Deck 15: Supplemental Techniques and Adjunctive Strategies

Question 1

Match the following

-Backflow

A) Appears pale pink to white
B) Dense layer of bone
C) Single tooth injection
D) Penetrates into bone
E) Used in endodontic procedures
F) Reverse movement of solution
G) Compressible osseous tissue
H) Buffering system
I) Peridental injection
J) Alternative to palatal injections

Answer 1

Reverse movement of solution

Question 2

Match the following

-Blanching

A) Appears pale pink to white
B) Dense layer of bone
C) Single tooth injection
D) Penetrates into bone
E) Used in endodontic procedures
F) Reverse movement of solution
G) Compressible osseous tissue
H) Buffering system
I) Peridental injection
J) Alternative to palatal injections

Answer 2

Appears pale pink to white

Question 3

Match the following

-Cortical plate

A) Appears pale pink to white
B) Dense layer of bone
C) Single tooth injection
D) Penetrates into bone
E) Used in endodontic procedures
F) Reverse movement of solution
G) Compressible osseous tissue
H) Buffering system
I) Peridental injection
J) Alternative to palatal injections

Answer 3

Dense layer of bone

Question 4

Match the following

-Intraligamentary

A) Appears pale pink to white
B) Dense layer of bone
C) Single tooth injection
D) Penetrates into bone
E) Used in endodontic procedures
F) Reverse movement of solution
G) Compressible osseous tissue
H) Buffering system
I) Peridental injection
J) Alternative to palatal injections

Question 5

Match the following

-Intraosseous

A) Appears pale pink to white
B) Dense layer of bone
C) Single tooth injection
D) Penetrates into bone
E) Used in endodontic procedures
F) Reverse movement of solution
G) Compressible osseous tissue
H) Buffering system
I) Peridental injection
J) Alternative to palatal injections

Question 6

Match the following

-Intrapulpal

A) Appears pale pink to white
B) Dense layer of bone
C) Single tooth injection
D) Penetrates into bone
E) Used in endodontic procedures
F) Reverse movement of solution
G) Compressible osseous tissue
H) Buffering system
I) Peridental injection
J) Alternative to palatal injections

Question 7

Match the following

-Intraseptal

A) Appears pale pink to white
B) Dense layer of bone
C) Single tooth injection
D) Penetrates into bone
E) Used in endodontic procedures
F) Reverse movement of solution
G) Compressible osseous tissue
H) Buffering system
I) Peridental injection
J) Alternative to palatal injections

Question 8

Match the following

-Onset

A) Appears pale pink to white
B) Dense layer of bone
C) Single tooth injection
D) Penetrates into bone
E) Used in endodontic procedures
F) Reverse movement of solution
G) Compressible osseous tissue
H) Buffering system
I) Peridental injection
J) Alternative to palatal injections

Question 9

Match the following

-Periodontal ligament

A) Appears pale pink to white
B) Dense layer of bone
C) Single tooth injection
D) Penetrates into bone
E) Used in endodontic procedures
F) Reverse movement of solution
G) Compressible osseous tissue
H) Buffering system
I) Peridental injection
J) Alternative to palatal injections

Question 10

Match the following

-Spongy bone

A) Appears pale pink to white
B) Dense layer of bone
C) Single tooth injection
D) Penetrates into bone
E) Used in endodontic procedures
F) Reverse movement of solution
G) Compressible osseous tissue
H) Buffering system
I) Peridental injection
J) Alternative to palatal injections

Question 11

Aspiration for PDL injections is unnecessary because there is no significant risk of intravascular injection with the technique.

Question 12

Anesthetic solution deposited in PDL injections diffuses through the periodontal ligament and alveolar bone to the apical region of the tooth.

Question 13

An intraseptal injection is commonly used for single tooth anesthesia.

Question 14

A PDL injection for tooth 19 requires four separate penetrations.

Question 15

If a decision is made to bend a needle to improve access during an injection, the needle should be bent to a 45-degree angle and as close as possible to the hub.

Question 16

Intraosseous injections should never be used for patients taking anti-clotting medications.

Question 17

Intraosseous injection techniques are used more frequently on the mandible due to increased bone density.

Question 18

Intraseptal injections are useful for anesthesia of palatal and pulpal tissues for one or two teeth.

Question 19

Intrapulpal injections provide anesthesia only in teeth with endodontic access already accomplished.

Question 20

An intense pain associated with an intrapulpal injection indicates that pre-intrapulpal anesthesia was inadequate.

Question 21

OnPharma's sodium bicarbonate buffering system reduces the acidity of local anesthetic solutions which reduces pain on injection and improves the onset time of anesthesia.

