Test Bank For Local Anesthesia for the Dental Hygienist, 1st Edition by Logothetis

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Test Bank For Local Anesthesia for the Dental Hygienist, 1st Edition by Logothetis

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WITH ANSWERS

 

Local Anesthesia for the Dental Hygienist, 1st Edition by Logothetis
Test Bank

 

Logothetis: Local Anesthesia for the Dental Hygienist

 

Chapter 01: Local Anesthesia in Dental Hygiene Practice: An Introduction

 

Test Bank

 

MATCHING

 

Match the following word or phrase with the correct drug category.

ester (E)

amide (A)

inhalation drug (I)

 

  1. Ether
  2. Lidocaine
  3. Prilocaine
  4. Procaine
  5. Nitrous oxide
  6. Halothane
  7. Mepivacaine
  8. Novocaine
  9. Causes more allergic reactions
  10. Patients experience fewer allergic reactions

 

  1. ANS: I REF:  Page 4
  2. ANS: A REF:  Page 4
  3. ANS: A REF:  Page 4
  4. ANS: E REF:  Page 4
  5. ANS: I REF:  Page 4
  6. ANS: I REF:  Page 4
  7. ANS: A REF:  Page 5
  8. ANS: E REF:  Page 4
  9. ANS: E REF:  Page 4
  10. ANS: A REF: Page 4

 

MULTIPLE CHOICE

 

  1. The first objections to the use of inhalation sedation included which of the following?
a. It was viewed as a religious offense
b. It was viewed as an unethical practice
c. It was viewed as a retardant to the health process
d. All of the above

 

ANS: D

Objections to operating on an unconscious patient included all of the above. Some viewed it as offensive to their religious beliefs; some viewed it as an ethical matter; and some objected because they believed that the relief from pain might actually retard the health process.

 

REF:  Page 4

 

  1. Who was the first dentist to use laughing gas for dental procedures?
a. William Clarke
b. Horace Wells
c. Henry Beecher
d. Nils Lofgren

 

ANS: B

Horace Wells was the first dentist to use laughing gas for dental procedures.

 

REF:  Page 4

 

  1. A highly effective analgesic and antipyretic compound, introduced in 1899 and still used today, is commonly referred to as what?
a. Aspirin
b. Alcohol
c. Novocaine
d. Opium

 

ANS: A

A new compound, introduced as aspirin in 1899, proved to be remarkably safe and well tolerated by patients. It is a highly effective analgesic and antipyretic.

 

REF:  Page 4

 

  1. Early methods of pain control included which of the following?
a. Use of opium
b. Scaring off of demons
c. Roots, berries, and seeds
d. All of the above

 

ANS: D

Early methods of pain control included all of the above: the use of opium, religious techniques of scaring off demons; and the use of plants and herbs for treating pain.

 

REF:  Page 4

 

  1. Pain threshold is best described as which of the following?
a. The physical and emotional response to a particular situation.
b. The relationship between human need fulfillment and human behavior.
c. A neurologic experience of pain.
d. The point at which a sensation starts to be painful and discomfort results.

 

ANS: D

Pain threshold is best described as the point at which a sensation starts to be painful and discomfort results.

 

REF:  Page 3

 

  1. The neurologic experience of pain is referred to as what?
a. Pain control
b. Pain threshold
c. Pain perception
d. Pain reaction

 

ANS: C

Pain perception is the neurologic experience of pain. It differs little between individuals.

 

REF:  Page 8

 

  1. An unpleasant sensory and emotional experience is called what?
a. Pain
b. Pain control
c. Pain threshold
d. Pain reaction

 

ANS: A

Pain is an unpleasant sensory and emotional experience.

 

REF:  Page 3

 

  1. The personal interpretation and response to the pain message is called what?
a. Pain
b. Pain control
c. Pain threshold
d. Pain reaction

 

ANS: D

The personal interpretation and response to the pain message is called ones pain reaction. It is highly variable among individuals.

 

REF:  Page 3

 

 

  1. The creation of the loss of sensation in a circumscribed area, without loss of consciousness, best defines which of the following?
a. Inhalation anesthesia
b. Local anesthesia
c. General anesthesia
d. All of the above

 

ANS: B

Local anesthesia creates a numbing feeling or the loss of sensation in a circumscribed area, without loss of consciousness.

 

REF:  Page 3

 

  1. The newest amide to arrive on the dental market in the United States is which one of the following?
a. Articaine
b. Mepivacaine
c. Lidocaine
d. Bupivacaine

 

ANS: A

The newest amide local anesthetic, introduced to the dental field in 2000, is articaine.

