Local

unexpected variation
aberrant innervation

expected variation
accessory innervation

divided nerves
bifid

accessory to mandibular incisors
cervical nerve plexus

hard tissue restricting flow of anesthesia
dense bone

response to drug based on time of day
diurnal body rhythms

soft tissue restriction to flow of anesthesia
inflammation

chemical barrier to anesthesia success
fascial planes

accessory innervation to mandibular teeth
mylohyoid nerve

drug tolerance
tiachyphylaxis

Devices used for delivery of local anesthetic solutions have very little impact on local anesthesia failure
True or False
True they do have little impact

Dental hygiene procedures require less duration of anesthesia than restorative procedures
True or false
False
They do not always require less

needle bevel orientations are not considered critical to the success of any injection
True or False
True they are not critical to success

I.A. nerve blocks may be unsuccessful when the needle penetration is lateral the the sphenomandibular ligament
True or False
FALSE it is not lateral to

a 25 gauge needle has less potential for deflection than a 27 gauge needle, although deflection is not a common cause for anesthetic failure
True or false
true 25 gauge do have less deflection than 27

nerve blocks typically require a similar volume of anesthetic solution to achieve profound anesthesia
True or false
False nerve blocks require more

a pH of lower than 3.3 can lead to failure of anesthesia because the solution is too acidic
True or False
True ph of lower than 3.3 lead to failure

aberrant innervations are expected anatomical variations
True or False
False accessory are expected
aberrant are not

fibers from the greater palatine nerve may provide accessory innervation to the palatal roots of maxillary molars
True or false
true fibers provide innervation to molars

PDL injections can overcome nearly all of the challenges that occur due to accessory and aberrant innervation
True or False
True pdl injections do

the higher the gauge of a needle, the greater its what is
flexibility and deflection in tissues is

a cartridge of anesthesia with a vasoconstrictor hsould have a pH of no lower than
3.3

tissue inflammation contributes to less anesthetic failure because the pH of the tissue is what compared to normal
less than normal

dense bony prominences, shallow vestibules, dilacerations, and soft tissues such as ligaments create what kind of barriers
physical

tachyphylaxis is most likely to occur once anesthetized tissues have returned to what of sensations
normal levels of sensations

inadequate anesthesia may typically be caused by all of the following except
quality of manufactured solutions

which of the following factors is most likely to correspond to anesthetic failures
physical and chemical barriers

which of the following does not have an effect on the ability to achieve profound anesthesia in the presence of inflammation
choice of topical anesthetic

which of the following is the best procedure to follow in the presence of inflammation
select an injectionthat will provide conduction blockade on the nerve trunk away from the area of inflammation

which of the following nerves is often considered most likely cause of accessory innervation to mandibular first molar
mylohyoid

which of the following injection would least likely solve inadequate anesthesia on the palate root of tooth #3
Facial infiltration

the gow gates is successful in providin ganesthesia for the mandibular molars in the presence of accessory innervation from the mylohyoid or lingual nerves because
it anesthetizes the IA nerve trunk higher in the pterygomandibular space

mepivicaine plain solutions may be used for reinjection following the use of lidocaine 2% with epi for all of the following EXCEPT
it is a strong vasodilator

True or False
A patient with severe systemic disease is classified as ASA IV
FALSE classified as ASA III

True or False
If a patient is described as ASA III due to blood pressure levels, recommended dental treatment may be initiated provided that intraoperative monitoring of blood pressure is considered and the patients are referred to physicians within one month
True ASA III dental treatment may be done but monitoring must be done also and physician must be seen within one month

True or Fale
A score of 18 on Corah’s Dental anxiety scale indicates mild fear
False
An 18 is high fear

True or false
a pulse oximiter attached to the patient’s finger may detect the presence of methemoglobinemia
True pulse oximiters can detect methemoglobinemia

Following a relatively severe heart attack, how long should elective dental treatment be delayed?
six months after a heart attack

