1. mechanical trauma
2. low temp
3. anoxia
4. chemical irritant
5. neurological agents
6. chemical agent

1. Acidic pH
2. rapid injection
3. LA solution maybe too warm

1. Inject slowly
2. store @room temp

Cause

-Numbness that lasts for days or hours causes

-Nerve trauma due alcohol contaminated or the needle nicking

Prevention

-adherence to injection technique and proper care handling of dental cart.

Management

-most resolve w/in 8wks

Lockjaw related to LA

**Prolong spasm of the jaw muscle by which the normal opening of the mouth is restricted

Causes

Trauma to muscle/blood vessels

Prevention

sharp needle

management

heat therapy, analgesives, muscle relaxer

-Nicked blood vessels that rarely produces significant damage caused by improper technique

 ***PSA most common

 ***IA 2nd most common

1. Always use the smallest amount of LA necessary
2. Inject slowly
3. Always aspirate

1. age
2. weight
3. presence of disease
4. genetic

1. cocaine
2. benzocaine
3. tetracaine

plasma

pesudocholin esterase

1. Articaine
2. bupivicaine
3. dibucaine
4. etidocaine
5. lidocaine
6. mepivicaine
7. prilocaine

Benzocaine

Lidocaine

Tetracaine

-Ester

-It has a high risk of systemic toxicity and rapid absorption

Understand

RN + H→RNH

ester-plasma

amide-liver

1. epinephrine
2. norepinephrine
3. levonordefin

Name 3 short acting LA.

How long should they last?

•  
  • Lidocaine 2%
  • Mepivicaine 3%
  • Prilocaine 4%
  • 30min

Articaine 4% 1:100

 Articaine 4% 1:200

Lidocaine 2% 1:50

Lidocaine  1:100

Lidocaine 1:200

Mepivicaine 2% 1:20

Prilocaine 4% 1:200

60min

Bupivicaine .5% 1:200

Etidocaine 1.5% 1:200 (NO LONGER USED)

2% = 36mg

4% = 72mg

Novocaine/procaine

What cranial nerve makes up the trigeminal nerve?

V1

V2

V3

 V1 is ........only and known as the .........nerve. It has the largest/smallest nerve division  and is/is not significate in dentistry.

1. Sensory Only
2. Opthalmic
3. Smallest division
4. Not significate in dentistry

Talk about V2

Is it sensory or motor

What size is it concidered

Where does it exit the cranium

Where does it come out in the facial bones

1. Sensory
2. Intermediate
3. exits cranium through the foramen rotundum
4. comes out of the face via infraorbital canal/foramen

Now name 4 things about V3

(3)

Biggest division

Motor root/sensory division

exits from: foramen ovale

thickest 25

 27

thinnest 30

27 gauge ultrashort w/ maricaine 1:200

15-30sec onset

IA: Molars to midline

-pulpal

-buccal soft tissue from the premolars to the incisors

L: Lingual soft tissue

3/4 long needle

4/5 short needle

1. contralateral premolars 
2. pterygomandibular raphe
3. occlusal plane
4. "tissue window"

1. Transient facial paralysis
2. High number of aspirations
3. Trismus of the medial pterygoid muscle
4. Hematoma

Buccal soft tissue only

molar to premolar

1cm above the occlusal plane and medial to the external oblique ridge

or

In the facial vestibule at level of buccal cusps distal to last molar

Easy technique

Many ways to do this injection

What is anesthetized when doing a incisive/mental combination?

(I/M)

incisive: premolars to midline

mental: buccal soft tissue lower lip and chin

Ballooning of tissues

possible hematoma around mental vessels

Adv: High success, good cross over

Disadv: Ballooning tissues/hematoma

1. mesial lingual cusp of the 2nd maxillary molar
2.  tragus of the ear
3.  head and neck of the condyle

Penetration: distal to the terminal molar above the ML cusp of that last molar

Deposit: lateral region of the condylar neck

1 to 2 carps

or

1.8ml to 3.6ml 

Advantages- high success, good for crossover innervation

Diadvantages-not easy to see landmarks

What anatomy is anesthetized using the Akinosi technique?

(AK)

• molars to midline
• pulpal buccal/lingual soft tissue
• mylohyoid

• 27 gauge long
• 3/4 of the length

Penetration: Distal to the terminal molar at the height of the mucogingival junction

Deposit: medial of ramus higher than IA but lower the G-G

Adv: one injections for IA, L, and LB when the mouth cannot open

Disadv: hard to see penetration

• Pulpal
• Soft tissue
• Nerve endings in areas being injected 

Gauge: 30 gauge extra short or ultra short

Penetration: base of the pocket until resistance is met

Base of the pocket

.2ml

Advatages: min. dose w/o getting other structures numb

Disadv: Leakage of anesthetic related to diffuculty with depositing LA 

Molars-all but the MB root of the 1st molar

pulpal and buccal soft tissue

25 or 27 gauge short

penetrating 1/2 to 3/4

Describe the site of penetration/depsite for PSA injections.

Also how much is deposited?

• Site of penetration: distal buccal root of 2nd molars, 45 to occlusal plane, 45 to midsagittal, 45 to long axis
• Depostion: Posterior surface of the maxilla
• 3/4 carp

• Trimus of lateral pterygoid
• hematoma
• mandubular anesthesia if angle is too flat

Adv: Atramatic, high success, less injection

Disadv: Hematoma, trismus, may need 2 injections

Premolars

pulpal/soft tissue

MB root of 1st molar

Discribe the site of an MSA injection and the site of deposit.

How much LA should be injected for a MSA?

Penetration: above the 2nd premolar at the muccobuccal fold

Deposit: Above the 2nd premolar

1/4 carp.

Adv: No fear of eye demage

Disadv: Nerve not always present

(only 28% of pop has this nerve)

canine eminence

mucobucal fold

lateral and canine

Where is the site of penetration and deposit for ASA injections?

How much should be deposited?

Penetrations: Above the lateral angle towards the canine fossa

Deposition: 1/4 of a carp near the canine fossa

Hematoma of the anterior facial vein

Hitting the nasal spine

Adv: Easy technique

Disadv: Discomfort if the nasal spine is hit

At the muccobucal fold along the long axis of the tooth just above the tooth being anesthetized

The LA would be deposited at the apex of the tooth

Adv: easy technique, can limit to one tooth

Disadv: not good substitute for block or quad

What is the site of penetration and deposit for Gp injections?

How much should be deposited?

Penetration: Between 1st and 2nd molars 1/2 way between gingval margin and midsagittal suture.

Deposit: Just anterior to palatine foramen

1/4 carp or until you see blanching

balloon tissue

anesthesia of soft tissue(less palatine nerve)

Adv: Minimizes both volume and needle penetration

Disadv: Soft tissue may be anesthetized, hard to swallow

Landmark: incisive papilla

Penetration: Either side of incisive papilla

Amount: .3ml or until you see blanching

Deposit: Just anterior to nasopalatine foramen

Adv: Minimizes both volume and needle penetration

Disadv: Discomfort, hard to place solution