You are on page 1of 29

Contents

1.

Introduction

2.

The Syringe

3.

4.

5.

Types of Syringe

Advantages & Disadvantages of the Syringe

Care & Handling of Syringe

Problems with Syringe

The Needle
-

Types

Anatomy of a Needle

Gauge

Length

Care & Handling of Syringes

Problems with Needles

The Cartridge
-

Components

Cartridge Contents

Care & Handling of Cartridges

Problems with Cartridges

Additional Armamentarium
-

Topical Antiseptic

Topical Anesthetic

Applicator Sticks

Cotton Gauze (2x2 inches)

6.

Hemostat

Preparation of the Armamentarium


-

Breech-loading, metallic or plastic cartridge type syringe


Recapping the Needle
Unloading the breech-loading, metallic or plastic, cartridge type
syringe

Placing an additional cartridge in a (traditional) syringe

Self-aspirating syringe

Ultrasafe aspirating syringe


Loading the safety syringe
Aspiration

7.

Conclusion

8.

References

Introduction
Effective local anesthesia is arguably the single most important pillar upon which
modern dentistry stands.

Paradoxically, the injection of local anesthetic is also

perhaps the greatest source of patient fear, and inability to obtain adequate pain
control with minimal discomfort remains a significant concern of dental practitioners.
Although the traditional aspirating syringe is the most common method by which
local anesthetics are administered, newer technologies have been developed that can
assist the dentist in providing enhanced pain relief with reduced injection pain and
fewer adverse effects.

The clinical uses of computer-controlled local anesthesia

delivery (C-CLAD) devices and intraosseous (IO) systems for local anesthetic
injection.
The equipment necessary for the administration of local anesthetics, includes the
syringe, needle, and local anesthetic cartridge, as well as additional items of
equipment. In additional to providing a description of the armamentarium the proper
care and handling of the equipment and problems that may be encountered with its
use. A proper technique for assembling and disassembling the equipment follows.

Types of Syringe
1.

Nondisposable syringes
-

Breech-loading, metallic, cartridge-type, aspirating

Breech-loading, plastic, cartridge-type, aspirating

Breech-loading, metallic, cartridge-type, self-aspirating

Pressure syringe for periodontal ligament injection

Jet injector ("needle-less" syringe)

2.

Disposable syringes

3.

"Safely" Syringes

4.

Computer-controlled local anesthetic delivery systems

Nondisposable Syringes
Breech-loading, Metallic, Cartridge-Type, Aspirating -

The breech-loading,

metallic, cartridge-type syringe is the most commonly used in dentistry. The term
breech-loading implies that the cartridge is inserted into the syringe from the side of
the barrel of the syringe. The needle is attached to the barrel of the syringe at the
needle adaptor. The needle then passes into the barrel, where it penetrates the
diaphragm of the local anesthetic cartridge.

The needle adaptor (screw hub or

convertible tip) is removable and sometimes is discarded inadvertently along with the
disposable needle.
The aspiring syringe has a device such as a sharp, hook-shaped end (often called the
harpoon) attached to the piston that is used to penetrate the thick silicone rubber
stopper (bung) at the opposite end of the cartridge (from the needle).

The thumb ring and finger grips give the administrator added control over the syringe.
Almost all syringe manufacturers provide syringes with both 'regular' and 'small'
thumb rings.
Advantages and Disadvantages of the Metallic, Breech-Loading, Aspirating
Syringe
Advantages

Disadvantages

Visible cartridge

Weight (heavier than plastik syringe)

Aspiration with one hand

Syringe may be too big for small

Autoclavable

operators.

Rust Resistant

Possibility of infection with improper

Long lasting with proper maintenance

care

Breech-Loading, Plastic, Cartridge-Type, Aspirating


A plastic, reusable, dental aspirating syringe is available that is both autoclavable and
chemically sterilizable. With proper care and handling, this syringe may be used for
multiple anesthetic administrations before it is discarded.

Advantages and

disadvantages of the plastic, reusable, aspirating syringe and listed.

