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Chapter 12: Maxillary Anesthesia Logothetis: Local Anesthesia for the Dental Hygienist, 3rd Edition
MULTIPLE CHOICE
1. What is the name of the type of injection that anesthetizes a small area of one or two teeth and the associated structures when the local anesthetic agent is deposited near the terminal nerve endings? a. Nerve block
b. Supraperiosteal
c. Topical
d. Infiltration
ANS: B Supraperiosteal is the name of the type of injection that anesthetizes a small area of one or two teeth and the associated structures when the local anesthetic agent is deposited near the terminal nerve endings. A nerve block anesthetizes a larger area than the local infiltration because the local anesthetic agent is deposited near large nerve trunks. Topical anesthetic is applied to the surface of the oral mucosa to block free nerve endings. Infiltration injections are used when soft tissue anesthesia is needed in a limited area.
DIF: Recall REF: p0745 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care | NBDHE, 3.4 Anxiety and Pain Control
2. What is the name of the type of injection that anesthetizes a large areas because the local anesthetic agent is deposited near large nerve trunks? a. Nerve block
b. Supraperiosteal
c. Topical
d. Infiltration injections
ANS: A Nerve block is the name of the type of injection that anesthetizes a large areas because the local anesthetic agent is deposited near large nerve trunks. Supraperiosteal is the name of the type of injection that anesthetizes a small area of one or two teeth and the associated structures when the local anesthetic agent is deposited near the terminal nerve endings. Topical anesthetic is applied to the surface of the oral mucosa. Infiltration injections are used when soft tissue anesthesia is needed in a limited area.
DIF: Recall REF: st0060 OBJ: 3 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care | NBDHE, 3.4 Anxiety and Pain Control
3. There is less variation in the anatomy of the mandibular anesthetic landmarks than there is in similar maxillary structures, thus making the mandibular injections more routine. Anesthesia in the maxillary arch usually does not require any troubleshooting of failure cases. a. Both statements are true.
b. Both statements are false.
c. The first statement is true; the second statement is false.
d. The first statement is false; the second statement is true.
ANS: D The first statement is false; the second statement is true. There is less variation in the anatomy of the maxillary anesthetic landmarks than there is in similar mandibular structures, thus making the maxillary
injections more routine. Anesthesia in the maxillary arch usually does not require any troubleshooting of failure cases.
DIF: Recall REF: p0735 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care | NBDHE, 3.4 Anxiety and Pain Control
4. Best practices for increasing patient comfort during the administration of maxillary injections include which of the following? a. The needle should not be moved within the tissue.
b. The patient’s upper lip should not be slightly jiggled for distraction.
c. There is no bony contact of the overlying sensitive periosteum with the needle.
d. All options listed.
ANS: D All options listed. Best practices for increasing patient comfort during the administration of maxillary injections include: the needle should not be moved within the tissue; the patient’s upper lip should not be slightly jiggled for distraction; and there is no bony contact of the overlying sensitive periosteum with the needle.
DIF: Recall REF: st0030 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care | NBDHE, 3.4 Anxiety and Pain Control
5. What is a good reason not to use distracters when administering maxillary facial anesthesia? a. The clinician needs her fingers for retraction of the upper lip.
b. Pulpal anesthesia may be blocked.
c. Movement may cause the anesthetic not to be placed at the target area.
d. All options listed.
ANS: C In the past, shaking the patient’s upper lip with the clinician’s retraction fingers was used to distract the patient during the injection, but this movement may actually increase discomfort because the needle bevel is moved and the anesthetic may not be placed at the target area. Using distractors should not affect ability to retract with fingers or attainment of pulpal anesthesia.
DIF: Recall REF: p0790 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care | NBDHE, 3.4 Anxiety and Pain Control
6. In which order would you administer the maxillary injections? a. Greater palatine, PSA
b. Infraorbital, PSA
c. PSA, MSA, ASA
d. Order of anesthetic is at the discretion of the clinician
ANS: C The maxillary injections, in the correct order, are PSA, MSA, and ASA. The PSA block is administered before any of the other maxillary facial injections as well as any palatal injections to allow the necessary time for the larger maxillary molars to undergo pulpal anesthesia. After the PSA block, the MSA and then ASA blocks (or IO block instead) are then administered and in that order for the maxillary quadrant. Palatal injections are provided after facial injections.
