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The Cartridge
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Components of the CartridgeThe 1.8 ml dental cartridge consists of four parts:
1) Cylindrical glass tube2) Stopper (Plunger, Bung)
3) Aluminum Cap4) Diaphragm
Carpule = registered trade name for the dental cartridge introduced by Cooke-Waite laboratories
in 1920
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-Rubber stopper should be lightly indented
-Flush or extruded stoppers: don’t use
-Aluminum cap holds the diaphragm in position
-Diaphragm is latex rubber through which the needlepenetrates the cartridge (no allergies ever reported)
Parts of the Cartridge
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-Liquid can diffuse through the diaphragm and contaminate the local anesthetic solution
(alcohol common culprit)
-Mylar plastic label surrounds glass with content information and color coded band to
identify the anesthetic
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Composition of Local Anesthetic Cartridge
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What is in the Cartridge?-Local Anesthetic: provides anesthesia; resists heat
-Sodium Chloride: produces isotonicity with body tissue
-Sterile Water: provides volume only
-Vasopressor: increases safety, duration and depth of anesthetic
-Sodium (meta) Bisulfite: antioxidant (preservative)
-Methylparaben: bacteriostatic agent and antioxidant-only found in multi-dose drugs, ointments, creams
-bacteriostatic, fungistatic and antioxidant-removed due to single use and paraben allergies
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Care and Handling-local anesthetic drug is stable and can be sterilized, heated, autoclaved, or boiled
without being broken down
-problem is that the diaphragm and vasopressor is heat labile and can easily be broken
down, so cartridges should not be autoclaved
-“blister packs” should be stored at room temperature and in the dark
-bacterial cultures taken off newly opened “blister packs” produce no bacterial growth
when cultured
-cartridges are ready to be used when removed from the package there is no need to
rub the diaphragm with alcohol
-cartridges should not be permitted to soak in alcohol or other sterilizing solutions
because the diaphragm will allow diffusion
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Cartridge Warmers-cartridge warmers are not necessary; the patient cannot
discern between warmed and room temperature local anesthetic
-patients do not complain of the local anesthetic solution feeling cold upon injection
-local anesthetics that are warmed too much, i.e., > 80 F will be described as too hot or burning upon injection
-local anesthetic warmers are deceptive if they claim that the injection will be less painful if the anesthetic is warmed
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ProblemsBubble In The Cartridge: 1-2 mm bubble can be found in the
cartridge which is nitrogen gas that is inserted into the cartridge when it is sealed to keep oxygen out; avoids oxygen oxidizing the vasopressor
Extruded Stopper: liquid was frozen at some point leading to extrusion sterile environment of the solution can no longer be guaranteed; it only takes one day for alcohol to diffuse through the diaphragm; alcohol is neurolytic and can cause extended lengths of parasthesia; do not soak cartridges in alcohol
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Burning On Injection
1) Normal response to the pH of the drug
2) Cartridge contains sterilizing solution
3) Overheated cartridge (local anesthetic warmer)
4) Cartridge containing a vasopressor (decreased pH)
5) Vasopressor decreases the pH from 5.5 (plain) to 3.3 – 4.0
6) Sodium Bisulfite Sodium Bisulfate (much more acidic)
7) -ite -ate occurs by oxidation after local anesthetic expiration
-with the addition of silicone as a lubricant around the stopper instead of paraffin this is not a problem anymore
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Cracked Cartridge Glass
-there is no need to hit the thumb ring with excessive
force when engaging the stopper with the harpoon
-controlled pressure with the palm of the hand will
provide adequate engagement
-some have a tendency to engage the harpoon too aggressively which is a bad habit that leads to
cracked glass cartridges
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Additional Armamentarium
1) Topical Antiseptic: betadine or thimerosal; 8% of Dentists use it and is considered optional; eliminates
post-injection infections
2) Topical Anesthetic: disguises the initial introduction of the needle into the tissues when applied for a minimum of 1 minute; if left for 2 to 3 minutes, profound topical
anesthesia is achieved; studies have shown that less than 10 seconds does not provide any more anesthesia than
placebo
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ReferencesMalamed, Stanley: Handbook of Local Anesthesia. 5th Edition. Mosby.
2004