Exam 16: Troubleshooting Inadequate Anesthesia

The treatment plan for Clare Ross included an MODL restoration on tooth #3. A right PSA, MSA, and intraseptal injection (to avoid a palatal injection) were administered with 2% lidocaine with 1:100,000 epinephrine. During cavity preparation, Clare jumped when the bur neared the palatal root. -What other anesthetic drugs may be considered and why?

Devices used for delivery of local anesthetic solutions have very little impact on local anesthesia failure.

Inadequate anesthesia may typically be caused by all of the following, except

Match the following: -Bifid

Match the following: -Accessory innervation

Explain the difference between suspected aberrant and accessory innervations.

What is recommended to avoid failed anesthesia and an increased risk of toxicity due to intravascular injection?

The treatment plan for Clare Ross included an MODL restoration on tooth #3. A right PSA, MSA, and intraseptal injection (to avoid a palatal injection) were administered with 2% lidocaine with 1:100,000 epinephrine. During cavity preparation, Clare jumped when the bur neared the palatal root. -What other injection(s) should be considered to anesthetize the palatal root?

Dense bony prominences, shallow vestibules, dilacerations, and ligaments create ________ barriers to the success of anesthesia.

Anita Mendoza presents with a large failing #30 MOD amalgam with distal lingual cusp fracture. She says she hated to have the tooth "worked on again because it's the only tooth that never gets numb no matter what they try." It is determined that a crown is the appropriate treatment for #30. She is assured that the tooth will be numb before treatment. IA, lingual and buccal nerve blocks are administered with a total of 1.5 cartridges of lidocaine with 1:1,000,000 epinephrine. She reports the "tooth and all around it feel numb," however when a pulp tester is applied to #30 she jumps with discomfort. Pulp testing on tooth number 29 and 31 are negative. The IA injection site is carefully re-evaluated and an IA injection is repeated with a second cartridge of the same drugs. An identical response to the pulp tester follows. -What other injection techniques should be considered to provide profound anesthesia?

Identify and discuss inadequate anesthesia following IA injections and suggest alternative injections to achieve anesthesia.