ThePrinciplesandPracticeofToothExtractionandLocalAnesthesiaoftheMaxillae 10031932
ThePrinciplesandPracticeofToothExtractionandLocalAnesthesiaoftheMaxillae 10031932
ThePrinciplesandPracticeofToothExtractionandLocalAnesthesiaoftheMaxillae 10031932
Pr i n c i p le s a n d Pr a c ti c e
of T o o th Ex tr a c ti o n
WI L L I AM J L EDER ER .
, DD S
. a .
D t l C
en a u lt n t t th G rm H
o ns a o e e an o spi ta l i n th e
C i ty f N w Y rk
o e o
NEW YO R K
1 4 1 - 1 45 W ES T 3 67 14
. S T R EET
A U T H OR S ’
NOTE
T h e ch apters o n CO ND U C T IVE A N E S T H ES I A
s h ould emphasi z e t h e g reat value o f this m ethod
in performing painless operations about th e teeth
and j aw s PA I N LE S S DE N T I S TR Y is n o t a d r eam any
.
ta l M fg C o as well as to th e K n y S ch ere r C o
. .
,
-
.
W ILLIAM J L E DER ER
. .
1 50 E as t Se v enty f u r th S tr ee t
-
o , Ne w Y rk o .
C O NT ENT S
PA R T I
C A R E O F I N S T R U M E N TS
TH E RE LA T I O N O F T H E O P ERATOR T O W A RD
T H E E xA PAT IE N T
M I N A TI O N O E T H E
TH E PR E PARA T I O N O F T H E P A T I E N T
I NDICA T I O NS F O R T OOT H E xT RA C T I O N
T H E O P ER A TO R S ARMAM E N T ARIU M :
’
I NS T R U M E N T S D R U G S AND D R ES S I N G S
,
C LAS S I FICA T I O N O F C AS ES
IX . T H E TE CHNI " U E O F NO RMAL E xT R A C
T I O NS
ROOT E X T RAC T I O N S
I MPAC TE D T E ET H
U N ER U P TE D T EET H
PO S T EX T RAC T I VE T R EA T M E N T
THE T R E A T M EN T O F C O MPLICA T I O N S
v
CO N TE N T S
PA R T I I
PA G E
I . A N A ES T H E SIA
G E N E RAL , LO CAL ,
CO ND U C T I VE ,
RE
G IO NAL
S OLU T I O NS F O R LO CAL A N E S T H E SIA : T H E
S O L VE N T M E DI U M
T H E ARMAM E N TARI U M
CO CAIN E NO VO CAIN ADR E NALIN
, ,
US E F U L F O R M U L JE AND P R E SCRIP T I O NS
POIS O NS A N D T H E IR A N T ID OTE S
T H E T R EA T M E N T O F EM ER G E N CIE S
G L O SSAR Y
I ND E X
DE N T AL A ND O RAL O PERAT I O N S IN T H E IR T R U E
AS P E CT
TH E prin c ipl e s of surge r y are al w a y s th e same no ,
th e same ru l e s m us t b e Ob s er ved .
3
4 T OOT H E X T RAC T I O N
like K irk J ack W ilson Darby Truman Mars h all
, , , , ,
—
V on M o s e ti g M oorhof the eminent V iennese ,
weeks .
that many men hav e not lea rned t h eir lesson well ,
”
calls the sense Of asep s i s
“
A n Operato r mu s t
.
7
8 T OOT H E X T RAC T I O N
A sepsis for the mouth specialist means aseptic
hands aseptic instrumen ts aseptic i ns trument ta
, ,
p a r tm e n ts w hich
,
become the receptacles for
sterile instruments T h ese instruments un avo i d
.
O H a n ds
’
2 Ca r e
. o f th e p e r a to r s
and orange wood stick The h ands are then rin sed
-
.
12
ATT I T U D E OF O P E RATO R 13
,
-
t h etics .
“
fever s o r es-
”
M ake it your b usines s to become
.
b e ext r a c ted.
FI G . 1
a inin g
Ex m th e S ub m a i ll ry
x a and S u bl in gua l G l a nd s
FI G . 2
a in ati n O f
Ex m o th e M o uth w ith R e tr ac to r s
FI G . 4
a i n i ng th C nt u r O f th L
Ex m e o o e o we rJ aw
PR E PARAT I O N OF TH E P AT IE N T
TH E succes s ful ou tcome Of any operation depends
to a large exten t upon the physical and mental
state Of th e patient NO Operation fi lls the p a
.
22
PR E PARA T I O N OF P AT I E N T 23
in ex treme cases .
i nfection .
VI
I NDICA T I O NS FOR T OOT H EX T RA C T I O N
1 Teeth resisting medicinal o r surgi cal treatmen t
. .
latio n ;
b Teeth wh i ch cannot be re stored by fil l
.
trouble .
5 S upernumerary tee th
. .
M a lp o s e d te e th s h o ul d n eve r b e ex tr a c ted fo r
th e c o r r e c ti o n o f a d ef o r m i ty un l es s a n o r th o
,
p r es s es s uc h a d es i r e .
”
surgical duty T h ere are many types Of forceps
.
FIG 7 .
F IG 8. .
FI G . 9
AR M A M E N T ARI U M 29
No 150
FI G 10
f r Cry r
.
Upp r e Roo t F rc p
o e s A te e
F IG 11
yr
.
L o we r Roo t Fo rc p e s A ft er (
‘
r e
F IG . 12
30 T OOT H EX T RAC T I O N
both uppe r and lower j aw al s o ve ry h a n dy fo r the ,
s tr um e n ts are required
( Fi g .
F IG 1 3 .
F IG 14
Le d r r Fl ap
.
e e
’
s K nif e *
FIG .
“
O btaina bl at e an y D nta l
e De p t o .
A R M A M EN TAR I U M 31
M o uth P r o p s Of
various S i z e O f met a l rubber
, ,
FI G . 18
De n h ar t u
M o th G a g
that the soft part s o f the mouth are not inj ured ;
th e instrument should never be opened unless i t i s
placed between the upper and lower teeth a s ,
FI G . 19
M eta l F in g r Pr t c t r
e o e o
FIG . 20. OR A L S C R EW
34 T OOT H EX T RAC T IO N
A pair Of ton gue forceps in ca se the ton gue
should fall b a ck .
FIG . 21 . TO N G U E FO R CEP S
C hisels fo r cutting bone as well as a mallet and ,
F IG . 22
Re t r a c to r l
s . 2 3 4 7 8 fo r
. . . . . L ip a n d Ch ks
s ee .
36 T O OT H EX T RAC T IO N
FI G 2 5
. . HEA DL IGHT
A caute r y o p e r ate d b y ele c t r i c i ty or b e n z ine .
ARMA M E N TARI U M 37
FI G . 26
FI G . 27
D R E SSIN G S
I odoform gauze in strips o n e half and one inch -
w id e fo r packing .
R u bb er tissue .
C otton swab s .
wide .
FI G . 28
S trychnine S ulphate gr , .
M orphine S ulphate gr ,
.
phate gr
, .
A m yl n i tr i te
in globules (gla s s pe a rl s h ol d in g 3
and 5 minims , whic h are br oken in a napkin and
inhaled b y th e patient ) .
Bromides B r o m ur a l (Knoll
. fiv e gr a in -
tablets .
I odoform p owder .
O r th o fo r m .
No v o c a i n .
Thiersc h S olution .
S aline S olution .
Burrow s S olution .
I odine .
A lcohol .
Bicarbonate O f S oda .
Hydrogen P eroxide .
C arbolic A cid .
I J YS O I .
A j ar Of V aseline .
C LASSI F ICA T I O N OF CAS E S
T OOT H extractions can be divided into
1 Normal e x tractions
. .
the w ound .
FIG . 29
e oo e, e e oo .
IX
TH E T E CHN I" U E OF NO RMAL T OOT H EX T RAC TIO N
F OR convenie n ce in teaching the writer d ivi d e s ,
F IG 30
and
.
P l ing th
ac e Fo rc p L
e s o o se ly Acr o ss th e H
42
44 T OOT H EX TR A C TIO N
FIG 32 .
App l i c a ti Of Be ak s t T th Th a t
on o oo th e D i stal P ar t Of I n str u
m en ts P o i n t s Aw ay fr o m M d ian L i ne
e .