Advantages and Disadvantages of the Plastic, Reusable, Aspirating Syringe


Advantages

Disadvantages

Plastic eliminates metallic,

Size (may be too big for small operators)

clinical look

Possibility of infection with improper

Lightweight: provides better 'feel'

care

during injection

Deterioration of plastic with repeated

Cartridge is visible

autoclaving

Aspiration with one hand


Rust Resistant
Long lasting with proper maintenance
Lower Cost

Breech-Loading, Metallic, Cartridge-Type, Self-Aspirating


Potential hazards of intravascular administration of local anesthetics are great and are
discussed more fully. The incidence of positive aspiration may be as high as 10% to
15% with some injection techniques. It is accepted by the dental profession that an
aspiration test before administration of a local anesthetics drug is of great importance.
To increase the ease of aspiration, self-aspiration syringes have been developed.
These syringe use the elasticity of the rubber diaphragm in the anesthetic cartridge to
obtain the necessary negative pressure for aspiration. The diaphragm rests on a metal
projection inside the syringe that directs the needle into the cartridge. Pressure acting
directly on the cartridge through the thumb disc or indirectly through the plunger shaft
distorts (stretches) the rubber diaphragm, producing positive pressure within the
anesthetic cartridge.
The self-aspirating syringe was introduced into the United States in 1981. After an
initial period of enthusiasm, the popularity of this syringe decreased.
Advantages and Disadvantages of the Metallic, Self-Aspirating Syringe
Advantages

Disadvantages

Cartridge visible

Weight

Easier to aspirate with small hands

Feeling of 'insecurity' for doctors

Autoclavable

accustomed to harpoon-type syringe

Rust Resistant

Finger must be moved from thumb ring

Long lasting with proper maintenance

to thumb disc to aspirate

Piston is scored (indicates volume of

Possibility of infection with improper

local anesthetic administered)

disc

Pressure Syringes
Introduced in the late 1970s, pressure syringes brought about a renewed interest in the
periodontal ligament (PDL) injection (also known as the intraligamentary injection
(ILI).
The original pressure devices, Peripress (Universal Dental Implements, Edison, NJ)
and Ligmajet (IMA Associates, Bloomington, Ind) were modeled after a device that
was available in dentistry in 1905- the Wilcox-Jewett obtunder. These first-genreation
devices, using a pistol grip, are somewhat larger than the newer, pen-grip devices.
The original pressure syringe looked somewhat threatening, having the appearance of
a gun.
Advantages and Disadvantages of the Pressure Syringe
Advantages

Disadvantages

Measured dose

Cost

Overcomes tissue resistance

Easy to inject too rapidly

Nonthreatening (new devices)

Threatening (original devices)

Cartridges protected

Jet Injector In 1947 Figge and Scherer introduced a new approach to parenteral
injection the jet or needle-less injection. This represented the first fundamental
change in the basic principles of injection since 1853, when Alexander Wood
introduced the hypodermic syringe.

Jet injection is based on the principle that liquids forced through very small openings,
called jets, at very high pressure can penetrate intact skin or mucous membrane
(visualize water flowing through a garden hose that is being crimped). The most
frequently used jet injectors in dentistry are the Syrijet Mark II (Mizzy Inc., Cherry
Hill, NJ) and the Madajet (Mada Medical Products Incorporated, Carlstadt, NJ).
Advantages and Disadvantages of the Jet Injector
Advantages

Disadvantages

Does not require use of needle

Inadequate for pulpal anesthesia or for

(recommended for needle phobics)

regional block

Delivers very small volumes of local

Some patients are disturbed by the jolt of

anesthetic (0.01 to 0.2 ML)

the injection.

Used in lieu of topical anesthetics

Cost
May damage periodontal tissues.

Disposable Syringes
Plastic disposable syringes are available in a variety of sizes with an assortment of
needle gauges.

Most often they are used for intramuscular or intravenous drug

administration, but they also may be used for intraoral injection.


Advantages and Disadvantages of the Pressure Syringe
Advantages

Disadvantages

Disposable, single use

Does not accept prefilled dental

Sterile until opened Lightweight

cartridges

(may feel awkward to the first-time

Aspiration difficult (requires two

user; tactile sensation better)

hands)

These syringes contain a Luer-Lok screw-on needle attachment with no aspirating tip.
Aspiration can be accomplished by pulling back on the plunger of the syringe before
or during injection. Because there is not thumb ring, aspiration with the plastic
disposable syringe requires the use of both hands.