 

REF:  Page 5

 

  1. Lidocaine is said to have revolutionized pain control in dentistry. Why?
a. It is more potent than prilocaine.
b. It is less potent than procaine.
c. Patients experience fewer allergic reaction with lidocaine.
d. Some combination of the above

 

ANS: C

Lidocaine is said to have revolutionized pain control in dentistry because it is less allergenic than procaine.

 

REF:  Pages 4, 5

 

  1. Procaine was used extensively in dentistry for a number of years; however, it was not the ideal local anesthetic. Why not?
a. It took a long time to produce the desired anesthetic result.
b. It lasted for prolonged periods of time.
c. It had a high potential for triggering allergic reactions.
d. Some combination of the above

 

ANS: D

Choices a and c are correct. Procaine took a long time to produce the desired anesthetic results and it had a high potential for triggering allergic reactions.

 

REF:  Page 4

 

  1. The first local anesthetic used in dentistry was which of the following?
a. Novocaine
b. Cocaine
c. Procaine
d. Lidocaine

 

ANS: B

Cocaine was the first anesthetic used in dentistry (in 1884).

 

REF:  Page 4

 

  1. The benefit of local anesthesia is not limited to pain control but could also include which of the following?
a. Hemostasis
b. Time management
c. Patient-centered stress reduction
d. All of the above

 

ANS: D

The benefit of local anesthesia is not limited to pain control but could also include hemostasis, achieved via the vasoconstrictor in the anesthetic; time management, because the dental hygienist can administer the anesthesia and obviate the need for the dentist and the patient to wait for anesthesia to take effect; and patient-centered stress reduction, which addresses the relationship between human need fulfillment and human behavior.

 

REF:  Pages 5, 8 and Table 1-2

 

  1. Jon presents to your dental office in pain with an abscessed tooth. Utilizing the Visual Analog Scale (VAS), Jon indicates that his pain level measures about 95 mm in length from the left hand end of the horizontal line. What is an appropriate translation of this action?
a. Jon is experiencing a significant amount of pain.
b. Jon is experiencing a moderate amount of pain.
c. Jon is uncomfortable but able to tolerate the pain.
d. None of the above because the pain scale is subjective

 

ANS: A

Operationally a VAS is usually a horizontal line, 100 mm in length. The VAS score is determined by measuring in millimeters from the left end of the line to the point that the patient indicates. Since Jon indicated that his pain threshold was close to the definitive end of 100 mm, one can assume that Jon is experiencing a significant amount of pain.

 

REF:  Page 8

 

  1. Considering the human needs paradigm, freedom from fear and stress includes which of the following?
a. The need to receive appreciation, attention, and respect from others
b. The need to be free from emotional discomfort
c. The need to feel safe
d. All of the above

 

ANS: D

Considering the human needs paradigm, freedom from fear and stress includes the need to receive appreciation, attention, and respect from others. It also includes the need to be free from emotional discomfort and the need to feel safe.

 

REF:  Page 9

 

  1. An astute practitioner looks for signs of patient anxiousness. These signs may include which of the following?
a. Overwillingness to cooperate with clinician
b. History of emergency dental care only
c. Elevated blood pressure and heart rate
d. All of the above

 

ANS: D

An astute practitioner looks for signs of patient anxiousness. These signs may include an overwillingness to cooperate with clinician, which could be portrayed through nervous conversations and/or quick answers; a history of emergency dental care only or a history of canceled appointments; and physical symptoms including elevated blood pressure and fast heart rate.

 

REF:  Page 9, Box 1-4

 

  1. The best method to manage an anxious patient is by:
a. Prevention
b. General sedation
c. Referral to an anxiety specialist
d. All of the above

 

ANS: A

The best method to manage an anxious patient is by prevention.

 

REF:  Page 9

 

  1. Performing a complete health history review at every appointment helps practitioners recognize stressors and health conditions that may complicate dental procedures. Taking a patients vital signs does not play an important role in assessing a patients level of apprehension.
a. Both statements are true.
b. Both statements are false.
c. The first statement is true; the second statement is false.
d. The first statement is false; the second statement is true.

 

ANS: C

Performing a complete health history review at every appointment helps practitioners recognize stressors and health conditions that may complicate dental procedures. Taking vital signs also plays an important role in helping to understand a patients total health history and in assessing a patients level of apprehension.