FI G 33
App l i c ati n O f Fo rc p Of T th
.
o e s to Cr o wn oo
APPLICA T I O N OF F O RC E PS 45
FI G 34
Cl i ng F rc p A b ut T t h Th I n d x F in g r
.
'
os o e s o oo . e e e H a s B ee n
W ith d w n f r m B tw n th F c p H dl an d
ra o e ee e or e s an es H a s B ee n
C u rv d A b ut th I n t r u m nt
e o e s e .
th e ro o t
.
FI G . 35
i n dicates
th e long axis of both the tooth
the fo rcep s beaks ; it also shows the path in which
-
r e c tly .
th e socket .
FIG . 36
ft r
A e th e o F rc
e p s A i e l r O pe I
’
pp l i d d th Ind x F in g r
Iy A e an e e e
ls P el ac d
o n T o p o f th e M i ddl F in g r th Th u m b I B r ugh t
e e ,
e S o
A o r un
d th e H an dl an d
e th e B e ak Cl d s o se .
C L O SIN G OF F O RC E PS 49
—
held in a board b y adhesion Bearing t h ese two .
”
retentive factors in mind w e formulate the ,
FI G 37
S h o w s Ap p l i cati n Of Fo rc p t R i gh t U p p r T h i r d M o la r ;
.
o e s o e
N o t L eft T h u m b an d In d x F i n g r P r t c tin g S f t P a r t s
e e e o e o .
52 T OO T H EX T RA C TIO N
FIG 39
S h o w s App l i c ati n O f F rc p t L ft U pp r T h i rd
.
o o e s o e e M o l a r ; No t e
L ft T h u m b d I n d x F ing r P r t t i n g S ft P r t
e an e e o ec o a s .
F IG 40
l ac in g In s t ru m nt L s ly
.
H ld in g L w r F rc p
o o e F i r t S tag
o e s, s e, P e oo e
Acr o Pa l m f Han d
ss o .
F IG . 41
I tr d uc i n g I n d x Fing r
n o e e t
B e w ee n Ha n dl s
e to O p n F rcep s
e o
54 T OO T H E X T RA CT I O N
t T th
o oo Th In d F ing r I S t i ll B tw n th H an dl th
e ex e s e ee e es , e
Th u mb Ext n d d A l n g th S h an k O f th I n t r u m n t
.
e e o e e s e .
APPL ICAT IO N OF F O RC E P S 55
F IG 43 .
S h w th e
o s pp l i c at i n f F rc p t a L w r B i cu pi d Th e
a o o o e s o o e s .
Ind x F i ng r H B n W i th dr w n P l c d A b v th M i ddl F in
e e as ee a a e o e e e
T
,
g d
er , an t h h u m b
e E t n d d A
x el n g teh S h an k o f th In tr u ment o e s e .
N t
o th
e Pa r l l l A pp l i c a t i n O f t h
e a e B ak
o t th L ng A x i
e e s o e o s
Of T th oo .
56 T O OT H EX T RAC T I O N
F I G 44 .
S h w L a t S t a g O f A pp l i c a t i n O f L w r F r p
o s s e th In d x o o e o ce s, e e
F ing r H B n W i thdra w n fr m B t w n th Handl th
e as ee o e ee e es , e
T h u m b I Ext n d d A l ng th e S han k th B ak A C l d A b ut
s e e o e e s re o se o
f th T t h
,
th Cr w n
e o o e oo .
tion O f the roots (or that the long axis of the be aks
runs as n early parallel to the long axis O f the
tooth as possible ) not Observing this accounts for
many failures .
FI G 45
.
Fo rc p C rr c t l y
e s o e and I n c rr t l y A pp l i d
o ec e to L o we r T th
ee
58 T OO T H EX T RAC T IO N
F I G 46
S h w App l i c ati n O f F rc p t L w r Ant r i r T e th ; N t e
.
o s o o e s o o e e o e o
L ft T h u m b S upp r ti g M a n d i bl
e o n an d Ind x a n d S ec n d F inger s
e, e o
P r t c tin g S ft P a r t
o e o s.
FI G 47 .
o e o ec o a s .
60 T OOT H EX T RAC T I O N
S O, a fter all if all points necessary fo r s ucces s
,
l oosely .
instrument .
F IG 49
s iti o n Of Operat o r Wh i l e Ext r ac ting U pper Le ft Anter i r T eth
.
Po o e
62 T OOT H EX T RAC T I O N
FI G 50
t U pp r P t r i r T
.
Po s iti n
o o fO p r at r Wh i l
e o e E xtra ct n i g R i gh e os e o ee t h
F I G 51
r P t r i r T th
.
FI G 52
Po s iti o n O f O per a to r xt racti ng Lo wer Ant r i r T eth
.
il
Wh e E e o e
P O S ITI O N OF O PE RAT OR
FIG 53
.
F I G 54
P o iti n f O p r t r Ex t rac tin g L eft Lo we r T eeth
.
s o o e a o (S o me ti me s
th e W r it r W i ll S tan d as in F i g
e .
FI G 55
ta nd ing in d atien t
.
S Be h th e P
X
TH E EX T RAC T I O N OF RO O T S
NO CLA SS f
conditions will test the skill Of th e
o
as pos sible .
68
C AR E OF GU M T ISS U E 69
‘t d;
-
l u
‘ ( d tu
FIG . 58
the forceps .
To c ut s o ft ti s s ues w i th th e f o r c ep s i s b r uta l ,
un s c i en ti fic , un s ur gi c a l , un n e c e s s a r y an d h a r m ful
to th e p a ti en t, f or it is no t c utti n g , b ut te a r i n g
ti s s ue.
c e dur e in these ca s es .
FI G . 59
I S h w s th F i rst B i c u pi d R o t i th A lv l u s 1 1 S h w s th
o e s o n e eo o e
Of th T i u A ft r
. .
.
G um In c i d III Sh w se . th A pp a r an c
. o s e e e e ss es e
Ex tr c ti n F ll w i n g P r p r In c i i n
a o o o I V S h w th e A pp a r an c
o e s o . . o s e e
O f th P a rt A f t r th E x tr ac ti n i f th O p r at r D N t I
e s e e o e e o oes o n
c i th G um F i r t b u t In cl ud t h S ft T i u W i th in th
,
se e s es e o ss es e
B lad
,
Of th F rc p
es e o e s .
I f the
root is a mol a r root two parallel incisions
c an be made and thus a flap prepared wh ich is
, ,
as to avoid s lipping .
F I G 60
El v a t r U d b y th A uth r Th R i gh t a n d L ft I n s t r um ent
.
e o s se e o . e e s
A re N O 1 3 an d N
. 1 4 S S Wh i t Th O th r Th r
O Eu r p an
.
,
. . e . e e e e, o e
In tr u m nt T h O at th Ex tr m R i gh t I P t h E l v at r
s e s e ne e e e s ar sc
’
s e o
P a r t i c u l a rl y A d apt d f
. ,
R m v al f L w r R t Th O N x t
e or e o o o e oo s e ne e
t Th i I L
.
E l v at r an d th O in th C nt r B t n ’
lu
’
o s s ec se s e o , e ne e e e et e s
El va t r
e o .
72 T OOT H EX TRAC T I O N
The blade of the instrument is then forced b e
tween root and alveolus s o as to force the root ,
p l i s h e d i e t h e removal
,
. o.f the
,
root wit h n o dam
a g e to adjacent tis sues The writer uses th e i n .
FI G . 61
S h o w s th e Mann r O f in an l v t r in th Upp r J w Th
e Us g E e a o e e a e
p t y lv l u t D m n tr at I t
.
In t ru nt
s me ls A pp l d an
i e to Em A eo s o e o s e s
U se .t t n
No e th e P o s i i o o f th e T u b O f th R i gh t H an d ; th
h m e e
tn p n
S a m e I s R es i g U o a l t t i S t a d i th H a d d
th e P a e ; h s e es e n an
P r v nt S l i pp i n g f t h I n tr u m nt
e e s O Th L ft H an d i E m p l y d
e s e e e s o e
L ip an d C h k Th I n t ru m n t I H ld V ry
.
t R t r ac t th
o e e s ee . e s e S e e
sh r t
o .
US E OF EL E VA TORS 73
F IG . 62
E l v at r App l i d
e o e to T oo th , R ghi t S id e L o we r Jaw
up o n o r a g a i n s t a n a dj o i n i n g to o th I t therefore
'
.
