Deck 20: Insights From Specialties: Oral Surgery, Periodontics, and Endodontics

Question 1

Match the following :

-Akinosi

A) Closed-mouth injection technique
B) Anxiolytic drugs
C) Technique used exclusively in endodontics
D) Provides deep topical anesthesia
E) Alternate when true anesthetic allergy is present
F) Long-acting anesthetic
G) Technique used to anesthetize lingual tissues
H) Spread along injection pathway
I) Guide sleeve for intraosseous injection
J) Penetrates efficiently through bone

Answer 1

Closed-mouth injection technique

Question 2

Match the following :

-Articaine

A) Closed-mouth injection technique
B) Anxiolytic drugs
C) Technique used exclusively in endodontics
D) Provides deep topical anesthesia
E) Alternate when true anesthetic allergy is present
F) Long-acting anesthetic
G) Technique used to anesthetize lingual tissues
H) Spread along injection pathway
I) Guide sleeve for intraosseous injection
J) Penetrates efficiently through bone

Answer 2

Penetrates efficiently through bone

Question 3

Match the following :

-Benadryl

A) Closed-mouth injection technique
B) Anxiolytic drugs
C) Technique used exclusively in endodontics
D) Provides deep topical anesthesia
E) Alternate when true anesthetic allergy is present
F) Long-acting anesthetic
G) Technique used to anesthetize lingual tissues
H) Spread along injection pathway
I) Guide sleeve for intraosseous injection
J) Penetrates efficiently through bone

Answer 3

Alternate when true anesthetic allergy is present

Question 4

Match the following :

-Benzodiazepines

A) Closed-mouth injection technique
B) Anxiolytic drugs
C) Technique used exclusively in endodontics
D) Provides deep topical anesthesia
E) Alternate when true anesthetic allergy is present
F) Long-acting anesthetic
G) Technique used to anesthetize lingual tissues
H) Spread along injection pathway
I) Guide sleeve for intraosseous injection
J) Penetrates efficiently through bone

Question 5

Match the following :

-Bupivacaine

A) Closed-mouth injection technique
B) Anxiolytic drugs
C) Technique used exclusively in endodontics
D) Provides deep topical anesthesia
E) Alternate when true anesthetic allergy is present
F) Long-acting anesthetic
G) Technique used to anesthetize lingual tissues
H) Spread along injection pathway
I) Guide sleeve for intraosseous injection
J) Penetrates efficiently through bone

Question 6

Match the following :

-Interpapillary

A) Closed-mouth injection technique
B) Anxiolytic drugs
C) Technique used exclusively in endodontics
D) Provides deep topical anesthesia
E) Alternate when true anesthetic allergy is present
F) Long-acting anesthetic
G) Technique used to anesthetize lingual tissues
H) Spread along injection pathway
I) Guide sleeve for intraosseous injection
J) Penetrates efficiently through bone

Question 7

Match the following :

-Intrapulpal

A) Closed-mouth injection technique
B) Anxiolytic drugs
C) Technique used exclusively in endodontics
D) Provides deep topical anesthesia
E) Alternate when true anesthetic allergy is present
F) Long-acting anesthetic
G) Technique used to anesthetize lingual tissues
H) Spread along injection pathway
I) Guide sleeve for intraosseous injection
J) Penetrates efficiently through bone

Question 8

Match the following :

-Needle tract infections

A) Closed-mouth injection technique
B) Anxiolytic drugs
C) Technique used exclusively in endodontics
D) Provides deep topical anesthesia
E) Alternate when true anesthetic allergy is present
F) Long-acting anesthetic
G) Technique used to anesthetize lingual tissues
H) Spread along injection pathway
I) Guide sleeve for intraosseous injection
J) Penetrates efficiently through bone

Question 9

Match the following :

-Stabident

A) Closed-mouth injection technique
B) Anxiolytic drugs
C) Technique used exclusively in endodontics
D) Provides deep topical anesthesia
E) Alternate when true anesthetic allergy is present
F) Long-acting anesthetic
G) Technique used to anesthetize lingual tissues
H) Spread along injection pathway
I) Guide sleeve for intraosseous injection
J) Penetrates efficiently through bone

Question 10

Match the following :

-Tetracaine

A) Closed-mouth injection technique
B) Anxiolytic drugs
C) Technique used exclusively in endodontics
D) Provides deep topical anesthesia
E) Alternate when true anesthetic allergy is present
F) Long-acting anesthetic
G) Technique used to anesthetize lingual tissues
H) Spread along injection pathway
I) Guide sleeve for intraosseous injection
J) Penetrates efficiently through bone

Question 11

Which of the following represents a reasonable rationale for the concurrent use of lidocaine and bupivacaine in oral surgery cases?