 

REF:  Page 9

 

  1. The use of anesthesia as needed is an important key to what?
a. Understanding why patients are fearful of dental appointments
b. Preventing fear associated with pain
c. Ensuring patient comfort and adequate care
d. B and C

 

ANS: D

The use of anesthesia as needed is an important key to preventing the fear associated with pain. This also ensures patient comfort so that they may receive adequate and necessary dental care.

 

REF:  Page 9

 

  1. Considerations that have the potential of influencing a dental patients pain reaction threshold include which of the following?
a. Age
b. Culture
c. Fatigue
d. All of the above

 

ANS: D

Pain reaction threshold may be influenced by the patients emotional state, fatigue, age, culture, and fear and apprehension.

 

REF:  Page 8, Table 1-2

 

  1. Patients who frequently miss dental appointments because of apprehension, often demonstrate what kind of pain reaction threshold?
a. A lower pain reaction threshold, which means that they have a high tolerance for pain
b. A lower pain reaction threshold, which means that they have a low tolerance for pain
c. A higher pain reaction threshold, which means that they have a high tolerance for pain
d. None of the above

 

ANS: B

Patients who frequently miss dental appointments because of apprehension will generally demonstrate a lower pain reaction threshold, which means that they have a low tolerance for pain and they will likely experience pain more quickly and/or intensely than if they were calm.

 

REF:  Page 8, Table 1-2

 

  1. Patients who are overly tired or stressed at the time of their dental appointment will generally demonstrate what kind of pain reaction threshold?
a. A lower pain reaction threshold, which means that they have a high tolerance for pain
b. A lower pain reaction threshold, which means that they have a low tolerance for pain
c. A higher pain reaction threshold, which means that they have a high tolerance for pain
d. None of the above

 

ANS: B

Patients who are overly tired or stressed at the time of their dental appointment will generally demonstrate a lower pain reaction threshold, which means that they have a low tolerance for pain and they will likely experience pain more quick and/or intensely than if they were well rested and calm.

 

REF:  Page 8, Table 1-2

 

  1. The difference between the legal wording that states that the dental hygienist may monitor nitrous oxide and that the dental hygienist may administer nitrous oxide is best explained by which of the following statements?
a. When it is said that the dental hygienist may administer nitrous oxide, this indicates that the hygienist may change the nitrous oxide and/or oxygen settings during the appointment as needed.
b. When it is said that the dental hygienist may monitor nitrous oxide, this means that the hygienist may turn on the nitrous oxide and/or oxygen settings during the appointment as needed.
c. In legal terms, someone with the authority to monitor nitrous oxide may change the nitrous oxide and/or oxygen settings; someone with the authority to administer nitrous oxide may turn on the apparatus.
d. In state law the terms monitor and administer can be used interchangeably.

 

ANS: C

In legal terms someone with the authority to monitor nitrous oxide may change the nitrous oxide and/or oxygen settings during the appointment as needed; someone with the authority to administer nitrous oxide may turn on the nitrous-oxide/oxygen apparatus.

 

REF:  Page 8

 

Logothetis: Local Anesthesia for the Dental Hygienist

 

Chapter 03: Pharmacology of Local Anesthetic Agents

 

Test Bank

 

TRUE/FALSE

 

  1. Prilocaine is biotransformed in the liver only.

 

ANS: F

Correct: Prilocaine is biotransformed in the lungs and the liver.

 

REF:  Page 44

 

  1. The most potent local anesthetic is bupivacaine which has the greatest degree of lipid solubility.

 

ANS: T                    REF:  Page 46

 

  1. Intravascular injections significantly increase the possibility of an overdose.

 

ANS: T                    REF:  Page 46

 

  1. The higher the pKa of an anesthetic, the faster the onset of action.

 

ANS: F

Correct: The higher the pKa of the anesthetic, the slower the onset of action.

 

REF:  Page 46

 

  1. The speed of recovery from local anesthetic is determined by the degree of binding to the receptor site of each anesthetic.

 

ANS: T                    REF:  Page 46

 

  1. Local anesthetics are vasoconstrictors and decrease the absorption of the drug by the blood.

 

ANS: F

Correct: Local anesthetics are vasodilators and increase the absorption of the drug by the blood.

 

REF:  Page 46

 

  1. If more anesthetic is needed for a procedure, it is important to reinject the anesthetic after the mantel fibers have fully recovered.