, ,
FI G 6 3
Em p l y in g E l v at r t G u g Out T th —L e ft L we r To th
.
o e o O o e oo o o
N t T h u m b f R i gh t H n d L ft H and
.
o e O a S h an k O f I n t r u m nt
o n s e e
P r t c t T ngu T h at S i d
.
o e s o L i p an d C h k
e, ee On e .
FIG . 65
U i g El va t o r to G ug
s n e o e i t Upp r R t N t P iti o n
O ut R gh e oo . o e os
o f R i gh t In d x F in g r a n d
e e i n O f L ft H n d an d F ing rs
P o s ti o e a e .
FI G . 66
78 T OOT H EX T RAC T I O N
v alue Of th e X ray T h e writer mak e s it routin e
-
.
2 I nduction O f a n a s th e s i a
.
=
.
3 I ncision A B
.
-
.
I ncision C D
-
.
I ncision B D
-
.
means o f retractor .
wound .
FI G . 67 FI G . 68
o r inc a rcerated.
gaged o r incarcerated .
FIG . 70
food / W W
FIG . 71
84 T OO T H EX T RAC T IO N
6 Ch i s e l
. or b ur s uffi cient bo ne a w ay to ex po s e
en ough tooth S O t h at it c an b e rem ove d with fo r
ce p s o r elev ato r .
iodoform g au z e .
due time .
per i n frequency .
FIG . 72
FIG . 73
o f ramus b y me an s O f b ur or c h i s e l .
b . ex po sed bo ne
s ho ws ac tua l bo ne ca vi ty
FI G . 75
atin g .
mouth .
I odine .
2 I nduction Of anaesthesia
. .
tis s ue s .
5 R emoval o f tooth
. .
F IG . 78
w e r e n o t disturbed .
p ositi on .
FIG . 80
featu r e s are :
1 The corre c t d ia gnos i s wh ich can in al l case s
.
,
1 01
1 02 T OOT H EX T RAC T IO N
a la r ger wound is created the part i s irrigate d ,
o r th o fo r m ,
to which a lit tle plain novocain is
added with glycerine o r p ack o r th o fo r m and novo
, ,
th e fa c t th at th e ti p i s ma d e of rubb er it i s b e s t ,
P AIN AF TER EX T RA C T I N G 1 05
upon bulb .
s a r y, o r tr i ge m i n , V py ra m i d on
gr ,
o r .
, g
r fi s s , .
1 06 T OOT H EX T RAC T IO N
w i ll p ro ve o f value T h e fi r s t e ss ent i al h o w
.
,
it must b e checked .
1 T r au m atism
. .
clot .
1 08 T OOT H EX T RAC T IO N
The socket i s t h en tigh tly plugged with io d ofo r m
gau z e upon wh ic h pre ss ure is exerted
,
.
forme d by e sc a r i z a ti o n of t h e v e ss el s with th e
thermo O r galvano cautery
- - -
.
tal pr acti c e .
fi r s t c o n s i d e r a ti o n S hould be placed
,
at perfect
r est s i tti n g up in a comfortable cha i r in a cool
, ,
S Y S TE MIC CO NDI T I O N S
G enera l systemic conditions of interest to th e
dentist in t h e treatmen t of post extracti v e h e m o r
r h a ge are mainly : A n a
em i a and hemophilia .
1 10 T OOT H EX T RAC T I O N
If the o p erator i s careful and closely o b serves
h i s patient before Opera ting he w i ll frequently
,
o ut
.
I f th e
teeth are the cause of infection of cour s e , ,
—
given and plen ty Of nouri s hing food milk broth , ,
,
n o a b n o r m a l hemorrhage .
HE M O PHILIA 113
above .
solution i s indicated .
S ho w in g t he M ann r Of Ty ing W i r
e e S p l in t
O f course is devitalization
, .
2 A c c i d e n ta l ly E x tr a c te d T e e th
3 F r a c tur e
. o f A d j o i n i n g T ee th
4 F r a c tur e
. o f A l v e o lus
5 F r a c tur e
. o f th e J a w
6 . Op en i n g o f th e A n tr um o H
f gi h m o r e
.4 T h e r adiograph .
8 F r a c tur e
. o f th e T o o th Wh i l e E x tr a c ti n g
Opinion .
P rimari l y t h e write r w ou l d s ay th a t a b r o k e n
Of f r oo t S h ould alway s be removed ; o n the other
hand he would not deem it wise to subj ect a p a
,
completed .
9 . T r i s m us (L o c ke d J aw )
S well ing about the face producing locke d “
”
tion pro duce s that swellin g har d a s a board “
,
to reduce ora l s ep s i s .
Normal ,
2 R oot extr a c tions
S ur gi cal
,
.
2 I nduction O f anaesthesia
. .
4 R etraction of flap
. .
tis sue .
tion .
g a ti o n of wound a s case
,
demands .
I
A N IES T H ES IA
— — —
G en er a l L o c a l C o n duc ti ve R egi o n a l
A N E ST H ES IA is th e loss Of s en s ation produced by
th e a ction Of agents k nown as anae sth etic s .
s c i o us n e s s a cc o m p an i e d b y c o m plete lo ss Of s en
s at i o n .
G e n e r al a naes t h e t i cs a r e i n t r o duced by i nh al a
t i on thr o ugh th e lun gs a n d by intrav enou s o r rec
tal infu s ion T h ey are a bs o rb e d b y th e bl ood and
.
,
L o c al anaest h e s i a i s th e r egi o n al l o ss O f s en s a
tio n p r o d u c ed by th e actio n O f certain agen ts up on
s e n s ory nerv e s A gent s producing lo c al los s O f
.
1 29
1 30 LO CAL A N ZES T H E S I A
write r s h all co nfi ne h imself s trictly to th e p roduc
tion Of local anaest h e s i a by th e use O f drugs .
b rain .
tracte d
Infiltratio n anae s t h e s ia would b e produced by i n
j e c ti n g the buccal and lingual aspects of th e al v eo
lar pro c es s which would cause a loss O f sensation
,
S OLU T I O N F OR LO CA L A N JES TH ES IA
IN VI E W Of t h e fact th at l o c al anae st h esia i s p r o
d uc e d by hypodermi c o r h yp o m uc o us injection o f
t h e anaes th e tic agent i n s olution and th is s olutio n
,
element s .
s ib le .
th e s enso ry ne rv es .
d e gr ee O f to x ity .
S O LUT I O N S 1 33
Th e S o lven t M e di um
If s t e r il e w ate r i s i nj ecte d hypodermicall y a ,
Th e ti ss ue c ell s by en d o s m o s i s t ak e up w ater ,
produce an ws th e s i a ; th e p a i n abolis h er i s th e
,
s olution .
c on s idered .
P r ep a r a ti o n o f th e S o l ven t M e di um
C h emically pure sodium chloride tablet s fo r
ma k ing normal salt solution can be purchased
from any Of the well known drug houses These
-
.
w hi c h h a s b een b o i l e d , b ut d i s ti l l e d w a te r w hi c h
h as b een s te r i l i z e d
) that a ,
per
so cent s odium .
O f t h e s olution ma k e s it unfi t fo r us e .
TH E A R MAM E N TA RI U M
Th e S y r i n g e
fi tti n g ,
interch angea ble asbe s to s plunger A .
in g a n d al c o h ol .
h and rest
-
.
1 38
1 40 LO CA L A N E S T H E SIA
Ne edl es
T h e a uth or use s tw o types o f s teel needles : for
mandibular inj ection s th e NO 1 ,
mm in . .
S tep s o I
f jn e c ti o n
move c ap .
th ird s p ecial di s h .
cotton .
boil ing .
T E CH N I " U E 145
d ry .
1 2 R e p lace
. into j ar .
I fP l a ti n um I r i d i um Ne ed l e I s Us ed
-
7 Burn O ff needle
. .
cotton .
1 0 Burn O ff n ee dle
. .
1 2 R e pl ac e sy r in ge an d n ee dle into j ar
. .
IV
CO CAIN E
LO CAL anaesthesia o n ly became an e s tablished fact
after the recogn ition O f cocaine a s an anaesthetic
agent P rior to this time compres sion o f nerve
.