Question 22

The active ingredient in OraVerse counters the effects of the local anesthetic drug allowing a faster recovery from the soft tissue symptoms of anesthesia.

Question 23

Phentolamine mesylate is added to local anesthetic solutions to enhance the depth of pulpal anesthesia.

Question 24

Periodontal ligament injections are commonly used when other injection techniques have ________.

Question 25

If it is deemed necessary to bend a needle, it should be bent at a 45-degree angle near the ________ of the shaft of the needle.

Question 26

The deposition site for a PDL injection is any point at which the tip of the needle is wedged between the root of a tooth and within the ________.

Question 27

It is important to observe pale pink tissue blanching for reliable success during PDL injections because blanching indicates ________.

Question 28

OSHA regulations prohibit the bending of ________ needles, except when there is compelling medical or dental rationale for doing so.

Question 29

Penetration sites for PDL injections are usually easiest and most effective from the ________ aspects of mandibular teeth.

Question 30

________ should be avoided or limited with intraosseous injections.

Question 31

Intraseptal injections can be useful to avoid ________ injections.

Question 32

Intraseptal injections provide significant ________ if vasoconstrictors are administered.

Question 33

An intrapulpal technique is frequently used to anesthetize teeth requiring ________ treatment.

Question 34

Which of the following is a recommended deposition rate for PDL injections?

A) 0.1 mL over 20 seconds or slower
B) 0.1 mL over 30 seconds or slower
C) 0.2 mL over 20 seconds or slower
D) 0.2 mL over 40 seconds or slower

Question 35

Which of the following statements is true regarding PDL injections?

A) The solution diffuses through the periodontal ligament to the dental plexus.
B) The solution diffuses through alveolar bone to the dental plexus.
C) The technique is useful only when other techniques have failed.
D) The orientation of the bevel is critical to the success of the procedure.

Question 36

Which of the following factors accurately describes recommendations for safety in bending needles?

A) Never bend a needle with one hand.
B) Make the bend at a 45-degree angle at the hub/shaft interface.
C) Always bend the needle at a 90-degree angle for minimal risk.
D) Bend a needle only when there is minimal risk it will be lost in tissue.

Question 37

Which of the following guidelines correctly recognizes the importance of ease of access as well as ergonomics when administering PDL injections?

A) For maxillary teeth, select sites on the lingual because the embrasures are larger.
B) For mandibular teeth, select sites on the facial for better access.
C) Prevent blanching whenever possible to relieve hand stress.
D) When blanching is observed circumferentially around the tooth, no more penetrations are necessary.

Question 38

Which statement describes why aspiration is not required for PDL injections?

A) There is no significant risk of intravascular deposition with this technique.
B) Special syringes used for PDL injections are self-aspirating.
C) It is impossible to aspirate with a bend in a needle.
D) The position of the syringe prohibits the ability to aspirate.

Question 39

Which of the following represents the best indication for an intraosseous injection?

A) As an alternative to PDL injections
B) To provide anesthesia to maxillary molars
C) To provide anesthesia when large amounts of drugs are needed
D) To provide anesthesia when other techniques have failed

Question 40

Which of the following devices is not used for intraosseous injections?

A) X-tip
B) Stabident
C) CCLAD
D) IntraFlow

Question 41

The optimal penetration site for an intraosseous injection is the:

A) Apical extent of the free gingival margin between adjacent teeth.
B) Apical extent of the attached gingiva between adjacent teeth.
C) Apical extent between the intrapapillary margins.
D) Apical extent of the attached gingival on the long axis of tooth.

Question 42

Which of the following techniques does not provide reliable pulpal anesthesia?

A) PDL
B) Intraseptal
C) Intraosseous
D) Intrapulpal

Question 43

Intraseptal injections provide:

A) Pulpal anesthesia to the teeth adjacent to the area penetrated.
B) Anesthesia to the tooth mesial to the area penetrated.
C) Significant hemostasis without a vasoconstrictor.
D) An alternative to palatal injection techniques.

Question 44

Which of the following statements describes the needle pathway for an intraseptal injection?

A) Advances through the interdental papilla within the attached gingiva until bone is contacted and then forced deeper into the interdental bone
B) Advances through the free gingiva of the interdental papilla until bone is contacted
C) Advances from the mucogingival margin below the interdental papilla until bone is contacted
D) Advances from the mucogingival margin below the interdental papilla and then is forced deeper into the facial bone to deposit solution in the spongy bone adjacent to the apex of the teeth

Question 45

What is a minimum recommended volume of anesthetic administered for an intraseptal injection?

A) 0.9 to 1.2 mL
B) 0.6 to 1.0 mL
C) 0.4 to 0.6 mL
D) 0.2 to 0.4 mL

Question 46

Which factor is most reliable when selecting the needle for an intrapulpal injection?

