DANS

• Dosage


  Varies and depends on the area to be anesthetized, the vascularity of the tissues, individual tolerance and the technique of anesthesia
• Administer the lowest dosage


  Needed to provide effective anesthesia even if the computation will give you up to 11 cartilages (that doesn't mean you are going to finish the entire 11 cartilages)
• Prevention of toxicity


  • Local anesthetics
  • Vasoconstrictors
• Re-assurance and psychological support

  • Essential and will increase the patient's confidence in his dentist
• INFORMED CONSENT


  GPA -> vital signs -> patient ready for procedure -> prepare patient psychologically to reassure, explain what you need to do (step by step) and even complications that may arise when you are doing the injection or procedure -> get consent of the patient (sign)
• Patient receiving local anesthetic injections

  Should be situated in a physiologically sound position prior to and during the injection. Feet are elevated slightly, aiding the return of blood to the heart
• Lessen the complication


  Vasodepressor syncope (common faint)
• Position of the patient

  May vary slightly according to the dentist's preference, a patient's medical status and different injection technique
• If Px has a heart condition or cardiovascular disease like elevated BP


  You cannot position them this way. Positioning them in a supine position would cause more elevation of the BP
• If Px has respiratory disease having difficulty in breathing


  You cannot also position them this way. They are positioned in a more upright position.
• Position of the clinician

  Depends on the injection to be given - upper or lower, left or right side move around the patient
• Straight back


  Whatever position you're in
• Palm up


  Better control over the syringe - always relax (too tense -> painful)
• Never in a palm down position


  Because if you do that the elbow is raised or elevated and you lose control.
• Disposable needles


  Sharp on first use
• With succeeding penetration of the tissue


  Their sharpness diminishes
• Barbed needles


  Cause increased pain on penetration and increased postanesthetic tissue discomfort
• It is recommended to change disposable needles

  After every 3 to 4 tissue penetrations
• Multiple injection


  Needle is exposed to the environment and it gets contaminated if you are going to use it multiple times then you are risking infection also.
• Needle is beveled


  As it touches bone then the tendencies for it is to become barbed (lumiliko yung dulo) -> barbed needle when you enter it to the tissue has resistance -> withdraw it from the tissue (merong sumasabit -> cause pain on tissue penetration and even on post injection the px will have soreness. (nag-wear off na yung anesthesia and then the patient will feel sore parang nabugbog yung area after the injection because of trauma to the soft tissue because of the use of barbed needles
• Gauge and length of the needle


  Is determined by the injection to be given
• Check the flow of local anesthetic solution

  After properly loading the local anesthetic cartridge into the syringe and with the aspirator tip embedded in the rubber stopper, expel a few drops of the solution from the cartridge.
• Before you use it to the patient

  Check for any bubbles -> expel few drops of solution
• Topical antiseptic


  Used to prepare the tissues at the site of injection. It is placed on the site of injection for about 15 to 30 seconds or is gargled for about 30 seconds
• Purpose of topical antiseptic

  To decrease the risk of introducing septic materials into the soft tissues, producing either inflammation or infection
• Topical antiseptics


  • Iodine 1% or Chlorhexidine 0.12% or 0.2%
• Hyperthyroid px - has hyperthyroidism


  Don't use Povidone Iodine
• Epinephrine


  Not recommended if they have active hyperthyroidism
• Pre-injection topical anesthesia


  1. Dry the tissue in and around the injection site

  2. The lip or cheek should be retracted to obtain adequate visibility

  3. Benzocaine 20%

  4. Lidocaine 5%,10%,15%

  5. Apply it on a dry mucosa

  6. A small quantity is placed at the site of needle penetration and permitted to remain for a minimum of 1 and preferably 2 minutes
• Topical anesthesia


  Only for needle insertion, once you start injecting, the px will already feel. It is up to you on how much pressure you're going to exert when you are injecting or depositing.
• Make the tissue taut

  1. The tissues at the site of injection should be stretched prior to injection

  2. No mouth mirrors when retracting - use your non working hand

  3. Ant. - hold lip retract the stretch it

  4. Post. - retract cheeks stretch it

  5. Stretching permits the sharp, stainless steel needle to cut through the mucous membrane with minimum resistance - less painful, less traumatic if you have a stretch mucosa
• Loose tissues


  Are pushed and torn by the needle as it is inserted producing more discomfort on injection and more postoperative soreness
• Passing of syringe


  1. Never show your needle to your patient

  2. If you are working with an assistant - assistant can pass it over the chest of the px (don't use if female px use the other way behind the head of the px)

  3. Working without an assistant - once you uncover the needle then immediately place it over the shoulder of the patient, out of sight. Never place it below the elbow or below the waist.
• Needle insertion and aspiration

  1. The needle should be inserted gently and directly in one continuous movement to the target area

  2. Before injection, control aspiration must always be made. The tip of the needle must remain unmoved neither pushed forward nor pulled out of the tissue. Pull the thumb ring of the syringe backward approximately 1 to 2 mm.

  3. No second guessing - risk of breaking of needle
• Aspiration


  Venous penetration - If you got blood -> reposition the needle and then aspirate until you get an (-) aspiration. Do not need to remove and change

  Arterial penetration - Need to change
• Actual injection


  1. Injection should be given with as little pressure as possible except for palatal injections where some pressure is necessary

  2. Anesthetic solution is slowly deposited at the rate of 1 ml/min

  3. Communicate with the patient

  4. Take a look of the reaction of the px -> frown -> pain -> pause -> tell px to relax -> deposit again

  5. Take note of the hand (fist) and feet. Tell them to relax and do some sort of distraction.

  6. Following completion of the injection, the syringe should slowly be withdrawn from the soft tissue and capped immediately with its plastic sheath
• Never leave the patient alone. Allergic or other reactions may occur
• From the mouth, change the cartridge, and repeat the procedure

  ACTUAL INJECTION
• Injection


  Should be given with as little pressure as possible except for palatal injections where some pressure is necessary
• Anesthetic solution


  Is slowly deposited at the rate of 1 ml/min