Professional Documents
Culture Documents
ESSAY
ANS:
Gel, spray, liquid, ointment, and one patch form
ANS:
Cotton tip applicators, sprays, brushes, patches, blunted cannulas and/or syringes, and
single-dose applicator swabs
TRUE/FALSE
1. The over-the-counter product Anbesol with benzocaine can be safely used by all family
members.
ANS: F
Correct: Anbesol comes in a variety of strengths. One concentration cannot be used safely by
all family members.
2. Although topical anesthetics are generally regarded as safe, if used improperly they can
produce adverse reactions that are fatal.
3. A patient presents to your dental office the day after her dental appointment complaining of
swelling and itching on the right side of her face. You should reassure the patient that it is not
possible that her symptoms are related to dental anesthesia.
ANS: F
Correct: Some allergic reactions occur up to 2 days after the anesthetic is given.
4. Benzocaine topical anesthetic exists almost entirely in its base form, making absorption into
circulation high.
ANS: F
Correct: Benzocaine topical anesthetic exists almost entirely in its base form, making
absorption into circulation low.
5. The published maximum dosage recommendation for the topical anesthetic benzocaine is 200
mg.
ANS: F
Correct: The published maximum dosage recommendations for benzocaine have not been
established and do not exist.
6. Lidocaine is metabolized in the liver and excreted via the kidneys with less than 10%
remaining unchanged.
7. The most commonly found form of lidocaine is in base form because it is water soluble and
can easily penetrate and be absorbed into the tissues.
ANS: F
Correct: The base form is poorly soluble in water and has poor penetration and absorption
abilities.
8. Tetracaine hydrochloride has a rather slow onset of action; however, it can last approximately
45 minutes.
MULTIPLE CHOICE
4. All of the following EXCEPT one are considered advantages for the use of topical anesthetic
agents. Which one is the EXCEPTION?
a. Minimize pain associated with needle insertion
b. Can be purchased over the counter
c. Useful in treatment of minor oral injuries
d. Reduce gag reflex during radiographic procedures
ANS: B
EXCEPTION: Can be purchased over the counter
The fact that topical anesthetic agents can be purchased over the counter is not necessarily an
advantage when one considers the risk of toxicity. Minimizing the pain associated with needle
insertion, use in treatment of minor oral injuries, and reduction of gag reflex during
radiographic procedures are three advantages for the use of topical anesthetic agents.
5. Which of the following characteristics could contribute to the properties of an ideal intraoral
topical anesthetic?
a. Allergenic
b. Allow pain-free application
c. Dissolves readily at the site of application
d. Produces some systemic toxicity
ANS: B
Ideal properties of an intraoral topical anesthetic would include the pain-free application of
the agent. Being allergenic, dissolving readily at the site of application, and producing some
systemic toxicity would not be beneficial properties.
6. What is the main difference in the mechanism of action between topical anesthetics and
injectable anesthetics?
a. Location of the blocking of nerve conduction
b. Increase of depolarization
c. Decrease of excitability threshold
d. All options listed
ANS: A
Topical anesthetics work by blocking nerve conduction at the surface of the skin or mucous
membrane. Depolarization is decreased, and there is an increase of excitability threshold.
7. To obtain the most benefit from the use of topical anesthetics, a fairly substantial amount of
topical should be placed on the cotton tip applicator. This amount mixes with the saliva and
may numb the tongue, soft palate, or pharynx.
a. Both statements are true.
b. Both statements are false.
c. The first statement is true; the second statement is false.
d. The first statement is false; the second statement is true.
ANS: D
The first statement is false, the second statement is true. Only a small amount of the gel or
ointment on the applicator tip is necessary to achieve the desired results. An excess amount
mixes with the saliva and may numb the tongue, soft palate, or pharynx, which usually leads
to patient dissatisfaction with the whole process.
8. Which of the following properties are advantages of topical anesthetics being in a liquid
form?
a. Provides anesthesia to a widespread area
b. Useful to decrease a patient’s gag reflex
c. Can be applied to site-specific areas with an applicator
d. All options listed
ANS: D
All options listed. Liquids are great for providing anesthesia to a widespread area. They are
especially useful when trying to decrease a patient’s gag reflex, and the use of a liquid for a
more site-specific procedure requires an applicator.