Safety Syringes
Recent years have seen a move toward the development and introduction of safety
syringes in both medicine and dentistry. Safety syringes minimize the risk of an
accidental needle-stick injury occuring to a dental health provider with a
contaminated needle after administration of a local anesthetic.
Devices such as the UltraSafety Plus XL and the 1 Shot Safety Syringe were available
as of January 2011. The UltraSafety Plus XL aspirating syringe system contains a
syringe body assembly and a plunger assembly.

Once the syringe is properly

assembled and the injection administered, the syringe may be made 'safe' with one
hand by gently moving the index and middle fingers against the front collar of the
guard. Once 'guarded' the now contaminated needle is 'safe', so that it is virtually
impossible for dental health providers to be injured with the needle.
Dental safety syringes are designed as single-use items, although they permit
reinjection.
Advantages and Disadvantages of the Safety Syringe
Advantages

Disadvantages

Disposable, single use sterile until

Cost : more expensive than reusable

opened

syringe

Lightweight (better tactile sensation)

May feel awkward to a first time


user

Computer-Controlled Local Anesthetic Delivery (C-CLAD) System


The standard dental syringe described previously is a simple mechanical instrument
that dates back to 1853, when Charles Pravaz patented the first syringe. The dental
syringe is a drug delivery device requiring that the operator simultaneously attempt to
control the variable of drug infusion and the movement of a penetrating needle. The
operator's inability to precisely control both of these activities during an injection can
compromise an injection technique. In addition, a traditional syringe is handled with
a palm-thumb grasp, which is not designed for ideal ergonomics or needle control
during the injection. For certain practitioners-those with small hands-just holding a
syringe with a full cartridge of anesthetic may be difficult.
In 1997 the first computer-controlled local anesthetic delivery (C-CLAD) system was
introduced into dentistry. The Wand (Milestone Scientific Inc., Livingston, NJ) was
designed to improve on the ergonomics and precision of the dental syringe. This
system enabled a dentist or hygienist to accurately manipulate needle placement with
fingertip accuracy and deliver the local anesthetic with a foot-achieved control. A
lightweight handpiece, held in a penlike grasp, provides increased tactile sensation
and control compared with the traditional syringe.
Hockman and colleagues were the first to demonstrate a marked reduction in pain
perception with injections using C-CLADs. Fifty blindfolded dentists participated
(they received the injection) in a controlled clinical study comparing the standard
manual syringe with The Wand/CompuDent System for palatal injection. Forty-eight
(96%) preferred injections with the C-CLADs.

Nicholson and associates conducted a randomized clinical study using two operators
administrating four different types of dental injections to compare C-CLADs with the
standard syringe.

The Wand/STA System


The STA-Single Tooth Anesthesia System (Milestone Scientific Inc., Livingston, NJ)
represents a significant advance in C-CLAD technology. The STA System was
introduced in 2007. This third-generation C-CLAD instrument represents a new and
meaningful innovation for subcutaneous injections performed both in dentistry and in
medicine. The technological advancement is related to the development of what is
called dynamic pressure-sensing technology (DPS technology).

DPS technology

enables the precise monitoring and control of fluid pressure at the needle tip when a
subcutaneous injection is performed. Fluid exit-pressure at the needle tip is used to
identify a given anatomic location and/or a specific tissue type based on this
repeatable finding.

Exit-pressure information is provided to the clinician on a

continuous basis in the form of spoken and/or audible sounds and visual indicators
emitted from the STA instrument, thus providing continuous real-time feedback while
a dental injection is performed.
Advantages and Disadvantages of The Wand/STA System
Advantages
-

Dynamic pressure-sensing (DPS) technology provides continuous real-time


feedback when an injection is performed, resulting in a more predictable
injection site location.

Allows the periodontal ligament (PDL) injection to be used as a predictable


primary injection.

Can be used for all traditional injection techniques.

Recommended device for newer injection techniques such as anterior middle


superior alveolar nerve block (AMSA), palatal anterior superior alveolar nerve
block (AMSA), palatal anterior superior alveolar nerve block (P-ASA) and
STA-intra-ligamentary injection.

Reduces pain-disruptive behaviour in children and adults.

