Deck 13: Injections for Palatal Pain Control

Question 1

The nasopalatine nerve is a terminal and short branch of the PSA nerve.

Answer 1

False

Question 2

Excessive blanching more commonly occurs when administering solutions that contain vasoconstrictors.

Answer 2

True

Question 3

The GP nerve branches from the maxillary nerve within the pterygopalatine fossa and is anesthetized by a GP nerve block just prior to its entrance to the pterygopalatine canal.

Answer 3

False

Question 4

The gate control theory suggests that pressure anesthesia blocks the stimulation of non-nociceptive fibers.

Question 5

The rate of deposition of solution for all palatal injections should be 0.4 mL over 40 seconds.

Question 6

It should take twice the time to deposit a cartridge of a 4% local anesthetic solution compared to a 2% solution.

Question 7

For palatal injections, if swelling or blanching occurs, withdraw the needle and choose another penetration site.

Question 8

A nasopalatine nerve block will anesthetize palatal soft and osseous tissue in the anterior third of the palate, from canine to canine.

Question 9

The optimum penetration site for the NP nerve block is adjacent to the narrowest portion of the incisive papilla to facilitate ease of insertion.

Question 10

The P-ASA injection successfully anesthetizes bilateral nasopalatine and ASA nerves.

Question 11

A P-ASA injection requires a 27 gauge long needle due to the increased depth of insertion.

Question 12

The field of anesthesia for a P-ASA injection includes the same structures that are innervated by the right and left NP and anterior branches of the ASA nerves.

Question 13

The rate of deposition of anesthetic solution is the same for the NP and P-ASA injections.

Question 14

The AMSA injection does not anesthetize labial tissues.

Question 15

The rate of deposition for an AMSA injection is 0.4 mL over 40 seconds.

Question 16

The penetration site for a GP injection is in the fossa located anterior to the GP foramen (also referred to as the anterior depression).

Question 17

Anesthesia of the soft palate is common because the lesser palatine nerve and foramen are located immediately posterior to the greater palatine foramen.

Question 18

The needle pathway for a GP nerve block is 6 to 8 mm through dense mucosal tissue.

Question 19

An extra short needle is not used for GP nerve blocks due to the penetration location at a more posterior position in the palate.

Question 20

The two-step method for pre-anesthesia for palatal injections includes a one-minute application of topical anesthesia and ________.

Question 21

Topical anesthetic patches may provide a ________ depth of anesthetic penetration.

Question 22

The nasopalatine nerve is the longest branch of the posterior superior nasal branch of the ________ nerve.

Question 23

The ________ theory explains why pressure anesthesia is effective in palatal nerve blocks.

Question 24

In order to avoid discomfort during palatal injections, the ________ is reduced.

Question 25

Computer-controlled local anesthetic devises (CCLAD) are ideal for palatal nerve blocks because they provide electronically regulated ________ recommended for all palatal injections.

Question 26

P-ASA and AMSA nerve blocks are advantageous for cosmetic procedures because anesthesia of the ________ is typically avoided.

Question 27

Rapid deposition of anesthetic solutions containing vasoconstrictors should be avoided to prevent ________.

Question 28

The use of 4% anesthetic solutions in the palate should be accompanied by very __________ depositions.

Question 29

Which one of the following is the most important consideration for palatal local anesthetic procedures?

A) Apply topical anesthetic for one to two minutes
B) Use ester topical anesthetic drug
C) Administer solution slowly
D) Withdraw the needle if swelling and ischemia occur

Question 30

Which statement correctly describes one precaution when using 4% local anesthetic drugs for palatal injections?

A) Deposit 0.4 mL over forty seconds
B) Deposit approximately twice as slowly as for 2% solutions
C) Use a 4% solution without a vasoconstrictor
D) Do not use 4% local anesthetic drugs for palatal injections

Question 31

The most common cause of failure of palatal nerve blocks is:

A) Solution deposited too far from deposition site
B) Solution deposited too rapidly and it backflows into the mouth
C) Vasoconstrictor constricts the vessels preventing the flow of solution to the nerve
D) Inadequate topical and pressure anesthesia prevent adequate penetration depth

Question 32

Which of the following nerve branches anesthetizes the upper lip and skin of the cheek?

A) Facial nerve
B) Trigeminal nerve, division 1
C) Trigeminal nerve, division 2
D) Trigeminal nerve, division 3

Question 33

Which of the following statements is true of the NP nerve block?

A) Provides highest rate of positive aspiration of palatal injections
B) Provides more durable anesthesia than other palatal injections
C) Provides bilateral anesthesia
D) Contact with bone should be avoided

Question 34

Which one of the following is not anesthetized by a nasopalatine nerve block?

