ArmamentariumArmamentarium

Types of SyringesTypes of Syringes

ReusableReusable

Breech-loading, metal, aspirating,cartridgeBreech-loading, metal, aspirating,cartridge

Breech-loading, plastic, aspirating,cartridgeBreech-loading, plastic, aspirating,cartridge

Breech-loading, metal, self-aspiratingBreech-loading, metal, self-aspirating

Pressure typePressure type

Jet injectorJet injector

DisposableDisposable

““Safety” syringeSafety” syringe

ADA CriteriaADA Criteria

Durable, able to withstand sterilizationDurable, able to withstand sterilization

Accept wide variety of cartridges & needlesAccept wide variety of cartridges & needles

Simple, easy to use, lightweight, self-contained, Simple, easy to use, lightweight, self-contained, and inexpensiveand inexpensive

Effective and easily visualized aspirationEffective and easily visualized aspiration

Advantages - reusable syringeAdvantages - reusable syringe

One-handed aspirationOne-handed aspiration

Visible cartridgeVisible cartridge

Autoclavable and rust-resistantAutoclavable and rust-resistant

Durable with proper maintenanceDurable with proper maintenance

Disadvantages - reusableDisadvantages - reusable

WeightWeight

SizeSize

Possibility of cross-infection withPossibility of cross-infection with

improper careimproper care

Advantages - plasticAdvantages - plastic

LightweightLightweight

Lower costLower cost

Rust freeRust free

Disadvantages - plasticDisadvantages - plastic

SizeSize

Deteriorates with repeated autoclavingDeteriorates with repeated autoclaving

Possibility of cross-infection with Possibility of cross-infection with

improper careimproper care

Self-aspirating SyringeSelf-aspirating Syringe

AdvantagesAdvantages

Easier to aspirate with small handsEasier to aspirate with small hands

Volume indicatorVolume indicator

DisadvantagesDisadvantages

Feeling of insecurityFeeling of insecurity

Finger must be movedFinger must be moved

WeightWeight

Advantages - pressure typeAdvantages - pressure type

Dose is measuredDose is measured

Overcomes tissue resistanceOvercomes tissue resistance

Cartridge is protectedCartridge is protected

Disadvantages - pressure typeDisadvantages - pressure type

CostCost

May inject too rapidlyMay inject too rapidly

Gun-like appearanceGun-like appearance

Advantages - jet injectorAdvantages - jet injector

No “sharp” needleNo “sharp” needle

Delivers small volumesDelivers small volumes

Use in lieu of topicalUse in lieu of topical

Disadvantages - jet injectorDisadvantages - jet injector

““Jolt” of injectionJolt” of injection

Inadequate for pulpal or regional blocksInadequate for pulpal or regional blocks

May damage periodontal tissueMay damage periodontal tissue

Advantages - disposable syringeAdvantages - disposable syringe

Sterile, no chance of cross contaminationSterile, no chance of cross contamination

LightweightLightweight

Disadvantages - disposableDisadvantages - disposable

Cannot use dental cartridgeCannot use dental cartridge

Cannot aspirate single-handedlyCannot aspirate single-handedly

Awkward to use intraorallyAwkward to use intraorally

Advantages - safety syringesAdvantages - safety syringes

DisposableDisposable

SterileSterile

LightweightLightweight

Needle covers automaticallyNeedle covers automatically

Disadvantages - safety syringeDisadvantages - safety syringe

Increased costIncreased cost

Feels awkward during learning processFeels awkward during learning process

Syringe MaintenanceSyringe Maintenance

Brush harpoon, clean syringe and Brush harpoon, clean syringe and

autoclave after each useautoclave after each use

Do Do notnot throw out needle adaptor throw out needle adaptor

Sharpen or replace harpoon periodicallySharpen or replace harpoon periodically

NeedlesNeedles

Stainless SteelStainless Steel

PlatinumPlatinum

Ruthenium-Platinum alloyRuthenium-Platinum alloy

Maintenance problemsMaintenance problems

Surface depositsSurface deposits

Dull or bent harpoonDull or bent harpoon

Excess wearExcess wear

Parts of a NeedleParts of a Needle

BevelBevel

ShankShank

HubHub

Syringe adaptorSyringe adaptor

Syringe-penetrating endSyringe-penetrating end

GaugeGauge

Measure of the diameter of the needle’s Measure of the diameter of the needle’s lumenlumen

Size number is inversely proportional to the Size number is inversely proportional to the diameterdiameter

Usual dental needle guages are 25,27, & 30Usual dental needle guages are 25,27, & 30