Reduces stress for patient

Reduces stress for operator

Disadvantages
-

Requires additional armamentarium

Cost

Comfort Control Syringe


Introduced several years after The Wand, the Comfort Control Syringe (CCS) System
attempts to improve on the C-CLAD concept. The CCS System is an electronic,
preprogrammed delivery device that provides the operator with the control needed to
make the patient's local anesthetic injection experience as pleasant as possible. As
with other C-CLADs, this is achieved by depositing the local anesthetic more slowly
and consistently than is possible manually. The CCS has a two-stage delivery system.
Injection begins at an extremely slow rate to avoid the pain associated with rapid
anesthetic delivery. After 10 seconds, the CCS automatically increases speed to a preprogrammed injection rate for the technique selected. Five preprogrammed injection
rate are available for specific injections: Block, Infiltration, PDL, AMSA/Palatal
anterior superior alveolar nerve block (P-ASA), and Lingual Infiltration.
Advantages and Disadvantages of the Comfort Control Syringe

Advantages
-

Familiar 'syringe' type of delivery system

Easy to see exactly how much local anesthetic solution has been dispensed,
just as on a manual syringe

Inexpensive disposables

All controls literally at the fingertips

Less costly than other C-CLADs

Allows selection of various rates of delivery matched to the user injection


technique utilized

Disadvantages
-

Requires additional armamentarium

More bulky than other computer-controlled local (C-CLAD) manual local


anesthesia delivery devices

Vibration may bother some users

Cost

Care and Handling of Syringes


When properly maintained, metal and plastic reusable syringes are designed to
provide long-term service. Following is a summary of manufactures recommendations
concerning care of these syringes.
1.

After each use, the syringe should be thoroughly washed and rinsed so as to be
free of any local anesthetic solution, saliva, or other foreign matter. The
syringe should be autuclaved in the same manner as other surgical
instruments.

2.

After every five autoclaving, the syringe should be dismantled and all threaded
joints and the area where the piston contacts the thumb ring and the guide
bearing should be lightly lubricated.

3.

The harpoon should be cleaned with a brush after each use.

4.

Although the harpoon is designed for long-term use, prolonged use will result
in decreased sharpness and failure to remain embedded within the stopper of
the cartridge. Replacement pistons and harpoons are readily available at low
cost.

Problems
1.

Leakage during injection

2.

Broken Cartridge

3.

Bent Harpoon

4.

Disengagement of the Harpoon from the Plunger during Aspiration

5.

Surface Deposits

The Needle
Types

The needle is the vehicle that permits local anesthetic solution to travel from the
dental cartridge into the tissues surrounding the needle tip. Most needles used in
dentistry are stainless steel and disposable. Needles manufactured for dental intraoral
injections are presterilized and disposable.
Reusable needles should not be used for injections. Because the needle represents the
most dangerous component of the armamentarium, the one most likely to produce
injury to patient or doctor, safety needles are being developed.

Anatomy of a Needle
The needle is composed of a single piece of tubular metal around which is placed a
plastic or metal syringe adaptor and the needle hub.
All needles have the following components in common: the bevel, the shaft, the hub,
and the cartridge-penetrating end.
The bevel defines the point or tip of the needle.

Bevels are described by

manufacturers as long, medium, and short. Several authors have confirmed that the
greater the angle of the bevel with the long axis of the needle, the greater will be the
degree of deflection as the needle passes through hydro-colloid (or the soft tissues of
the mouth)
The shaft of the needle is one long piece of tubular metal running from the tip of the
needle through the hub, and continuing to the piece that penetrates the cartridge. The
hub is a plastic or metal piece through which the needle attaches to the syringe. The
interior surface of metal hubbed needles is prethreaded, as are most but not all plastichubbed needles.

The cartridge-penetrating end of the dental needle extends through the needle adaptor
and perforates the diaphragm of the local anesthetic cartridge. Its blunt end rests
within the cartridge.

Gauge
Gauge refers to the diameter of the lumen of the needle: the smaller the number, the
greater the diameter of the lumen. A 30-guage needle has a smaller internal diameter
than a 25-guage needle. In the United States, needles are colour-coded by gauge.
There is a growing trend towards the use of smaller-diameter (higher number gauge)
needles, based on the assumption that they are less traumatic to the patient than
needles with larger diameters. This assumption in unwarranted. Hamburg
demonstrated as far back as 1972 that patients cannot differentiate among 23-, 25-,
27-, and 30-gauge needles.

