Table Of ContentLocal 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
