A- Course Description:
This course is a series of
weekly lectures extending over two semesters and formed of two parts.
Local anaesthesia: which covers patient assessment and his suitability
for local anaesthesia and surgery, pain control, neuro-anatomy of the oral
cavity and peri-oral tissue, neuro-physiology, pharmacokinetics of the drugs
used in local anaesthesia and any local or systematic complications which may
occur, and how to avoid and how to manage.
Exodontia [teeth extraction]: which covers sterilization, control of
infection, the different methods for extraction [intra-alveolar and
trans-alveolar], the used instruments [forceps and elevators], suture types and
Also, it covers indications
and contra-indications for teeth extraction, post-operative instructions and
follow-up. Lastly, complications which may occur during or after extraction and
surgery, how to reduce and manage.
B- Course Objectives:
The student should be able to:
Learn the art of assessing patients and their suitability for all minor
procedures, by taking systematic history, including detailed medical history,
thorough physical examination and the proper use of investigations.
Study and learn the applied surgical anatomy of the area and
Appreciate and understand the physiology of pain and pain conduction
in order to
understand the mechanism of action of anaesthetic agents.
4. Understand the pharmacokinetics and the mode of action of the various
local anaesthetic agents, the techniques employed to block nerve conduction and
produce anaesthesia. The student, also, should study the possible complications,
their aetiology, signs an symptoms, prevention and their management.
5. Study and learn the methods and techniques employed to institute
infection control measures, sterilization, asepsis and disinfection.
6. Learn about the indications and contraindications for extraction of
teeth, study the different techniques and the methods used to perform teeth
7. Learn about the intra-alveolar technique and the principles of
forceps and elevators use.
8. Study the indications for trans-alveolar technique, the designing of
flaps, the methods employed for bone removal and the different types of suture
9. Understand and give post-operative instructions and medications when
10. Recognise and manage the different complications encountered during
extraction of teeth or immediately following the extraction.
C - Lecture topics in details [contents]
Introduction: Definition of pain, pain control, pain perception
pain reaction and pain threshold.
2- Patient Evaluation: The art and science of history taking to assess
systemic condition of the patient prior to receiving local anaesthesia,
extraction of teeth and minor oral surgery.
3- Assessment of the local and systemic contra-indications prior to
extraction, learn the essential and routine investigations for patient
preparation e.g. radiographs.
4- Neuro-anatomy: The Trigeminal nerve and its
branches supplying the teeth and their tissues.
5- Neuro-physiology I: Nerve pathways, types of nerves, and pain
theories particularly Gate Control theory.
6- Neuro-physiology II: Membrane and electrical
action potential and ionic properties and spread of impulses.
7- Pharmacology I: Composition & requirement of local anaesthetic
solution, classification and pharmacology of local anaesthesia drugs, and the
mechanism of action. Commonly used agents e.g. Procaine, Lignocaine, and
Pharmacology II: types and function of vasoconstrictors used with local
anaesthesia, Adrenaline, Noradrenaline and Felypressin.
Instruments for local anaesthesia:
syringe: Types, side and breech-loading metal syringes.
needles: parts, design and gauge.
parts and types.
Topical, Infiltration and Regional nerve block techniques:
a. Local Anaesthetic techniques
used in the maxilla:
Methods of infiltration: Submucosal,
Supraperiosteal, Subperiosteal, Intra-osseous, Intraligmental and intrapulpal.
Nerve Block: Infraorbital, posterior superior alveolar and maxillary
b. Local anaesthetic in the mandible:
Methods of Inferior Alveolar Nerve Block: Direct, Gow-Gates &
Mental Nerve block and infiltration in the anterior region.
11- Complications of local anaesthetics I: Local complications: Failure,
pain haematoma, trismus, paralysis, broken needles.
12- Complications of local anaesthesia II: Systematic complication:
Syncope, fainting toxicity, hypersensitivity reaction, drug interaction.
Forceps, Parts and types
Elevators, Parts and types.
Intra-alveolar technique I: Principles of forceps extraction.
Position of the patient and the dentist. The use of the left hand.
The use of forceps to move teeth in the upper and lower jaws.
Intra-alveolar technique II:
Principle of elevators use.
Wedge, Lever and Fulcrum and Wheel and Axle.
Indications for their uses.
design, classification and requirement of muco-
Trans-alveolar Technique II:
Principle of bone removal: burs, chisels, Rongeur.
Tooth division, sutures: Types and techniques
18- Postoperative instructions and therapeutics:
and instructions concerning mouth wash, the use of cold and hot applications.
Prescribing analgesics, antibiotics and anti-inflammatory drugs.
Indications and contra-indications for teeth extraction.
20- Complications of Exodontia I:
crown, roots, alveolar process and mandible.
of teeth or roots into the antrum, inferior alveolar canal, the
ptyregomandibular space and the infratemporal fossa: causes & management.
the TMJ: causes and management.
21- Complications of Exodontia II:
Haemorrhage: types, causes and management.
Nerve affection: Types, classification and management
22- Complications of
Infection, dry socket: causes, predisposing factors,
clinical manifestation and management
E- Grades Distribution
Type of Evaluation Grades
Continuous Assessment Written
Continuous Assessment Written
F- Required text books:
Handbook of Local Anesthesiaby
Stanley F. Malamed
Extraction: A Practical Guide
By Paul Robinson
Contemporary Oral and
By Peterson, Ellis, Hupp, Tucker. 4 edition (2003).