Length
Dental needles are available in three lengths: long, short and ultrashort. Ultrashort
needles are available only as 30-gauge needles. Despite the claim for uniformity of
length by manufactures, significant differences are found.
The length of a short needle is between 20 and 25 mm (measured hub to tip) with a
standard of about 20 mm, and is 30 to 35 mm for the long dental needle, with a
standard of about 32 mm.

Care and Handling of Needles


Needles available to the dental profession today are presterilized and disposable.
With proper care and handling, they should not be the cause of significant difficulties.

1.

Needles must nerve be used on more than one patient.

2.

Needles should be changed after several (three or four) tissue penetrations in


the same patient.

3.

Needles should be covered with a protective sheath when not being used to
prevent accidental needle-stick with a contaminated needle.

4.

Attention should always be paid to the position of the uncovered needle tip,
whether inside or outside the patient's mouth. This minimize the risk of
potential injury to the patient and the administrator.

5.

Needles must be properly disposed of after use to prevent possible injury or


reuse by unauthorised individuals.

Problems with Needles


1)

Pain on Insertion

2)

Breakage

3)

Pain on Withdrawal

4)

Injury to the Patient or Administrator

The Cartridge
The dental cartridge is a glass cylinder containing the local anesthetic drug, among
other ingredients. The dental cartridge is, by common usage, referred to by dental
professionals as a carpule. The term carpule is actually a registered trade name for the
dental cartridge prepared by Cook-Waite Laboratories, which introduced it into
dentistry in 1920.

Components
The prefilled 1.8 mL dental cartridge consists of four parts :
1.

Cylindrical glass tube

2.

Stopper (plunger, bung)

3.

Aluminum cap

4.

Diaphragm

The stopper (plunger, bung) is located at the end of the cartridge that receives the
harpoon of the aspirating syringe. The plunger occupies a little less than 0.2 ml of the
volume of the entire cartridge. Glycerin was added in channels around the stopper as
a lubricant, permitting it to traverse the glass cylinder more easily.
In an intact dental cartridge, the stopper is slightly indented from the lip of the glass
cylinder. An aluminum cap is located at the opposite end of the cartridge from the
rubber plunger. It fits snugly around the neck of the glass cartridge, holding the thin
diaphragm in position. It is silver colored on most cartridges.
The diaphragm is a semipermeable membrane that allows any solution in which the
dental cartridge is immersed to diffuse into the cartridge, thereby contaminating the
local anesthetic solution.

Cartridge Contents
Component
Local anesthetic drug (eg. Lidocaine HCl)
Sterile water
Vasopressor (eg., epinephrine, levonordefrin)

Function
Blockage of nerve conduction
Volume
Depth and duration of anesthesia;
absorption of local anesthetic and

Sodium (meta) bisulfite


Methylparaben

vasopressor
Antioxidant
Bacteriostatic agent

Care and Handling


Lost commonly today, local anesthetics are marketed in cardboard boxes of
approximately 50 cartridges. Within the box are 5 sealed units of 10 cartridges each,
called blister packs. Kept in this container until use, cartridges remain clean and
uncontaminated.
Local anesthetic cartridges should be stored in their original container, preferably at
room temperature (eg. 21C to 22C), and in a dark place. There is no need to
'prepare' a cartridge before use. The doctor or assistant should insert it into the
syringe. However, many doctors feel compelled to somehow "sterilize" the cartridge.
When this urge strikes, the doctor should apply an alcohol wipe moistened with
undiluted 91% isopropyl alcohol or 70% ethyl alcohol to the rubber diaphragm.
Cartridges should not be permitted to soak in alcohol or other sterilizing solutions
because the semipermeable diaphragm allows diffusion of these solutions into the
dental cartridge, thereby contaminating it.
Cartridge warmers are unnecessary.

Indeed, occassionally they may produce

problems. Overheating the local anesthetic solution can lead to (1) discomfort for the
patient during injection, and (2) the more rapid degradation of a heat-labile

vasopressor (producing a shorter duration of anesthesia with more burning on


injection.

Problem
1.

Bubble in the cartridge

2.

Extruded stopper

3.

Burning on injection

4.

Sticky stopper

5.

Corroded cap

6.

'Rust' on the cap

7.

Leakage during injection

8.

Broken cartridge

Additional Armamentarium
1.