H i s to r y
P izarro , wh e n invading P eru in 1 532 d i s covere d ,
146
1 48 LO CAL A N JES T H ES I A
, , , , ,
P hy s i o l o gi c A c ti o n o f C o c a i n e
q u i c k a n d d e ep t
,
h e u
p p i l generally d i l a te d and ,
L o cal Eflee ts o f C o c a i n e
usually .
N o vo c a i n
A fter many sub sti tutes for cocaine were
b rought out an d found wanti n g P rof E inhorn O f ,
.
,
p
-
a m i n O b en
-
z o y l d i e th y l a m i n ceth a n O l w hic h r e,
B I B L I OG R A P H Y :Cu h in g Ph a rm c l gy an d Th r ap uti c s
s a o o e e .
H a r P r a c ti c a l T h r ap uti c
,
B raun Di L ka l
, e o aes th e i
an s c . e, e e s .
1 58 LO CAL A N ZES T H E S I A
Dr . Biberfeld ex p er i mented w i th th e n ew
J .
following d a ta
No vo c a i n po ss esse s th e s ame a c t i on upon s en
sory nerves as cocaine ; a per c en t s olu tion .
c ocaine does .
anim a l ex p e r iments .
1 60 LO CAL A N E S T H E S I A
co ve r ed t h e l ocal anaes th etic I n spite Of all the ,
2 Novocain nitrate
. .
3 No v o c a i n h ydrochlorate
. .
in g it s p ro p ertie s .
A d r en a li n
T h e fi ndi n gs o f C o m in g (1 885) th at c o c aine i n
j e c te d into an an aemic area will produ c e a naes th e
I N F IL T RA T I O N is th e region a l l os s Of
an azs th e s i a
(Fig .
Th e T e c hn i q ue o I
f fin l tr a ti o n A n a e s th e s i a
( F i g .
F I G 86 .
S h o w in g P r u C h a rac t r O f U pp r J a w in P t r i r P o r ti o n
—S h w T ub r ity Of U pp r M ax i ll a—A l D m n tr at th
o s
o
e os
o s e
e
e ,
so
os e
e o s
o
es e
D n C h r ct r O f th M an d i bl in th P t r i r P r t i n O f th
e se a a e e e e os e o o o e
B dyo .
F I G 89
ia i n An te r i o r P o r ti o n O f Upp er Jaw No te
.
In fi l t r ti o n An th e
a aes s .
Po iti n O f S y r in g
s o e .
I N F IL T RA T I O N 1 69
F I G 90
.
In fi l t rati n Anaesth e i a
o s on Lingua l A p c t O f Lo wer
s e Mo l a r R egi o n
cu s pid region of th e mandible th e i nfi ltration ,
Th e advanta g e s a n d disadvanta g e s O f th e tw o
met h od s a r e :
1 70 LO CA L A N E S T H E SIA .
FI G 91
A n ws th e s i a by I n fi l t ra ti n o I n L Owe r J a w , C anin e io n
R eg
I n fil tr a ti o n C o n d uc ti ve
L ast s a S h ort time . L asts longe r .
3 I nfected
. ti ss ue can By blocking O ff the
not be anaest h etized . nerve at its foram i
nal exit distal i n
,
fe c te d a r ea s a r e an
aes th e ti z e d .
4 M ore
. frequent i n j e c 4 . Fewer injection s r e
tion s required . quired .
VI
A NAT O MICAL CO N S IDERATIO N S
TH E anatomical considerations in t h i s ch apt e r
should merely serve to recall to the re a der s mi n d ’
The c en tr a l a n d l a te r a l i n c i s o r an d c a n i n e te e th
are supplied by the a n te r i o r s up e r i o r d en ta l
b r a n c h ; the b i c us p i d s by the m i d d l e s up e r i o r d en
,
ta l b r a n c h es and the m o l a r s by th e p o s te r i o r s u
,
p e r i o r d en ta l b r a n c h e s o n each side.
The a n te r i o r s up e r i o r d en ta l b r an c h is given
O ff from the superior maxillary nerv e ju s t b efo r e
1 72
A NAT O M Y 1 73
The m i d d l e s up e r i o r d en ta l b r a n c h i s given O ff
from the s ame nerve in the back part Of the infra
orbital canal and runs downward and forw a rd in
,
The p o s te r i o r s up e r i o r d en ta l b r an c h es a r i s e
fro m the trunk of th e s uperior m ax illary nerve
ju s t as it enters the inf r ao rb i tal canal running ,
entering the p o s te r i o r d en ta l c an a ls o n th e zy g o
matic surface o f t h e bone .
r i o r s up e r i o r d en ta l b r a n c h must be injected at
50 0( \ 0 (
N
k yd a flo u
p fi e
A nl r um
‘ ‘
.
“ (w e
FI GU R ES 92 A N D 93
S h w in g th N rv S upp l y O f th V a r i u s G r o up s O f T ee th Th
o e e e e o e
P t r i r S up r i r D nta l N r v S upp l y in g t h M lar
.
os e o e o e e th A nt
e e o s, e e
r i r S up r i r D nta l N rv S upp ly i ng th C ntr al an d L at r a l
o e o e e e e e e , as
W ll
e th C anin
as ean d th M i ddl S up r i r D nta l N rv S up
e e e e o e e e
p ly in g th B i c u pids A l o sh w s th A st m s s B t w
e s . s o th e na e o e e een e
D i ff r nt B r a c h
e e n es .
1 76 LO CAL A N ZES T H ES I A
or m ay b e a ffect e d I t therefore may b e n e c e s
no t .
b ot h o n the palatin e a n d fa c ia l a s p e c t w il l b e th e
si mpler method .
te r i o r p a la ti n e c a n a l s upplying th e muc ou s m em
,
n e r ve .
Th e M a n d i bul a r I n j e c ti o n
IN OR DER to p r actice conductive anaes th esia o r ,
FI G 96
a C r n o i d P ro c ss ; b C n dy l i d Pr o c ess ; c S igm i d No t ch ;
.
o o e o o o
j B dy f M a n d i bl ; k R am u ; 1 A n gl ; e M nta l F r am n ;
. . .
o o e s e e o e
M y l h y i d R idg T r m i nat i n g a s My l h y i d
. . . .
o -
o e, e In t r na l o -
o or e
O bl i qu L in ; d Ex t r na l O bl iqu L i n ; 1 T r i g nu m R tr m l a r
e e e e e 1 o e o o e,
f rm d by th Ex t r na l d In t r na l Obl iqu Lin s an d th Di ta l
. .
o e e e an e e e e s
S u r fa c f th L a s t M l a r T th ; m L ingu la th B n y S pin
e o e o oo , e o e
d i r t ly ab v th Inf r i r D n ta l F ram n f t h w th
ec o e e e o e o e o s o e
F ram n an d L in gula to b tt r a dv ant ag th e L ingu l a h s b n
.
o e e e e, a ee
sh a d d w i th in k
e .
MA N DI B U LA R I N J E C T I O N 1 81
FI G . 97
FI G . 98
in in r T ip P l ac d
S h o w g F ge - e i n th e R gh i t Re tr o mo l a r T r i a n gl e
l i t ly T i l t d
.
Th e F in r
ge l s S gh e .
FI G . 1 00
th B i c u pi d R gi n th N dl A b ut t P i rc th M u c u M m
,
e s e o e ee e o o e e e o s e
br an 1 m Ab v th M r a l S u r fa c f th e M l a r T th R t
,
e c o e e o s e o o ee es
t h N ai l o f th L ft In d x F inge r
.
,
i g
n on e e e e .
FI G . 1 01
FI G . 1 02
S h o w s Po s i o ti n f S y r in g A ft r I t H B n R tat d T w a rd
o e e as ee o e o
d
th e S i e to B e A n th t i d J u t P r i r t Th ru ting th N dl
aes e ze , s o o s e ee e
l n
A o g th e L in ua l A p c t f th R a m u
g s e o e s .
an ar c as shown in Fig 1 03
,
. .
FI G
1 03
yr n dl I
.
A B In d i c at t n
e s th e P o s i i o o f th e S i ge a s th e N e e e s
T ru t T r u
. .
h s h o gh th e M uc u
o s Me m br an tr i k in
e, S g th e a u C D
R m s
yr ady
. .