DIF: Recall REF: p0880 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care | NBDHE, 3.4 Anxiety and Pain Control
7. Practices to avoid when administering local anesthetic include which of the following? a. Not using enough for patient comfort and hemostatic control
b. Overadministering of anesthesia
c. Administering anesthesia to a larger treatment area than can be completed in one visit
d. All options listed
ANS: D All options listed. Local anesthesia should be administered only in the areas of treatment that can be completed in one visit. Overestimating the treatment and administering more anesthesia than necessary should be avoided, as should not using enough anesthetic for patient comfort and hemostatic control.
DIF: Recall REF: p0890 OBJ: 6 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care | NBDHE, 3.4 Anxiety and Pain Control
8. All of the following are strategies for when the clinician encounters exostosis EXCEPT one. Which one is the EXCEPTION? a. Increase retraction
b. Move the needle injection site more superior
c. Utilize the palatal injections
d. Keep needle parallel to the bone
ANS: C EXCEPTION: Utilize the palatal injections. Palatal injections do not provide the pulpal anesthesia achieved with facial injections. Increasing retraction, moving the needle injection site more superior, and keeping the needle parallel to the bone and the long axis of the tooth will help the clinician work around the exostosis.
DIF: Recall REF: p0895 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care | NBDHE, 3.4 Anxiety and Pain Control
9. Which of the following are best practices for the maxillary supraperiosteal injection technique? a. The bevel orientation of the needle should be away from the bone.
b. The needle should be inserted parallel with the long axis of the tooth.
c. The needle tip is placed inferior to the apex of the selected tooth.
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d. All options listed.
ANS: B The needle should be inserted parallel with the long axis of the tooth. The bevel orientation of the needle should be toward the bone, and the needle tip is placed superior to the apex of the selected tooth.
DIF: Recall REF: st0020 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care | NBDHE, 3.4 Anxiety and Pain Control
10. What should the clinician do if she accidently positions the anesthetic needle against the periosteum and bony contact is made? a. Withdraw the needle and reinsert it farther away from the periosteum.
b. Withdraw the needle and change it because it may be dull.
c. Withdraw the needle, apply more topical anesthetic, and select a different injection to perform first.
d. Without withdrawing the needle, move the needle slightly, aspirate, and attempt anesthesia again.
ANS: A The patient may experience pain if bony contact is mistakenly made. The needle needs to be withdrawn and reinserted farther away from the periosteum. A dull needle is usually a result of repeated penetrations. Reinserting the needle should be attempted before considering changing injection type. Needle movement may cause tissue trauma and discomfort to the patient.
DIF: Recall REF: t0055 OBJ: 6 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care | NBDHE, 3.4 Anxiety and Pain Control
11. Which of the following are reasons for inadequate anesthesia? a. Deposition of the solution superior to the apex of the tooth.
b. Dense bone covers the apices of the teeth as seen in children.
c. The apex of the tooth lies beneath the maxillary sinus.
d. All options listed.
ANS: B Inadequate anesthesia can be a result of depositing solution inferior to the apex of the tooth, or if dense bone covers the apices (as usually seen in children), or when the apex of the tooth lies beneath the nasal cavity (as is the case around the maxillary central incisors).
DIF: Recall REF: p0800 OBJ: 6 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care | NBDHE, 3.4 Anxiety and Pain Control
12. Which of the following is the reason a clinician would hit bone while administering the PSA block? a. The needle is bent slightly in order to accomplish the necessary needle angulations.
b. The needle is parallel to the long axis of the distal root of the maxillary second molar.
c. The angle of the needle is greater than 45 degrees backward from the apex of the
maxillary second molar.
d. The angle of the needle is not 45 degrees
backward from the apex of the maxillary second molar.
