Question

Case: A female patient has pain on the lower 3rd molar. The patient has hyperthyroidism and diabetes. Her body weight is 45 kg Clinical examination shows severe inflammation around the crown. The treatment plan includes surgical extraction of the third molar. If you have given anesthesia to the patient with a proper technique, she may still have pain during the extraction Would you answer these questions with details: 1. Which type of local anesthesia injection should be done? 2. What is the type of syringe and needle that should be used? 3. Which nerves should be anesthetized? 4. Which area will be anesthetized? 5. What is the local anesthetic cartridge that should be used for this patient? discuss 6. What is the maximum number of cartridges of the local anesthetic that you select? 7. How to know that anesthesia is successful? 8. Why the patient may have pain while you are trying to extract the tooth?

Answer 1

1. Use of adrenaline in hyperthyroid patients is of great concern. In hyperthyroid patients use if adrenaline can cause increase in heart rate (tachycardia), irregular heart beats (arrhythmia) and high blood pressure followed by cardiac arrest. This is due to the vacoconstrictor effexct of adrenaline. To overcome this problem, use of plain LA i.e. without adrenaline, can be used in such patients as a precautionary measure.

3. Inferior alveolar nerve, long buccal nerve and lingual nerve of the same side should be anaesthesised.

4. Areas that are anaesthesised are:-

• Mandibular teeth to the midline
• Body of the mandible, inferior portion of the ramus
• Buccal mucoperiosteum, mucous membrane anterior to the mandibular first molar
• Anterior two thirds of the tongue and the floor of the oral cavity (lingual nerve)
• Lingual soft tissues and periosteum (lingual nerve)