S h o w s th e Po s i i o t no f th e S i n ge W n he p r at r
th e O e o Is R e
ld dl l n
to S i e th e N ee e A o g th e R m s to E e a u nt r patiu m
th e S
Pte r ygo -M an d i bu l a . . cr i b d by D i ta l
t e , D B A r c De s e s yr in g
En d o f S e .
1 88 L OCA L A N JES T H E S I A
th e s patium p te r n m a n d i b ul a r e
-
.
1 12 ,
otherwise th e technique is id enti c ally
the s ame a s e x e cuted o n the ri gh t s i d e .
Tub e r o s i ty I n j e c ti o n
FI G . 1 06
P a l p a ting Fa c ia l A p c t
s e o fA lv la r P r c
eo o es s
FI G . 1 07
Pla ing I ndex Fi
c nge r in Re tr o mo la r Tr i angl e
191 PL A TE III
B r inging S yr ing T w a rd S i d
e o e to B e A n th ti ze d
aes e
FI G . l ll
Ent r in g S patium
e P te r ygo M a n d i b ul a r e
-
an d Em ptying S yr ing
e
T U B ER O S I T Y I N J E C TI O N 1 93
FI G . 1 14
Ma ki ng T ub r s ity I nj c ti n
e o e o
P o s te r i o r P a l a ti n e I n j e c ti o n
FI G . 1 15
Inj c ting
e th e P o s t ri r
e o Pa latin e Ca na l
p l e te l y an ae s t h etized The
. palatine surfa c e loses
s ensa tion up to th e canine tooth I n many i n .
A n te r i o r P a l a ti n e I n j e c ti o n
FI G . 1 17
Inj c ting Inf r a rb ita l F ram n
e o o e o n S kull No t D i r c ti n
e e o o f
N dl an d S y r i n g
.
ee e e .
F IG 1 18
L ft Ha d
.
M ak in g I n fr a rb ita l Inj c ti n
o e o . No t e Po s iti n
o o f e n
ME N TA L I N J E C T I O N 197
M en ta l I n j ec ti o n
T h e mental foramen is reach e d by dr awing the
lip d own wit h t humb and index fi n ger an d thrus t
FI G . 1 19
in
S ho w g Me nta l Inj c ti n
e o on S k u ll . No t L c ti n
e o a o o f Fo ram ne
an d i r c ti n
D e o o f Ne e dl e .
1 98 L OCA L A N E S T H ES I A
FI G 1 2 0
.
Inj tin
ec
g th e Me nta l F ram n
o e
(S e e C a s e 4 7 in A n ai s th e s i a R e p o r t s ).
200 L O CA L A NE S T H ES I A
th e s ele c tion o f th e anaesthesi a re s t s w i th t h e
Operator S ome o f t h e writer s most e nth u s ia s tic
.
’
renin .
stan c es .
”
use it There is no infl exible rule in medicine
.
employe d .
1 S afety to patient
. .
'
I felt pain ”
,
and pain means s h o c k .
denti s ts .
induced .
*
See R p rt e f C m m itt
o o P r a c ti c
“
o f th D nta l S
ee on e o e e o
i ty
c e f th
o S tat f N w Y rk
e e ana lg ia D t l C m
o e o on es . en a os o s,
N v m b r 19 1 4 ; pag 1266
o e e , e .
206 L O CA L A N AES T H E S I A
7 L. e s s a ss i s t an c e required th a n in inh a l a t i on
anaesth esia .
traumatic S h ock .
b r o m ur a l o r in extreme ca s es opiate s
,
.
K ey to Ta b l es
R U
. .
= r i gh t S ide upper j aw .
upper canine .
L U
. .
: l e ft side upper j aw .
R L
. .
= r i gh t S ide lower j aw .
L L
. .
: l e ft side lower j aw .
209
21 0 L O CA L A N E S T I I ES I A
.
B N b uc c a l nerv e
. .
= .
palatine canal .
I n fi l t = i n fi l tr a ti o n
. .
foramen .
No v .
=
p e r cent o f novocain
. .
N asal t = . n a s al tampon .
21 2 L O CA L A NE S T H ES I A
C O N D U C T I V E A NE S T H ES I A IN
SI E O
T F I NJ EC T I O N
I m p ac t e d L L . . 8
U n r u p te d L
e . L 5 . l B N 1
. . 8 1;
L L 7 . . 1 B N l
. . 8 l}
7 B N l 2 I}
P r ic e m e n t i t i s
. . .
L L 6. . e B N l
. . 3 1}
R m v al f T u m r
e o o o
R L 8 . t V III
. . ac .
R L 6 . t XV . . ae .
L L O t X III ae
A bs s d L L 6 t X
. . .
ces e . . . ac .
L L 6 t X ac
I m pa t d L L B
. . .
c e
L L O a t XI V
. .
e
A b se d L L 6
. . .
sc es t X . . . ae .
R L 6 a t XVI
. . . e .
R L 6 a t XI II
. . . e .
17 A b c se d L L 6 t IX
s es . . ae .
R L 6 . t X . . ac .
L I 6
L L B
. . . ae t . XII
L L 6
. .
L L 6
. . . ae t . XII
R L 6
. . . ae t . V III
I m pac t d L e . L 8 .
L O W ER j A W IN O R AL S UR GE R Y
R E S U LT REMA R KS
a ft r 2 inj c t i n s
e e o to us e i s l an d b u r
ch e
las te d 1 h u r
,
o p rat i e o n o
Pa t i n t c m p l ain d
e o e o f Di ffi c u lt c as e u s e d c h i e ls s
O f a l i ttl e p i a n d b u rs O p r t i n
,
a n e a o
last e d 45 m i n u t s ; pa
,
e
t i n t m a rk e d n e u r t ic
e o
Pe rf c t An t h e i a
e e s s
ls t Ma nd i b ular fa i l d ; e
2d p r f t
. e ec
B r gr
. . X B c la k
C o ffe e
C h i ld r i d tat d h w c e s e o
p
,
Pe rf c t A n
e th ia v
e s
r h ad
es
e e
“
no ai n
P r fe c t An
e t h e sia e s
P r f c t A n t h ia
e e e s es
Pe rf c t An e t h ia
e s es
B r gr X P rf c t An
e e h s ia e st e
P rf c t A n e t h ia
. .
e e s es
P rf t An e t h ia
e ec s es
P r f c t An e t h i
e e s es a
Pe rf c t A n e st h ia
e l st M a n d i b u la r fa i l d
es e
S h w e d sy m p t m s f C h i ld r i d
o o o c e
An t h s i a
e s e
S h o w d sy m pt m s f C h i l d c r ie d
e o o
An st h s ia
e e
P r f c t An
e e th sia e s e
S h w d s i gn s f
o e C h i ld ie d
o cr
A st h e s i a
ne
P r fe c t An
e th ia e s es
S h w d ign
o e fs C h ild c r i d
s o e
A n st h s ia
e e
Pa t i t ai d h f l t a en s e e
l i ttl pain b ut t e no
u g h t m i nd i t
,
eno o
80 B r g r X l st d 2d M a nd i b u l a r an
a ff t d th e l in gu al
. .
ec e
n e r v al n e 8d i j e o n ec
t i n ga v a fa i r l y g d
.
o e oo
B r gr X
. . P rf c t A n e t h ia
e e An e st h i a
s es es
21 4 L O CA L A N JE S T H ES I A
CO N D U CT IVE A N / E S T H ES IA I N
5
3
8
.
L L 6
. . . ae t . IX
L L 6
. . . ae t . VI II
L L 6
. . . ae t . X II
L L 6
. . . ae t . XIII
L L 6
. . .
R L 6. . . ae t . XIII
32 L L 6
. . . ae t . XII
33 R L 6. . . ae t . XII
34 R L 6. . . ae t . XI
35 I ’
36 P L L 8
. . .
37 P L L 6
. . . 2 2
38 B N I . 2 2
39 P R L 6. . . B N l . 3 2
40 P R L 6. . . B N l . 3 2
41 P L L 4 L hu l 2
n
1t
I
. . . l .
.
n l
-
I
42 P L L 8
. . . B N . 3 2
43 R L 7. . . 2 2
44 P R L 8765
. . L L 6 . 5 2
45 P U n r up t e d L L B
e B N ] 3 2 1
I m pac t e d R L 8
. . . . .