 

ANS: F

Correct: If more anesthetic is needed for a procedure, it is important to reinject the anesthetic before the mantel fibers have fully recovered.

 

REF:  Page 46

 

  1. Local anesthetics affect the CNS and CVS after biotransformation.

 

ANS: F

Correct: Local anesthetics affect the CNS and CVS before biotransformation.

 

REF:  Page 46

 

  1. The rate of systemic absorption of local anesthetics depends on the total dose, concentration, route of administration, vascularity of tissues, and presence or absence of a vasoconstrictor.

 

ANS: T                    REF:  Page 46

 

  1. Local anesthetics easily cross the blood-brain barrier.

 

ANS: T                    REF:  Page 46

 

MULTIPLE CHOICE

 

  1. What is the significant clinical difference between esters and amides?
a. Potential for allergic reactions
b. Cross-hypersensitivity
c. Lipid solubility
d. Drug potency

 

ANS: A

The significant clinical difference between esters and amides is the potential for allergic reactions.

 

REF:  Page 44

 

  1. Which component of the local anesthetic molecule improves the lipid solubility, which facilitates the penetration of the anesthetic through the lipid-rich membrane where the receptor sites are located?
a. Hydrophilic amino group
b. Intermediate hydrocarbon ester or amide chain
c. Lipophilic aromatic ring
d. All of the above

 

ANS: C

The lipophilic aromatic ring improves the lipid solubility of the molecule, which facilitates the penetration of the anesthetic through the lipid rich-membrane where the receptor sites are located.

 

REF:  Page 37

 

  1. Which component of the local anesthetic molecule renders the molecule water soluble?
a. Hydrophilic amino group
b. Intermediate hydrocarbon ester or amide chain
c. Lipophilic aromatic ring
d. All of the above

 

ANS: A

The hydrophilic amino group renders the molecule water soluble.

 

REF:  Page 37

 

  1. Dissociation constant refers to which of the following descriptions?
a. Determines the portion of administered anesthetic dose in the lipid-soluble state (RN)
b. Determines the onset of anesthetic action as the increase of molecules crossing the nerve membrane decreases the time of the anesthetics onset
c. The pH at which 50% of the molecules exist in the lipid-soluble form and 50% in the water-soluble form
d. All of the above

 

ANS: D

All of the statements above describe the phenomenon of dissociation constant.

 

REF:  Pages 39, 40 and Table 3-1

 

  1. Why is lipid solubility an important characteristic of local anesthetic drugs?
a. A greater lipid solubility enhances the diffusion of the anesthetic drug through the nerve.
b. A greater lipid solubility indicates a higher potency of the anesthetic drug.
c. A greater lipid solubility allows for a lower effective dose of the local anesthetic drug.
d. All of the above.

 

ANS: D

All of the statements above describe the importance of the characteristic of lipid solubility of the local anesthetic drugs.

 

REF:  Page 39, Table 3-1

 

  1. Why is protein binding an important characteristic of local anesthetic drugs?
a. Increased protein binding allows more cations (RNH+) to bind to the receptor sites within the sodium channels, prolonging the presence of anesthetic at the site of action.
b. Increased protein binding allows more RN molecules to bind to the receptor sites within the sodium channels, prolonging the presence of anesthetic at the site of action.
c. Decreased protein binding allows more cations (RNH+) to bind to the receptor sites within the sodium channels, prolonging the presence of anesthetic at the site of action.
d. Decreased protein binding allows more RN molecules to bind to the receptor sites within the sodium channels, prolonging the presence of anesthetic at the site of action.

 

ANS: A

Increased protein binding allows more cations (RNH+) to bind to the receptor sites within the sodium channels, prolonging the presence of anesthetic at the site of action.

 

REF:  Page 38, Table 3-1

 

  1. What characteristic of local anesthetic drugs determines the speed of nerve recovery?
a. The concentration of the local anesthetic
b. The degree of lipid solubility
c. The degree of protein binding
d. The nonnervous tissue diffusibility

 

ANS: C

The degree of protein binding at the receptor site for each anesthetic determines the speed of nerve recovery.

 

REF:  Page 43, Table 3-1

 

  1. What does the membrane expansion theory of the action of local anesthetics suggest?
a. Anesthetics that are highly hydrophilic cause the matrix of the nerve membrane to expand, narrowing the sodium channels, thus preventing depolarization.
b. Anesthetics that are highly lipid soluble cause the lipoprotein matrix of the nerve membrane to expand, narrowing the sodium channels, thus preventing depolarization.
c. Anesthetics cause the sodium channels to expand, thus allowing the increase in protein binding within the channels.
d. All of the above

 

ANS: B

The membrane expansion theory suggests that anesthetics that are highly lipid soluble cause the lipoprotein matrix of the nerve membrane to expand, narrowing the sodium channels, thus preventing depolarization.

