Test Bank For Local Anesthesia for Dental Professionals, 2nd Edition Bassett, DiMarco & Naughton,

Test Bank For Local Anesthesia for Dental Professionals, 2nd Edition Bassett, DiMarco & Naughton,

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WITH ANSWERS

 

 Local Anesthesia for Dental Professionals, 2nd Edition Bassett, DiMarco & Naughton,-

Test Bank

 

Chapter 1

 

Perspectives on Local Anesthesia for Dental Professionals

 

True or false

 

1) Troubleshooting is the ability to critically assess and resolve anesthesia inadequacies in order to provide comfortable patient care.

1. A) True
2. B) False

Answer: A

Objective: 1

 

2) Dental hygienists and mid-level providers in all states and provinces receive the same education, and require the same level of supervision for administering local anesthesia.

1. A) True
2. B) False

Answer: B

Explanation: B) Specific requirements for dental hygienists and mid-level providers vary regarding the type, degree, or extent of injections, as well as the required extent of supervision, education, and examination. Clinicians must be knowledgeable regarding the specifics of the practice acts governing their particular practice locations.

Objective: 1

3) Dentists are the only providers of local anesthesia in dentistry in North America.

1. A) True
2. B) False

Answer: B

Explanation: B) In most states and provinces, dental local anesthesia providers include dentists, dental hygienists, and in some states and provinces, mid-level and/or expanded function clinicians.

Objective: 2

 

4) The first state to license dental hygienists to deliver local anesthetic agents was California in 1975.

1. A) True
2. B) False

Answer: B

Explanation: B) The first state to license dental hygienists to deliver local anesthetic agents was Washington in 1971.

Objective: 2

5) The first state to license dental hygienists to deliver local anesthetic agents was Washington in 1971.

1. A) True
2. B) False

Answer: A

 

Objective: 2

6) Dentists have been able to deliver local anesthetic drugs in cartridge form since 1884.

1. A) True
2. B) False

Answer: B

Explanation: B) Dentists have been able to deliver local anesthetic drugs in cartridge form since 1921.

Objective: 2

 

7) Troubleshooting anesthesia inadequacies always requires referral to a dental specialist.

1. A) True
2. B) False

Answer: B

Explanation: B) Every dental professional who administers local anesthesia can and should have ready troubleshooting skills, and familiarity with pain control alternatives.

Objective: 3

 

8) Only a dentist can assess and resolve anesthesia inadequacies.

1. A) True
2. B) False

Answer: B

Explanation: B) Every dental professional who administers local anesthesia can and should have ready troubleshooting skills, and familiarity with pain control alternatives.

Objective: 3

 

9) Mastering a wide variety of techniques is critical to safe and effective pain control.

1. A) True
2. B) False

Answer: A

Objective: 3

 

Multiple choice

 

1) The fundamentals of pain management include all of the following except

1. A) Comprehensive assessment
2. B) Knowledge of drug effects
3. C) Periodontal assessment
4. D) Mastering multiple injection techniques

Answer: C

Objective: 1

2) The fundamentals of pain management include

1. A) Administering drugs that provide the shortest period of anesthesia possible
2. B) Patient safety
3. C) Integrating evidence based knowledge in clinical decisions
4. D) Knowledge in a wide variety of techniques

Answer: A

Objective: 1

3) Local anesthetics have been available in dentistry since

1. A) 1971
2. B) 1948
3. C) 1906
4. D) 1884

Answer: D

Objective: 1

4) Which situations best demonstrate the fundamentals of pain management?

1. A) A clinician assesses the patient, including taking vital signs. The patient receives the same dose of drug that has always been effective. Today the patient is not adequately numb and he is asked to reschedule an appointment for another day.
2. B) A clinician assesses the patient and determines there is no physical reason the patient could not receive anesthesia for periodontal maintenance. The patient reports she always has difficulty getting numb therefore the patient is referred to a periodontist for treatment.
3. C) A clinician assesses the patient and readies the patient for treatment. The patient mentions that he was not numb enough at his last appointment. It is decided that another drug and technique will be tried at this appointment.
4. D) A clinician asks the patient if she has had any difficulty with anesthesia in the past. The patient indicates she has never had any problem and always gets really numb; therefore treatment is provided without difficulty.

Answer: C

Objective: 1

 

Short answer/essay

 

1) Discuss a providers responsibility for troubleshooting local anesthesia inadequacies.

Answer: Every provider of local anesthesia should have confidence in his or her pain control strategies, have ready troubleshooting skills, and familiarity with alternate techniques to provide successful anesthesia.

 

2) Discuss the responsibility of local anesthesia providers.

Answer: Providing safe, effective, and appropriate pain control is a responsibility of all dental local anesthesia providers. This requires knowledge of and competency with the fundamentals of pain management.

Objective: 3

 

3) Discuss the fundamentals of pain management.

Answer: The fundamentals of pain management include conducting a comprehensive patient assessment, recognizing and responding to patient factors, integrating evidence-based knowledge, and understanding relevant drugs, their effects, indications, and contraindications. Fundamentals also include developing clinical decision-making skills and mastering a wide variety of techniques and appropriate modifications.