46 . . . B N i
. . 9 2 3
ch o r n i al v la r a b c eo sc ess
w i t h m n tal f i t u l a e s
R L 6
. . . P ul p xt i r pa t i n
e o
R L 8
. . .
R L 6
. . . e t XII
a .
216 L O CA L A NE S T H ES IA
CO N DU C T I V E A N E S T H ES IA I N
S I TE o r I NJ ECT I O N m5
a
.
m 3
o
c
m
v
o
g
1 u
e
3
0 ?
k
.
Fr ac t ur e d R . L 5 .
2 i nj t
’
4
’
s,
u
T mo r o f um e x te nd 1 cc m l ccm 2}
f ro m i de a ro u d
. .
i ng L I -8
’
ea s
tum o r
. . .
Fr a c t u r e d L L O
U ne r u p te d I m pac te d
. .
LL . . 8
R L 6
U ne r u p te d I m p ac te d i nj e c t i o n s
. .
2
L L 5
. .
R L 6
. . . ae t. V III
R L 6 ae t V III
r a tu r d L
. . . .
F c e . L 7
Ab s dR
c e ss e . L 7 .
R L 8
. .
R . L . 6
. a e t. XI II
R . L . 8
R . L . 6 . ae t . XIII
R L 8
I m pac te d R
. .
. L 8 .
t
A f e r th i s t h e a uth o r re t urn e d to th e use o f t
S o lu io n o f N o vo c ai n
R E C O R DS 21 7
L IN
M A ND I B E OR A L S U R G ER Y
R ES U LT REM A R KS
Pe rf t A n e st h i a
ec es
F i t M a n d i b u la r fa i l d
rs e
S e v e r al a t t e m p ts h a d b e e n
m a d e to r e m o v e t h i s r o o t
Ve r y d i ffi c ul t o pe rat i o n
use d c h i se l s a d b u r s
,
n
o p e rat i o n 50 m i n
,
F i r st M a d i b ula r fa i le d se c
n
d p e rf e c t d i fii c ul t c as e
.
‘
o n
u s d c h i se lsa n d b u r s O p r
, ,
e e
at i n la te d o v e r 1 h r
,
o s .
21 8 L OCA L A N IES T H ES IA
'
CO ND U C T I V E A N I E S T H ES I A IN
SITE O F I NJ EC T I O N
71 P Cy t s ex e t nd i ng 1 1 1 1 Nasal t.
*
5 I I} 15
L U 1 -6
‘
. . 1
72 P C y st . L U 3-4
. . 2 1 N asal t . 5 1 I; 15
73 P C y st L U 3 . . .
74 L U G
. .
75 L U 6
P Un ru t d
. .
76 e p e R U 3 . .
77 P L U S
L
. .
78 U 58
. . .
79 R U 6
Tu r r i
. .
80 m o R U 3 eg . . o n
81 P Al v t y
e o lo o m
82 P Frac t u re d R U 8
P I m pa t e d R U S
. .
83 c . .
84 P R U 8 . .
85 P 8 U .
86 P .U 8 .
87 P t 8 U .
88 P W 8 U
m p utat i
.
P t5A
”
R o o o n
89
LU1
F a tur d R U 8
. .
90 r c e
L U 468
. .
91 . . . .
92 M al p d R U 3 o se
d i ng
. .
N r i s x
l
t ec os e en
93
L U 35
94 P F r a t u r d R U 8
. .
c e . . 2 2 i 10
95 P R U 8 2 2 i 10
dL U6
. .
96 P A b e sc sse . . 2 2 i 15
97 P t p m p ut t i 1 I Na s al t 3 2 1 15
q
a o n .
l . 2 l
a
T m po ns o f N o vo c ai n so t
lu io n i n no se ; al so 1 ccm . b y i n fil r tai t o n .
220 L O CA L A N JE S T H ES I A
CO ND U C T I V E A N E S T H E S I A I N
98 P R U B
U ne r u p t d
. . .
99 P e L U 3 . . . N asal t .
1 00 P
1 01 P L U7
P A b sc sse d L U 7
. . .
1 02 e . . .
C O ND U C T I V E ‘ -
A N zE S I I I E S I A
’
IN BOTH U PP E R
S ITE o r I NJR c T I O N IN U PPE R J
A W . S IT E o r
1 08 P L U . .
L 6
LL
.
1 09 P . . 5 .
1 10 P LU4
LL5
. .
R L . 7 5
. . . . .
P R U 6
. . . R L 6 . . .
R E C OR DS 221
R ES U LT R E MA R K S
15 B ro .
g r . Pe r fec t A n e st h e s i a
10 Bro .
g r .
10 Bro .
g r . X
15 Bro .
g r . X
15 B ro .
g r . X
I NJECT . L JA w
.
R ES U LT R EM A R K S
6 1 1} 1§ B r o gr
. . X Pe rf ec t A ne s t h e s ia
i ii i i
6 2 2
222 L OCA L A N E S T H ES I A
C O ND U C T I V E A N E S T H ES IA IN
O PE RAT IO N
1 12 G r u nd d w L ft L 4 a nd 7 f b r i d g abut
o o n e o r e 2
m n ts
.
,
e
1 1 3 Pul p r m v d L ft L w r 6 y m l a r
e o e e o e o
1 1 4 Ca vi t y pr p a r at i
.
e on
1 1 5 C r vi al a i t y p r pa r at i n
e c c v e o
1 1 6 Ca vi t y pr p ara ti n L L
e o
1 1 7 Ca vi t y pr pa r at i n L L 6 7
. .
e o
1 1 8 Ca vi t y pr p arat i
. .
R L 7 6
e o n
1 1 9 P r pa r d avi t y in L L 7 E t ra t d L L 6
. . .
e e c . . . x c e . .
1 20 R m v d pu l p R L 6
e o e 2
1 21 Ca vi t y pr pa rat i n L L 4
. .
e o 2
1 22 C a vi t y pr pa r at i n
. .
e o 1%
1 23 Ca vi t y p r p rat i n L L 6
e a R m v d pu l p L L 4
o e o e 2
1 24 P r pa r d L L b r i d g ab ut m n
.
.
. . .
e e f o r e e ts 2
1 25 Ca vi t y p r p r at i n R L 7 (v r y
.
e a n s i ti v )
o , . . e se e 2
1 26 Pr pa re d c m p u n d a vi t y R
e o o c L 7
P r pa re d v r y se n i t iv e s i
.
, .
1 27 e e s ero on c av i t y ,
L L 7
. . .
1 28 R e m v al f p ul p L L 7
o o , . .
1 29 R e m o va l o f p ul p R L 6 ,
. . 2
1 30Cav i t y pr pa r at i e o n, L L 7 . . 2
131 Cav i t y p r pa ra t i n e o , R L 6 7 . . .
R e c o rd s furn i s h e d b y S . W A . . Fr an k a u, D D S
. .
: a nd H F B rg e , D D S
. . a . . .
224 L OCA L A N JES T H E S I A
C O N D U CT IVE AN E S T H ES IA IN
O PE RA T I O N
1 82 Ca vi t y pr para t i R U 7 6
e on . . . I };
1 33 P u l p r m v a l L U 3
e o . .
1 34 a v i ty p par a t i n L U G
re o I };
1 35 ul p r m va l L U 6
. .
e o I };
1 36 r p a t i n f ro t f
. .
e ra o o o or
L ga Cr o w L U l
o n n
1 37 P r p a a t i n f b r i d ge ab u t
. . .
e r o o
m n ts R U 7 3
e 1%
1 38 Cav i t y p r e pa r t i n L U G S
. . .
a o . . .
1 39 Pr e p ar t i fa r w LU6
o n o r c o n .
1 40 Cav i t y p r parat i e R U 7 6 on 2
Ca vi t y p re pa r t i R
. . .
a o n .
U 7 6
Pu l p r e m v al L U 7
. .
o . .
at s si n
o ne es o
Pu l p r e m val R U 6
Ca vi t y pr e p L U 6 7 l
o
1 42 1% E S
. . .
1 43 a v i t y p r e p
. . . .
Pu l p
r m val L V 3
.
e o
1 44 C av i t y pr e p a r a t i n L U S
. .
o
I 45 Ca vi t y p r p a at i n L U G
. .
e r o . . 1%
1 46 C av i t y p r parat i e L U l o n
147 P u l p r m v al R U l
. .
e o
1 48 Cav i t y p p a r a t i n R U 7
. .
re o . . I };
149 P ul p r emo v al R . U 1 .
*
I }; 1x
1 50 P ul p r emo val R U 5 . .
