Preparation for Endodontic Therapy

Rubber Dam Application Reasons for Use Prevention of salivary bacterial leakage Protection Efficiency Legal Consideration

Special Situations Isolations without Use of Clamps

Special Situations Controlling Leaks

ANESTHESIA

ACHIEVE PROFOUND ANESTHESIA HOW DO ANESTHETICS WORK?

CONDUCTION OF ACTION POTENTIALS

HOW LOCAL ANESTHETICS WORK

NA+ CHANNEL CYCLE… Purves et al eds. Neuroscience 3 rd Edition, 2004

CONDUCTION BLOCKADE

ACHIEVE PROFOUND ANESTHESIA COMMON MISUNDERSTANDINGS

LIP SIGNS / NUMBNESS Lip Numbness indicates pulpal anesthesia Myths about anesthesia Claffey E. JOE 2004 Mikesell P. JOE 2005

LIP SIGNS / NUMBNESS Lip Numbness indicates pulpal anesthesia Soft tissue stick indicates pulpal anesthesia Myths about anesthesia Vreeland D. JOE 1989 Hinkley S. JOE 1991 McLean C. JOE 1993

LIP SIGNS / NUMBNESS Lip Numbness indicates pulpal anesthesia Soft tissue stick indicates pulpal anesthesia Lip numbness obtained; pulpal anesthesia is on its way Myths about anesthesia Vreeland D. JOE 1989 Hinkley S. JOE 1991 McLean C. JOE 1993 Hannan L. OOOOE 1999 Fernandez C. JOE 2005

ANATOMY Myths about anesthesia

ANATOMY Lack of accurate inferior alveolar nerve block causes failure Myths about anesthesia Hannan L. OOOOE 1999 Berns JM. JADA 1962 Galbreath JC. OOO 1970

ANATOMY Lack of accurate inferior alveolar nerve block causes failure Accessory innervation causes failure Myths about anesthesia Clark S. OOOOE 1999 Foster W. Anesth Prog 2007 Frommer J. JADA 1972 Wilson S. JADA 1984

ANATOMY Lack of accurate inferior alveolar nerve block causes failure Accessory innervation causes failure Incorrect Needle bevel orientation causes failure Myths about anesthesia Steinkruger G. JADA 2006

VOLUME Myths about anesthesia

VOLUME Two cartridges are better than one Myths about anesthesia Vreeland D. JOE 1989 Yared GM. JOE 1997 Nusstein J. Gen Dent 2002

VOLUME Two cartridges are better than one Increase epinephrine concentration gives better results Myths about anesthesia Wali M. JOE 1988 Dagher BF. JOE 1997

VOLUME Two cartridges are better than one Increase epinephrine concentration gives better results Repeat another IAN block Myths about anesthesia Nusstein J. Gen Dent 2002

TYPE OF ANESTHETIC Lidocaine Mepivacaine Articaine Marcaine Myths about anesthesia

TYPE OF ANESTHETIC 3% Mepivicaine/ 4% Prilocaine won’t work for an IAN block Myths about anesthesia McLean C. JOE 1993

TYPE OF ANESTHETIC 3% Mepivicaine/ 4% Prilocaine won’t work for an IAN block Articaine is better than Lidocaine Myths about anesthesia Claffey E. JOE 2004 Malamed SF. JADA 2000 Tofoli GR. Anesth Prog 2003 Moore PA. JADA 2006

SECRETS TO ACHIEVING PROFOUND ANESTHESIA Do so Before You Start!!

TAKE A GOOD HISTORY Kaufman E. JADA 1984

INJECT SLOWLY!! Kanaa MD. JOE 2005

TEST APPROPRIATE FIBERS Dreven L. JOE 1987 Certosimo A. Oper Dent 1996 Nusstein J. JOE 1998

TEST APPROPRIATE FIBERS Dreven L. JOE 1987 Certosimo A. Oper Dent 1996 Nusstein J. JOE 1998

TEST APPROPRIATE FIBERS Dreven L. JOE 1987 Certosimo A. Oper Dent 1996 Nusstein J. JOE 1998

SUPPLEMENTAL ANESTHESIA

BUCCAL INFILTRATION Haase JOE 2008 Matthews JOE 2009

LENGTH OF EXPOSED NERVE IS CRITICAL Percent Nerve Activity Raymond et al Anesth Analg 1989

INTRAOSSEOUS

INNOVATIONS IN ANESTHESIA

WHY WON’T LOCAL ANESTHETICS WORK

SUGGESTED REASONS Central Core Theory Reader, Endo Topics 2002 DeJong, JADA 1997 Strichartz, Anesth 1967

SUGGESTED REASONS Central Core Theory pH

SUGGESTED REASONS Central Core Theory pH Inflammed tissues have altered resting potentials and decreased excitability thresholds Wallace, OOO 1985 Byers, JOE 1990

DIAGRAM DEPICTING RESPONSE Courtesy of Ken Hargreaves

DIAGRAM DEPICTING RESPONSE Courtesy of Ken Hargreaves

DIAGRAM DEPICTING RESPONSE Courtesy of Ken Hargreaves

SUGGESTED REASONS Central Core Theory pH Inflammed tissues have altered resting potentials and decreased excitability thresholds Tetrodotoxin resistant (TTXr) class of sodium channels Roy, J Neurosci 1992 Sorenson, JOE 2004

SUGGESTED REASONS Central Core Theory pH Inflammed tissues have altered resting potentials and decreased excitability thresholds Tetrodotoxin resistant (TTXr) class of sodium channels Fear Reader, Endo Topics 2002

Questions?