Local Anesthesia for the Dental Hygienist SECOND EDITION Demetra Daskalos Logothetis, RDH, MS Professor Emeritus and Graduate Program Director, Department of Dental Medicine, University of New Mexico, Albuquerque, New Mexico Educational Consultant, Albuquerque, New Mexico 2 Table of Contents Cover image Title page Copyright Dedication Reviewers Contributors Preface Acknowledgments Part I. Introduction to Pain Control 1. Local Anesthesia in Dental Hygiene Practice: An Introduction Introduction History of Pain Control Anesthesia in Dental Hygiene Practice Patient Perception of Local Anesthesia Human-Needs Paradigm Summary 2. Neurophysiology Introduction Organization of the Nervous System Neuroanatomy Generation and Conduction of Nerve Impulses Mode of Action of Local Anesthetics Part II. Local and Topical Anesthetic Agents 3. Pharmacology of Local Anesthetic Agents Introduction Chemistry 3 Routes of Delivery Pharmacodynamics of Local Anesthetic Drugs Mechanism of Action of Local Anesthetic Agents Pharmacokinetics of Local Anesthetic Drugs 4. Pharmacology of Vasoconstrictors Introduction Chemistry The Use of Vasoconstrictors in Dentistry Epinephrine (Adrenalin) Levonordefrin (Neo-Cobefrin) Other Vasocontrictors Side Effects and Overdose of Vasoconstrictors 5. Local Anesthetic Agents Composition of Local Anesthetic Agents Selection of Local Anesthetic Agents Amide Local Anesthetics Ester Local Anesthetic 6. Topical Anesthetic Agents Introduction Mechanism of Action of Topical Anesthetics Topical Anesthetic Forms and Methods of Delivery Common Topical Agents Used in Dentistry Combinations of Topical Drugs Special Considerations Part III. Patient Assessment 7. Preanesthetic Assessment Introduction Medical, Dental, and Dialogue History Physical Examination Psychological Evaluation Risk Assessment Contraindications to Local Anesthesia Vasoconstrictor Drug-Drug Interactions Vasoconstrictors and Systemic Disease Interactions Allergies Ester Derivative Local Anesthetic Interactions Amide Local Anesthetic Drug/Drug Interactions Other Amide Local Anesthetic Interactions 4 8. Determining Drug Doses Introduction Maximum Recommended Doses of Local Anesthetic Drugs Calculating Milligrams of Anesthetic Administered Calculating Additional Doses of the Same Drug Calculating Additional Doses of Different Drugs Maximum Recommended Dose of Anesthetic for Medically Compromised Patients and Elderly Patients Maximum Recommended Dose of Anesthetic for Pediatric Patients Vasoconstrictor Doses Calculating Milligrams of Vasoconstrictor Administered Determining the Limiting Drug Part IV. Local Anesthetic Techniques for the Dental Hygienist 9. Armamentarium/Syringe Preparation Introduction Syringes Types of Local Anesthetic Syringes Needle Anesthetic Cartridges Supplementary Armamentarium Preparation of the Breech-Loading Aspirating Syringe Unloading the Breech-Loading Aspirating Syringe Assembly of the Wand STA Computer-Controlled Local Anesthetic Delivery System Disassembly of the Wand STA Computer-Controlled Local Anesthetic Delivery System 10. Anatomic Considerations for Local Anesthesia Administration Introduction to Anatomic Considerations Orofacial Skull Bones Trigeminal Nerve Facial Nerve Vascular and Glandular Structures 11. Basic Injection Techniques Administration Techniques Steps to Providing a Successful Injection Basic Injection Techniques for Computer Controlled Local Anesthetic Delivery 12. Maxillary Anesthesia Introduction to Maxillary Anesthesia Maxillary Supplemental Injections Maxillary Facial Nerve Blocks 5 Palatal Nerve Blocks Common Technique Errors Associated with Maxillary Injections 13. Mandibular Anesthesia Introduction to Mandibular Anesthesia Mandibular Nerve Blocks Inferior Alveolar Block Buccal Block Mental Block Incisive