*
A re t t
I n fi l ra i o n A n e s t hesia .
R E C OR DS 225
U PPE R JA W IN O PE R AT IV E D EN T I S T R Y
R ES U LT R EM A R K S
O P r f c t A ne th e sia N n
e e s o e
O
G
-
a
l
Go o d Pat i n t m p la i n e d
e co
v r y sl i gh t pa i n
e
G P r f c t A ne th s i a
e e s e I fi l t te d gum a b o ut C e n
n ra
t ral w i t h a f w d r p s e o
Pat i n t e m p la i n d f a
co e o
l i tt l pa i n
e
"
“ Pe rf ec t A n e st h s i a
e
a
R U 6 S l i gh t S n sat i n e o
LU
. . .
.
Pe r fe c tA ne s
th e S I a
P rf A n e st h e i a S l i gh t c yan si o s, d i sap
e ec t s
p ea r ed s h r tl y
o .
I n j e c t e d c c m b e tw e e n
n c k a nd a p e x fac i all y
.
I nj e c te d 1 c o m b e tw e e
n e k a nd a pe x o n pal
.
c
at i n e a p ec t s
I j e c t e d I c c m o n L in
n .
gu al u rfac e s
I n j ec te d 1 c c m n B u c c al . o
as p ec t
226 L O CA L A N zE S T H E S I A
ane s the s ia .
1 38 ) perfect .
1 . A
bs o lute asepsis .
2 Th e use o f i s oton i c s o l ut i o n s
. .
5 T h e u s e o f pure n o n o x i d i z ed d rugs ; a di s
.
,
-
K EY T o CO N DU C T I VE A NE S T H ES IA F OR E X TR A C T I O N S
Upp e r J a w
W ait 5 1 0 minute s-
.
c cm .
W ait 5 1 0 minute s-
.
1 s t M o l a r Tubero s i ty 1 cc m ;
, ,
. 1 co m .
Wait 5 1 0 minutes -
.
W ait 5 1 0 minutes -
.
1 s t Bicus p i d I n fr a o r b i fo r , 1 co m
, . . .
C anin e I n fr a o r b i fo r 1 ccm ; A P C
,
. .
, . . . .
, A?
1 ccm .
W a i t 5 10 m inute s
-
.
KEYS 229
L ateral , I n fr a o r b i fo r . .
,
I ccm .
; com .
Wa it 5 10
-
minutes .
C entral , I n fr a o r b i fo r . .
,
I ccm .
; A
1 ccm
), .
Wait 5 10
-
minutes .
L o w er J aw
m inutes .
minute s .
minutes .
an d L in gu a l A spect o f Bi c com .
,
.
p o s i te side ccm ,
.
p o s i te side ccm ,
.
p o s i te side ccm ,
.
L ateral ,
ccm ; o f C en tra l
. ccm ,
.
minute s .
K EY T o C O N DU C TI VE A N E S T H ES I A F O R M U LT I P LE
E X TR A C T I O N S
To A n a e s th e ti z e On e H a lf Up p e r J a w
-
Tuberosity I ccm ,
.
1 ccm .
co m .
I n fr a o r b fo r . .
,
I ccm .
To A n a e s th e ti z e th e Upp e r J a w C o m p l e tely
Tuberosity I ccm o n b oth side s
,
.
,
.
I n fr a o r b fo r I c cm o n b ot h s i de s
. .
,
.
,
.
To A n a es th e ti z e th e Wh o l e L eft S i d e ,
an d th e
R i g h t Up to an d I n c lud i n g th e C a n i n e
M an dibul a r , 2 ccm (left ) .
tion 1 ccm
,
.
To A n a e s th e ti z e S ix A n te r i o r Te e th i n M a n di b l e
M ental fo r . ccm o n both sides
,
I .
,
.
To A n a es th e ti z e th e S i x A n te r i o r T ee th, Upp e r
Jaw
I nfraorbital for .
, I ccm on both sides
,
.
I ccm .
232 L O CA L A NE S T H ES I A
1 s t M ol a r,i nj ect facially a b out c ente r o f r oo t ,
1 A c cm lingually
1 ), . ccm ,
.
1 c cm ; lingually
. ccm , .
1 ccm ; lingually
. ccm ,
.
1 c cm ; lin gually
. co m ,
.
c cm ; lingually
. ccm ,
.
ccm ; lingually
. ccm ,
.
K EY T o L O CA L A NE S T H ES I A IN O P ER A T I VE DE N T I S
TR Y . F O R O P ER A T I O N S UP ON
— —
U pper M olars Tu b erosity I / z ccm wait
l .
minutes .
—
U pper Bicuspid s I n fil tr a te both F acial and
g u al aspect Of process near apex — l
/z I -
—
U pper C anine I n fraorbital fo r amen I ccm .
5 1 0 mi nutes
-
.
.
.
1 0 20 minutes
-
.
CON C LU S I O N S 233
m a ndibular or
inj ection 2
L owe r B i cus Mental for a men
co m a n d .
pi d s 1 c o m w a it 5 1 0 -
mental for a
.
L ow e r C anine minute s
men o r men
.
I n fi l tr a te mental
L ower L ater a l ta l fo ss a o n
fo s s a 1 ccm wait
L o we r C entral 0 p p o s i t e
.
5 1 0 m i nute s -
s i d e fo r cen
.
tr al re gi on ) .
four inci s or s .
is a me a ns o f reducing pain .
A l l typ es o f A n a e s th es i a m us t b e a d m i n i s te r e d
I t i s d an ge r ous i n th e h and s o f th e m an wh o
doe s n o t app re c i ate th e full me an ing o f A s ep s i s .
236 L O CA L A N IE S T H E S IA
P e r m a n g an a te o f P o tas h S o l uti o n
K alii h y p er m an gan
A qu e dest
stronger .
L i quo r A lum i n i A c e ta ti s
A lum i n i s ul p h a ti s
A cidi acetici aa
C alc i i carbonici
A qu e dest
Di lute d wit h four o r ten parts o f w a ter well ,
swelling .
moved w i t h pumice .
2 P r es c r i p ti o n s
.
L i q A l um i n i A c e ta ti s , U S P
. . . .
(3 i v )
S Dilute wit h four parts o f water
. an d apply e x
PR E S CR IP T I O N S 237
A s a wa s h
L i q A l um i n i A
. c e ta ti s , (3 i v )
S Tw o
. t e a s poonfuls in a h alf gla ss o f wat e r a s -
No t to be u s ed before meal s as it mi gh t a fi e c t ,
t h e appetit e .
A n ti s ep ti c Wa s h es
S o l K a h I h yp e r m an g ,
.
( )
3 11
S . F i fteen drop s in o n e h al f -
gla ss of w at e r as
mo uth was h .
R
S o l Hy d r o gen n h yp er o xy d ,
.
(3 i v )
S .O n e tablespoonful in o n e h al f gl a ss o f wat e r -
a s mout h w a sh .
No t to b e u s e d fo r an y len gth o f t i me a s th e ,
3
L iq A . n ti s e p ti c us A lk al .
, ( )
3 i v
w a sh i s u s efu l
238 L O CA L A N E S T H ES IA
ch lora s
K a lI I 3 i ss
Tr Myrrhe .
3 i
A qu e dest q s a d .
,
. .
3 iii
M S A teaspoonful in
. . o ne -
half gl a s s o f water
as mouth was h .
M i ll e r ’
s Was h
Th ym o l i s gr i i i s s
.
Tr E ucalypti
. 3 SS
A lc o h o l i s ab s o l . 3 i ii ss
Ol . M enth e pip m xv
S tea s poonful in a glass of water as mouth
. A
wash afte r me al s and before retiring
,
.
A s tr i n g en t Wa s h es
B
L iquor B ur r o w i , or L i q A lum i n i A
. c e ta ti s ,
(3 iv )
S . On e
to two teaspoonfuls in one half glas s -
wa te r a s mouth wash .
S p t M enth e pip
. .
5i
A cidi Tannici gr . v -
gr . x
Tr M yrrh e
. 3 ss
Tr A r n i ce
.
, q . s ad
. .