 

REF:  Page 41

 

  1. What does the specific protein receptor theory of the action of local anesthetics suggest?
a. The specific protein receptor theory suggests that anesthetics that are highly lipid soluble cause the lipoprotein matrix of the nerve membrane to expand, narrowing the sodium channels, thus preventing depolarization.
b. The method by which the impulses travel down the length of the nerve affects whether nodes of Ranvier are stimulated or not.
c. Displaced Ca++ and local anesthetic drugs compete to bind to receptor sites within the ion channels of cell membranes.
d. All of the above

 

ANS: C

During depolarization, Ca++ are displaced and are thought to be the most significant factor responsible for the influx of sodium into the nerve. During slow depolarization, local anesthetics work by competing with Ca++ to bind to these ion channels.

 

REF:  Page 40

 

  1. Tachyphylaxis is a term used to describe what phenomenon?
a. An increased tolerance to a drug that is administered repeatedly.
b. If the dental procedure lasts longer than the duration of the anesthetic and the mantel and core fibers have fully recovered, the reinjection of local anesthetic will be ineffective.
c. Once the mantel fibers return to function, the patient experiences pain yet administration of anesthetic does not alleviate the pain.
d. All of the above

 

ANS: D

All of the above describe the phenomenon of tachyphylaxis.

 

REF:  Pages 36, 43

 

  1. What factor/factors influence the duration of the effects of local anesthetics?
a. Degree of protein binding
b. Vascularity of injection site
c. Addition or absence of a vasoconstrictor
d. All of the above

 

ANS: D

The duration of local anesthetics is influenced by the degree to which the local anesthetic is bound to the receptor sites or the protein binding; the vascularity of the injection site; and the addition or absence of an added vasoconstrictor to the local anesthetic.

 

REF:  Page 43

 

  1. What is the purpose of adding a vasoconstrictor to the local anesthetic?
a. To increase the rate of absorption of the anesthetic
b. To reduce the rate of absorption of the anesthetic
c. To reduce systemic toxicity
d. To increase hemostasis

 

ANS: B

To reduce the rate of absorption, vasoconstrictors are added to local anesthetics.

 

REF:  Page 43

 

  1. Which organs of the body will have higher concentrations of anesthetics?
a. High vascular organs
b. Low vascular organs
c. Brain, heart, liver, kidneys, lungs
d. Some combination of the above

 

ANS: D

High vascular organs such as the brain, heart, liver, kidneys, and lungs will have higher concentrations of anesthetics.

 

REF:  Page 43

 

  1. What is another name for the elimination of the local anesthetic from the blood and tissues?
a. Tachyphylaxis
b. Dissociation constant
c. Half-life
d. Distribution barriers

 

ANS: C

Another name for the elimination of the local anesthetic from the blood and tissues is the half-life of the anesthetic.

 

REF:  Page 44

 

  1. Which part of the chemical structure of a local anesthetic determines the pattern of biotransformation of the anesthetic?
a. Lipophilic part
b. Hydrophilic part
c. Intermediate chain
d. All of the above

 

ANS: C

The intermediate chain determines the pattern of biotransformation of the anesthetic.

 

REF:  Page 44

 

  1. What is the inability to hydrolyze ester local anesthetics and other chemically related drugs called?
a. Atypical pseudocholinesterase
b. Low hepatic dysfunction
c. Para-aminobenzoic acid intolerance
d. None of the above

 

ANS: A

The inability to hydrolyze ester local anesthetics and other chemically related drugs is called atypical pseudocholinesterase.

 

REF:  Page 44

 

  1. Esters, benzocaine, tetracaine, and procaine are hydrolyzed in the plasma by the enzyme pseudocholinesterase and by liver esterases. Procaine is metabolized to PABA and is the major metabolic byproduct responsible for allergic reactions.
a. Both statements are true.
b. Both statements are false.
c. The first statement is true; the second statement is false.
d. The first statement is false; the second statement is true.

 

ANS: A

Both statements are true.