Objective: 1

 

AU: Question 5 and answer to question 4 are identical; is this intended?

Chapter 3

 

The Neuroanatomy and Neurophysiology of Pain Control

 

Match the following

 

1. A) Water loving
2. B) Passage through nerve membrane
3. C) Nerve bundle of nerve fibers
4. D) Nerve membrane
5. E) Covering on nerve membrane
6. F) Forms myelin layer
7. G) Ionic activity on nerve membrane
8. H) Area of synapses
9. I) Little or no stimulation on nerve
10. J) Gap in sheath

 

1) Dendritic zone

Objective: 1

 

2) Depolarization

Objective: 1

 

3) Fasciculi

Objective: 1

 

4) Hydrophilic

Objective: 1

 

5) Ion channel

Objective: 1

 

6) Impulse

Objective: 1

 

7) Myelination

Objective: 1

 

8) Neurolemma

Objective: 1

 

9) Node of Ranvier

Objective: 1

 

10) Schwann cells

Objective: 1

 

Answers: 1) H 2) I 3) C 4) A 5) B 6) G 7) E 8) D 9) J 10) F

 

True or false

 

1) The epineurium surrounds all of the fasciculi, their associated supporting connective tissue including blood vessels and lymphatics, and the perineuria.

1. A) True
2. B) False

Answer: A

Objective: 1

 

2) The strength of nerve impulses weakens as the energy transfers from one section of nerve membranes to the next.

1. A) True
2. B) False

Answer: B

Explanation: B) Impulses do not lose any of their strength in the transfer of energy from one section of membrane to the next. Current flow at successive areas of a nerve membrane actually exceeds that which is necessary to fire nerve impulses.

Objective: 2

 

3) Saltatory conduction is the term for the process by which impulses are slowly conducted along nonmyelinated nerves.

1. A) True
2. B) False

Answer: B

Explanation: B) Saltatory conduction is the term for the process by which impulses are more rapidly conducted along myelinated nerves.

Objective: 2

 

4) In response to stimulation, calcium ions release from the receptor sites, allowing an influx of sodium ions into the axoplasm.

1. A) True
2. B) False

Answer: A

Objective: 2

 

5) There are more positively charged ions outside the depolarized nerve cell than inside because the nerve membrane is relatively impermeable to sodium.

1. A) True
2. B) False

Answer: A

Objective: 3

 

6) The electrical potential of a nerve axoplasm in the resting state is approximately -70 mV.

1. A) True
2. B) False

Answer: A

Objective: 3

 

7) Depolarization refers to a potential change across a nerve membrane from -70 mV to +40 mV.

1. A) True
2. B) False

Answer: A

Objective: 3

8) Depolarization is a reversal of ion concentrations in the recovery phase.

1. A) True
2. B) False

Answer: B

Explanation: B) The reversal of ion concentrations in the recovery phase is called repolarization.

Objective: 3

 

9) A relative refractory period occurs when a nerve fiber can only be restimulated by a much stronger stimulus than the initial stimulus.

1. A) True
2. B) False

Answer: A

Objective: 3

10) An absolute refractory period occurs when a nerve fiber can be restimulated only by a much stronger stimulus than the initial stimulus.

1. A) True
2. B) False

Answer: B

Objective: 3

 

11) Schwann cells release neurotransmitters when stimulated by impulses.

1. A) True
2. B) False

Answer: B

Explanation: B) Organelles are located in the terminal zones of nerve axons and release neurotransmitters when stimulated by impulses. Schwann cells produce myelin, a specialized connective tissue that surrounds and protects peripheral nerves.

Objective: 4

 

12) Nodes of Ranvier are small, raised areas on the neurolemma that permit ions to pass into the axoplasm.

1. A) True
2. B) False

Answer: B

Explanation: B) Nodes of Ranvier are minute gaps on myelinated nerves between adjacent Schwann cells.

Objective: 4

 

13) Local anesthetic drugs are effective only at the nodes of Ranvier and in order to be effective, multiple nodes must be exposed to the drug to block impulses.

1. A) True
2. B) False

Answer: A

Objective: 4

 

14) Due to the effectiveness of local anesthetic drugs, exposure of a 1 to 3 millimeter section of nerve membrane to an anesthetic solution is adequate to ensure profound anesthesia.

1. A) True
2. B) False

Answer: B

Explanation: B) Eight to ten millimeters of the nerve membrane must be flooded by an anesthetic solution in order to achieve anesthesia in larger, heavily myelinated nerves, such as the inferior alveolar nerve.

Objective: 4

 

15) All cell bodies of sensory nerves that innervate oral tissues are located in the trigeminal ganglia and participate in impulse transmission.

1. A) True
2. B) False

Answer: B

Explanation: B) All cell bodies of sensory neurons that innervate oral tissues are located in the trigeminal ganglia and provide metabolic support to the cell. The cell bodies are located away from the axon, and therefore do not participate in impulse transmission.

