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Lecture Notes on

ORAL-SURGERY
‫يحي الهادي‬/‫د‬

Additional armamentarium
Lecture
The components of the Local anesthetic armamentarium
 major

- The syringe
- The needle
- The cartridge
- Other items :
- Topical antiseptic
- Topical anesthetic
- Applicator sticks
- Cotton gauze
- Hemostat
Topical antiseptic:
 The preparation of the tissues ( at the site of injection ) before the initial
needle penetration
( intra oral injection )
 Sterile gauze wipe for cleansing the soft tissue at the site of needle
penetration
(removes any gross debris from the area )
 produce a transient decrease in the bacterial population
risk of post injection infections
( virtually eliminate them )
- Just to moisten the cotton portion of the swab
( applicator stick )
- 15-30 seconds
 Available agents:
- Betadine ( povidone – iodine )
- Merthiolate ( thimerosal )
 Topical antiseptics containing :
- alcohol should not be used ( tissue irritation )
( tincture of iodine – tincture of merthiolate)
-iodine (risk allergy to iodine )
 69.7 % dentists never used topical antiseptics before injection
 22.4% sometimes
 7.9 % always
Topical anesthetic :
- Strongly recommended
- minimal quantity ( applicator stick )

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- 2-3 minutes (10-15 seconds ??? ) profound soft tissue analgesia
 The ester local anesthetic benzocaine
- allergic reaction
- Benzocaine is not absorbed systemically allergic reactions are localized to
the site of application
 The amide topical anesthetic lidocaine (only) possesses a topical anesthetic
activity in clinically acceptable concentrations
- The risk of overdose is greater and increases with the area of application
 The ester local anesthetic benzocaine
- allergic reaction
- Benzocaine is not absorbed systemically allergic reactions are localized to
the site of application
 The amide topical anesthetic lidocaine (only) possesses a topical anesthetic
activity in clinically acceptable concentrations
- The risk of overdose is greater and increases with the area of application
 Small measured doses should be administrated
 Metered sprays ( deliver a fixed dose with each administrator regardless of
the length of time the nozzle is depressed )
 Xylocaine 10 mg per administration
 Preservatives : methyl paraben (allergy ) ???
 Topical forms of lidocaine :
-ointments
- Gels
- Pastes
- Sprays
- Emla ( eutectic mixture of local anesthetic )
- surface anesthetic of intact skin
- Topical cream formulation
- Combination : lidocaine , prilocaine
- No flavoring agent ( bitter tasting )
- Sterilization of the spray nozzle (difficult )
- Disposable nozzle

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Applicator sticks:
 Wooden sticks with a cotton swab at one end
 Used :
-to apply topical antiseptic , topical anesthetic
To mucous membranes
-To compress tissue during palatal injections

Cotton Gauze:
- 2 x 2 inch size
- For wiping the area of injection before the administration of a local anesthetic
(not as effective as the topical antiseptic )
- Drying the mucous membrane to aid retraction
- ( makes the tissue ( lips , cheeks ) easier to grasp and retract)
- improved access and visibility to the injection site

HEMOSTAT:
(or pickup forceps)
 Should be available in the dental office
 Functions : removal of a needle from the soft tissues ( breakage )

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Preparation of the Armamentarium:
 Proper care and handling of the local anesthetic armamentarium can
prevent
( minimize ) the complications associated with ( needle , syringe , cartridge )
Breech – loading Metallic or plastic , cartridge – type syringe :
1- Remove the sterilized syringe from its container
2- Retract the piston fully before attempting to load the cartridge
3- Insert the cartridge into the syringe
( insert the rubber stopper end of the cartridge first )
4- Engage the harpoon
Gently push the piston forward until the harpoon is firmly engaged in the plunger
 Do not hit the piston in an effort to engage the harpoon
( Risk cracked or shattered glass cartridges)
5-Attach the needle to the syringe
- Remove the white or clear protective plastic cap from the syringe end of the
needle
- Screw the needle onto the syringe
6- remove the colored plastic cap from the opposite end of the needle
7- Expel a few drops of solution to test for proper flow
the syringe is now ready for use
 Attach the needle to the syringe before placing the cartridge
This requires hitting the piston hard to engage the harpoon ( breakage –
leakage )
Recapping the needle:
 Immediately after removal of the syringe from the patient’s mouth
- the time when the administrator :
- is most likely to be injured ( stuck ) with a needle
- The most dangerous time to be stuck (contamination with blood , saliva , debris)
-Scoop technique
the uncapped needle is slid into needle sheath lying on the instrument tray or
table
Needle cap holders :
 Hold the cap stationary while the needle is being inserted into it
- Commercially made
- Self-made ( acrylic)
Unloading the breech-loading , metallic or plastic , cartridge – type syringe:
1- Retract the piston and pull the cartridge away from the needle with thumb +
forefinger until the harpoon disengages from the plunger

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2- Remove the cartridge by inverting the syringe
( fall free )
3-Discard the used needle not discarding the metal needle adaptor from the
syringe

-Sharps container is recommended for storage of discarded contaminated

needles
-Separate sealed container is recommended for discarded local anesthetic
cartridge
SELF-ASPIRATING SYRINGE:
( absence of a harpoon )
1-Insert the cartridge
2- attach the needle
3-the syringe is now ready for use
ULTRRASAFE ASPIRATING SYRINGE:
 Loading :
1- insert the cartridge into the body assembly
( the needle pierces the rubber diaphragm on the cartridge )
2- Grasp the octagonal plug on the body assembly
Between the thumb and index-finger
Align the legs with the notches and snap the 2 sections ( body and plunger )
Together snapping sound
3-Grasp the body assembly below its collar between the thumb and the index
finger
Point the needle end down
4- Engage the harpoon into the stopper of the cartridge ( palm of the hand)
5-Express several drops of anesthetic solution
6-The syringe is ready for use
Unloading the ultra safe aspirating syringe:
- Single use
- Aften the last injection the entire device should be discarded into a sharps
container
- The ultra safe aspirating syringe may be reloaded with an additional cartridge as
follows
 Making the ultrasafe aspirating Syringe safe
 Safety precautions ,
- Keephands behind the needle at all times during use and disposal

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 - Do not attempt to override or defeat the locking safety mechanism
- Use the syringe only once
- For aspiration , use standed operating procedures for the aministration of
an anesthetic
One – handed guarding technique
1- after injection , move the index and middle fingers against the front collar of
the guard
 Pull back on the needle ( pulling back the plunger )
 Until it is retracted into the guard and the guard legs lock into the body
notches ( click is heard)
Tow-handed Guarding Technique:
 When the entire cartridge has not been administered
 If the administrator has small or petite glove size hands
 Grasp guard near its collar with free hand
 Pull back the needle until locked the body
 Pull the body back until the needle is retracted into the guard and the guard
legs lock into the body notches
( the needle is safe )
The entire until can be discerded in the sharps container
Grip the plunger handle:
 Loading the ultra safety plus XL system
1- tear back paper seal and remove the sterile unit from the blister pack
- Grip the barred firmly and fully insert the anesthetic cartridge into the open end
of the syringe

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