,000 a patient with significant cardiovascular disease may receive?

C. Max epi dose with Cardiac disease = 0.04mg. 1:50,000 epi = 1mg /50ml = 0.02 mg x 1.7 = 0.034mg (1 carp) if 0.006 more that would equal 0.04. Therefore 1 carp of 0.034mg is max.

Topical anesthetic should be applied after the application of a topical antiseptic. Topical antiseptic can be sued to decrease infection. A. Both statements are true B. Both statements are false

Both statements are true

Pulling the tissue taut before needle insertion helps all of the following, except? A. Visibility B. ease of needle insertion C. ease of needle penetration through the tissue D. Burning sensation felt by the patient

Burning sensation felt by the patient

3. The dental hygienist administered 2.3 cartridges of 3% mepivacaine. How many cc were administered?

C. (Recalculate using 1.7 ml and NOT 1.8 ml) Remember cc's are the same as mL. Since 2.3 cartridges of mepivacaine 3% was administered, you must take the number of cartridges administered and multiply by 1.7 (since there are 1.7 mL in one cartridge of anesthetic) to get the number of ml administered. 2.3 x 1.7 = 3.91 ml (ccs = mls) = 3.91

18. The dental hygienist administered three cartridges of mepivacaine 3% to a 170-lb patient. How many more cartridges of mepivacaine can the dental hygienist administer to complete the treatment?

C. 170lb patient. MRD = 170 x 3.0 mg/lb= 510mg *However, absolute MRB = 400 per appointment. Mepivacaine 3% = 30 x 1.7 mL = 51 mg (per carp) 51mg x 3 (carps already used) = 153. 400mg (max amount) - 153 mg (already used) = 247 mg (left to use) 247 divide by 51mg = 4.84 carps left to use

Anterior superior alveolar (ASA) block

Commonly used with MSA instead of using an infraorbital blockterm-47 Anesthetizes the pulp of the maxillary canine and the incisor teeth, the associated periodontium, gingiva, and facial soft tissue Needle gauge and length: 27-gauge, short. Landmarks: Canine eminence, canine fossa, maxillary mucobuccal fold, maxillary canine. Needle insertion point: Height of mucobuccal fold at apex of maxillary canine. Depth of needle penetration: Approximately 5 mm or one-fifth the depth of short needle. Deposit location: Superior to apex of maxillary canine. Amount: Approximately 0.6 to 0.9 mL or one third to one-half cartridge (based on 2% solution; if using 4% solution, reduce the amount to at least one-half amount of 2% solution). Length of time to deposit: Approximately 30 to 40 seconds.

Computer-controlled local anesthetic delivery device (CCLAD)

Computerized local anesthetic delivery system that controls the amount and rate of administered anesthetic.

Following a positive aspiration, the dental hygienist must always change the cartridge and redo the procedure. A. True B. False

False

Converting vasocontrictor volume to Max Carps

Healthy Patient 1:50,000 (epi) = 0.2 mg / 0.034 = 5.8 carps max 1:100,000 (epi) = 0.2 mg / 0.017 = 11.7 carps max 1:200,000 (epi) = 0.2 mg / 0.0085 = 23.5 carps max 1:20,000 (levo) = 1.0 mg / 0.085 = 11.7 carps max Cardiac patient 1:50,000 (epi) = 0.4 mg / 0.034 = 1.1 carps max 1:100,000 (epi) = 0.4 mg / 0.017 = 2.3 carps max 1:200,000 (epi) = 0.4 mg / 0.0085 = 4.7 carps max 1:20,000 (levo) = 0.2 mg / 0.085 = 2.3 carps max

Maximum recommended dose

Highest amount of drug that can be safely administered per appointment to a patient depending on their physical health.

10. If the clinician wanted to anesthetize teeth #9-11, and associated buccal and lingual gingival tissue, it would be BEST to administer which of the following local anesthetic blocks? A. Infraorbital block only B. Infraorbital and nasopalatine blocks C. Infraorbital and greater palatine blocks D. Anterior superior alveolar and middle superior alveolar blocks

Infraorbital and nasopalatine blocks

2. When performing maxillary nerve anesthesia, which is the ONLY local anesthetic block that requires the clinician to contact bone with the needle to ensure success? A. Infraorbital block B. Anterior superior alveolar block C. Middle superior alveolar block D. Posterior superior alveolar block

Infraorbital block

Surface anesthesia can be achieved by all of the following EXCEPT one. Which one is the exception? A. Gels B. Cream C. Sprays D. Injections

Injections

Lumen

Inner tubular (channel) area of an anesthetic needle.

Greater palatine (GP) block

Innervate greater palatine nerve Anesthetize: Lingual gingival tissue of maxillary premolars and molars and posterior hard palate in one quadrant (no pulpal anesthesia)

Hemostat

Instrument used in dentistry to retrieve small items, such as broken needles.