Objective: 5

16) The minimal threshold stimulus required to stimulate a C fiber will be sufficient to stimulate an A fiber.

1. A) True
2. B) False

Answer: B) C fiber impulses travel in a range of 0.52.3 m/sec and A fibers at 15100 m/s.

Objective: 6

 

17) Nonmyelinated C fibers are the most common nerve fiber types on peripheral nerves and conduct slowly producing a sensation of dull and aching pain.

1. A) True
2. B) False

Answer: A

Objective: 6

 

18) A fibers are the most numerous of the fiber types. They are nonmyelinated and transmit sharp pain sensations.

1. A) True
2. B) False

Answer: B

Explanation: B) C fibers are the most numerous of the fiber types. They are nonmyelinated, conduct more slowly, providing the sensation of dull and aching pain.

Objective: 7

19) The mantle bundles are located on the outer area of the nerve membrane and the core bundles are located in the central area. Both have significance in the order of anesthesia development.

1. A) True
2. B) False

Answer: A

Objective: 11

 

20) Local anesthetic molecules have a greater affinity for protein receptor sites within the nerve membrane compared to calcium ions; therefore, they displace the calcium ion and block impulse transmission.

1. A) True
2. B) False

Answer: A

Objective: 11

 

Fill in the blank

1) The four structural parts of the neuron are the ________, ________, ________, and ________.

Answer: dendritic zone, axon, cell body, terminal arborization

Objective: 1

 

2) Sensory neurons carry impulses to the ________ for processing.

Answer: central nervous system (CNS)

Objective: 1

 

3) Motor nerves carry impulses away from the CNS to ________ and ________.

Answer: effector cells (muscles), tissues and organs

Objective: 1

 

4) Lipophilic membranes are described as ________.

Answer: fat loving

Objective: 1

 

5) Nerves are classified as myelinated or nonmyelinated according to the extent of the ________ tissue that encloses them.

Answer: connective

Objective: 1

6) Nerve membranes are called ________ and are bilayered phospholipid membranes.

Answer: neurolemmas

Objective: 2

 

7) The process of sequential impulse generation to the CNS is referred to as ________.

Answer: propagation

Objective: 2

 

8) The ________ ion is the gatekeeper in the nerve membranes resting state.

Answer: calcium

Objective: 2

 

9) The inability of a nerve membrane to be restimulated following impulse generation and conduction is known as a ________.

Answer: refractory state

Objective: 3

 

10) Specialized connective tissue cells that surround and protect peripheral nerves are called ________.

Answer: Schwann cells

Objective: 3

 

11) Myelinated nerves have minute gaps consisting of unprotected nerve membranes between adjacent Schwann cells called ________.

Answer: nodes of Ranvier

Objective: 3

 

12) ________ is a process by which impulses are rapidly conducted along myelinated nerves.

Answer: Saltatory conduction

Objective: 3

 

13) ________ fibers are lightly myelinated and primarily provide a sharp pain sensation.

Answer: A delta (A)

Objective: 7

 

14) The two most significant ________ of local anesthetic solutions are the perilemma and the perineurium.

Answer: barriers to diffusion

Objective: 9

 

 

15) Mantle fibers within the inferior alveolar nerve innervate the ________ region.

Answer: molar

Objective: 10

 

Multiple choice

1) Which description of nerve membranes is correct?

1. A) Trilayered sandwich-like membranes
2. B) Bilayered phospholipid membranes
3. C) Hydrophilic ends facing inward
4. D) Have fatty cores that allow large hydrophilic molecules to pass into the axoplasm

Answer: B

Objective: 2

 

2) Which statement is not accurate when describing nerve impulses?

1. A) Electrical in nature
2. B) Depend on ionic activity on nerve membranes
3. C) Require firing threshold to transmit to CNS
4. D) Successive impulses decrease in size

Answer: D

Objective: 2

 

3) Which statement accurately describes the process known as saltatory conduction?

1. A) Impulses are rapidly conducted along myelinated nerves.
2. B) Impulses are slowly, uniformly conducted along nonmyelinated nerves.
3. C) Impulses are conducted only through the nodes of Ranvier on myelinated nerves.
4. D) Impulses are conducted through the Schwann cells and axoplasmic membrane to the CNS.

Answer: A

Objective: 2

 

4) Saltatory conduction is defined as the

1. A) Slow transmission of a nerve impulse due to diffusion of sodium across nerve membrane
2. B) Rapid diffusion of sodium chloride into the nerve cell during impulse conduction
3. C) Slow conduction of an impulse along a nonmyelinated nerve at the nodes of Ranvier
4. D) Rapid transmission of nerve impulses along a myelinated nerve fiber

Answer: D

Objective: 2

 

5) The axoplasm of a nerve at rest:

1. A) Is electrically positive at +70 mV.
2. B) Is electrically negative compared to the extracellular environment.
3. C) Contains more sodium ions than the extracellular environment.
4. D) Contains less calcium ions than the extracellular environment.

