LOCAL ANAESTHESIA

INDICATIONS,CONTRAINDICATIONS
& ARMAMENTARIUM

THE ARMAMENTARIUM
4 PARTS:
1) The Syringe
2) The Needle
3) The Cartridge
4) Preparation

ADA Standards for Injection Syringes

They must be durable and able to withstand repeated

sterilization without damage

They should be capable of accepting a wide variety of

cartridges and needles from different manufacturers and
permit repeated use

They should be inexpensive, self-contained, lightweight

and simple to use with one hand

Provide aspiration so that blood can be seen through the glass

cartridge

TYPES
I. Nondisposable
a. Breech-Loading, Metallic, Cartridge-Type, Aspirating
b. Breech-Loading, Plastic, Cartridge-Type, Aspirating
c. Breech-Loading, Metallic, Cartridge-Type, Self-Aspirating
d. Pressure syringes
e. Jet injectors

II. Disposable syringes

III. Safety syringes
IV. Computer controlled local anesthetic delivery systems

Breech-Loading, Metallic, Cartridge-Type,

Aspirating
Breech loading implies that the
dental cartridge is loaded from
the side of barrel
A needle is attached to the
barrel of the syringe at the
needle adaptor
The needle passes into the barrel
and pierces the diaphragm of the
local anesthetic cartridge
Chrome-plated brass and
stainless steel

S.N
O.

ADVANTAGES

DISADVANTAGES

1.

Visible catridge

Weight(heavier than plastic

syringe)

2.

Aspiration with one hand

Syringe may be too big

3.

Autoclavable

Possibility of infection if
there is improper care

4.

Rust resistant

5.

Long lasting with proper

maintenance

Breech-Loading, Plastic, Cartridge-Type,

Aspirating
Reusable
Autoclavable & chemically
sterilizable
Used for multiple anesthetic
administrations

S.N
O.

ADVANTAGES

DISADVANTAGES

1.

Plastic eliminates metallic

clinical look

2.

Light weight:provides better Size of Syringe may be too

feel during injection
big

3.

Cartridge is visible

4.

Aspiration with one hand

5.

Rust resistant

6.

Long lasting with proper

maintenance

7.

Lower cost

Possibility of infection with

improper care

Deterioration of plastic with

repeated autoclaving

Breech-Loading, Metallic, Cartridge-Type,

Self-Aspirating(1981)
Negative pressure is applied to the
thumb ring by the administrator, if
blood enters the glass local
anesthetic cartridge (carpule) then
the tip of the needle is inserted
into the lumen of a blood vessel
These syringes use the elasticity of
the rubber diaphragm in the
anesthetic cartridge to obtain the
necessary negative pressure for
aspiration

 Major factor for aspiration is the gauge of the needle being

used
Most doctors using the harpoon-type syringe, retract the
thumb ring back too far and with excessive force
which frequently disengages the harpoon from the silicone
rubber stopper of the cartridge

 1st generation self-aspirating syringes required a thumb disk

which forced the operator to remove their index and middle
fingers from the thumb ring to the thumb disk to aspirate
2nd generation self-aspirating syringes have removed this
thumb disk

Dentists only need to stop applying pressure to the thumb ring

for aspiration; aspiration becomes very easy to do

Pressure Syringes
PDL (intraligamentary) injections make it possible to achieve
single tooth pulpal anesthesia in the mandible when, in the
past,complete IANB was necessary

 Pressure syringes can allow too easy of an administration of

local anesthetic producing pain and post-operative discomfort
Pressure syringes are expensive > $200.00
Can shatter glass cartridge if too much pressure is applied too
quickly

2000 psi Jet Syringes ($1,600)

Needle-less injection
Liquids forced through very small openings, called jets, at
very high pressure can penetrate skin or intact mucous
membrane
Syrijet is the most popular used today
Syrijet holds any 1.8 ml cartridge of local anesthetic
Syrijet is calibrated to deliver .05 to .2 ml of solution at 2000
psi; traditional syringes deliver 600 psi maximum

 Primary use is to obtain topical anesthesia before using a

needle
Regional nerve blocks/supraperiosteal injections are still
necessary
Topical anesthetics provide the same effect at a fraction of the
cost
Patients complain of soreness where the 2000 psi hit their
tissue

Safety Syringe
Aspiration is possible
Some brands come with an
autoclavable plunger and
disposable self-contained
injection unit
All dental safety syringes are
made to be single use items

 Sliding the index and middle finger forward against the front
collar of the guard makes the needle safe by sliding a
protective plastic sheath over the needle tip that locks into
place
More expensive than reusable syringe units
Large disadvantage arises when it comes to re-injecting;
complication ensues due to the needle tips newly acquired
safety coping

CCLAD (Computer Controlled Local

Anesthetic Delivery
Designed to improve ergonomics
and precision of injection
technique
Foot activated delivery of
solution using finger tip precision
Pen-like grasp offers increased
tactile sensation

The Wand
Flow rates of solution delivery are
computer controlled and remain
consistent
Operator is able to focus attention
on the position of the needle tip
while the motor of the machine
delivers local anesthetic at a
preprogrammed rate of flow

 The Wand is less threatening to the patients visually

Allows two rates of delivery:
1) Slow: .5 ml/minute
2) Fast: 1.8 ml/minute
Releasing the foot rheo-stat will tell the machine to aspirate
automatically; the aspiration cycle is approximately 4.5
seconds

 Extremely high pressure in non-resilient tissues cause

(traditional syringe) moderate/severe pain in most patients
The wand eliminates a lot of this discomfort by maintaining
constant pressure delivery of the solution
Less painful pdl, palatal, attached gingiva injections