ANS: C If bone is contacted or resistance is felt while administering a PSA block the angle of the needle toward the midline is too great more than 45 degrees backward from the apex of the maxillary second molar, and the clinician would hit bone. To correct decrease the angulation to 45 degrees, The needle should never be bent because it can break during the injection, and is not a cause of hitting bone during the PSA block. If the needle is parallel to the long axis of the distal buccal root of the maxillary second molar, the clinical would be administering a supraperiosteal injection and only the distal buccal root would be anesthetized. If the syringe barrel angulation is not 45 degrees backward from the apex of the maxillary second molar, the needle is not in the proper location for effective anesthesia.
DIF: Recall REF: p0985 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care | NBDHE, 3.4 Anxiety and Pain Control
13. When administering the PSA injection, what other nerve may inadvertently be anesthetized? a. Infraorbital nerve
b. Greater palatine nerve
c. MSA nerve
d. Mandibular nerve
ANS: D Inadvertent and harmless anesthesia of branches of the mandibular nerve may also occur with a PSA block because it may be located lateral to the PSA nerve. The infraorbital, greater palatine, and MSA nerves are not affected by the PSA injection.
DIF: Recall REF: p0980 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care | NBDHE, 3.4 Anxiety and Pain Control
14. Where should the site for the MSA injection be if the patient is missing one of his premolars due to orthodontic treatment? a. Halfway in the dental arch
b. Mesial to the existing premolar
c. Distal to the existing premolar
d. Use the infraorbital injection
ANS: A If one of the premolars has been removed for orthodontic therapy, thereby moving the existing premolars from their original place in the dental arch, the injection site should be halfway in the dental arch to provide the best anesthetic coverage to the maxillary premolars. The infraorbital injection anesthetizes a wider area (ASA and MSA nerves) and requires a greater volume of anesthetic than the MSA alone.
DIF: Recall REF: p1040 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care | NBDHE, 3.4 Anxiety and Pain Control
15. What is an important post-infraorbital injection procedure? a. The clinician should check for a hematoma across the lower eyelid.
b. Maintain pressure and massage the solution into the infraorbital foramen for approximately 2 minutes to enhance anesthetic diffusion.
c. Maintain finger pressure on the infraorbital foramen during the injection to help keep the syringe toward the foramen.
d. All options listed.
ANS: B An important post-infraorbital injection procedure is to maintain pressure and massage the solution into the infraorbital foramen for approximately 2 minutes to enhance anesthetic diffusion. Although rarely, a hematoma may occur. However, checking for hematoma is not an important postinjection procedure. Nondominant hand finger placement, not finger pressure, is used during the injection to help in keeping the syringe toward the foreman.
DIF: Recall REF: p1135 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care | NBDHE, 3.4 Anxiety and Pain Control
16. Both the right nasopalatine nerve and the left nasopalatine nerve are anesthetized by the nasopalatine block. Only one injection is needed for both sides of the palate. a. Both statements are true.
b. Both statements are false.
c. The first statement is true; the second statement is false.
d. The first statement is false; the second statement is true.
ANS: A Both statements are true. Both the right nasopalatine nerve and the left nasopalatine nerve are anesthetized by this block. Only one injection is needed for both sides of the palate.
DIF: Recall REF: st0145 OBJ: 5 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care | NBDHE, 3.4 Anxiety and Pain Control
17. Which injection is commonly used when performing cosmetic dentistry on the maxillary anterior teeth? a. ASA block
b. MSA block
c. AMSA block
d. Greater palatine block
ANS: C The anterior middle superior alveolar (AMSA) block is commonly used when performing cosmetic dentistry on the maxillary anterior teeth because the clinician can immediately and accurately assess the patient’s smile line. The ASA and MSA injections provide anesthesia to the upper lip and face, which can interfere with assessment of the patient’s smile line. The greater palatine block provides anesthesia to the posterior palate and is not commonly used during cosmetic dental procedures.