4. What is the MRD dose of 2% lidocaine for a 120-lb patient?

Multiply the patients weight by the number of mg/lb for the selected anesthetic. For lidocaine, the number of mg/lb is 3.2. Therefore, 120 x 3.2 (MRD in lbs for lidocaine) = 384

3. Which block is MOST appropriate to successfully anesthetize the buccal tissue of the maxillary premolars? A. Greater palatine block B. Nasopalatine block C. Anterior superior alveolar block D. Middle superior alveolar block

Middle superior alveolar block

6. Which of the following local anesthetic blocks anesthetizes the mesial buccal root of tooth #3 in ONLY 28% of the population? A. Greater palatine block B. Nasopalatine block C. Anterior superior alveolar block D. Middle superior alveolar block

Middle superior alveolar block

5. 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. A. Both the statement and the reason are correct and related. B. Both the statement and the reason are correct but NOT related. C. The statement is correct, but the reason is NOT. D. The statement is NOT correct, but the reason is correct. E. NEITHER the statement NOR the reason is correct.

NEITHER the statement NOR the reason is correct.

Aspiration test

Negative pressure placed on the anesthetic syringe prior to the deposition of anesthetic to determine if the tip of the needle rests within a blood vessel, observed by absence or entry of blood into the cartridge.

The dental hygienist will provide nonsurgical periodontal therapy of teeth #18 to 24. Which injection administration technique should the dental hygienist use? A. Supraperiosteal B. Local Infiltration C. Nerve Block D. Surface anesthesia

Nerve block

Crossover-innervation

Overlap of terminal nerve fibers from the contralateral side.

Safety syringe

Plastic disposable syringe that decreases the risk of accidental exposure to the clinician from contaminated needles.

Syringe adaptor

Plastic or metal adaptor that provides a means to attach the needle to the syringe.

9. Which local anesthetic block listed below requires the needle insertion point to be at the height of the mucobuccal fold, superior to the apex of the maxillary second molar? A. Infraorbital block B. Anterior superior alveolar block C. Middle superior alveolar block D. Posterior superior alveolar block

Posterior superior alveolar block

Negative pressure

Produced when the thumb ring of a syringe is pulled back, causing retraction of the rubber stopper producing an aspiration test.

Nasopalatine (NP) block

Provides anesthesia to the anterior hard palate Bilaterally from mesial of the right first premolar to the mesial of the left first premolar Recommended when lingual soft tissue anesthesia is needed from canine to canine, including the palatal bone and the lingual gingival tissue.

After removing the needle, what is the immediate next step? A. Rinsing the patients mouth B. Documenting the producer C. Recapping the needle D.Monitoring the patients reaction

Recapping the needle

Posterior superior alveolar (PSA) block

Recommended for pulpal anesthesia of the molar teeth and associated periodontium. It is recommended that the PSA block be given before any of the other maxillary facial injections or palatal injections to allow the necessary time for the larger molars to become completely anesthetized. PSA Enters Distal of Maxilla @ 1cm (1/2") above MB Apex of 2nd Molar depth of penetration is 16 mm Importance of Aspiration Major Blood Vessels are located Superior to PSA Foramen Maxillary Artery Pterygoid Plexus

Harpoon

Sharp tip attached to the internal end of the piston of an aspirating syringe that embeds into the silicone rubber stopper allowing retraction for an aspiration test.

Piston

Solid metallic cylinder of the anesthetic syringe attached to the thumb ring that displaces anesthetic solution when positive pressure is exerted on the thumb ring.

What is the recommended patient position when administering anesthesia? A. Supine B. Semisupine C. Upright D. Head below heart level

Supine

If the dental hygienist wants to anesthetize tooth #12, which injection administration technique should the clinician use? A. Supraperiosteal B. Local Infiltration C. Nerve Block D. Surface anesthesia

Supraperiosteal

What type of injection administration technique is the anterior superior alveolar (ASA)? A. Supraperiosteal B. Local Infiltration C. Nerve Block D. Surface anesthesia

Supraperiosteal

Hematoma

Swelling that develops when a blood vessel, particularly an artery, is punctured or lacerated by the needle.

Middle superior alveolar (MSA) block

Teeth anesthetized - Maxillary first and second premolars and mesiobuccal root of maxillary first molar in 28% of population Other structures anesthetized Periodontium of anesthetized teeth and buccal soft tissue of premolar region Landmarks: Maxillary mucobuccal fold and maxillary second premolar. Needle insertion point: Height of mucobuccal fold at apex of maxillary second premolar. Needle gauge and length: 27-gauge, short. Depth of needle penetration: Approximately 5 mm or one-fifth the depth of short needle. Deposit location: Superior to apex of maxillary second premolar

Absolute maximum dose

The absolute maximum dose that any patient can receive per appointment, regardless of their weight.