Answer: B

Objective: 2

 

6) In the resting state, a nerve membrane has an electrical potential of:

1. A) -40 mV to +40 mV.
2. B) +40 mV.
3. C) +70 mV to +90 mV.
4. D) -70 mV.

Answer: D

Objective: 2

 

7) Which two ions are responsible for the uninterrupted maintenance of the resting potential across the nerve membrane?

1. A) K+ and Na+
2. B) K+ and Cl-
3. C) Ca+ and Na-
4. D) H+ and Cl-

Answer: A

Objective: 2

8) Which positively charged ion functions as a gatekeeper in ion channels?

1. A) Calcium
2. B) Sodium
3. C) Potassium
4. D) Hydrogen

Answer: A

Objective: 2

 

9) Which of the following does not occur upon rapid depolarization?

1. Calcium rapidly floods into the axoplasm
2. Sodium rapidly floods into the axoplasm
3. Electrical potential of the axoplasm is +40 mV
4. Absolute refractory state

Answer: A

Objective: 3

 

10) Which of the following sequences best describes the events in a successful impulse generation?

1. A) Stimulation, firing threshold, rapid depolarization, slow repolarization, resting state
2. B) Stimulation, slow depolarization, firing threshold, rapid depolarization, recovery
3. C) Resting state, stimulation, slow depolarization, rapid depolarization, firing threshold
4. D) Resting state, stimulation, slow depolarization, rapid depolarization, slow depolarization

Answer: B

Objective: 3

11) Which statement describes slow depolarization?

1. A) Allows dehydrated sodium ions to enter the negatively charged axoplasm causing the threshold for firing threshold
2. B) Allows release of the sodium ions from the receptor sites in the ion channels allowing negative ions to enter the axoplasm
3. C) Occurs until the axoplasm has depolarized 15 to 20 mV to reach -50 to -55 mV, which is the firing threshold
4. D) Occurs until the calcium ions rebind with the receptor sites to reach firing threshold at -50 to -55 mV

Answer: C

Objective: 3

 

12) Which statement best describes rapid depolarization?

1. A) The membrane rapidly depolarizes at the site of stimulation causing a firing threshold that is followed by displacement of the calcium ions.
2. B) The membrane rapidly depolarizes once the firing threshold has been achieved allowing a flood of sodium ions into the axoplasm.
3. C) The membrane rapidly depolarizes along the entire nerve until the strength of the stimulus increases enough to cause an impulse.
4. D) The membrane rapidly depolarizes following the refractory resting state.

Answer: B

Objective: 3

 

13) Which statement best describes the relative refractory state when the membrane has not fully returned to its resting state?

1. A) The same strength of a single stimulus can create a firing threshold.
2. B) No amount of stimulus relative to the previous impulse will produce a firing threshold.
3. C) Rapid repetition of the same strength stimulus will create a firing threshold.
4. D) A larger stimulus than the previous stimulus can produce a firing threshold.

Answer: D

Objective: 3

 

14) Which statement best describes the repolarization process?

1. A) The nerve membrane has reestablished a potential of +70 mV.
2. B) Positively charged sodium ions return to the axoplasm due to the negative charge of the axoplasm during polarization.
3. C) Positively charged sodium, calcium, and potassium ions are actively transported from the axoplasm to the extracellular environment.
4. D) Calcium ions re-bind to the receptor sites to ensure that Na+ will not continue to depolarize the axoplasm.

Answer: D

Objective: 3

 

15) Which of the following is correct when a nerve is in the resting state?

1. Na+ concentration is the highest inside the axoplasm
2. Nerve membrane is more negative on the extracellular side
3. Nerve axoplasm is approximately -70 mV
4. Nerve membrane will respond to any stimulus

Answer: C

Objective: 3

 

16) The process of sequential impulse generation to the CNS is called:

1. A) Impulse generation
2. B) Firing potential
3. C) Firing threshold
4. D) Propagation

Answer: D

Objective: 3

17) Myelin is composed of:

1. A) Connective tissues
2. B) Fatty tissues
3. C) Neuron tissues
4. D) Phospholipid tissue

Answer: A

Objective: 4

 

18) Which cells produce myelin?

1. A) Sensory neurons
2. B) Myelinated neurons
3. C) Schwin cells
4. D) Schwann cells

Answer: D

Objective: 4

19) Nerve impulses travel rapidly on myelinated nerves because:

1. A) Myelin allows for a consistent incremental impulse over the membrane surface
2. B) Impulses travel through the membrane, generating new impulses at each node
3. C) Impulses bypass nodes and travel up to 810 mm to subsequent nodes, decreasing the length of nerve over which impulses must be generated
4. D) Transmit rapidly because they are small nerves

Answer: C

Objective: 4

 

20) What are the functions of Schwann cell sheaths?

1. A) Protection and insulation for cell bodies
2. B) Protection for the nodes of Ranvier and neurons
3. C) Protection and insulation for the neurons
4. D) Produce Schwann cells and cell membranes

Answer: C

Objective: 4

 

21) What is the correct relationship of Schwann cells to the nodes of Ranvier?

