Local Anesthetic Review
                                 8 Homestudy Credit Hours
                              Anthony S. Mennito, D.M.D. 
                                                               The Academy of Dental Learning is 
                                                               an ADA CERP Recognized Provider.
                                     Table of Contents 
        
        
       Table of Contents ........................................................................................................................ 9 
       Objectives .................................................................................................................................. 10 
       Introduction ............................................................................................................................... 11 
       History of Local Anesthetics ................................................................................................... 12 
       Neurophysiology ....................................................................................................................... 13 
       Pharmacology ........................................................................................................................... 14 
       Anesthetic Action ..................................................................................................................... 15 
       Uptake, Distribution, and Elimination ..................................................................................... 16 
        Systemic Effects of Local Anesthetics ..................................................................................... 16 
       Pharmacology of Vasoconstrictors ........................................................................................ 17 
       Topical Anesthetics .................................................................................................................. 19 
       Selection of Anesthetics .......................................................................................................... 21 
       Toxicity ...................................................................................................................................... 23 
        Epinephrine Overdose ............................................................................................................. 25 
       Armamentarium ........................................................................................................................ 26 
        Syringes ................................................................................................................................... 26 
        Needles.................................................................................................................................... 27 
        Cartridge .................................................................................................................................. 28 
        Preparation of the Syringe ....................................................................................................... 28 
       Patient Evaluation ..................................................................................................................... 29 
       Injection Techniques ................................................................................................................ 31 
        General Injection Technique .................................................................................................... 31 
        Maxillary Anesthesia ................................................................................................................ 33 
        Mandibular Anesthesia ............................................................................................................ 36 
        Other Mandibular Nerve Block Anesthetic Techniques ........................................................... 38 
       Complications ........................................................................................................................... 42 
        Pain on Injection ...................................................................................................................... 42 
        Paresthesia .............................................................................................................................. 42 
        Hematoma ............................................................................................................................... 42 
        Trismus .................................................................................................................................... 43 
        Infection ................................................................................................................................... 43 
        Facial Nerve Paralysis ............................................................................................................. 44 
        Broken Needles ....................................................................................................................... 44 
       Latest Updates in Local Anesthesia ....................................................................................... 45 
        Electronic Dental Anesthesia ................................................................................................... 45 
        Lidocaine Patch ....................................................................................................................... 45 
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                                                                                                                  Objectives 
                   
                  Upon completion of this course, the student will be able to: 
                       •   Explain the action of a nerve. 
                       •   Explain the action of local anesthetic drugs on nerves. 
                       •   Describe  different  techniques of local anesthe tic  administration,  and what teeth  are 
                           affected by each injection. 
                       •   Identify the toxicity level for all anesthetic medications used. 
                       •   Identify  symptoms of   complications that may result from administration  of  local 
                           anesthesia and the treatment for each. 
                       •   Understand the rationale behind the use of a lternative forms of anest hesia, including 
                           sedation and electronic dental anesthesia.  
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                                                                                            Introduction 
                
               Pain  control  is the fo undation  of  successful  dental pat ient  management. Go od  injection 
               technique is essential f or consistent anesthesia. Dental professionals licensed to  administer 
               local anesthesia (Dentists and some Dental Hygieni sts) must use the medications available to 
               them with caution and confidence.  
               The  patient's  psychological  state  must be   evaluated  before the   administration  of any 
               anesthesia. A relaxed, confident patient will respond better to local anesthesia. An anxious or 
               phobic dental patient may require some type of intervention strategy to relieve the stress before 
               administering anesthesia. Other co nsiderations such as the health of the tissue (presence or 
               absence of infection) and deviation from normal anatomy must be assessed as well.  
               This course is a review of currently accepted practices for dental local anesthetic administration. 
               This course will not lead to licensur e of local anesthetic ad ministration. The student should be  
               knowledgeable about head and neck anatomy and basic emergency medical procedures for the 
               dental office, including CPR.  
                
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