7. Which of the following structures does the infraorbital local anesthetic block anesthetize? A. The teeth and periodontium in either the upper left or upper right quadrant B. The teeth and peridontium in the entire maxillary arch C. The anterior and middle superior alveolar nerves in one maxillary quadrant D. The anterior and middle superior alveolar nerves in both maxillary quadrants

The anterior and middle superior alveolar nerves in one maxillary quadrant

Deflection

The deviation in direction of the anesthetic needle from its intended path.

Gauge

The diameter of the tubular lumen (channel) of the needle.

Limiting drug

The drug that limits the total amount of volume delivered based upon the patient's medical status.

Shaft

The length of the needle comprised of long tubular metal.

Hub

The location of the shaft of the needle that joins and secures the needle to the syringe adaptor.

Penetrating end

The part of the needle shaft that passes through the hub and penetrates the rubber diaphragm of the cartridge.

8. Where is the target area located for the posterior superior alveolar local anesthetic block? A. The posterior superior alveolar nerve as it enters infratemporal fossa B. The posterior superior alveolar nerve as it exits the ptergopalatine fossa C. The posterior superior alveolar nerve as it exits the parotid salivary gland near the facial nerve D. The posterior superior alveolar nerve as it enters the maxilla through the posterior superior alveolar foramina

The posterior superior alveolar nerve as it enters the maxilla through the posterior superior alveolar foramina

1. Anesthesia of the maxillary teeth is MORE successful than the mandibular teeth BECAUSE the maxillary bone overlying the teeth is more dense. A. Both the statement and the reason are correct and related. B. Both the statement and the reason are correct but NOT related. C. The statement is correct, but the reason is NOT. D. The statement is NOT correct, but the reason is correct. E. NEITHER the statement NOR the reason is correct.

The statement is correct, but the reason is NOT

Needle adaptor

Threaded tip of the syringe that allows the attachment of the needle to the barrel of the syringe.

What is the main goal of aspirating on two planes? A. To determine if the bevel of the needle is abutting against a blood vessel providing a false negative aspiration on the first aspiration test. B. To determine definite backwards movement of the ribber stopper C. To determine id disengagement of the harpoon occurred D. To provide the clinician a second chance to see if a clear bubble entered the cartridge

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? A. to decrease the amount of anesthetic that would be administered B. To ensure the harpoon is fully engaged into the rubber stopper C. to ensure the rubber stopper is not sticky D. To ensure free flow of anesthesia through the needle

To ensure a free flow of anesthetic through the needle

What is the minimum number of times a clinician should aspirate before administering the anesthetic solution? A. once B. twice C. zero D. Four

Twice

Nerve block

Type of injection that anesthetizes a larger area than the local infiltration because the local anesthetic agent is deposited near large nerve trunks.

Supraperiosteal injection

Type of injection that anesthetizes a small area—one or two teeth and associated structures—when the local anesthetic agent is deposited near terminal nerve endings. Recommended when pulpal anesthesia is needed target area is the apex of selected tooth

Anterior middle superior alveolar (AMSA) block

Type of injection that anesthetizes most of the maxillary teeth and their associated periodontium as well as most of the facial and lingual gingival tissue in one quadrant

Infraorbital (IO) block

Used when nesthesia is needed for maxillary anterior teeth in one Anesthetizes: pulps of the maxillary teeth - Central Incisors to mesiobuccal root of the first molar, Buccal hard and soft tissue overlying these teeth, Lower eyelid, lateral aspect of the nose and upper lip Needle insertion point: Height of mucobuccal fold, superior to maxillary first premolar. Depth: Approximately 16 mm or one-half depth of long needle or three-fourths of short needle. Deposit location: Superior rim of infraorbital foramen until bone is gently contacted. Amount of anesthetic: Approximately 0.9 to 1.2 mL or one-half to two-thirds cartridge (based on 2% solution for adult). Length of time to deposit: Approximately 60 to 90 seconds.

What is the most common medical emergency observed in the dental office? A. Cardiac arrest B. Vasodepressor syncope C. Seizures D. Respiratory failure

Vasodepressor syncope

After the patient has consented to treatment, when is a good time to communicate with the patient to alleviate fears of needle injection? A. After the procedure is over so as to no distract the clinician from the procedure B. When preparing the equipment C. When inserting the needle D. When preparing the tissue for injection

When preparing the needle

Finger grip

Winged or wingless component of the syringe that allows the clinician to hold and control the syringe.

When do most reactions or dental emergencies associated with the administration of local anesthetics happen? A. Before the procedure B. When the patient gets home C. Within 5 minutes of the procedure D. Within 1 hour of the procedure

Within 5 minutes of the procedure