Armamentarium utilized for dental anesthesia

By: Dr. Alshaimaa Ahmed Lecturer of Oral & Maxillofacial surgery

The armamentarium
This includes : 1. Syringe 2. Needle

3. Local anesthetic cartilage

4. Additional items like : topical antiseptic, topical anesthesia &cotton applicator

The syringe

It is the vehicle whereby the content of the anesthetic cartilage are delivered through the needle to the patient

The syringe
1. 2. 3. 4. 5. 6. Parts: Needle adaptor Syringe barrel Piston Harpoon Finger grip Thumb ring

The syringe

The syringe
ADA criteria for acceptance of dental syringe: 1. Durable and able to withstand repeated sterilization without damage 2. Capable of accepting a wide variety of cartilage and needles 3. Inexpensive 4. Lightweight

5. Simple to use in one hand

6. Provide effective aspiration and constructed so that the blood may be easily observed in the cartilage

Types of dental syringe

According to aspiration: Aspirating dental syringe Non-aspirating dental syringe

Self- Aspirating dental syringe

Types of dental syringe

Self aspirating dental syringe: These syringes use the elasticity of the rubber diaphragm in the anesthetic cartilage to obtain the necessary negative pressure for aspiration Parts : thumb disc & metal projection Advantage :easy to aspirate with small hands Disadvantages: feeling of insecurity

Types of dental syringe

According to the Loading:
Basal Loading Lateral loading (Breechloading)

Types of dental Syringes

According to the material: Metal ( chrome plated or stainless steel ) Plastic

Types of dental syringe

Advantages and disadvantages of the plastic Syringe : A. Advantages: 1. Plastic eliminate metallic look 2. Lightweight 3. Cartilage is visible

4. Rust resistance
B. Disadvantages: 1. Possibility of infection with improper care 2. Deterioration of plastic with repeated autoclaving

Types of dental syringe

Pressure Syringe: introduced in the late 1970

Used for the periodontal ligament injection

Advantage: 1. Measured dose 2. Overcome tissue resistance 3. Cartilage protected Disadvantage: 1. Cost

2. Easy to inject too rapidly

3. threatening

Types of dental syringe

Jet Injector: based on the principle that liquids forced through very small openings called jets at very high pressure can penetrate the intact skin or mucous membrane Used to obtain topical anesthesia or anesthesia at the palate Advantages: 1. Does not require use of needle 2. Deliver very small volumes of local anesthesia Disadvantages: 1. Inadequate for pulpal anesthesia 2. Some patient disturbed by the jolt of injection 3. Damage the periodontal ligament

Types of dental syringe

Types of dental syringe

Disposable syringe: Advantages: 1. Disposable, single use 2. Sterile until opened 3. Lightweight Disadvantages: 1. Dose not accept prefilled dental cartilage 2. Aspiration difficult

Types of dental syringe

Safety syringe
It minimize the risk of accidental needle stick injury These syringes posses a sheath that locks over the needle when it is removed from patient mouth Advantages: 1. Disposable, single use 2. Sterile until opened 3. Lightweight

Disadvantages:
1. Cost 2. May feel awkward to first time user

Types of dental syringe

Computer- Controlled local anesthetic delivery system

Care and handling of syringes

The syringe should be washed and rinsed before the autoclaving After five autoclavings, the syringe should be dismantled and lubricated Harpoon should be cleaned with a brush after each use Replace the harpoon and piston if they lost their sharpness

Problems
Leakage during injection Broken cartilage Bent harpoon Disengagement of the harpoon from the plunger during aspiration Surface deposits

The Needle
The needle is the vehicle that permitting local anesthetic solution to travel from dental cartilage into the tissue surrounding the needle tip The needle are made of stainless steel Needle manufactured for dental intraoral use are presteralized and disposable

The Needle
Parts of the needle : Bevel Shaft

Hub
The needle adaptor The cartilage penetrating part

The Needle
The gauge:
It is the diameter of the lumen of the needle The smaller the number the greater the diameter of the lumen There are many available diameters 25, 27 & 30 gauge. They are color coded Small or large gauge needle? The advantages of using larger gauge over smaller gauge needle: 1. Less deflection as the needle advances through tissues 2. Greater accuracy of injection

3. Less chance of needle brakage

4. Easier aspiration

The Needle
Length: Dental needles are available in three length: Long (30-35mm standard 32) and used for nerve block injections Short (20-25 mm standard 20) used for infilteration injections

Ultra-short available only in 30 gauge needles

Care and handling of needle

Needle must never be used on more than one patient Needle should be changed after several tissue penetration in the same patient Needle should be covered with protective sheath Attention should always be paid to the position of the uncovered needle tip

Needle must be probably disposed after used.

The problems
Pain on insertion Breakage Pain on withdrawal

injury to patient or administrator

The Cartilage
Component: The prefilled 1.8ml dental cartilage consists of four parts:

1. Cylindrical glass tube

2. Stopper (plunger) 3. Aluminum cap

4. diaphragm

The Cartilage

The Cartilage
Content: 1. Local anesthetic drug 2. Vasopressor drug

3. Preservative (sodium bisulfite)

4. Sodium chloride 5. Distilled water

6. Methylparaben

Care and handling

Storage Sterilization Cartilage warmers

Problems
Bubble in the cartilage Extruded stopper Burning on injections Corroded Cap Rust on the cap Leakage during Injection Broken cartilage

Preparation of armamentarium
Loading of the syringe: 1. Retract the piston 2. Apply the cartilage

3. Attach the harpoon

4. Screw the needle Reloading the syringe

Management of patient receiving local anesthesia

Case History

Informing the patient about the procedure Testing the local anesthesia for sensitivity through: 1. Skin test

2. Intranasal test
Preparation of the site of injection: 1. Topical anesthesia 2. Dryness 3. Topical antiseptic injection