A) Narrow enough to fit into the pulp chamber or canals
B) Long enough to reach the apex of the root without exiting the canal
C) Wide enough to prevent breakage in the canal
D) As narrow as possible to prevent discomfort in the chamber or canal

Question 47

Which of the following will minimize backflow of anesthetic solution in a PDL injection?

A) Reduce the depth and pressure of penetration to avoid backflow away from the bone.
B) Increase the depth of penetration to block the flow of solution away from the deposition site.
C) Use a shorter needle and insert to the hub.
D) Use a 30 gauge needle to control the rate and amount of solution deposited under pressure in tight spaces.

Question 48

Which of the following complications is most often related to supplemental injection techniques?

A) Trismus and infection
B) Hematoma and heart palpitations
C) Damage to cortical bone and infection
D) Pain at the injection site and surrounding area

Question 49

Which of the following anesthetics is recommended for use with Onset^{TM ?}

A) 4% prilocaine plain
B) 4% Articaine with 1:200,000 epinephrine
C) 2% Lidocaine with 1:100,000 epinephrine
D) 2% mepivacaine with 1:20,000 levonordefrin

Question 50

Which of the following is not a potential benefit of Onset^TM?

A) Increases duration time of anesthesia
B) Decreases the onset time of anesthesia
C) Decreases tissue irritation
D) Produces carbon dioxide which has an anesthetic effect on tissues

Question 51

How many mg of phentolamine mesylate are contained in one cartridge of OraVerse?

A) 0.2 mg
B) 0.4 mg
C) 0.8 mg
D) 1.8 mg

Question 52

What is the maximum recommended dose of OraVerse for a child age 8 who weighs 54 lbs?

A) 1/4 cartridge
B) 1/2 cartridge
C) 1/3 cartridge
D) 2 cartridges

Question 53

Which of the following statements best describes the pharmacological action of Onset^TM?

A) It reduces the effects of local anesthesia by reversing the buffering effects of the drug solution within tissues.
B) It reduces the effects of local anesthesia by altering the pKa of the solutions in the cartridge.
C) It is a nonselective alpha-adrenergic blocking agent that counters the effects of epinephrine on tissues.
D) It is a nonselective beta blocking agent that counters the beta effects of epinephrine on smooth muscle linings of vessels.

Question 54

List indications for periodontal ligament (PDL) injections.

Question 55

When is an intrapulpal injection technique used?

Question 56

Explain safety factors required for bending needles.

Question 57

Discuss the potential benefits of phentolamine mesylate (OraVerse) for post-anesthetic care for children.

Question 58

Tom Reynaldo is scheduled for restorations for recurrent decay on #18 and #19. He has received two IA nerve blocks without profound anesthesia of tooth #19. The surrounding teeth and soft tissues are very numb. He says he is usually numb for hours after the many injections he typically receives but he notes that one tooth, #19, never gets numb enough.

-Which nerve likely provides accessory innervation to tooth #19?

Question 59

Tom Reynaldo is scheduled for restorations for recurrent decay on #18 and #19. He has received two IA nerve blocks without profound anesthesia of tooth #19. The surrounding teeth and soft tissues are very numb. He says he is usually numb for hours after the many injections he typically receives but he notes that one tooth, #19, never gets numb enough.

-Which alternate injections can be considered to provide anesthesia for the accessory innervation?

Question 60

Tom Reynaldo is scheduled for restorations for recurrent decay on #18 and #19. He has received two IA nerve blocks without profound anesthesia of tooth #19. The surrounding teeth and soft tissues are very numb. He says he is usually numb for hours after the many injections he typically receives but he notes that one tooth, #19, never gets numb enough.

-Explain why the alternate injections were selected.

Question 61

Tom Reynaldo is scheduled for restorations for recurrent decay on #18 and #19. He has received two IA nerve blocks without profound anesthesia of tooth #19. The surrounding teeth and soft tissues are very numb. He says he is usually numb for hours after the many injections he typically receives but he notes that one tooth, #19, never gets numb enough.

-What drug can be suggested to Mr. Reynaldo that will shorten his recovery from profound soft tissue anesthesia?

Question 62

Tom Reynaldo is scheduled for restorations for recurrent decay on #18 and #19. He has received two IA nerve blocks without profound anesthesia of tooth #19. The surrounding teeth and soft tissues are very numb. He says he is usually numb for hours after the many injections he typically receives but he notes that one tooth, #19, never gets numb enough.

-What is the appropriate dose of drug that will shorten Mr. Reynaldo's recovery from profound soft tissue anesthesia?