1. A) Schwann cells are located in the nodes of Ranvier.
2. B) Schwann cells are twice as thick as the nodes of Ranvier.
3. C) Nodes of Ranvier are gaps between Schwann cells.
4. D) Nodes of Ranvier are wrapped around the Schwann cells.

Answer: C

Objective: 4

 

22) In myelinated nerves, local anesthetic molecules are effective:

1. A) As they diffuse through the myelin sheath.
2. B) As they diffuse at the synapse.
3. C) Only at the cell body.
4. D) Only at the Nodes of Ranvier.

Answer: D

Objective: 4

 

23) Which statement correctly describes sensory and motor neurons?

1. A) Sensory neurons are efferent and conduct impulse away from the CNS.
2. B) Sensory neurons are afferent and conduct impulses toward the CNS.
3. C) Motor neurons participate in impulse conduction toward the CNS.
4. D) Motor neurons and sensory neurons have cell bodies that participate in the conduction of nerve impulse transmission.

Answer: B

Objective: 5

24) Which statement correctly describes the cell bodies of sensory and motor neurons?

1. A) Motor neuron cell bodies are located away from the axon.
2. B) Sensory neuron cell bodies participate in impulse transmission.
3. C) Sensory neuron cell bodies do not participate in impulse transmission.
4. D) Motor neuron cell bodies do not participate in the impulse transmission.

Answer: C

Objective: 5

 

25) Nerve impulses are initiated in the:

1. A) Dendritic zone
2. B) Axon.
3. C) Cell body.
4. D) Terminal arboration

Answer: A

Objective: 5

 

26) All oral cell bodies of sensory nerves are located in the:

1. A) Axon
2. B) Dendrite zone
3. C) Ganglia
4. D) Nerve membrane

Answer: C

Objective: 5

 

27) Which statement inaccurately describes nerve fiber types?

1. A) Dental pulp has more A than C nerve fiber types.
2. B) C fibers are more numerous in the peripheral nervous system.
3. C) A delta fibers are lightly myelinated and are responsible for the sensation of sharp pain.
4. D) C fibers are nonmyelinated and are responsible for the sensation of dull and aching pain.

Answer: D

Objective: 6

28) The immediate painful sensation from a traumatic injury to the lip is transmitted to the brain by which nerve fiber type?

1. A) A delta fibers
2. B) C delta fibers
3. C) B fibers
4. D) A and C fibers

Answer: A

Objective: 7

 

29) What is the function of the endoneurium?

1. A) Insulates the electrical activity of individual nerve fibers
2. B) Bundles nerve fibers into fasciculi
3. C) Is the inner layer of the perineurium
4. D) Provides metabolic support for the neuron membranes

Answer: A

Objective: 9

 

30) What is the function of the perineurium?

1. A) Forms the epineural sheath
2. B) Bundles nerve fibers into fasciculi
3. C) Produces connective tissues that insulate nerves
4. D) Forms a sheath around Schwann cells

Answer: B

Objective: 9

 

31) Which nerve layers represent the most significant barriers to the diffusion of anesthetic solutions and the development of anesthesia?

1. A) Perilemma and fasciculi
2. B) Fasciculi and epineurium
3. C) Perilemma and perineurium
4. D) All neuromembranes present a significant barrier to diffusion.

Answer: C

Objective: 9

 

32) What are three divisions of the dental plexus?

1. Interdental, interradicular, and periodontal
2. Inner dental, interradicular, and dental
3. Inner dental, interradicular, and periodontal
4. Interdental, interradicular, and dental

Answer: D

Objective: 10

 

33) The aromatic, lipophilic portion of an anesthetic molecule allows the anesthetic solution to:

1. A) Diffuse through the nerve membrane
2. B) Bind at the receptor site
3. C) Diffuse through the interstitial tissues
4. D) Be more effective in the presence of inflammation

Answer: A

Objective: 11

34) With which ion does the local anesthetic molecule compete within the nerve membrane?

1. A) Sodium
2. B) Calcium
3. C) Potassium
4. D) Hydrogen

Answer: B

Objective: 11

 

35) Which statement is true regarding the specific protein receptor theory?

1. A) Local anesthetic molecules compete with sodium ions for receptor sites.
2. B) Local anesthetic molecules displace calcium ions at receptor sites.
3. C) It explains why local anesthetic molecules affect only sensory nerves.
4. D) It blocks proteins that cover specific protein receptors on Schwann cells.

Answer: B

Objective: 11

 

36) Local anesthetics block pain impulses by:

1. A) Preventing repolarization of the nerve membrane
2. B) Preventing diffusion of the free base molecules
3. C) Decreasing the absolute refractory period between impulses
4. D) Preventing depolarization of the nerve membrane

Answer: D

Objective: 11

 

37) Which of the following is not directly related to impulse extinction caused by local anesthetics drugs?

1. A) Drug classification
2. B) Volume delivered
3. C) Drug concentration
4. D) Length of nerve exposed to the drug

Answer: A

Objective: 11

 

38) Local anesthetic molecules have a greater affinity for protein receptor sites within the nerve membranes compared to which ion(s)?

