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SRP injections

I am new at giving LA and am pretty nervous and excited. For the Max & Mand quads what types of LA would you suggest? PSA, MSA, ASA, IA, B, M is what we where told in our class. Does anyone give the AMSA?Thank you!



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4 Answers

Regarding which anesthetic to use, I review the patient’s medical history for absolute and relative contraindications and decide from there. On which injections to give, I do what I learned in school based on which teeth need to be anesthetized. I only do palatals if absolutely needed. Sometimes I will infiltrate tooth 8 or 9 (depending on which quad I’m working on) because of cross-inervation, if the patient is especially tender when I’m scaling the anteriors.

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I use a lot of the injections learned in school but will modify if needed. I will usually infiltrate the max anteriors and use the ASA injection on occasion. I have not needed to use palatals very often but if the patient is very sensitive on the linguals I will use one. As with the mandibular teeth I use the IA 98% of the time as I feel it is the most successful even if the pt is missing the molars. If they are missing the molars and I have a hard time finding the insertion point I will use a mental. Local anesthetic type, I agree with Kara to review the health hx and go from there. Lidocaine 2% with 1:100,000 epi is the one I use most often but if I cannot use epi I will use Carbocaine 3% with no epi.

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I use the AMSA all the time and love it! It’s unpleasant but it usually gets the patient very numb. Honestly I find that with practice it isn’t too bad, you learn exactly where to penetrate. Plus every patient is different, some tell me it hurt but most just feel pressure (use topical). I always tell the patient it will be uncomfortable but worth it, and honestly the vast majority agree when all is said and done!

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For SRP I commonly use the PSA, MSA, ASA, IA, L and B blocks. I rarely use the mental/incisive during SRP though. If the patient is still uncomfortable, then I will anesthetize that area. I usually just use Cetacaine topical on the linguals of the max arch if they need it because the GP and NP blocks are so painful for the patient.
If the doc wants you to anesthetize their resto patients, maybe speak with him/her to know what their expectations are for fillings, crowns etc. I know my doc and many others only want local infiltration on max arch. You’ll need to have a good idea of when they’ll be using a rubber dam too so the patient is comfy with the clamp on.
Happy anesthetizing!

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