3BDS: Endodontics 10

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why do you need LA if the pulp is necrotic or for any endo procedures in general
Necrotic pulp may have vital remnants apically.
Instrumentation and irrigation- cause pressure and can result in pain.
Prior to rubber dam placement (use of rubber dam clamps is uncomfortable as they can apply pressure which can be painful) so we need: p
1 of 9
how would you test if the LA worked
• Pulp test: cold. (If the person doesn’t fill the cold= high chance the pulp tissue is fully anesthetise)
2 of 9
why is it difficult to achieve LA in inflamed pulp particularly irreversible pulpitis
In inflamed or infected tissue, there’s a low pH= many hydrogen ions which drives the equilibrium favouring more of the charged LA.
There is less of the uncharged LA, therefore less to pass through the lipid bilayer. And when its gets inside the nerve, t
3 of 9
why are nerves much more sensitive and resistant to LA when in close proximity to inflammation
Increased blood flow and tissue pressure= hyperalgesia
Inflammation changes nerves due to release of nerve GF, along the length of the nerve. Gene regulation and expression of nerves and Na channels.
- Promotes sprouting: more nerves ending and changes ex
4 of 9
what is the gold standard LA, when should you use it with caution
2% lidocaine and 1:80,000 adrenaline
Cautious if patient has severe uncontrolled cardiac conditions such as unstable angina, dysrhythmias. Careful even if they have other cardiac problems. Caution if patient has an allergy as it contains a preservative a
5 of 9
what LA would you use if you cant use adrenaline on someone
3% prilocaine and fellypressin
6 of 9
how does 3% prilocaine and fellypressin work
Fellypressin is the vasoconstrictor but the downside is that it works on the venous side of the vascular bed and it can slow the flow of blood flow but it doesn’t give this potent vasoconstriction that you get iwht adrenaline and doesn’t give you the same
7 of 9
when can you absolutely not use prilocaine and fellypressin
if the patient is pregnant
8 of 9
what LA is not very good to use in any endo procedures because it wont last
mepicacaine
9 of 9

Other cards in this set

Card 2

Front

how would you test if the LA worked

Back

• Pulp test: cold. (If the person doesn’t fill the cold= high chance the pulp tissue is fully anesthetise)

Card 3

Front

why is it difficult to achieve LA in inflamed pulp particularly irreversible pulpitis

Back

Preview of the front of card 3

Card 4

Front

why are nerves much more sensitive and resistant to LA when in close proximity to inflammation

Back

Preview of the front of card 4

Card 5

Front

what is the gold standard LA, when should you use it with caution

Back

Preview of the front of card 5
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