A) Soft tissues of the anterior one third of the palate
B) Lingual gingiva, canine to canine
C) Maxillary incisors and canines
D) Incisive papilla

Question 35

Which location represents the correct penetration site for a nasopalatine nerve block?

A) Palatal mucosa lateral to the widest anteroposterior dimension of the incisive papilla
B) Palatal mucosa at the base of the incisive papilla on the right or left side of the incisive papilla
C) Midline in the incisive papilla at the widest anteroposterior dimension of the incisive papilla
D) Perpendicular to the incisive papilla at the widest dimension

Question 36

Which of the following represents the correct penetration depth for a nasopalatine nerve block?

A) 2 to 3 mm
B) 4 to 7 mm
C) 6 to 12 mm
D) 10 to 16 mm

Question 37

Which statement describing the injection steps for a nasopalatine nerve block is not correct?

A) Use a two-step pre-anesthesia method
B) Penetrate parallel to the incisive canal until bone is contracted
C) After contacting bone, withdraw 1 mm
D) Deposit solution at a rate of 0.4 mL over forty seconds

Question 38

What is the most likely cause of unilateral failure of a nasopalatine nerve block?

A) Use of an extra-short needle
B) Inadequate volume of anesthesia
C) Opposite wall of canal is not contacted with needle
D) Backflow of solution along the needle pathway

Question 39

Which of the following is the best indication of a P-ASA nerve block?

A) Pain management of palatal tissue
B) Pain management for extensive restorative therapy
C) Pain management for cosmetic dental procedures
D) Pain management for anterior facial and lingual soft tissues

Question 40

Which structures are not anesthetized by the P-ASA nerve block?

A) Facial and palatal soft and hard tissues associated with the teeth and the pulps of the teeth canine to canine
B) Structures anesthetized by right and left MSA nerve blocks
C) Structures innervated by the right and left nasopalatine nerves
D) Structures innervated by the right and left anterior branches of the ASA nerves

Question 41

Which statement best describes the needle pathway for a P-ASA nerve block?

A) Advance needle to a depth of 6 to 10 mm in the center of the canal
B) Advance needle to a depth of 4 to 6 mm within the canal
C) Advance needle parallel to the long axis of the central incisors to a depth of 6 to 10 mm into the canal
D) Using the wall of the canal as a guide, advance needle parallel to the long axis of the central incisors to depth of 6 to 10 mm into the canal

Question 42

What is the correct penetration depth for a P-ASA nerve block?

A) 2 to 6 mm
B) 2 to 10 mm
C) 4 to 6 mm
D) 6 to 10 mm

Question 43

Which needle is commonly used for a P-ASA nerve block?

A) 25 gauge short
B) 27 gauge long
C) 27 gauge short
D) 25 gauge extra short

Question 44

What is the correct deposition rate for the P-ASA nerve bock?

A) 0.5 mL over 60 seconds
B) 0.5 mL over 90 seconds
C) 1.8 mL over 1 minute
D) 1.8 mL over 2 minutes

Question 45

What is the typical minimum volume of anesthetic solution deposited for P-ASA nerve blocks?

A) 0.5 to 1.0 mL
B) 0.9 to 1.8 mL
C) 1.4 to 1.8 mL
D) 1.0 mL

Question 46

What nerve branch can provide assessory innervation causing incomplete anesthesia following a P-ASA nerve block?

A) Facial nerve branch
B) Nasal nerve branch
C) MSA nerve
D) Greater palatine

Question 47

Which of the following best describes the nerves anesthetized by the AMSA nerve block?

A) GP, MSA, NP
B) NP, ASA, MSA
C) NP, ASA, MSA, PSA
D) ASA, MSA, NP, GP

Question 48

Which of the following is not a clinical advantage of the AMSA nerve block?

A) No anesthesia of associated labial tissues for cosmetic procedures
B) Profound pulpal anesthesia of maxillary first molar
C) Less total drug volume administered
D) Requires one needle penetration

Question 49

The field of anesthesia for an AMSA nerve block includes:

A) Pulps of central and lateral incisors, canine, premolars, and molars on the anesthetized side
B) Pulps of central and lateral incisors, canine, and premolars, and upper lip and facial gingival tissues on the anesthetized side
C) Pulps and lingual gingival of the central and lateral incisors, canine, premolars, and molars bilaterally
D) Pulps of the central and lateral incisors, canine, and premolars, and palatal tissues from the central incisors through the second molar on the side of injection on the anesthetized side

Question 50

What is the optimum site of penetration for an AMSA nerve block?

