WREB Anesthesia Board Review Exam Questions with Correct Answers 100% Verified By
Experts| 2025/2026 Latest Update
duration of action of 2% lidocaine 1:50,000 epi pulp: 60 min / soft:180-300 min
intermediate
duration of action of 2% lidocaine 1:100,000 epi pulp: 60 min / soft:180-300 min
intermediate
duration of action of 4% prilocaine plain infiltration: pulp: 10-15 min / soft: 90-120 min
block: pulp: 40-60 min / soft: 120-240 min
short
duration of action of 4% prilocaine 1:200,000 epi pulp: 60-90 min/ soft: 180-480 min
intermediate
duration of action of 3% mepivacaine plain Plain - pulp 20-40 minutes
short
duration of action of 2% mepivacaine 1:20,000 levo pulp 60 minutes / soft: 180 - 300 min
intermediate
duration of action of 4% articaine 1:100,000 epi pulp 60-75 minutes / soft 180 -360 min
intermediate
duration of action of 4% articaine 1:200,000 epi pulp 45-60 minutes / soft 120-300 min
intermediate
,duration of action of 0.5% bupivacaine 1:200,000epi pulp 90-180 minutes / soft 240-540
minutes
which anesthetics would be safest for a patient with cardiovascular disease - any plain
anesthetic
- 1:200,000 epi = 4% articaine or 4% prilocaine (no more than 0.04mg total)
- 1:20,000 levo = 2% mepivacaine (no more than 0.2mg total)
desirable characteristics of local anesthetic drugs Biocompatibility
- Non-irritable
- Nontoxic
- Non-allergenic
- Biotransformable & easily eliminated
- Completely reversible effects
Safety & Efficacy
- Effective in tissues and mucous membranes
- Short onset of action and no residual effects
- Reasonable duration of action
- Adequate potency
- Sterilizable
- Patients remain conscious
Which nerve is anesthetized with the ASA injection? Anterior superior alveolar nerve. And
some terminal branch nerves of the facial nerve. The ASA nerve is the internal terminal branch
of the maxillary division of the trigeminal nerve.
There is a branching off from the infra orbital nerve in the infraorbital canal 6-10mm before the
infraorbital foramen.
,ASA needle path Local anesthetic solution diffuses easily through the bone and anesthetizes
the ASA nerve.
ASA avoids multiple needle penetrations when anesthesia is needed for more than one
maxillary anterior tooth in the same quad.
Which structures are anesthetized by the ASA injection? It anesthetizes the canine lateral
and central teeth, pulp along with the facial tissues of affected teeth.
All upper lip cheek and lower nose.
ASA site of penetration Height of mucobuccal fold: The depression between canine and
lateral (canine fossa)
What is the optimum depth of penetration for the ASA injection? 3-6mm
ASA needle selection 27 or 25 gauge short
ASA volume of anesthetic .9 mL - 1.2 mL (½ - ⅔ of a cartridge)
ASA % of positive aspirations 1%
ASA common reasons for incomplete anesthesia Deposition too far from the target and
inadequate volume of solution are the most common reasons. Others cause inflammation or
injection in the area of deposition and inadequate diffusion of solution.
Cross innervation is also likely!!!
MSA anatomical considerations The MSA nerve separates at varying points from the
infraorbital branch of the maxillary nerve within the infraorbital canal. It supplies sensation to
the dental plexus of the first and second premolars and, in some individuals, the mesiobuccal
root of the maxillary first molar. Studies have reported the absence of an MSA nerve branch in
somewhere between 50% and 72% of individuals. An anatomical variation that can complicate
, MSA nerve blocks is the presence of a large zygomaticoalveolar crest. These excessive bony
processes may obstruct access to the apices of the maxillary second premolars.
MSA field of anesthesia Teeth anesthetized:
Maxillary premolars and mesiobuccal root of first molar
Periodontium/Soft tissues:
Facial to affected teeth
MSA needle pathway The needle advances parallel to the long axis of the second premolar
through thin mucosal tissue to superficial fascia consisting of loose connective tissue,
microvasculature, and nerve endings.
MSA site of penetration The optimum site of penetration is at the height of the mucobuccal
fold over the maxillary second premolar. The deposition site is well above the apex of the
second premolar.
MSA needle selection 27 or 25 gauge short
MSA volume of anesthetic .9 mL - 1.2 mL (½ - ⅔ of a cartridge)
MSA depth of penetration 5-8mm
MSA % of positive aspirations 1%
MSA common reasons for incomplete anesthesia The most common causes of anesthesia
failure for the MSA technique include deposition of solution too far from the target and
inadequate volumes. Other causes include inflammation or infection in the areas of deposition
and inadequate diffusion of solutions, because of anatomic (fascial plane) deflection of solution
away from target sites.
