Local Anesthesia and Alginate: Techniques, Complications, and Assessment, Study notes of Radiography

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Local Anaesthetic

● Infection = acidic environment → RN binds to H+ → no membrane diffusion = no anaesthesia.

● LA = Vasodilator → Increase rate of absorption, decreased duration of action,

increased bleeding.

○ 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.

● Max recommended dosage: 4.4mg per kg. 2.2mL cartridge of 2% lignocaine =

44mg LA = 1 carpule per 10kg.

Pterygomandibular Space

Local Anaesthesia

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):

• S ize of tray
• M ix = Smooth and homogenous
• A mount of alginate is adequate, all sulci and Pa vault captured (muscle trimmed correctly).
• R emoved correctly (minimal tearing)
• T ime to set was adequate (no drag lines)

Advantages Disadvantages

• Easy manipulation
• Acceptable taste
• Non toxic
• Non irritant
• Elastic
• Can control setting time
• Records most detail in mouth
• Hydrophilic
• Low viscosity
  • Lower surface reproducibility (minimal detail)
  • Dimensional changes
  • Must be cast quickly
  • Single use
  • Tear when thin/in undercuts
  • Silica dust = biological hazard

Endodontics

Healing or elimination of apical periodontitis

Diagnosis:

Pulpal + Periapical + Cause

● Irreversible pulpitis w/ acute apical periodontitis due to caries/ restoration

breakdown.

● Necrotic and infected pulp w/ acute apical perio due to crack.

Causes?

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

• vital pulp, extensive inflammation. Low chance of healing with conservative therapy. · Initial sharp pain in response to hot/cold → dull lingering pain. Removal of stimulus does not alleviate pain.
• no TTP. EPT normal/delayed.

Necrotic pulp

• sterile or infected.
• +/- symptoms. Continuous dull ache.
• Cold -ve, EPT -ve. Not TTP.

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.

• Slight TTP. no reaction to pulp sensibility tests · periapical RL on radiograph.

Apical Abscess Symptomatic

- s welling visible in mouth

• Severe, intense, throbbing pain → lack of drainage = pressure.
• pain on eating
• fever, malaise, lymphadenopathy **Asymtomatic
• N** o pain. Draining sinus. Cold -ve, EPT -ve.

Pt present complaining of pain.

1. Describe 3 key features evident on this radiograph:
2. Indicate 4 key clinical features you would may find during an intraoral exam of

this tooth.

3. Differential diagnosis?

Pt present complaining of pain.

1. Describe the key features that are evident in the radiographic image.
2. What are the key features that allow you to differentiate between reversible

and irreversible pulpitis as a provisional diagnosis?

Panoramic Radiography

Primary and secondary images

● Primary image = real image. Object is in between the axis of rotation and

the film.

○ Double primary images: Real images replicated twice, mirrored.

Structure located in central region captured twice e.g. hard palate, soft

palate, hyoid bone.

● Secondary image = artifact/ghost image. Object between source and axis of

rotation.

● Why are there no secondary images of teeth present?

http://www.stedmansonline.com/webFiles/Dict-Dental2/23_med_dent_Panoramic

%20_osition%20Error.pdf (pdf explaining errors and how to correct)

Clinic Tips

- Report systemically to your tutor

• E.g. “Pt is X years old, CC is sharp pain in his front teeth, MHx: takes cyclosporin

after a liver transplant etc.

- Base Chart

• Some teeth can drift mesially so use anatomy of tooth to ID the tooth, or ask

patient if they had a tooth extracted in the past

- All Chart

• Use your triplex and dry the tooth completely
• If you see a discolouration or anything out of the norm, NOTE IT DOWN
• Tip: Summarise any generalised features to save time
  • E.g. generalised brown staining in upper palatal surfaces of teeth

- Periodontal Charting

• You will have one session with a Periodontal Support tutor
• Depending on your tutor, they may allow margin of error in pocket depth readings
• Do not treat Periodontal Health lightly, you can fail clinic just from perio

Clinic Tips

- Periodontal Charting Continued..

• When reporting perio health use the following format:
  • Location (generalised/localised) + Severity (mild/moderate/severe) +

Diagnosis + Cause (e.g. induced by plaque)

- General Tips

• Ask patient to hold suction cause you have no DA
• Restorations: margins sealed, contact points are present
• Manage your time well, Semester 2 -> 2 patients in 3hr block
• Always ask pt if they have taken their medications today
• Keep count of how many cons and perio you have done for each tutor
• Always check on your pt a day or two before appt to mentally prepare yourself
• Use rubber dam where applicable, areas where RD will not work use gauze,

cotton rolls and dryguard

• Give pt free samples to get them to like you :)