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Local Anesthetic Review 8 Homestudy Credit Hours Anthony S. Mennito, D.M.D. The Academy of Dental Learning is an ADA CERP Recognized Provider. Table of Contents Table of Contents ........................................................................................................................ 9 Objectives .................................................................................................................................. 10 Introduction ............................................................................................................................... 11 History of Local Anesthetics ................................................................................................... 12 Neurophysiology ....................................................................................................................... 13 Pharmacology ........................................................................................................................... 14 Anesthetic Action ..................................................................................................................... 15 Uptake, Distribution, and Elimination ..................................................................................... 16 Systemic Effects of Local Anesthetics ..................................................................................... 16 Pharmacology of Vasoconstrictors ........................................................................................ 17 Topical Anesthetics .................................................................................................................. 19 Selection of Anesthetics .......................................................................................................... 21 Toxicity ...................................................................................................................................... 23 Epinephrine Overdose ............................................................................................................. 25 Armamentarium ........................................................................................................................ 26 Syringes ................................................................................................................................... 26 Needles.................................................................................................................................... 27 Cartridge .................................................................................................................................. 28 Preparation of the Syringe ....................................................................................................... 28 Patient Evaluation ..................................................................................................................... 29 Injection Techniques ................................................................................................................ 31 General Injection Technique .................................................................................................... 31 Maxillary Anesthesia ................................................................................................................ 33 Mandibular Anesthesia ............................................................................................................ 36 Other Mandibular Nerve Block Anesthetic Techniques ........................................................... 38 Complications ........................................................................................................................... 42 Pain on Injection ...................................................................................................................... 42 Paresthesia .............................................................................................................................. 42 Hematoma ............................................................................................................................... 42 Trismus .................................................................................................................................... 43 Infection ................................................................................................................................... 43 Facial Nerve Paralysis ............................................................................................................. 44 Broken Needles ....................................................................................................................... 44 Latest Updates in Local Anesthesia ....................................................................................... 45 Electronic Dental Anesthesia ................................................................................................... 45 Lidocaine Patch ....................................................................................................................... 45 9 Objectives Upon completion of this course, the student will be able to: • Explain the action of a nerve. • Explain the action of local anesthetic drugs on nerves. • Describe different techniques of local anesthe tic administration, and what teeth are affected by each injection. • Identify the toxicity level for all anesthetic medications used. • Identify symptoms of complications that may result from administration of local anesthesia and the treatment for each. • Understand the rationale behind the use of a lternative forms of anest hesia, including sedation and electronic dental anesthesia. 10 Introduction Pain control is the fo undation of successful dental pat ient management. Go od injection technique is essential f or consistent anesthesia. Dental professionals licensed to administer local anesthesia (Dentists and some Dental Hygieni sts) must use the medications available to them with caution and confidence. The patient's psychological state must be evaluated before the administration of any anesthesia. A relaxed, confident patient will respond better to local anesthesia. An anxious or phobic dental patient may require some type of intervention strategy to relieve the stress before administering anesthesia. Other co nsiderations such as the health of the tissue (presence or absence of infection) and deviation from normal anatomy must be assessed as well. This course is a review of currently accepted practices for dental local anesthetic administration. This course will not lead to licensur e of local anesthetic ad ministration. The student should be knowledgeable about head and neck anatomy and basic emergency medical procedures for the dental office, including CPR. 11
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