Epinephrine is contraindicated in a patient with what
uncontrolled hypothyroidism

a petient with chronic obstructive pulmonary disease requiring oxygen is classified as ASA what
ASA IV

a patient with well-controlled NIDD is classified as
ASA II

what is the maximum recommended dose of epinephrine for patients in category AMC III with cardiovascular disease
0.04 mg

according to the 2007 AHA guidelines, which of the following conditions does not require antibiotic premedication for the prevention of infective endocarditis
hemophillia

following a CVA or a TIA how long should elective dental treatment be delayed
Six months after a stroke

Which of the following are initial signs and symptoms of methemoglobinemia
gray cyanosis of mucous membranes, lips, nail beds

which of the following local anesthetic drugs may represent a relative contraindication for patients with compromised liver functions
lidocaine

A patient with asthma is classified as ASA type
Asthma is ASA II

a patient with congestive heart failure is classified as ASA type
CHF is ASA III

patients with poorly controlled diabetes may have a relative contraindication to the use of
epinephrine

nerve fiber that releases adrenaline
adrenergic

smooth muscle contraction
Alpha receptor

cardiac stimulation
beta 1 receptor

smooth muscle relaxation
beta 2 receptor

adrenal gland neurotransmitters
catecholamines

adrenaline
epinephrine is adrenaline

synthetic catecholamine
levonordefrin is synthetic

vasoconstrictor not used in dentistry
norepinepnrine is not used in dentistry

mimics sympathetic mediators
sympathomimetic mimics

contains a nitrogen atom
amide

body’s management of a drug
biotransformation

positively charged ion
cation

pKa
dissociation constant

removal of drug by kidneys
elimination

50% of a drug is removed from circulation
elimination half-life

identifies chemical natrure of local anesthetic drug
intermediate chain

uncharged molecule
neutral base

effect of local anesthetic drug on nerve membrane
specific receptor theory

restricts vascular flow
vasoconstrictor restricts vascular flow

which of the following is Not a desirable characteristic of local anesthetic drugs
distributed easily

during normal nerve function which ion is easily displaced when a membrane is stimulated
calcium is easily displaced

which portion of the local anesthetic molecule passes through the nerve membrane
base

which percentage is bupivicaine found in
0.5%

why do manufacturers manipulate the pKa’s of local anesthetic drugs
clnically useful onset time of anesthesia

what factor decreases the effectiveness of local anesthesia when tissues are inflamed
inflammatoin causes a decrease in pH of surrounding tissues

what factors influences the shift of the neutral base form (RN) of local anesthetic molecules to the cation form (RNH+) whitin the axoplasm
H+ ions are sufficently available in the axoplasm at a pH of 7.4

which portion of the local anesthetic molecule binds to receptor site inside the nerve membrane, preventing depolarization
cation

prilocaine is biotransfomed by the
liver, kidneys, and lungs

ester-type local anesthetic drugs are biotransformed in the
blood by pseudocholinesterase

elimination of half life refers to the time it takes for half of the drug to be
out of the circulation

MRD stands for
maximum dose recommended that can be safely administered in most situations

what is the clnically safest available diluction of vasoconstrictor with lidocaine
1:100,000

what is the primary site of biotransformation of lidocaine
liver

what percentage is prilocaine
4%

what percentage is procaine
3%

what percentage of lidocaine is excreted by the kidneys unchanged
10%

what is known for the sulfur ring
bupivicaine

what is lidocaine’s pregnancy factor
pregnancy factor B

name the atom present in the ring structure of articaine that helps to make it more lipophilic
sulfur

Mepivicaine is a weak or strong vasodilator
weak vasodilator

what type is the shortest time for lido (%)
Lidocaine 2% plain is the shortest

which formulation of articaine is correct
4% articaine with 1:100,000 epi

the maximum recommended dose for lidocaine is
300 mg per appointment

what is the target for the IA
mandibular foramen

a minimum of what ml of anesthetic solution is required for an IA nerve block due to large diameter of the nerve
1.5 ml of solution for the IA