Topical antiseptic

2.

Topical anesthetic

3.

Applicator sticks

4.

Cotton gauze (2x2 inches)

5.

Hemostat

Topical Antiseptic
A topical antiseptic may be used to prepare the tissues at the injection site before the
initial needle penetration.

Its function is to produce a transient decrease in the

bacterial population at the injection site, thereby minimizing any risk of postinjection
infection.
The topical antiseptic, on an applicator stick, is placed at the site of injection for 15 to
30 seconds. There is no need to place a large quantity on the applicator stick; it
should be sufficient just to moisten the cotton portion of the swab.
Available agents include Betadine (povidone-iodine) and merthiolate (thimerosal).
Topical antiseptics containing alcohol (eg., tincture of iodine, tincture of Merthiolate)
should not be used because the alcohol produces tissue irritation.
If a topical antiseptic is not available, a sterile gauze wipe should be used to prepare
the tissues adequately before injection.

Topical Anesthetic
With proper application, initial penetration of mucous membrane anywhere in the oral
cavity can usually be made without the patient's awareness.

For effectiveness, it is recommended that a minimal quantity of topical anesthetic be


applied to the end of the applicator stick and placed directly at the site of penetration
for approximately 1 minute.
A variety of topical anesthetic agents are available for use today. Most contain the
ester anesthetic benzocaine. The risk of overdose with amide topical anesthetics is
greater than that with the esters and increases with the area of application of the
topical anesthetics. Topical forms of lidocaine are available as ointments, gels, pastes,
and sprays.
EMLA (eutectic mixture of local anesthetics) is a combination of lidocaine and
prilocaine in a topical cream formulation, designed to provide surface anesthesia of
intact skin.
EMLA has been used effectively intraorally; however, it is not designed for intraoral
administration, so it contains no flavoring agent and is bitter tasting. Unmetered
sprays of topical anesthetics are potentially dangerous and are not recommended for
routine use.
Metered sprays that deliver a fixed dose with each administration, regardless of the
length of time the nozzle is depressed, are preferred for topical formulations that are
absorbed systemically.

An example of this form of topical anesthetic spray is

Xylocaine, which delivers 10 mg. per administration.

Applicator Sticks
Applicator sticks should be available as part of the local anesthetic armamentarium.
They are wooden sticks with a cotton swab at one and they can be used to apply
topical antiseptic & anesthetic solutions to mucous membrane and compress tissue
during palatal injection.

Cotton Gauze
Cotton gauze is included in the local anesthetic armamentarium for (1) wiping the
area of injection before needle penetration and (2) drying the mucous membrane to
aid in soft tissue retraction for increased visibility.
A variety of sizes of cotton gauze are available for tissue retraction, but the most
practical and the most commonly used in the 2x2 inches size.
Note : That when gauze is placed intraorally to stop bleeding, it is recommended that
2x2 inches squares not be used. Larger 4x4 inch gauze squees are much preferred.

Hemostat
Although not considered an essential element of the local anesthetic armamentarium,
a hemostat or pickup forceps should be readily available at all times in the dental
office. Its primary function in local anesthesia is removal of a needle from the soft
tissues of the mouth in the highly unlikely event that the needle breaks off within
tissues.

Preparation of the Armamentarium

Breech-Loading, Metallic or Plastic, Cartridge-type Syringe


1.

Remove the sterilized syringe from its container.

2.

Retract the piston fully before attempting to load the cartridge.

3.

Insert the cartridge, while the piston is fully retracted, into the syringe. Insert
the rubber stopper end of the cartridge first.

4.

Engage the harpoon. While holding the syringe as if injecting, gently push the
piston forward until the harpoon is firmly engaged in the plunger. Excessive
force is not necessary. Do not hit the piston in an effort to engage the harpoon
because this frequently leads to cracked or shattered glass cartridges.

5.

Attach the needle to the syringe. Remove the white or clear protective plastic
cap from the syringe end of the needle and screw the needle onto the syringe.
Most metal and plastic hubbed needles are prethreaded, making it easy for
them to be screwed onto the syringe; however, some plastic hubbed syringes
are not prethreaded, requiring the needle to be pushed toward the metal hub of
the syringe while being turned.

6.

Carefully remove the colored plastic protective cap from the opposite end of
the needle, and expel a few drops of solution to test for proper flow.