A) Mucogingival junction between the maxillary premolars
B) Junction between the vertical and horizontal aspects of the palate at an imaginary line drawn from the gingival margin between the maxillary second premolar and the first molar
C) Between the premolars along an imaginary line drawn from the base of the interdental papilla
D) Junction between premolars approximately halfway from the median palatine raphe to the gingival margin

Question 51

What is a typical minimum volume of anesthetic solution deposited for an AMSA nerve block?

A) 0.2 to 0.6 mL
B) 0.6 to 1.8 mL
C) 0.9 to 1.2 mL
D) 1.2 to 1.8 mL

Question 52

What is the correct deposition rate for an AMSA nerve block?

A) 0.5 mL over 60 seconds
B) 0.3 mL over 40 seconds
C) 0.5 mL over 30 seconds
D) 1.2 mL over 90 seconds

Question 53

Which of the following statements is the most accurate description of the field of anesthesia for a greater palatine nerve block?

A) Soft and hard palatal tissues unilaterally from the midline
B) Soft and hard palatal tissues bilaterally from the midline
C) Soft and hard palatal tissues unilaterally distal to the canine
D) Soft and hard palatal tissues unilaterally from the canine to the molars

Question 54

Terminal fibers of the GP nerve overlap the:

A) Lesser palatine nerves
B) Nasopalatine nerves
C) Anterior superior alveolar nerves
D) Opposite greater palatine nerve

Question 55

What is the penetration site for a GP nerve block?

A) Slightly anterior to the greater palatine foramen
B) Greatest depression of the greater palatine foramen
C) Junction of the maxillary and palatal bones medial to an imaginary line drawn between the maxillary first and second premolars
D) Slightly distal to the greater palatine foramen

Question 56

What is the approximate depth of penetration for a GP nerve block?

A) 2 mm
B) 2 to 6 mm
C) 6 to 10 mm
D) 9 to 12 mm

Question 57

What is a typical minimum dose of anesthetic solution deposited for GP nerve blocks?

A) 1 stopper width (0.2 mL)
B) 2 to 3 stopper widths (0.4 - 0.6 mL)
C) 0.9 to 1.2 mL
D) One-half of a cartridge

Question 58

What is the recommended maximum dose of a 4% anesthetic solution for a GP nerve block?

A) 0.3 mL
B) 0.6 mL
C) 0.9 mL
D) 1.2 mL

Question 59

What are the two most important considerations for patient comfort for all palatal local anesthetic procedures?

Question 60

Explain the gate control theory of pain perception related to the use of pressure anesthesia for palatal injections.

Question 61

Describe the two-step method of topical anesthesia.

Question 62

Discuss the procedural modification necessary if excessive tissue blanching and bulging occur when depositing anesthetic solutions for palatal nerve blocks.

Question 63

Explain the advantages of using P-ASA and AMSA nerve block techniques.

Question 64

Color in the field of anesthesia and list the structures anesthetized by a nasopalatine nerve block.

Question 65

Color in the field of anesthesia and list the structures anesthetized by a P-ASA nerve block.

Question 66

Color in the field of anesthesia and list the structures anesthetized by an AMSA nerve block.

Question 67

Color in the field of anesthesia and list the structures anesthetized by a GP nerve block.

Question 68

The treatment plan for Marjorie Dickens includes crown preparations for teeth #7, #8, and #9.

-Which injection(s) is/are needed for pulpal, facial, and palatal soft tissue anesthesia for #7, #8, and #9 with the least number of needle penetrations planned?

Question 69

The treatment plan for Marjorie Dickens includes crown preparations for teeth #7, #8, and #9.

-Which other injection choice(s) can be considered if needle penetrations are not limited?

Question 70

The treatment plan for Marjorie Dickens includes crown preparations for teeth #7, #8, and #9.

-Which needle(s) should be used?

Question 71

The treatment plan for Jim Martin includes an MOD restoration on tooth #14 requiring rubber dam placement on tooth #15.

-Which injection(s) is/are needed for pulpal and soft tissue anesthesia?

Question 72

The treatment plan for Jim Martin includes an MOD restoration on tooth #14 requiring rubber dam placement on tooth #15.

-Which needle(s) should be used?

Question 73

The treatment plan for Jim Martin includes an MOD restoration on tooth #14 requiring rubber dam placement on tooth #15.

-The gingivopalatal aspect of #14 and #15 has failed to be anesthetized. What is the most common cause(s) for failure of anesthesia following a GP injection?