DIF: Recall REF: st0160 OBJ: 5 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care | NBDHE, 3.4 Anxiety and Pain Control
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18. What technique is best when administering the AMSA block? a. Disposable syringe
b. Nonaspirating syringe
c. Computer-controlled delivery device
d. Topical anesthetic and aspirating syringe
ANS: C Studies show that the AMSA block is best accomplished with a computer-controlled delivery device
because it regulates the pressure and volume ratio of solution delivered, which is not readily attained with a standard syringe, including disposable, nonaspirating, or aspirating syringes.
DIF: Recall REF: st0160 OBJ: 5 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care | NBDHE, 3.4 Anxiety and Pain Control
19. What should the clinician do if she notices excessive blanching of the palatal tissue during the AMSA block administration? a. Slow down the deposition of anesthetic solution.
b. Stop the deposition of anesthetic solution for a few seconds.
c. All options listed.
d. None of the options listed.
ANS: C All options listed. If excessive blanching is noted, slowing or stopping the device for a few seconds to let the solution dissipate will diminish the chance of tissue ischemia and sloughing.
DIF: Recall REF: st0160 OBJ: 5 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care | NBDHE, 3.4 Anxiety and Pain Control
20. What is the most common technique error associated with supraperiosteal, ASA, and MSA injections? a. Incorrect fulcrum
b. Incorrect angulation of the syringe barrel and the needle
c. Incorrect target site and solution deposition
d. Incorrect aspiration
ANS: B The most common technique error associated with supraperiosteal, ASA, and MSA injections is the incorrect angulation of the syringe barrel and the needle. Incorrect fulcrum, incorrect target site and solution deposition, and incorrect aspiration are not technique errors commonly associated with supraperiosteal, ASA, and MSA injections.
DIF: Recall REF: st0080 | st0095 OBJ: 6 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care | NBDHE, 3.4 Anxiety and Pain Control
21. What is the most common technique error associated with the infraorbital injection? a. Incorrect fulcrum
b. Incorrect angulation of the syringe barrel and the needle
c. Incorrect target site and solution deposition
d. Incorrect aspiration
ANS: B The most common technique error associated with the infraorbital injection is the incorrect angulation of the syringe barrel and the needle. Incorrect fulcrum, incorrect target site and solution deposition, and incorrect aspiration are not technique errors commonly associated with the infraorbital injection.
DIF: Recall REF: st0110 OBJ: 6 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care | NBDHE, 3.4 Anxiety and Pain Control
22. Supraperiosteal injections are NOT recommended when there is (are) a. close proximity to infection.
b. close proximity to inflammation.
c. several teeth to be anesthetized.
d. All options listed.
ANS: D All options listed. Supraperiosteal injections are NOT recommended when there is close proximity to infection or inflammation and when several teeth need to be anesthetized.
DIF: Recall REF: p0765 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care | NBDHE, 3.4 Anxiety and Pain Control
23. Supraperiosteal injections are not recommended when several teeth in the quadrant need to be anesthetized because larger volumes of anesthetic would be provided and there is increased patient discomfort due to multiple penetrations. a. Both the statement and reason are correct and related.
b. Both the statement and reason are correct but NOT related.
c. The statement is correct, but the reason is NOT.
d. The statement is NOT correct, but the reason is correct.
e. NEITHER the statement NOR the reason is correct.
ANS: A Both the statement and the reason are correct and related. Supraperiosteal injections are not recommended when several teeth in the quadrant need to be anesthetized because larger volumes of anesthetic would be provided and there is increased patient discomfort due to multiple penetrations.
DIF: Recall REF: st0025 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care | NBDHE, 3.4 Anxiety and Pain Control
24. Which of the following describes the maxillary intraceptal injection? a. Useful for hemostasis
b. Intraosseous injection
c. Can use higher concentration of vasoconstrictor
d. Usually administered after nerve block
e. All options listed
ANS: E All options listed. The intraceptal injection is an intraosseous injection often administered after a nerve block. It is useful for achieving hemostasis and the clinician may use a higher level of vasoconstrictor.
