Local Anesthetic Techniques

Technique	Features
1. Infiltration	Also called as submucosal analgesia. Terminal branches or free nerve endings are anesthetized. Only that area into which the local anesthetic solution is infiltrated is anesthetized.
2. Field Block	Large Terminal Branches are anesthetized.
a) Paraperiosteal	Most commonly used technique. The solution is deposited alongside the periosteum. It is indicated widely in the porous maxilla than in the dense mandible.
b) Interosseous	Means injecting directly into the bone. Painful and dangerous procedure. It is not commonly used.
c) Interseptal	It is most effective in children and young adults. LA is injected into the thin porous interseptal bone.
d) Intraligamentary	Most effective for anesthetizing single tooth by injecting LA into the periodontal ligament under high pressure.
e) Intrapulpal	LA is injected into the pulp chamber. The needle should be wedged firmly.

Must know Facts about Local Anesthetics / LA

This table lists some unique properties of local anesthetic agents.

Properties	Local Anesthetic
Natural local anesthetic agent	Cocaine
Local anesthetic agent with intrinsic vasoconstriction property	Cocaine
LA which is most dilating of all	Procaine

List of Medical Syndromes and their Important Features

1. Developmental Disturbances

Syndrome	Important Features
Parry Romberg's Syndrome	Facial Hemiatrophy
Vander Woude's Syndrome	Pits of lower lip and cleft of palate
Ascher's Syndrome	Acquired double lip + Blepharochalasis + Non toxic thyroid enlargement
Oro Facial Digital Syndrome	Cleft tongue nd clefting of mandibular alveolar process
Median Cleft Face Syndrome	Hypertelorism + Median cleft of premaxilla, palate + Cranium bifidum occultum
Meischer's Syndrome	Cheilitis granulomatosa

Setting time of Dental Materials : Alginate setting time, GIC, ZOE, Impression plaster and Zinc Phosphate Setting Time

The Setting time of some of the dental materials is listed in the table below.

Material	Setting time
Fast setting alginates	1-2 minutes
Normal setting alginates	2.5 - 4 minutes
Alginate (Optimal)	3-4 minutes
Impression plaster	4 minutes

MCQs on Tooth Extraction (Exodontia) and Impactions

# All of the following statements about inhaled tooth fragment are true except:
A. It usually enters in the right bronchus
B. It may cause lung abscess
C. It may cause bronchiectasis
D. It will be coughed out spontaneously, no treatment is necessary

# Rotatory movement is used for the extraction of the :
A. Mandibular canine
B. Maxillary central incisor
C. Maxillary lateral incisor
D. All of the above

Important Signs in Clinical Medicine and their Significance : Murphy's Sign, Auspitz's sign, Trousseau's Sign, etc.

Important Signs and their significance

Sign	Significance
Nikolsky's sign	➤ Seen in Pemphigus, familial benign chronic pemphigus and recessive form of epidermolysis bullosa ➤ Loss of epithelium due to rubbing resulting in raw, sensitive surface
Auspitz's sign	➤ Seen in Psoriasis ➤ If the deep scales are removed, one or more tiny bleeding points are disclosed

Treatment of Acute Necrotising Ulcerative Gingivitis (ANUG)

Treatment of ANUG

First Visit	➥Removal of pseudomembrane and non attached debris after the application of a topical anesthetic ➥Patient is advised to rinse with 3% H2O2 (hydrogen peroxide) in equal dilution with warm water every two hours ➥Patients with systemic symptoms and local lymphadenopathy are placed on Amoxicillin 250 or 500 mg QID and Metronidazole 250 or 500 mg TID