3 iv
M S . . A teaspoo n ful in o ne -
half glas s o f water
240 L OCA L A NE S T H ES I A
F o r P o s t E x tr a c ti ve P a i n
C aps T r i ge m i n
. aa gr v .
D . N0 vi . .
R
Ph ena c et in e
A s pirine ,
aa gr xxx
.
Div i d e in ch artulas NO vi . .
I f an O piate i s required
3
P h enacetine gr x 11 .
Na tr i i bicarb g r xx .
C ode i ne S ulph gr i .
C a ffeine citrat gr i v .
A que 3i
S O n e h alf to b e ta k en at once ; b al a nce
.
-
No n -
r e p i ta n tur
PR E S CR I P T I O N S 241
L ax a ti ves
retiring .
Ta b C a s cara S a gr a d a a a
. chocolate coated
,
.
Or
E x t C ascara S agrada fld
. .
,
1 0 30 minim s
-
.
L i q M a gn e s u C i tr a ti s , U S P
. . . .
S . On e -
half to one . Twelve ounce bottle-
.
F o r th e C o n tr o l o f H e m o r r h a g e
S . A teaspoonful every tw o h ou rs .
242 L O CA L A NE S T H ES I A
A cid i G all i c i 4 0 5 i .
A c idi S ul p h ur i c i d i luti 8 0 5 ii . . . .
A que dest q 8 ad 90 0 3 i i1 i
.
,
. . .
C al c u l a c ta ti s 5 i ss
Di vide in ch artu l as No v i . .
G en e r a l T o n i c
S tr y c h n i e S ul p h a ti s
A c idi A r s e n o i s i
" ui n in e S ul p h a ti s
Ferri S ul p h a ti s A x s i c c a t
et. f .
p i l ue Nxxx
O . .
C o c ai n e
A mm o ni a , c o ffee , s t r ych ni a e th e r an d a lc o h o l
,
.
po i s o nin g .
C o r r o s i ve S ub li m a te
L a r geam o unt s o f egg albumen fo ll owed by ,
E th e r
A rt ifi ci a l re s pira ti on ; strychnine h y p o d e r m a t
i c al l y ful l dos e ; friction and hot a ppli c ation s ;
,
tion o f t o n gue .
I o di n e
L ar ge amounts o f starch h o t appl i c ati o n s , ,
I Od o fo r m
S odium bi c arbo n ate to c o mb ine w i t h i o din e ,
al
M i n e r a l A c i ds
M a gn e s ium , l ime , soap , w hite egg a s a nti o f
dotes ; wh i te of egg ext e rnal h eat oil s and op ium
, ,
M e r cur y B i c hl o r i d e
S e e C o r r o s i ve S ub li m a te .
A N TI DO T E S 245
M o r p hi n e
E meti cs or stomach pump tann ic ac i d bl a ck-
, ,
N o vo c a i n
A m yl nitrite inh al ation ,
co fi ee (see C o c a i n e ) .
Ni tr a te o fS i l ve r
C ommo n sal t a s an ti dote ; opium and oils to
all ay i rr i tat i on al so l a rge amounts of milk and
,
P o ta s s i um C h l o r a te
Di uret i cs , s aline i nfusion .
S tr y c hn i n e
I nh alation a m yl nitrite stomach pump tan
o f , ,
H i c c o ugh s
S pirits o f camph or o n e dra ch m H o ffman s .
’
h al ation .
H c a r tfa i lur e
A drenalin one to tw o drachms i n pint
Of n ormal saline intraveno us ly o r by h y p o de r
,
m o dy s i s .
E p i s ta wi s
t h e fing er s .
248 L OCA L A N JES T H ES I A
C o n vuls i o n s
Pl a c e Denhart gag betwee n pat i ent s j aw s s o
’
,
glan d .
A l ve o l a r p r o c es s portions of j a w bearing t h e
,
teeth .
water .
A n a lg es i a insensibility to pain
,
.
p us c l e s ;
primary that caused by disease of th e bl oo d o r
,
bl ood .
250 L O CA L A NE S T H ES I A
A n a e s th e s i a ,
a s tate of in s en s ib il i ty ;
g eneral o n e a fi e c ti n g the wh ole body ;
,
n e r ve ;
A n gi n a a s en s e o f su ffocation ;
,
l ary ti s sue s .
b i n a ti o n s u s eful a s a toni c ; al s o u s ed a s an
escharotic .
B l a n c hi n g ,
turning pale .
B r o m ur a l proprieta r y combination
,
o f Bromide
and V al erian .
252 L O CA L A N JES T H E S I A
purpura ) .
E ti o l o gy t h e s c i en c e O f th e c au s e s O f di s ea s e s
,
.
tum f r o m w i th in outward .
body temperature .
G a lli c a c i d,
acid obtained from nutgall s .
G a n g r en e death of soft t i ss ue
,
.
an ounce .
p us c l e s .
H em o gl o b i n o m e te r , an instrument to d etermine
the amo unt o f h emoglobin in th e blood .
normal c o a gulation .
ein o r c ap illary ;
v
sto p ped .
sure ) .
s ure ) .
s ue from o n e p er s o n to anoth er ;
ph y s io l ogi c g r afting living tissue ;
,
I n fil tr a ti o n fluid e fi us i o n in to an or g a n o r ti ss ue
,
.
I o di ae to a p pl y io d ine
,
.
I r r i ga ti o n c on s tant wa sh ing
,
.
s ur e a s t h e blood s erum .
L ax a ti ve a pu r gative
, .
254 L OCA L A N E S I H ES IA
’ ‘
L eg e a r ti s , a cc ording to th e l a w of t h e art (c o r
r ec tly ) .
L o c k j a w t r i s mu s , .
L o c ke d j aw c onditio n w h e n t h e ja w s c a nn ot be
,
L ues s yp h il i s
,
.
L ue ti c s yp h i l iti c
, .
L ux a ted l oo s en ed , .
M a n di b l e th e l owe r j aw
,
.
M a x i ll a, th e j aw .
s typ t i c .
My el i ti s inflammatio n o f s p in al marro w
, .
My o c a r di ti s inflammatio n o f h ea r t muscl e
, .
N ec r o s i s , d eath o f b on e .
N ep h r i ti s , i nflammation o f th e kidn ey .
po s t e r io r, m oto r roots .
256 L O CA L A N zES T H E S IA
P y r a mi d o n a n antipyreti c d eriv a ti ve o f a n te p y r i n
,
.
R a di o g r a p hy ,
t h e a r t o f m ak ing an X r ay pi c ture -
.
t h e no s e .
R o en tg en gr a m see S ki a g r a m ,
.
fe et .
S ep ti c relating to s ep s i s (putrefact i on )
,
.
hemorrh age ;
human s erum from h uma n bl ood
,
.
i njury o r operation .
S i n us a h o ll ow cavity o r po ck et
, .
S i n us i ti s inflammation of a S inus
, .
S p a ti um p ter yg o m a n d i b ula r e,
a flattened s pa c e
between the mandible and internal pterygoid
muscle through which the mandibular and
,
s troying b acteria ) .
r h a ge .
S up r a r en i n s ee A d r en a l i n , .
tive procedure ;
pla s ti c the repair o f defe c tive ti ss ue by tran s
,
plantation .
S y m p hy s i s a junction o f b one , .
O b struction .
T o o th o n e of th e organs o f mastication
, .
Tr a um a a n inju ry wound
, ,
.
Tr a um a ti s m trauma ,
.
Tr i g e m i n an anti neuralgic
,
-
.
Ur o l o gi c a l ,
pertaining to U rolo gy (sc ience o f di s
eases o f th e genito u r inary s y s tem ) -
.
TH E GH
C OP Y R I TS OF TH I S B OO K ,
IN A LL E NG L IS H E
S P A K I NG
C OU N TR E I S , A RE OW N ED BY R E BM A N CO N EW Y O R K
.
,
260 I N DE x
C l d a p pl i ca ti n s 1 09 1 25
o o F a i l u r s i n C ndu ctiv A n a s
e o e e
C m p l i c ati n f T th Ex tr a c
, ,
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UNIVERS lTY O F MIC HIGA N
DENI IS I RY l lB
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Leder er , i l l i am
Th e p r i n c i p l e s
and p r a c t i c e o f
t o o th ext r a c t i o n
l o c a l an e s the s i a
t h e ma x i l l a e .