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Pain Management (The Drugs (Lidocaine (New drugs must be as safe and…
Pain Management
The Drugs
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Topicals
Benzocaine
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More allergies, keeps reaction local though
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Maxillary Techniques
Infiltration
Anesthetizes pulp and root, connective tissue, and mucous membrane of tooth
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Landmarks: height of mucobuccal fold, crown of tooth, root contour
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MSA
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Deposition site above #4 or #13, well above the root
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IO
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Maxillary anteriors, premolars, MB root of first molar, buccal tissue, lower eyelid, lateral side of nose, upper lip
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PSA
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Landmarks: height of mucobuccal fold, maxillary tuberosity, zygomatic process
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AMSA
Landmarks: gingival margin, mid-palatal suture
Anesthetizes the subneural plexus: premolars, canine, laterals, palatal tissue to third molar
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Mandibular Techniques
IA
Mandibular teeth to midline, body of mandible, anterior 2/3 of tongue, lingual soft tissues
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Landmarks: pterygomandibular raphe, coronoid notch, internal oblique ridge
Penetration site: lateral to raphe, 2-3 mm above greatest concavity, medial to internal oblique
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Akinosi
positive aspiration 10% (in case of positive, dont go deeper)
Landmarks: mucogingival junction of maxillary molar, maxillary tuberosity, coronoid notch
anesthetizes the IA, incisive, mental, lingual, and mylohyoid nerves
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Gow-Gates
IA, buccal, lingual, mylohyoid, auriculotemporal
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Landmarks
Exrraoral: intertragic notch, flare of the tragus
Intraoral: ML cusp of maxillary 2nd molar, depression posterior to last molar,
Sit patient up rapidly, stay open for 20 seconds
Complications
Local
Needle Breakage
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Factors that increase likelihood: small needles, bent needles, defective needles
Nor retrievable? little migration, very difficult and destructive surgery to retrieve. Sometimes oral surgeon will leave it in
Pain on Injection
Causes: careless, too rapid deposition, barbed needle, poor words
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Burning
Causes: pH, to rapid, contamination, warming cartidges
Paresthesia
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Persistent burning, tingling, or numb sensation
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Taste perversions: ageusia (complete loss), hypoageusia (partial)
Trismus
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Causes: contaminated solution, intramuscular injection, hemorrhage, low grade injection, multiple injection, barbed needle, excessive volume
Therapy: heat, warm saline rinse, analgesics, muscle relaxants if indicated
Hematoma
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Prevention: knowledge of anatomy, short needle for PSA
Management: direct pressure, ice
Infection
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Prevention: sterile needles, avoid contamination, proper care
Edema
Causes: trauma, infection, allergy, hemorrhage
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