LengthLength

Long - approximately 40mm or 1 5/8 inLong - approximately 40mm or 1 5/8 in

Short - approximately 25 mm or 1 inShort - approximately 25 mm or 1 in

Needle HandlingNeedle Handling

Single pt. use, change after several injections Single pt. use, change after several injections

Cap between uses, dispose of in “sharps” Cap between uses, dispose of in “sharps” containercontainer

Check for barbs if pain on withdrawalCheck for barbs if pain on withdrawal

Never force against resistanceNever force against resistance

Never insert a needle to the hubNever insert a needle to the hub

Problems related to improper useProblems related to improper use

Pain on insertionPain on insertion

Pain on withdrawalPain on withdrawal

Needle breakageNeedle breakage

Needle stick injuryNeedle stick injury

Needle size vs. comfortNeedle size vs. comfort

Patients cannot differentiate between 23, 25, Patients cannot differentiate between 23, 25, 27, or 30 guage needles.27, or 30 guage needles.

Hamburg, H. L. 1972 Hamburg, H. L. 1972

Advantage of larger needlesAdvantage of larger needles

Less deflectionLess deflection

Less chance for breakageLess chance for breakage

More reliable aspirationMore reliable aspiration

Cartridge Cartridge

1.8 cc volume1.8 cc volume

Glass tubeGlass tube

Rubber stopperRubber stopper

Aluminum cap with diaphragmAluminum cap with diaphragm

Contents of CartridgeContents of Cartridge

AnestheticAnesthetic

VasoconstrictorVasoconstrictor

Preservative for vasoconstrictorPreservative for vasoconstrictor

Sodium chlorideSodium chloride

Distilled waterDistilled water

Preservative for VasoconstrictorPreservative for Vasoconstrictor

Sodium BisulfiteSodium Bisulfite

Most common antioxidant (burning)Most common antioxidant (burning)

Prolongs shelf life to aprox. 8 mos.Prolongs shelf life to aprox. 8 mos.

Handling of CartridgesHandling of Cartridges

Should Should notnot be: be:

autoclavedautoclaved

stored in alcohol or disinfectantstored in alcohol or disinfectant

Should be:Should be:

kept in original containerkept in original container

kept in dark placekept in dark place

Handling of CartridgesHandling of Cartridges

No need for:No need for:

Cartridge warmerCartridge warmer

Sterilization prior to injectionSterilization prior to injection

- may wipe with alcohol if not in original - may wipe with alcohol if not in original containercontainer

Problems with CartridgesProblems with Cartridges

Bubble in cartridgeBubble in cartridge

Small - N2 which is normalSmall - N2 which is normal

Large(>2mm) - freezingLarge(>2mm) - freezing

Extruded stopperExtruded stopper

Freezing, or uptake of holding solutionFreezing, or uptake of holding solution

Problems with CartridgesProblems with Cartridges

Burning on injectionBurning on injection

Normal response to pH of drugNormal response to pH of drug

Response to preservativeResponse to preservative

Diffusion of holding solution Diffusion of holding solution

Overwarmed cartridgeOverwarmed cartridge

Problems with cartridgesProblems with cartridges

Leakage during injectionLeakage during injection

Eccentric penetration of diaphragmEccentric penetration of diaphragm

Stopper sticksStopper sticks

Rare, may be cold Rare, may be cold

(check that needle has penetrated diaphragm) (check that needle has penetrated diaphragm)

Problems with CartridgesProblems with Cartridges

CapCap

Corrosion - cold sterilizing solutionsCorrosion - cold sterilizing solutions

Rust - leakage in containerRust - leakage in container

Broken cartridgeBroken cartridge

Rough handlingRough handling

Excessive force to engage harpoonExcessive force to engage harpoon

Additional ArmamentariumAdditional Armamentarium

Topical antiseptic ?Topical antiseptic ?

Topical anestheticTopical anesthetic

Cotton tip applicatorCotton tip applicator

GuazeGuaze

HemostatHemostat

Preparation of ArmamentariumPreparation of Armamentarium

Loading the SyringeLoading the Syringe

Attaching the NeedleAttaching the Needle

Recapping the NeedleRecapping the Needle

““Scoop” TechniqueScoop” Technique

Unloading the SyringeUnloading the Syringe

Needle SticksNeedle Sticks

Avoid by capping needle when not in useAvoid by capping needle when not in use

Notify employer Notify employer

Blood samples from pt. and person exposedBlood samples from pt. and person exposed

Health care evaluation - consider Hep B Health care evaluation - consider Hep B vaccination or other prophylactic coverage vaccination or other prophylactic coverage