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1. The Basic Examination and Anesthetic Instruments


a. Loading the Syringe. When a disposable needle is used, the plastic hub is threaded on to the syringe without breaking the seal or removing the outer protective plastic cylinder. The first step is inserting the proper needle. The next step is to withdraw the plunger of the syringe and insert the Carpule™ (cartridge) of the anesthetic. After inserting the Carpule™, release the plunger and secure the barb in the rubber stopper by striking the thumb ring in the palm of the hand. The protective cylinder may be removed at the discretion of the dentist
. This usually will be done after the Carpule™ of anesthetic solution has been and inserted just before the injection is made. The needle and hub are discarded after use, following standard precautions, and in accordance with local policy.

b. The Injection.

(1) When the dentist is ready to inject the anesthetic solution, he will dry the injection area with 2-inch by 2-inch or 4-inch by 4-inch gauze. He may then apply an antiseptic solution to the area with an applicator. The tissue is then ready for the injection. The specialist may hand each item to the dentist as needed and receive them from him as each step is accomplished. The dental specialist will be expected to assist by retracting tissues, reassuring the patient, and observing the patient for signs of fainting or any other reaction to the anesthetic.

(2) Local anesthetics are undoubtedly the most frequently used drugs employed in the practice of dentistry. The local anesthetic most commonly used in the Army is Xylocaine®, also called lidocaine hydrochloride (two per cent concentration with epinephrine 1:50,000 or 1:100,000). The manner of packaging these anesthetics, in disposable cartridges, makes their use in the dental syringe quick and simple. Anesthetic needles come in different gauges and lengths. The long needle is used primarily for "block" type injections and the short needle for infiltration type injections; however, the long needle may be used for both types. The 25-gauge, long needle is the one provided in the dental field kit.

c. Possible After Effects. Although the techniques are followed, and drugs are used which have a very high margin of safety, and equipment is used which is efficient and easily sterilized, complications do occur. The most common is syncope (fainting), which is caused by cerebral anemia (which is usually psychogenic in nature), and normally lasts from 30 seconds to 2 minutes. If the patient does not injure himself (that is, by falling or aspirating a foreign body and obstructing his airway), no problem of any consequence will arise. Syncope is treated by placing the unconscious patient in the shock position, using a cold, damp towel on his forehead, and/or allowing him to inhale the irritating fumes from an ammonia ampule. Occasionally, allergic reactions to the drugs used may arise, but these are extremely rare.

David L. Heiserman, Editor

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Revised: June 06, 2015