9. All of the following are advantages of purchasing a single-dose unit of a topical anesthetic
EXCEPT one. Which one is the EXCEPTION?
a. Dose manageable
b. Cost-effective
c. Less cross-contamination
d. Less messy
ANS: B
EXCEPTION: Cost-effective. Individual packaging of topical anesthetic is usually more
expensive. Individual packaging of topical anesthetic is not only less messy, it also helps to
prevent possible cross-contamination and allows monitoring of the dosage being used.
10. Unmetered sprays are not recommended because they do not allow control of the amount of
anesthetic dispensed, nor are they easily contained at a specific site.
a. Both the statement and reason are correct and related.
b. Both the statement and reason are correct but NOT related.
c. The statement is correct, but the reason is NOT.
d. The statement is NOT correct, but the reason is correct.
e. NEITHER the statement NOR the reason is correct.
ANS: A
Unmetered sprays are not recommended because they do not allow control of the amount of
anesthetic dispensed, nor are they easily contained at a specific site. However, the use of a
metered spray with a disposable nozzle enables control over the amount of agent being
dispensed, thus decreasing the risk for systemic toxicity.
11. Methemoglobinemia has been reported following topical anesthesia use of benzocaine,
particularly with higher concentrations of 14%-20% spray applications applied to the mouth
and mucous membrane. An advisory statement informing the public of the association
between benzocaine and methemoglobinemia has been released by the Institute of Safe
Medication Practices and the U.S. Food and Drug Administration.
a. Both statements are true.
b. Both statements are false.
c. The first statement is true; the second statement is false.
d. The first statement is false, the second statement is true.
ANS: A
Both statements are true. Methemoglobinemia has been reported following topical anesthesia
use of benzocaine, particularly with higher concentrations of 14%-20% spray applications
applied to the mouth and mucous membrane. An advisory statement informing the public of
the association between benzocaine and methemoglobinemia has been released by the
Institute of Safe Medication Practices and the U.S. Food and Drug Administration.
12. Which of the following are considered advantages of the application of dental topical
anesthetics in a patch form?
a. Site-specific
b. Multiple choices
c. Cost-effective
d. All options listed
ANS: A
Site-specific. The advantage of patches over other methods of administration is that they can
be placed directly to desired sites. Patches available for intraoral topical anesthesia are
limited. Dental topical anesthetic patches cost more than other forms of topical anesthetics.
14. Possible localized adverse effects of topical anesthetics could include which of the following?
a. Stinging at the site of application
b. Tissue discoloration
c. Sloughing
d. All options listed
ANS: D
All options listed. Possible localized adverse effects of topical anesthetics could include
stinging at the site of application, tissue discoloration, and sloughing.
15. What is the reason that concentrations of topical anesthetic agents are higher than those of
their injectable counterparts?
a. Topical agents are not natural vasoconstrictors like injectable anesthetic agents.
b. They facilitate high plasma concentrations of topical anesthetic agents.
c. They facilitate diffusion of the topical anesthetic agent through the mucous
membranes.
d. With topical anesthetic agents, systemic absorption decreases.
ANS: C
The reason that concentrations of topical anesthetic agents are higher than that of their
injectable counterparts is to facilitate diffusion of the topical anesthetic agent through the
mucous membranes. Neither topical nor injectable anesthetics used in dentistry are natural
vasoconstrictors. With these higher concentrations and lack of vasoconstriction abilities, the
risk of local and systemic absorption increases, thus increasing the risk of toxicity.
16. Which patients may be more susceptible to adverse effects to topical anesthetic agents?
a. Children
b. Elderly
c. Medically compromised
d. All options listed
ANS: D
All options listed. Children, elderly, and medically compromised individuals are more
susceptible to adverse reactions to topical anesthetics.
17. Why does the local and systemic absorption of topical anesthetics increase the risk of
toxicity?
a. Topical anesthetics do not contain vasoconstrictors.
b. Topical anesthetics are formulated in high concentrations.
c. Topical anesthetics are absorbed quickly into the tissue and blood stream due to
vasodilation of the area.
d. All options listed
ANS: D
All options listed. With the higher concentrations of the topical anesthesia and in the absence
of vasoconstricting abilities, the risk of local and systemic absorption increases with the use of
topical anesthetics.
19. What is the maximum recommended dose of Oraqix at one dental treatment session?
a. Two cartridges
b. Four cartridges
c. Five cartridges
d. Eleven cartridges
ANS: C
The maximum recommended dose of Oraqix at one dental treatment session is five cartridges.
21. While at room temperature, Oraqix is in gel form in the cartridge. It will liquidate as it reaches
body temperature in the periodontal pocket.
a. Both statements are true.
b. Both statements are false.
c. The first statement is true, the second statement is false.
d. The first statement is false, the second statement is true.