DIF: Recall REF: st0040 OBJ: 2 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care | NBDHE, 3.4 Anxiety and Pain Control
25. The PSA injection can be useful during maintenance or recare appointments. Many times the maxillary molars are the first teeth involved in periodontal disease. a. Both statements are true.
b. Both statements are false.
c. The first statement is true; the second statement is false.
d. The first statement is false; the second statement is true.
ANS: A Both statements are true. The PSA injection can be useful during maintenance or recare appointments. Many times the maxillary molars are the first teeth involved in periodontal disease.
DIF: Recall REF: st0065 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care | NBDHE, 3.4 Anxiety and Pain Control
26. Administering the PSA block first is a good way to introduce the patient to less discomfort with local anesthesia because the injection does not contact bone and there is a relatively small area of soft tissue into which the local anesthetic is deposited. a. Both the statement and reason are correct and related.
b. Both the statement and reason are correct but NOT related.
c. The statement is correct, but the reason is NOT.
d. The statement is NOT correct, but the reason is correct.
e. NEITHER the statement NOR the reason is correct.
ANS: C The statement is correct, but the reason is NOT. Administering the PSA block first is a good way to introduce the patient to less discomfort with local anesthesia because the injection does not contact bone and the there is a relatively large area of soft tissue into which the local anesthetic is deposited.
DIF: Recall REF: st0065 OBJ: 4 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care | NBDHE, 3.4 Anxiety and Pain Control
27. The use of pressure anesthesia before, during, and after palatal injections to blanch the tissue is recommended to reduce patient discomfort. The overlying palatal tissue is dense and adheres firmly to the underlying bones of the palate. a. Both the statement and reason are correct and related.
b. Both the statement and reason are correct but NOT related.
c. The statement is correct, but the reason is NOT.
d. The statement is NOT correct, but the reason is correct.
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ANS: A Both statements are true. The use of pressure anesthesia before, during, and after palatal injections to blanch the tissue is recommended to reduce patient discomfort. The overlying palatal tissue is dense and adheres firmly to the underlying bones of the palate.
DIF: Recall REF: p1155 OBJ: 5 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care | NBDHE, 3.4 Anxiety and Pain Control
28. Each of the following is a description of the AMSA injection EXCEPT one. Which one is the EXCEPTION? a. Palatal nerve block
b. Provides pulpal anesthesia
c. Provides soft tissue anesthesia
d. Provides anesthesia to the anterior teeth of one sextant
ANS: D EXCEPTION: Provides anesthesia to the anterior teeth of one sextant. The AMSA is a palatal nerve block that provides both pulpal and soft tissue anesthesia to a maxillary quadrant except for the structures innervated by the PSA.
DIF: Recall REF: p1205 OBJ: 5 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care | NBDHE, 3.4 Anxiety and Pain Control
29. In patients who have a vaulted palate, the GP foramen appears closer to the midline. Conversely, in patients with a more shallow palate, the foramen appears closer to the dentition. a. Both statements are true.
b. Both statements are false.
c. The first statement is true; the second statement is false.
d. The first statement is false; the second statement is true.
ANS: B Both statements are false. In patients who have a vaulted palate, the GP foramen appears closer to the dentition. Conversely, in patients with a more shallow palate, the foramen appears closer to the midline.
DIF: Recall REF: p1240 OBJ: 5 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care | NBDHE, 3.4 Anxiety and Pain Control
30. Which statement describes the P-ASA block? a. No anesthesia of upper lip and face
b. Anesthesia for the maxillary anterior teeth of one sextant
c. 3- to 4-minute deposition period
d. All options listed
ANS: D
All options listed. The P-ASA block provides anesthesia for the maxillary anterior teeth of one sextant with no collateral anesthesia of upper lip and face. The deposition period is 3 to 4 minutes.
DIF: Recall REF: p1310 OBJ: 5 TOP: NBDHE, 3.0 Planning and Managing Dental Hygiene Care | NBDHE, 3.4 Anxiety and Pain Control