Experts| 2025/2026 Latest Update
duration of action of 2% lidocaine 1:50,000 epi pulp: 60 min / soft:180-300 min
intermediate
duration of action of 2% lidocaine 1:100,000 epi pulp: 60 min / soft:180-300 min
intermediate
duration of action of 4% prilocaine plain infiltration: pulp: 10-15 min / soft: 90-120 min
block: pulp: 40-60 min / soft: 120-240 min
short
duration of action of 4% prilocaine 1:200,000 epi pulp: 60-90 min/ soft: 180-480 min
intermediate
duration of action of 3% mepivacaine plain Plain - pulp 20-40 minutes
short
duration of action of 2% mepivacaine 1:20,000 levo pulp 60 minutes / soft: 180 - 300 min
intermediate
duration of action of 4% articaine 1:100,000 epi pulp 60-75 minutes / soft 180 -360 min
intermediate
duration of action of 4% articaine 1:200,000 epi pulp 45-60 minutes / soft 120-300 min
intermediate
,duration of action of 0.5% bupivacaine 1:200,000epi pulp 90-180 minutes / soft 240-540
minutes
which anesthetics would be safest for a patient with cardiovascular disease - any plain
anesthetic
- 1:200,000 epi = 4% articaine or 4% prilocaine (no more than 0.04mg total)
- 1:20,000 levo = 2% mepivacaine (no more than 0.2mg total)
desirable characteristics of local anesthetic drugs Biocompatibility
- Non-irritable
- Nontoxic
- Non-allergenic
- Biotransformable & easily eliminated
- Completely reversible effects
Safety & Efficacy
- Effective in tissues and mucous membranes
- Short onset of action and no residual effects
- Reasonable duration of action
- Adequate potency
- Sterilizable
- Patients remain conscious
Which nerve is anesthetized with the ASA injection? Anterior superior alveolar nerve. And
some terminal branch nerves of the facial nerve. The ASA nerve is the internal terminal branch
of the maxillary division of the trigeminal nerve.
There is a branching off from the infra orbital nerve in the infraorbital canal 6-10mm before the
infraorbital foramen.
,ASA needle path Local anesthetic solution diffuses easily through the bone and anesthetizes
the ASA nerve.
ASA avoids multiple needle penetrations when anesthesia is needed for more than one
maxillary anterior tooth in the same quad.
Which structures are anesthetized by the ASA injection? It anesthetizes the canine lateral
and central teeth, pulp along with the facial tissues of affected teeth.
All upper lip cheek and lower nose.
ASA site of penetration Height of mucobuccal fold: The depression between canine and
lateral (canine fossa)
What is the optimum depth of penetration for the ASA injection? 3-6mm
ASA needle selection 27 or 25 gauge short
ASA volume of anesthetic .9 mL - 1.2 mL (½ - ⅔ of a cartridge)
ASA % of positive aspirations 1%
ASA common reasons for incomplete anesthesia Deposition too far from the target and
inadequate volume of solution are the most common reasons. Others cause inflammation or
injection in the area of deposition and inadequate diffusion of solution.
Cross innervation is also likely!!!
MSA anatomical considerations The MSA nerve separates at varying points from the
infraorbital branch of the maxillary nerve within the infraorbital canal. It supplies sensation to
the dental plexus of the first and second premolars and, in some individuals, the mesiobuccal
root of the maxillary first molar. Studies have reported the absence of an MSA nerve branch in
somewhere between 50% and 72% of individuals. An anatomical variation that can complicate
, MSA nerve blocks is the presence of a large zygomaticoalveolar crest. These excessive bony
processes may obstruct access to the apices of the maxillary second premolars.
MSA field of anesthesia Teeth anesthetized:
Maxillary premolars and mesiobuccal root of first molar
Periodontium/Soft tissues:
Facial to affected teeth
MSA needle pathway The needle advances parallel to the long axis of the second premolar
through thin mucosal tissue to superficial fascia consisting of loose connective tissue,
microvasculature, and nerve endings.
MSA site of penetration The optimum site of penetration is at the height of the mucobuccal
fold over the maxillary second premolar. The deposition site is well above the apex of the
second premolar.
MSA needle selection 27 or 25 gauge short
MSA volume of anesthetic .9 mL - 1.2 mL (½ - ⅔ of a cartridge)
MSA depth of penetration 5-8mm
MSA % of positive aspirations 1%
MSA common reasons for incomplete anesthesia The most common causes of anesthesia
failure for the MSA technique include deposition of solution too far from the target and
inadequate volumes. Other causes include inflammation or infection in the areas of deposition
and inadequate diffusion of solutions, because of anatomic (fascial plane) deflection of solution
away from target sites.