ANS: B
Both statements are false. While at room temperature, Oraqix is in liquid form in the
cartridge. It will gel as it reaches body temperature in the periodontal pocket.
22. What has the combined lidocaine/prilocaine cream been approved and effectively used for?
a. Medical procedures
b. Dental procedures
c. Topical anesthetic for skin abrasions
d. All options listed
ANS: A
The combined lidocaine/prilocaine has cream been approved and effectively used for medical
procedures. FDA approval is for nonmucosal skin, and the recommendation is that it be only
applied to intact skin.
23. Which of the following are best practices to follow when administering local anesthesia of
any kind in the dental office?
a. Review the patient’s health and dental history at all appointments.
b. Use the lowest concentration of anesthesia to satisfy clinical requirements.
c. Limit the area of application.
d. Know the concentration of the drug being used.
e. All options listed
ANS: E
All options listed. Best practices to follow when administering local anesthesia of any kind in
the dental office include: review the patient’s health and dental history at all appointments;
use the lowest concentration of anesthesia to satisfy clinical requirements; limit the area of
application; and know the concentration of the drug being used.
24. Prior to providing an injection, the topical agent should remain at the site of penetration for
about 4 minutes. Anesthesia should be achieved to a depth of approximately 5-6 mm into the
tissue.
a. Both statements are true.
b. Both statements are false.
c. The first statement is true; the second statement is false.
d. The first statement is false; the second statement is true.
ANS: B
Both statements are false. The topical agent should remain at the site of penetration for 1-2
minutes. Anesthesia should be achieved to a depth of approximately 2-3 mm into the tissue.
25. The onset of action for benzocaine is rapid. The duration of action for benzocaine is 5-15
minutes.
a. Both statements are true.
b. Both statements are false.
c. The first statement is true; the second statement is false.
d. The first statement is false; the second statement is true.
ANS: A
Both statements are true. The onset for benzocaine can occur as early as 30 seconds, with peak
effect at 2 minutes. The duration of action is 5-15 minutes.
28. Topical anesthetics are available in concentrations ranging from 0.2% to 20%. Products
available over the counter can have concentrations just as high as those used professional in
the dental office.
a. Both statements are true.
b. Both statements are false.
c. The first statement is true; the second statement is false.
d. The first statement is false; the second statement is true.
ANS: A
Both statements are true. Topical anesthetics are available as a prescription or over the
counter, with concentrations ranging from 0.2% to 20%
xxxix. Marche
de Constance
vers la Perse.
Constance n'assista pas à ce synode: il marchait
alors vers la Perse, d'où l'on craignait sans cesse [Soz. l. 2, c. 9-
une irruption. La haine de Sapor contre les 14.]
Romains croissait de plus en plus. Tant que la
religion chrétienne avait été persécutée dans Cod. Th. lib. 11,
l'empire, la Perse avait ouvert les bras aux t. 7, leg. 5.
chrétiens qui venaient y chercher un asyle. Mais
depuis la conversion de Constantin, Sapor les
regardait comme autant d'espions et de traîtres: il Aug.
de Civ. l.
18, c. 52, t. 7, p.
les accusait de favoriser les Romains, avec 535.
lesquels ils s'accordaient dans le culte. Sous ce
prétexte il les livrait aux plus affreux supplices. Les
tables ecclésiastiques donnaient les noms de Baron. an. 344.
seize mille martyrs, tant hommes que femmes[146].
Le reste était innombrable. Ces cruels traitements [Themist. or. 4,
contribuaient à fortifier les soupçons de Sapor: un p. 58.
grand nombre de fidèles se réfugiaient dans les
villes romaines, et par une sorte de reflux la Chron. Alex.
persécution les ramenait dans les mêmes vel. Pasch. p.
contrées, d'où la persécution les avait chassés. 289.
Constance s'avança jusqu'à Nisibe[147], où se
rendait sans doute une partie de ces pieux fugitifs. Ducange,
Mais on ne voit pas que les Perses aient cette Const. chr. p. 91
année passé le Tigre, et l'empereur revint à et 92.]
Antioche sans avoir tiré l'épée. On avait
commencé le 17 d'avril à construire à Constantinople des thermes
magnifiques, qui portèrent le nom de Constance. Il y fit transporter
d'Antioche les statues de Persée et d'Andromède.
[146] Voyez les additions au livre v, § 22.—S.-M.
[147] Il était dans cette ville le 12 mai 345.—S.-M.