Block Gow-Gates Mandibular Block Vazirani-Akinosi Mandibular Block Mandibular Supplemental Injections 14. Local Anesthesia for the Child and Adolescent Introduction Local Anesthetic Systemic Toxicity in Children Local Anesthetic Agent Selection for Children Local Anesthesia Delivery Techniques Part V. Complications, Legal Considerations, and Risk Management 15. Local Anesthetic Complications Introduction Local Complications Systemic Complications Allergic Manifestations Management of Medical Emergencies 16. Legal Considerations and Risk Management Risk Management Exposure Prevention and Management Glossary Index 6 Copyright 3251 Riverport Lane St. Louis, Missouri 63043 LOCAL ANESTHESIA FOR THE DENTAL HYGIENIST, ED 2 ISBN: 978-0-323-39633-2 Copyright © 2017 by Elsevier, Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). Notices Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility. With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. Previous edition copyrighted 2012. Library of Congress Cataloging-in-Publication Data Names: Logothetis, Demetra Daskalos, author. Title: Local anesthesia for the dental hygienist / Demetra Daskalos Logothetis. Description: Second edition. | St. Louis, Missouri : Elsevier, [2016] | 7 Includes bibliographical references. Identifiers: LCCN 2016001025 | ISBN 9780323396332 (pbk. : alk. paper) Subjects: | MESH: Anesthesia, Dental--methods | Dental Hygienists | Anesthesia, Local--methods | Anesthetics, Local--administration & dosage Classification: LCC RK510 | NLM WO 460 | DDC 617.9/676--dc23 LC record available at http://lccn.loc.gov/2016001025 Content Strategist: Kristin Wilhelm Content Development Manager: Luke Held Associate Content Development Specialist: Anna Miller Marketing Manager: Traci Cahill Publishing Services Manager: Jeff Patterson Senior Project Manager: Anne Konopka Design Direction: Ashley Miner Last digit is the print number: 9 8 7 6 5 4 3 2 1 8 Dedication To my parents Pete and Soula Daskalos, because of your guidance, love, and support, I have become the person I am today. To my husband Nick, for your unwavering, unconditional support and love of our family; for always reminding me every day of what is really important in life; and for always putting a smile on my face. To my children Stacey and Costa, for the joy you bring to my life; you both constantly amaze me every day. 9 Reviewers Judith E. DiLorenzo, RDH, MA, Department Chair, Department of Dental Hygiene, Hudson Valley Community College, Troy, New York Kimberly A. Erdman, RDH, PHDHP, MSDH, Clinical Coordinator and Assistant Professor, Department of Dental Hygiene, Baltimore City Community College, Baltimore, Maryland Allen Fielding, DMD, MD, MBA, Clinical Adjunct Professor, Department of Oral Maxillofacial Pathology, Medicine and Surgery, Temple University, Philadelphia, Pennsylvania Cherie Fritz, RDH, BS, Professor, Department of Dental Hygiene, Rochester Community and Technical College, Rochester, Minnesota Sheila Gross-Rogers, RDH, MS, CDA, Program Director, Department of Dental Hygiene, Northeast Wisconsin Technical College, Green Bay, Wisconsin Rebekah Pittman, CRDH, BSDH, Professor, Department of Dental Hygiene, Valencia College, Orlando, Florida Sue Raffee, RDH, EFDA, MSA, Department Chair and Professor, Department of Dental Health Sciences, Sinclair Community College, Dayton, Ohio Jennifer Sherry, RDH, MSEd, Associate Professor, Department of Dental Hygiene, Southern Illinois University, Carbondale, Illinois Cynthia A. Stegeman, EdD, RDH, RD, LD, CDE, FAND, Department Chair and Professor, Department of Dental Hygiene, University of Cincinnati, Cincinnati, Ohio Laura Webb, RDH, MS, CDA, MAADH, Dental Education Consultant and Continuing Education Provider, LJW Education Services, Fallon, Nevada 10