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Detailed information on local anesthesia techniques, complications, and the use of alginate in dentistry. Topics include the role of pH and vasodilators in anesthesia, the importance of correct injection angles and depths, and the complications of injecting into the pterygomandibular space. Additionally, the document covers the use of alginate in creating dental impressions, including the chemical reactions involved and methods for manipulating setting time.
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● Infection = acidic environment → RN binds to H+ → no membrane diffusion = no anaesthesia.
○ Vasoconstrictor addition = decreased blood flow to site, slower absorption, higher concentration maintained at site, reduced bleeding, decreased risk of OD. ○ Other additives: Methyparaben (antibacterial preservative), Bisulphite (antioxidant for vasoconstrictor) → both may cause allergy.
IANB Technique Complications:
● Too medial = inject into medial pterygoid = trismus ● Too lateral = hit bone too early = failure of anaesthesia ○ Or may scrape periosteum off causing pain ● Too deep = parotid gland = facial paralysis ● Too superficial = not reached pterygomandibular space = failure of anaesthesia ● Too superior = lateral pterygoid = trismus
LA complications
● Always inform and reassure pt. Record all incidences. ● Pain on insertion: periosteal stripping, pressure of solution, rapid injection. ● Bleeding on withdrawal: damages to blood vessels → possible haematoma. ● Trauma post Rx: Loss of protective reflexes/numbness → POI. epithelial desquamation, sterile abscess → cause: topical, ishcaemia → NSAIDs, orabase (topical corticosteroid) ● Pain and limited opening: Trismus → heat packs, NaCl rinse, NSAIDs, physio ● Restless, sweaty, pale: Adrenaline IV or OD → supine, DRABC. ● Facial nerve paralysis: reassure it is transient, remove contact lenses, eyepatch to protect eye. injected too far post into parotid - correct this how?
Alginate
5 criteria for alginate assessment (SMART):
Advantages Disadvantages
Pulpal
Reversible pulpitis
· pulp with some localised area of inflammation · High potential to heal · Mild, short, sharp pain in response to stimuli · cold +ve, no TTP, EPT normal · No radiographic changes
Irreversible pulpitis
Necrotic pulp
Apical periodontistis changes at the apex of tooth.
Symptomatic · Spontaneous, aching, severe, lingering pain · Well localized – pt able to identify the tooth in pain. · Tooth may be in high occlusion · Tender to percussion and palpation · Tooth may be mobile · May show widened PDL or periapical lesion.
Asymptomatic · Often no signs or symptoms.
Apical Abscess Symptomatic
- s welling visible in mouth
Pt present complaining of pain.
this tooth.
Pt present complaining of pain.
and irreversible pulpitis as a provisional diagnosis?