True or False
lingual is usually given with IA
False lingual only given when needed

True or False
Buccal is usually given with IA
False buccal only given when needed

the depth of insertion for a mental nerve block is typically how many mm
4-6mm

the optimum site of penetration for infiltration injections is at the
hight of the mucobuccal fold closest to the tooth apex being anesthetized

the deposition site for an infiltration injection is where
at the apex of the tooth

an anatomical variation that can complicate an MSA injection is the presence of a large
zygomaticoalveolar crest

the optimal site of penetration for an ASA injectin is at the hight of the mucobuccal fold what to the canine eminence
anterior to the canine eminence

the needle pathway of an MSA injection parallels the long axis of the
maxillary second premolar

which of the folowing is an anatomical barrier to the success of an infiltration technique
large exostoses

studies have demonstrated the absence of the MSA nerve in
50-72% of individuals

what anatomical feature may restrict the penetratoin site for an MSA injection
zygomaticoalveolar crest may restrict penetration

True of False the rate of deposition of a solution for all palatal injections should be 0.4ml over 40 seconds
False the rate should Not be .4 over 40 seconds

True or False
The gate control theory suggests that pressure anesthesia blocks the stimulation of non nociceptive fibers
FALSE
blocks the response of nociceptive fibers

True or False for palatal injections, if swelling or blanching occurs, withdraw the needle and choose another penetratin site
FALSE slow it down to stop blanching and swelling

True or False
the penetration site for a GP injection is in the fossa located anterior to the GP foramen
True gp injection is in the fossa located anterior to the gp foramen

the two-step method for pre-anesthesia for palatal injections includes a one-minute application of topical anesthesia and
firm pressure for a subsequent minute

which statement correctly describes a precaution when using 4% local anesthetic for a palatal injection
reduce total volumes by 50%

which one of the folowing is the most important consideration for palatal local anesthetic procedures
adminster solutions slowly

which of the following best describes the nerves anesthetized by AMSA nerve block
ASA, MSA, NP, GP nerves all anesthetized by AMSA

the field of anesthesia for an AMSA nerve block includes
pulpal anesthesia of the cental and lateral incisors, canine, premolar, and palatal tissue to the midline through the molars; and frequently the buccal periodontium of the pulpally affected teeth

terminal fibers of the GP nerve overlap the
nasopalatine nerves

which statement best describes the penetration site for GP
slightly anterior to the greater palatine foramen

the two most important safety steps in the delivery of local anesthetic agents are
rate of delivery and aspiration

True or False
smaller gauge used for deep penetration because of less flexible and larger lumen provides for ease of accuracy
TRUE
smaller gauge better for deep penetratin and larger lumen provides ease of accuracy

True or False
Heat causes sediment in cartridge
True heat causes sediment

true or false
a cartridge with bubbles should be disgaurded
true bubbles hsould be thrown out

what injection deposits local anesthetic near larger terminal nerve branches
field block

what injection deposits local anesthetic near major nerve trunks at a greater distance from the area of treatment, which provides wider areas of anesthesia
nerve block

what is the primary reason a needle bevel is oriented toward bone during injection
to reduce trauma to periosteum when bone is contacted

which statment describes the correct positioning of the long window of the syringe
toard the clinician to permit visibility through the injection

which stament best describes why retractoin of tissue keeping th etissue taut is important during injection
it allows for ease of needle penetration and establishes a point of stability for the syringe

which stament correctly describes a false-negative aspiration
rotating the syringe slightly a quarter turn and reaspirating will release the bevel from a vessel wall

glass cylinder
cartridge

32 mm
long needle

22mm
short needle

holloow part of needle
lumen

aspiratoin and administer slowly is most important true or false
true aspiration and administer slowly

the strength of nerve impulses weakens as the energy transfers from one section of nerve membranes to the next
true or false
false

the electrical potential of a nerve axoplasm in the resting state is approximately -70 mV
true or false
true approx. -70

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