A) Rapid onset of lidocaine and long duration of bupivacaine
B) Ease of diffusion of lidocaine and low potency of bupivacaine
C) Slow onset of lidocaine and high potency of bupivacaine
D) Rapid onset of lidocaine prevents the high toxicity risk of bupivacaine

Question 12

Rationale for selecting a 25 gauge long needle for oral surgical procedures includes which one of the following?

A) There is a frequent need to avoid areas of infection.
B) The risk of patient movement is higher given the increased potential for pain.
C) The depth of most injections requires a long needle to reach the deposition site.
D) Long needles allow all types of injections to be administered without changing needles.

Question 13

Which of the following is not a reason geriatric patients are more susceptible to local anesthetic toxicity?

A) Slower rate of metabolism and excretion
B) Underlying complicating medical conditions
C) Concomitant use of medications that may have effect on drug metabolism or clearance
D) Risk of hematomas

Question 14

Which of the following is not a local anesthesia consideration in oral and maxillofacial surgery when treating an infected patient?

A) Use a greater amount of local anesthetic to help overcome acidity created by the infection. (Make sure maximum doses are not exceeded.)
B) Use a regional nerve block away from the area of inflammation.
C) Discard the needle after injecting in or near an area of inflammation/infection.
D) Use a local anesthetic agent with a lower pH.

Question 15

Which class of drugs decreases the toxic threshold for any local anesthetics administered?

A) Antibiotics
B) Benzodiazepines
C) Antihistamines
D) Vasodilators

Question 16

All of the following are local anesthetic considerations when treating a patient with an oral infection, except

A) Selection of anesthetic technique
B) Increased amount of anesthetic drug
C) Use of anesthetic drug with a higher pH
D) Always premedicate with antibiotics

Question 17

Which of the following additives to local anesthetic solutions increases the effectiveness of a local anesthetic by raising the pH when an infection is present?

A) Methyparaben
B) Sodium bicarbonate
C) Vasoconstrictor
D) Cocaine

Question 18

Which of the following is not an option for treatment of patients with true local anesthetic allergies?

A) Use of an alternate local anesthetic
B) 1% Benadryl (diphenhydramine hydrochloride)
C) 0.09% benzyl alcohol
D) 0.1% sodium benzoate

Question 19

Which of the following represents a plausible explanation for the occurrence of lingual paresthesia?

A) The lingual nerve is not usually in the pathway of the needle during the IA injection.
B) The lingual nerve is a large nerve therefore more easily encountered.
C) The lingual nerve is attached to the interpterygoid fascia and does not slide away when encountered.
D) A small but significant anatomical anomaly exists where the lingual nerve is attached to the IA nerve in the pterygomandibular space.

Question 20

Why is caution recommended when considering vasoconstrictors for intraosseous injection techniques?

A) Vasoconstrictors will stop the flow of blood into a viable tooth.
B) Vasoconstrictors produce rapid CVS effects including a rapid heartbeat.
C) The duration of anesthesia is not critical, as the endodontic procedure quickly stems the firing ability of the nerve.
D) Vasoconstrictors increase the risk of post-treatment necrosis in the surrounding tissues.

Question 21

Intrapulpal techniques require all of the following, except

A) endodontically prepared tooth
B) use of any local anesthetic is equally effective
C) use of pressure anesthesia created by the volume of solution
D) wide opening through the crown to permit access to the large volume of anesthetic required for success

Question 22

Which injection technique can be used to provide lingual anesthesia of the mandibular premolars and incisors following a mental incisive nerve block without inducing widespread anesthesia of the tongue?

A) Mylohyoid nerve block
B) Akinosi nerve block
C) Interpapillary infiltration
D) Bilateral lingual nerve block

Question 23

The AMSA injection technique is used in procedures involving maxillary anteriors and premolars because the field of anesthesia includes

A) lingual and facial soft tissues and pulps of incisors and premolars on the injected side, minimizing the number of palatal and facial injections
B) facial soft tissues and pulps of incisors and premolars on the injected side, minimizing the number of facial injections
C) lingual soft tissues on the injected side, minimizing the number of palatal injections
D) facial soft tissue and pulps of the incisors and premolars on the injected side, minimizing the need for two injections on the palate and the infraorbital on the facial

Question 24

Which of the following is a reason vasoconstrictors are usually required in periodontal procedures?