7.

The syringe is not ready for use.

Recapping the Needle


After removal of the syringe from the patient's mouth, the needle should be recapped
immediately. Recapping is one of the two times when health professionals are most
likely to be injured (stuck) with a needle; it is probably the most dangerous time to be

stuck because the needle is now contaminated with blood, saliva, and debris.
Although a variety of techniques and devices for recapping have been suggested, the
technique recommended by most state safety and health agencies is termed the scoop
technique.
Various needle cap holders are available commercially made or self-made (from
arcylic) that hold the cap stationary while the needle is being inserted into it, making
recapping somewhat easier to accomplish.

Unloading the Breech-Loading, Metallic or Plastic, Cartridge-Type Syringe


After administration of the local anesthetic, the following sequence is suggested for
removing the used cartridge :
1.

Retract the piston and pull the cartridge away from the needle with your
thumb and forefinger as you retract the piston, until the harpoon disengages
from the plunger.

2.

Remove the cartridge from the syringe by inverting the syringe, permitting the
cartridge to fall free.

3.

Properly dispose of the used needle. All needles must be discarded after use to
prevent injury or intentional misuse by unauthorised persons.

Carefully

unscrew the now recapped needle, being careful not to accidently discard the
metal needle adaptor. The use of a sharps container is recommended for
needle disposal.
Placing an Additional Cartridge in a (Traditional) Syringe
On occasion it is necessary to deposit an additional cartridge of local anesthetic
solution. To do this, the following sequence is suggested with the metallic or plastic
breech-loading syringe :

1.

Recap the needle using the scoop (or other appropriate) technique, and remove
it from the syringe.

2.

Retract the piston (disengaging the harpoon from the rubber stopper).

3.

Remove the used cartridge

4.

Insert the new cartridge

5.

Embed the harpoon

6.

Reattach the needle

The estimated time necessary to complete this procedure is 10 to 15 seconds.

Self-Aspirating Syringe
1.

Insert the cartridge (as in the preceding instructions).

2.

Attach the needle

3.

The syringe is now ready for use

Because of the absence of a harpoon, loading and unloading the self-aspirating


syringe are simple procedures.

Ultrasafe Aspirating Syringe


Loading the Safety Syringe
1.

While gripping the barrel firmly, fully insert the anesthetic cartridge into the
open end of the injectable system.

2.

Grip the plunger handle, putting the thumb behind the finger holder. Introduce
the handle tip into the barrel of the injectable system, behind the cartridge.

3.

Next, slide the sheath protecting the needle backward, toward the handle, until
it Clicks (the click is made as the sheath hits the handle and locks the unit
together).

4.

All movements now are away from the needle. Remove the needle cap and
discard. The system is now ready to use.

Aspiration
Passive Aspiration (Self-Aspiration): At the base of the cartridge barrel of the
injectable system, you will see there is a small protuberance. It appears as a blob of
glue holding the centered needle, the needle-end that penetrates the diaphragm of the
cartridge when inserted. At the start of the injection, the diaphragm is pressed against
the protuberance; a depression occurs, and when released (injection stopped), the
diaphragm moves back away from the protuberance and aspiration occurs.

Active Aspiration : Active aspiration is obtained by the silicone top of the plunger
handle creating a vacuum when, thumb in ring, the practitioner pulls back. The bung
follows the plunger tip, providing active aspiration, which is best observed when a
minimum of 0.25 to 0.3 ml of solution (providing space) has been expelled or used
form the cartridge.

Conclusion
The equipment necessary for the administration of local anesthetics, includes the
syringe, needle, and local anesthetic cartridge, as well as additional items of
equipment. In additional to providing a description of the armamentarium the proper
care and handling of the equipment and problems that may be encountered with its
use. A proper technique for assembling and disassembling the equipment follows.
The introduction of computer-controlled local anesthetic delivery (C-CLAD) systems
has enhanced the delivery of local anesthetic for many dentists and their patients.
These devices have demonstrated great utility in the painless delivery of dental local
anesthetics.

References

1)

Handbook of Local Anesthesia (6th Edition)


- Stanley F. Malamed

2)

Monheim's Local Anesthesia & Pain Control in Dental Practice (7th Edition)
- C. Richard Bennett

You might also like