1. A) Chlorine and hydrogen
2. B) Hydrogen and sodium
3. C) Calcium
4. D) Sodium

Answer: C

Objective: 11

 

39) Which statement does not describe the typical onset of anesthesia?

1. A) Anesthesia will affect smaller nerves before larger nerves.
2. B) Anesthesia will affect sensory nerves before motor nerves.
3. C) Mantle bundles will be anesthetized before core bundles.
4. D) Onset is faster on incisors, soft tissues of chin, and labial tissues.

Answer: D

Objective: 11

Short answer/essay

1) What is the composition and function of the neurolemma?

Answer: Nerve membranes, called neurolemmas, are bilayered phospholipid membranes. The function of a bilayered membrane is to act as a barrier. Lipid membranes are composed of phospholipids having both lipophilic (fat-loving) and hydrophilic (water-loving) ends. Membranes are held together by the attraction of the lipophilic ends at their centers.

Objective: 2

 

2) Explain the structure and function of Schwann cells and nodes of Ranvier.

Answer: Schwann cells are specialized connective tissue cells that produce myelin. Myelin forms extensive sheaths around axons that insulate and protect the nerve membranes from their surrounding environments. Axons and their associated Schwann cells are collectively referred to as nerve fibers. Local anesthetic solutions cannot diffuse through myelinated nerves except in areas where they come into direct contact with the membrane at the nodes of Ranvier.

Objective: 4

 

3) Describe the process of firing threshold and impulse generation.

Answer: When a nerve is stimulated, the ion channels respond by releasing the gatekeeper calcium ions. The channels are then wide enough to allow the positively charged, hydrated Na+ ions to begin to enter through the channels into the more negatively charged axoplasm. The initial influx of positively charged Na+ ions causes a slow depolarization. Once there are sufficient Na+ ions in the axoplasm to reduce the electrical potential by approximately 15 to 20 mV, extracellular Na+ ions flood the axoplasm.

Objective: 3

 

4) Define local anesthesia.

Answer: Local anesthesia may be defined as a loss of sensation in a usually small area of the body that is temporary. A primary distinction between local and general anesthesia is that when local anesthesia alone is in effect, the patient remains conscious.

Objective: 11

 

5) Explain how local anesthetics work.

Answer: Local anesthetic drugs all work similarly. Local anesthetic molecules have a greater affinity for protein receptor sites within the nerve membrane compared to Ca+2 ions and subsequently displace them. Different local anesthetic drugs have varying affinities for these receptor sites, which account for clinically significant differences in drug action.

Objective: 11

 

Identify the structures indicated on the figure below

 

 

 

1) Identify A.

Answer: axon

Objective: 2

 

2) Identify B.

Answer: cell body

Objective: 2

 

3) Identify C.

Answer: Schwann cell

Objective: 2

 

4) Identify D.

Answer: dendritic zone

Objective: 2

 

5) Identify E.

Answer: terminal aborization

Objective: 2

 

 

Identify the structures indicated on the figure below

 

 

 

 

1) Identify A.

Answer: fasciculi

Objective: 7

 

 

2) Identify B.

Answer: perilemma

Objective: 7

 

3) Identify C.

Answer: perineurium

Objective: 7

 

4) Identify D.

Answer: Schwann cells

Objective: 7

 

5) Identify E.

Answer: axon

Objective: 7

Use the information provided in the Case Study below to answer the questions that follow.

 

Case Study

An injection has been completed on the right side of the mandible. The patient, Ralph, tells the clinician that his back teeth are numb; however, his lower lip and chin are not very numb.

 

1) Taking into consideration the sensory neuron structure, are the mantle bundles or the core bundles more affected by the anesthetic drug?

Answer: The mantle bundles are more effectively anesthetized.

Objective: 11

 

2) Provide two reasons Ralph does not feel as numb in the anterior area.

Answer: The anesthetic solution reaches the core bundles only after the solution has penetrated through the mantle bundles. It takes longer for the anesthetic solution to reach the core bundles.

There is a diluting effect on the solution due to the binding of the drug molecules to receptor sites in the mantle bundles. Once at the core, there are fewer anesthetic molecules remaining to bind to the receptor sites in the core.

Objective: 11

 

3) After waiting several more minutes, Ralph is not yet numb in the anterior region. Explain why this may occur.

Answer: There are actually several reasons the lower anterior region is not as numb as the posterior region. Impulse extinction is directly related to the volume of anesthetic solution administered, the concentration of the drug, and the length of nerve that was exposed to the solution. One other possibility could be the presence of accessory innervations in the anterior region.

Objective: 11

Chapter 13

 

Injections for Palatal Pain Control

 

True or false

 

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

1. A) True
2. B) False

Answer: B

Explanation: B) The nasopalatine nerve is a terminal and longest branch of the PSA nerve.

Objective: 2

 

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

1. A) True
2. B) False

Answer: A

Objective: 2

 

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.

1. A) True
2. B) False

Answer: B

Explanation: B) The GP nerve branches from the maxillary nerve within the pterygopalatine fossa and is anesthetized by a GP nerve block after it exits through the greater palatine foramen on the hard palate of the maxilla.