 

REF:  Page 44

 

  1. What factor/factors determine the severity of an overdose reaction to local anesthetic?
a. Degree of drop in blood pressure
b. Time lapse between the administering of the local anesthetic to the overdose
c. Number of symptoms patient experiences
d. All of the above

 

ANS: B

The time lapse between the administering of the local anesthetic to the overdose reaction determines its severity.

 

REF:  Page 45

 

  1. Which anesthetic drug has a short half-life of 45 minutes and is the least toxic of the anesthetics?
a. Articaine
b. Lidocaine
c. Mepivacaine
d. Prilocaine

 

ANS: A

Articaine has a short half life of 45 minutes and is the least toxic of the anesthetics.

 

REF:  Page 44

 

Answer the following questions based upon the following case study.

 

Sam, a businessman who travels extensively, has been in your dental chair for 2 hours for extensive nonsurgical perio procedures. He insisted on having a long appointment in order to get everything done at one time. A review of Sams health history reveals that he is taking medications for high blood pressure; has no known allergies; recently quit smoking; and is a recovering alcoholic. He mentions that he is going through a divorce and that he is leaving for China within the week. You explain to Sam that, because of the long appointment and the amount of work that you need to accomplish, you will use a long-lasting local anesthetic to ensure his comfort. You apply topical benzocaine to all injection sites on the right side. You choose to administer the local anesthetic bupivacaine because of its long-lasting effect. Although Sam is a good-natured patient, you experience difficulty in achieving the desired level of anesthesia in order to keep Sam comfortable. Within 5 minutes of the administration of yet another cartridge of anesthetic, Sam begins to complain of a headache and you notice that he is slurring his words. You quickly retake his blood pressure only to discover that it has actually gone down since the beginning of the appointment. What thoughts should be going through your mind at this time?

  1. Based on Sams physical symptoms, what should you consider?
a. Sam is extremely relaxed and his blood pressure medication is working.
b. Sam is extremely stressed.
c. Sam may be experiencing a mild overdose to the anesthetic.
d. Sam may be experiencing a cardiovascular crisis.

 

ANS: D

Symptoms of an overdose on the cardiovascular system include headache and increased slurring of speech.

 

REF:  Page 45, Table 3-7

 

  1. Why do you think Sams blood pressure decreased from the beginning of the appointment?
a. Sam became more comfortable during the appointment.
b. Symptoms of a CNS and CVS overdose are biphasic.
c. Symptoms of a possible overdose change from a depression phase to a stimulation phase.
d. Some combination of the above

 

ANS: D

Choices a and b are correct. When patients become more comfortable and less apprehensive with dental procedures, a drop in blood pressure may be noted. However, in Sams case, the fact that he began experiencing a headache immediately after another injection combined with the noticeable drop in blood pressure should lead one to think about the possibility of an anesthetic drug overdose. Symptoms of a CNS and CVS overdose are biphasic, meaning that they progress from a stimulation phase to a depression phase.

 

REF:  Page 45

 

  1. Considering Sams health history, what anesthetic drug may have been a better choice?
a. Procaine
b. Articaine with epinephrine
c. Lidocaine
d. Mepivacaine

 

ANS: B

Consider that Sam is a recovering alcoholic who may or may not have liver damage. Because only about 10% of articaine is biotransformed in the liver, it may, at first, appear to be a better choice for Sam; however, due to its half-life, more anesthetic would be required in the long run to keep Sam comfortable, thus making articaine an unacceptable choice. BUT the addition of a vasoconstrictor such as epinephrine to the articaine changes this situation. The vasoconstrictor will delay the absorption of the local anesthetic into the tissue, thus prolonging tissue anesthesia and allowing the dental hygienist to work longer. This illustrates the range of considerations that affect local anesthetic selection.

 

REF:  Pages 45, 46

 

  1. Reflecting on your experience with Sam, what other factors may contribute to an incident similar to Sams?
a. The use of topical anesthetics plus intravascular injections
b. An injection that is administered too rapidly
c. The perio infection and inflammation
d. All of the above

 

ANS: D

All of the above. Reflecting on ones technique of administering anesthetic drugs and working to improve that technique can prevent further incidents such as Sams. Intravascular injections rapidly produce high blood levels and topical anesthetics are administered in high concentrations that are absorbed quickly from the site of administration: both techniques increase the possibility of toxicity. The rate of injection can increase the chance of toxicity because tissues cannot accept the large, rapid volume of anesthetic. Vascular areas due to infection, inflammation, or vasodilation from the local anesthetic agent will increase systemic toxicity.

 

REF:  Page 45

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