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1. The Basic Examination and Anesthetic Instruments


a. Sterilized Instruments. As in the basic examination, the anesthesia also requires a certain setup. (Look in Annex A for typical instrument setups for various dental procedures.) One instrument in the setup that always requires autoclaving is the syringe. The other items are sterilized by the manufacturer and packaged in this condition.

b. The Topical Anesthetic. The first item in the setup is topical Xylocaine®. This anesthetic is produced in a jelly-like or ointment form. It is most often used to anesthetize the area where the actual injection is to be made. Two-inch by two-inch gauze or cotton tip applicators will be necessary when administering topical Xylocaine®. A small amount is placed on the applicator and applied over the area to be injected. The purpose of this topical anesthesia is to lessen the discomfort to the patient during the actual injection.

c. The Syringe. The syringe (side-loading cartridge syringe) is the only item in the setup that will require autoclaving after each patient. This syringe is used to administer local anesthetics. Syringe needles are the disposable type. The length and gauge needle used will vary depending on the preference of the dentist
. You will be handling two different needles: an infiltrative and a conductive needle. The infiltrative needle is 13/16" long and is used for maxillary injections. It is used to anesthetize a small area of possibly two or three teeth. The conductive needle is 1-3/8" long. Block injections are made with this, anesthetizing an entire area.

d. Local Anesthetics. Currently, two types of local anesthetics are available through routine supply: lidocaine hydrochloride (Xylocaine®) with epinephrine (1:50,000 to 1:100,000); and mepivacaine hydrochloride (Carbocaine®) without epinephrine. These types can be identified by their stopper color and by the color of their containers. For example: lidocaine hydrochloride with epinephrine, one part to fifty thousand, is recognized by a green stopper and green stripe on the container; lidocaine hydrochloride with epinephrine 1:100,000, has a red stopper and a red striped can; and mepivacaine hydrochloride has a white stopper and a brown container. The epinephrine is the controlling factor as to how long the anesthetic will last. The more epinephrine, the longer the area will stay anesthetized. The epinephrine is a vasoconstrictor that causes the tissue around the capillaries to swell and thus constricts the capillaries and slows the blood flow. The decreased blood flow slows diffusion of the anesthetic throughout the body thus prolonging its action. It also aids in controlling bleeding.

e. Aspiration Required. The assembly and usage of the aspirating syringe is quite simple. The syringe is equipped with a device enabling the dentist
 to determine if he is injecting into the blood stream. The accidental injection of the agent into the circulatory system may produce undesirable symptoms or death. Notice the thumb ring and the barbed plunger. The barb penetrates the rubber stopper of the anesthetic cartridge, permitting aspiration when the dentist
 retracts the syringe plunger by means of the thumb ring.

f. Instrument Setup. For the instrument setup for local anesthesia, see figure 1-16.

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Figure 1-16. Instrument setup for anesthesia.

David L. Heiserman, Editor

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Revised: June 06, 2015