Objective: 2

 

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

1. A) True
2. B) False

Answer: B

Explanation: B) In dentistry, the gate control theory suggests that by stimulating non-nociceptive fibers of other nerves, pressure anesthesia blocks the stimulation of nociceptive fibers and related pain sensations from the teeth and their supporting structures.

Objective: 2

 

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

1. A) True
2. B) False

Answer: B

Explanation: B) The rate of deposition varies for palatal injections based on the location of the injection site and the need for comfort and risk of tissue damage due to trauma and/or ischemia.

Objective: 2

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

1. A) True
2. B) False

Answer: A

Objective: 2

 

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

1. A) True
2. B) False

Answer: B

Explanation: B) If either swelling or blanching occurs, continue with the deposition only after pausing to allow for diffusion and absorption of the solution from areas of swelling and for the mucosa to return to normal coloration.

Objective: 2

 

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

1. A) True
2. B) False

Answer: A

Objective: 3

 

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.

1. A) True
2. B) False

Answer: B

Explanation: B) The optimum penetration site for the NP nerve block is adjacent to the widest anteroposterior aspect of the incisive papilla.

Objective: 3

 

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

1. A) True
2. B) False

Answer: A

Objective: 3

 

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

1. A) True
2. B) False

Answer: B

Explanation: B) A short needle has adequate length for a P-ASA injection.

Objective: 3

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.

1. A) True
2. B) False

Answer: A

Objective: 3

 

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

1. A) True
2. B) False

Answer: B

Explanation: B) The rate of deposition of anesthetic solution for the NP is 0.4 mL over 40 seconds compared to the slower rate of deposition for the P-ASA injection, which is 0.5 mL over 60 seconds.

Objective: 3

 

14) The AMSA injection does not anesthetize labial tissues.

1. A) True
2. B) False

Answer: A

Objective: 3

 

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

1. A) True
2. B) False

Answer: B

Explanation: B) The rate of deposition for an AMSA injection is 0.5 mL (or less) over 60 seconds.

Objective: 3

 

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).

1. A) True
2. B) False

Answer: A

Objective: 3

 

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

1. A) True
2. B) False

Answer: A

Objective: 3

 

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

1. A) True
2. B) False

Answer: A

Objective: 3

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.

1. A) True
2. B) False

Answer: B

Explanation: B) A 27 or 30 gauge short or x-short needle is commonly used.

Objective: 3

 

Fill in the blank

 

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

Answer: one minute of pressure anesthesia

Objective: 2

 

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

Answer: 4 to 6 mm

Objective: 2

 

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

Answer: maxillary

Objective: 2

 

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

Answer: gate control

Objective: 2

 

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

Answer: rate of deposition

Objective: 2

 

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

Answer: slow rates of deposition

Objective: 2

 

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

Answer: labial tissue (upper lip)

Objective: 2

 

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

Answer: ischemia

Objective: 2

 

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

Answer: slow

Objective: 2

Multiple choice

 

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

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

Answer: C

Objective: 2

 

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

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

Answer: B

Objective: 2

 

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

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

Answer: A

Objective: 2

 

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

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

Answer: C

Objective: 2

 

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

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

Answer: C

Objective: 3

 

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

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

Answer: C

Objective: 3

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

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

Answer: A

Objective: 3

 

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

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

Answer: B

Objective: 3

 

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

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

Answer: B

Objective: 3

 

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

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

Answer: C

Objective: 3

 

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

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

Answer: C

Objective: 3

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

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

Answer: B

Objective: 3

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

1. A) Advance needle to a depth of 6 to 10 mm in the center of the canal
2. B) Advance needle to a depth of 4 to 6 mm within the canal
3. C) Advance needle parallel to the long axis of the central incisors to a depth of 6 to 10 mm into the canal
4. 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

Answer: D

Objective: 3

 

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

1. A) 2 to 6 mm
2. B) 2 to 10 mm
3. C) 4 to 6 mm
4. D) 6 to 10 mm

Answer: D

Objective: 3

 

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

1. A) 25 gauge short
2. B) 27 gauge long
3. C) 27 gauge short
4. D) 25 gauge extra short

Answer: C

Objective: 3

 

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

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

Answer: A

Objective: 3

 

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

1. A) 0.5 to 1.0 mL
2. B) 0.9 to 1.8 mL
3. C) 1.4 to 1.8 mL
4. D) 1.0 mL

Answer: C

Objective: 3

 

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

1. A) Facial nerve branch
2. B) Nasal nerve branch
3. C) MSA nerve
4. D) Greater palatine

Answer: D

Objective: 3

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

1. A) GP, MSA, NP
2. B) NP, ASA, MSA
3. C) NP, ASA, MSA, PSA
4. D) ASA, MSA, NP, GP

Answer: D

Objective: 3

 

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

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

Answer: B

Objective: 3

 

21) The field of anesthesia for an AMSA nerve block includes:

1. A) Pulps of central and lateral incisors, canine, premolars, and molars on the anesthetized side
2. B) Pulps of central and lateral incisors, canine, and premolars, and upper lip and facial gingival tissues on the anesthetized side
3. C) Pulps and lingual gingival of the central and lateral incisors, canine, premolars, and molars bilaterally
4. 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

Answer: D

Objective: 3

 

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

1. A) Mucogingival junction between the maxillary premolars
2. 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
3. C) Between the premolars along an imaginary line drawn from the base of the interdental papilla
4. D) Junction between premolars approximately halfway from the median palatine raphe to the gingival margin

Answer: D

Objective: 3

 

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

1. A) 0.2 to 0.6 mL
2. B) 0.6 to 1.8 mL
3. C) 0.9 to 1.2 mL
4. D) 1.2 to 1.8 mL

Answer: C

Objective: 3

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

1. A) 0.5 mL over 60 seconds
2. B) 0.3 mL over 40 seconds
3. C) 0.5 mL over 30 seconds
4. D) 1.2 mL over 90 seconds

Answer: A

Objective: 3

 

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

1. A) Soft and hard palatal tissues unilaterally from the midline
2. B) Soft and hard palatal tissues bilaterally from the midline
3. C) Soft and hard palatal tissues unilaterally distal to the canine
4. D) Soft and hard palatal tissues unilaterally from the canine to the molars

Answer: C

Objective: 3

 

26) Terminal fibers of the GP nerve overlap the:

1. A) Lesser palatine nerves
2. B) Nasopalatine nerves
3. C) Anterior superior alveolar nerves
4. D) Opposite greater palatine nerve

Answer: B

Objective: 3

 

27) What is the penetration site for a GP nerve block?

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

Answer: A

Objective: 3

 

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

1. A) 2 mm
2. B) 2 to 6 mm
3. C) 6 to 10 mm
4. D) 9 to 12 mm

Answer: C

Objective: 3

 

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

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

Answer: B

Objective: 3

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

1. A) 0.3 mL
2. B) 0.6 mL
3. C) 0.9 mL
4. D) 1.2 mL

Answer: A

Objective: 3

 

Short answer/essay

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

Answer: The two most important considerations for patient comfort for all palatal local anesthetic procedures are use of a two-step pre-anesthesia technique consisting of a 1-minute topical anesthesia application followed by an additional minute of pressure anesthesia, and the slow administration of anesthetic solutions never exceeding 1.8 mL over 2 to 3 minutes.

Objective: 2

 

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

Answer: The gate control theory of pain perception suggests that there are neurological gates that can block signals to the brain. This theory asserts that the perception of physical pain is not based solely on the activation of nociception. The experience of pain is a modulation between activation of large non-pain-transmitting (non-nociceptive) nerve fibers and small pain-transmitting (nociceptive) nerve fibers; the activation of large non-nociceptive fibers can interfere with signals from small nociceptive fibers; and the stimulation of non-nociceptive fibers is greater than the stimulation of nociceptive fibers causing pain to be inhibited or blocked.

The stimuli of pressure anesthesia therefore blocks the pain stimuli caused by the penetration of the needle.

Objective: 2

 

3) Describe the two-step method of topical anesthesia.

Answer: The two-step method of topical anesthesia includes application of a topical anesthetic for one minute followed by one minute of pressure applied with a cotton swab or a smooth, blunt-ended instrument handle until the site blanches.

Objective: 2

 

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

Answer: If either excessive tissue blanching or bulging occurs, continue with the deposition only after pausing to allow for diffusion and absorption of the solution from areas of swelling, and for tissue coloration to return to normal. This will reduce tissue damage from stretching and will allow normal blood flow to return to the area. In either instance, when deposition proceeds it should occur at an even slower rate (less than one cartridge per three minutes).

Objective: 2

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

Answer: The P-ASA and AMSA nerve block reduce the total number of injections necessary and therefore the total volumes of solution necessary to achieve the same field of anesthesia as traditional approaches. The labial tissues are not anesthetized with these techniques; therefore, they work especially well for cosmetic procedures that involve assessment of the patient smile lines and for ease in speaking.

Objective: 3

 

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Answer:

Objective: 3

 

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Answer:

Objective: 3

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Answer:

Objective: 3

 

 

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

 

 

Answer:

Objective: 3

 

 

Use the information provided in the Case Study below to answer the questions that follow.

 

Case Study 1

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

 

1) 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?

Answer: P-ASA

Objective: 3

 

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

Answer: infiltrations #7, #8, #9, NP

Objective: 3

 

3) Which needle(s) should be used?

Answer: short 25 or 27 gauge

Objective: 3

 

Use the information provided in the Case Study below to answer the questions that follow.

 

Case Study 2

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

 

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

Answer: left PSA, MSA, and GP

Objective: 3

 

2) Which needle(s) should be used?

Answer: short 25 or 27 gauge

Objective: 3

 

3) 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?

Answer: The most common causes of anesthetic failure following a GP nerve block include deposition of solution that is too shallow, too lateral, or too medial to the foramen as well as inadequate volumes of solution.

Objective: 3

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