A) Only short durations are required
B) Increased risk of toxicity
C) Hemostasis
D) Vasodilating properties

Question 25

Which concentration of epinephrine is usually adequate for periodontal surgeries?

A) 1:50,000
B) 1:20,000
C) 1:200,000
D) 1:100,000

Question 26

Discuss specific challenges encountered in the administration of local anesthesia in oral maxillofacial practice settings.

Question 27

Why is local anesthesia administered in addition to the use of inhalation, intravenous, and general anesthesia in OMFS practices?

Question 28

Why are geriatric patients generally at greater risk of local anesthetic toxicity?

Question 29

Why is it easier to exceed recommended doses of local anesthetics in pediatric patients?

Question 30

Explain the risks associated with the use of cocaine and methamphetamine with vasoconstrictors in local anesthetic drugs.

Question 31

Susan Johnson is scheduled for an endodontic procedure on tooth #12. She is nervous because she never had a "root canal"; however, she knows she cannot stand the pain any longer and does not want to lose the tooth. She has no medical complications. The only medication she is currently taking is amoxicillin, prescribed for her 2 days ago. Obvious redness and swelling remain around #12.

-Why is it important to address Ms. Johnson's nervousness before treatment?

Question 32

Susan Johnson is scheduled for an endodontic procedure on tooth #12. She is nervous because she never had a "root canal"; however, she knows she cannot stand the pain any longer and does not want to lose the tooth. She has no medical complications. The only medication she is currently taking is amoxicillin, prescribed for her 2 days ago. Obvious redness and swelling remain around #12.

-What is the first consideration in the choice of injection technique for Ms. Johnson?

Question 33

Susan Johnson is scheduled for an endodontic procedure on tooth #12. She is nervous because she never had a "root canal"; however, she knows she cannot stand the pain any longer and does not want to lose the tooth. She has no medical complications. The only medication she is currently taking is amoxicillin, prescribed for her 2 days ago. Obvious redness and swelling remain around #12.

-What nerve block injection technique(s) are good choices for 12 after noting that observable redness and swelling remain? Which injections are not likely good choices? Explain each choice.

Question 34

Susan Johnson is scheduled for an endodontic procedure on tooth #12. She is nervous because she never had a "root canal"; however, she knows she cannot stand the pain any longer and does not want to lose the tooth. She has no medical complications. The only medication she is currently taking is amoxicillin, prescribed for her 2 days ago. Obvious redness and swelling remain around #12.

-During the root canal procedure it is determined that the tooth is not profoundly nesthetized. What additional injection technique should be considered? Explain this choice.

Question 35

Barbara Jones, age 72 arrives for a morning appointment for periodontal surgery on teeth #3, 4, 5, and 6. She has a history of heart disease with a single stent placed two years ago, as well as hypertension. She reports she sees her physician regularly. Her medications include atorvastatin (40 mg daily) and metoprolol (50 mg twice daily). Her blood pressure is 145/92 and her heart rate is 84.

-Identify and discuss Ms. Jones' medical conditions and current medications related to the planned treatment and the use of local anesthesia.

Question 36

Barbara Jones, age 72 arrives for a morning appointment for periodontal surgery on teeth #3, 4, 5, and 6. She has a history of heart disease with a single stent placed two years ago, as well as hypertension. She reports she sees her physician regularly. Her medications include atorvastatin (40 mg daily) and metoprolol (50 mg twice daily). Her blood pressure is 145/92 and her heart rate is 84.

-Identify and discuss appropriate drug choice or limitations for the planned treatment for Ms. Jones.

Question 37

Barbara Jones, age 72 arrives for a morning appointment for periodontal surgery on teeth #3, 4, 5, and 6. She has a history of heart disease with a single stent placed two years ago, as well as hypertension. She reports she sees her physician regularly. Her medications include atorvastatin (40 mg daily) and metoprolol (50 mg twice daily). Her blood pressure is 145/92 and her heart rate is 84.

-Identify and explain what maxillary injection(s) should be considered for the planned surgery given the limit of 2 cartridges with vasoconstrictor?