The decision to use a pharmacologic agent for management of anxiety and pain is dependent upon?
- Periodontal health status
- the treatment being rendered
- and the patient’s pain threshold must all be considered. Pain threshold is highly individual and variable.
Indications for Local Anesthesia during Dental hygiene procedures?
- scaling and root planing in areas with probing depths of 4 mm or greater
- Extensive instrumentation with either manual or power-driven instruments
- Treatment in areas of challenging pocket topography, furcations, or other difficult root anatomy
- Instrumentation in areas of painful, inflamed soft tissue.
- Treatments that involve soft tissue manipulation: gingival curettage, suture removal, and removal of subgingival overhang.
- Treatment in areas of excessive hemorrhage.
Indications for Local Anesthesia regarding Patient factors?
- extent of patient’s disease and deposits directly influence the extent or rigor of the needed treatment.
- Patient’s pain reaction or pain threshold.
- Disposable, intended for single patient use. Parts and lengths of the needle are shown on the next slide. . Used for most injections. Ultra-short needle. Approximately 1/2 inch or 12 mm. Gauge or needle diameter. . They are preferred for accuracy when a long needle is needed. Aspiration. Larger-gauge needles provide easier and more accurate aspiration.
- Long needle. Approximately 1-1/2 inches or 40 mm.
- Short needle. Approximately 1 inch or 25 mm
Design features: durable metal or plastic can be sterilized and reused with the addition of a new needle and cartridge. Single-use, disposable syringes have safety features to prevent inadvertent needlestick after use. Provide good visibility of the cartridge. Promote easy aspiration: Manual aspiration is the traditional design. Self-aspirating syringe works well for small hands.
Cartridge or carpule:
Volume: 1.8 mL of solution in the United States. Storage. Store at cool room temperature and away from the light. Do not store in an alcohol or disinfectant solution. Label each cartridge: drug, manufacturer, and expiration date information. Color-coding: local anesthetic drug is identified by color on cartridge.
Armamentarium for local anesthesia?
- Cartridge or carpule
- Topical antiseptic
- Cotton gauze
- Needle recapping device
- Sharps disposal system
- 1. Threaded tip
- 2. Harpoon
- 3. Piston rod
- 4. Barrel of syringe
- 5. Finger grip
- 6. Finger bar
- 7. Thumb ring
- 8. Syringe assembled with needle and anesthetic
Cartridge or carpule Color-coding?
- Lidocaine (gold / gray)
- Carbocaine (red)
- which penetrates the rubber diaphragm
- which attaches the needle to the syringe (made of plastic or metal)
Gauge or needle diameter:
- Size. Ranked from largest to smallest, 25-, 27-, and 30-gauge needles are used in dentistry.
- Rigidity. 25-gauge needles are stiffer and deflect less as they penetrate the tissue
- or shank or shaft, which penetrates the oral tissue
The Dental anesthetic needle:
Dental needles are available in . Lengths vary slightly between manufacturers. The components of the needle are of the dental cartridge; so that anesthetic solution is deposited at the desired site.
Insert of needle:
shows an enlargement of the tip of the needle with sharp terminus and bevel. When giving an injection, the needle is oriented so that the bevel is parallel to the bone to help prevent the needle from catching the periosteum, the sensitive covering over the bone.
Pre-procedural Rinse = prevent post injection infections
Cotton tip applicator
- wipe the injection site to clean, dry, and remove the topical anesthetic
- improve grasp for lip or cheek retraction
Needle recapping device:
self-recapping needle is not used.
Sharps disposal system:
to meet safe practice standards for used needle disposal
Sequence for assembling a breech-loading aspirating syringe:
- 1.Pull back on thumb ring.
- 2.Insert anesthetic cartridge, rubber stopper end first, toward the thumb ring, then the diaphragm end toward the needle opening.
- 3.Set harpoon and test for lock into rubber stopper.
- 4.Remove safety cap from needle.
- 5.Screw needle onto the syringe.
What are the requirements of sharps containers?
- OSHA is very specific about the makeup of sharps containers.
- Employers must have closable, puncture-resistant, leak-proof sharps containers that are appropriately labeled and color-coded.
- sharps containers must have an opening that is large enough to accommodate disposal of the entire blood collection assembly (needles, blades, etc.).
- sharps containers should have a fill-to line, and one should be able to tell how full the container is before placing an item inside.
- sharps containers should have a lid that will seal completely to prevent spills during transport in case it is dropped.
- Needle recapping: Sheath card, One handed technique
- No manipulation
- Needle removal
How to Prevent of percutaneous injury?
- Alternative needle recapping methods.
- One-handed recapping or recapping with a safety mechanical device to hold the needle sheath is acceptable.
- (A) “Scoop” technique. Cap is placed on the tray and the needle is guided into it. (B) Example of commercially available holder for cap. Device is fastened to the tray, and cap is removed and recapped by directing the needle into the cap holder. Needles must be discarded in a puncture-resistant container.
(A)“Scoop” technique. Cap is placed on the tray and the needle is guided into it.
(B) Example of commercially available holder for cap.
- (superficial anesthesia )
- applied directly to the surface of the mucous membrane
- produce a loss of sensation
- does not influence sensations in the teeth
- not a substitute for local anesthetic administered by injection
Indications for use of Topical anesthesia?
- preparation for local anesthesia injection.
- Prevention of gagging in radiographic techniques and impression taking.
- Temporary relief of pain from localized diseased areas, such as oral ulcers, wounds, or inflammation.
- During instrumentation for probing and scaling.
- When discomfort involves the teeth as well as gingiva, a local anesthetic usually is indicated. Suture removal.
Purpose of topical anesthesia?
desensitize the mucous membrane by anesthetizing the terminal nerve endings
Absorption of drug:
- Varies with thickness of stratified squamous epithelial covering / degree of keratinization.
- Highly resistant: skin, lips, palatal mucosa. Absorb slowly: attached gingiva, buccal mucosa. Prompt absorption: tissue without keratinization, such as vestibular mucosa or over the pterygomandibular space.
Completion of Topical Anesthetic Application:
- Wait appropriate length of time for anesthetic to take effect before proceeding.
- Limit drug exposure. Apply only to the area of need. Use the smallest effective amount. Remove residual drug after application time.
- Apply to a limited area at a time when using a drug with a short duration of action for a long procedure such as scaling.
- Record topical anesthetic drug information in the patient’s record.
Factors to Teach the Patient regarding Conscious sedation?
- Level of sedation
- Control of personal actions
- Eat before procedures
Factors to Teach the Patient regarding Local and topical?
be careful not to bite lip, cheek, or tongue while tissues are without normal sensations. Warn and watch children to prevent injury. Do not test anesthesia by biting the lip. Avoid chewing hard foods and avoid hot food and drinks until normal sensation has returned.