The most common type of dental anesthesia. It reliably relieves pain by 100%, so that the patient only has tactile sensitivity. He continues to experience vibration, touch and pressure, which are often perceived as unpleasant by the patient. These unpleasant sensations are intensified if the patient experiences anxiety or nervous tension. Our task in this case is to completely protect the patient not only from pain, but also from discomfort and stress.
There are four methods of local anesthesia in dentistry:
- Application anesthesia: used as an initial treatment for superficial oral anesthesia. Usually it is a gel or spray with an anesthetic: lidocaine or benzocaine.
- Infiltration anesthesia: the drug is injected into the gum with several injections next to the tooth. This is the most common type of pain relief in dentistry. It is used in the treatment of caries, dental pulpitis, surgical operations in dentistry.
- Conductive anesthesia: The drug is injected in the immediate vicinity of the nerve, after which it infiltrates the area around the nerve and the nerve itself. It is usually used in dental surgery for major operations in the lower part of the oral cavity.
- Stem anesthesia: This method involves injecting a drug into the base of the skull to block all branches of the trigeminal nerve. It is used in a hospital setting with increased pain sensitivity of the patient, neuralgia and some other rare cases.
Carpool anesthesia in dentistry
At the Doctor Dent clinic we use so-called carpool anesthetics. Cartridges are disposable drug cartridges that are inserted into a special syringe-injector. Then a needle is put on the syringe, which pierces the carpula with the opposite end. Advantages of carpool anesthetics:
- Fine needle for maximum comfort. We use 0.3 mm carpool needles, while the needle thickness of a conventional disposable syringe is about 0.6 mm. Therefore, the injection into the pre-treated area with the gel does not cause absolutely any pain.
- Complete sterility of treatment due to the tightness of the cartridges with the drug.
- Prolonged action. In addition to the actual anesthetic, carpul may contain an additional vasoconstrictor drug (adrenaline), which significantly increases the duration of the anesthesia.
Drugs used
In the past, traditional lidocaine and novocaine were used for pain relief in dentistry, which can now be found in budget clinics. Doctor Dent uses modern drugs based on much more effective anesthetics: mepivacaine and articaine.
- Ultracaine. Combined preparation for local anesthesia, contains articaine and the vasoconstrictor epinephrine (epinephrine) to prolong anesthesia. Produced by Sanofi Aventis (France). As an anesthetic, ultracaine is 6 times more effective than procaine, and 2 times more effective than lidocaine. Exists various forms release of the drug, both with and without epinephrine. It has a very limited range of contraindications, it can be used in the treatment of children, the elderly, and pregnant women. The specific form of the drug is chosen by the doctor depending on the presence of contraindications in the patient (allergies, cardiovascular diseases, pregnancy in women, etc.)
- Scandonest. A local anesthetic based on mepivacaine, manufactured by the French company Septodont. Does not contain adrenaline and other vasoconstrictor drugs, as well as preservatives. For this reason, it is not used during pregnancy (see below). It is usually used in cases where the patient has serious contraindications to the use of anesthetics with adrenaline.
- Septanest. An analogue of ultracaine, manufactured by Septodont.
Anesthesia during pregnancy
Sedation
Since local anesthesia does not affect the tactile sensitivity and psycho-emotional state of the patient, sedation can be used, if necessary. Sedation increases the pain threshold and calms the patient, but does not lull him to sleep. In the course of treatment, the patient is in a pleasant relaxed state, but remains able to understand and respond to the doctor's requests.
Sedation has practically no contraindications and side effects... It is only necessary to exclude alcohol the day before the visit to the dentist.
Questions and Answers
Which painkillers, listed in the article, are most preferable as anesthesia in dental treatment in case there is a risk of a stroke after the use of local anesthetics? I ask this question because my friends, unfortunately, had such side complications (lethal, half an hour after treatment). Maybe the medicine got burned, maybe the dose was too high, or maybe adrenaline shouldn't be used for such people? For this reason, I am afraid to go to the dentist.
In our clinic, we use the method of individual selection of anesthesia for each patient. To do this, we conduct a thorough survey of the patient about his state of health and, if necessary, involve general practitioners and anesthesiologists. What list of drugs did you mean?
I have to have implants installed, how to prepare for dental implantation?
If the implantation will be performed under local anesthesia, no special preparation is required. The only recommendation is to eat an hour before the procedure. But if the implantation is carried out under sedation, then the anesthesiologist will give you recommendations.
My gums are swollen, and my tooth hurts a lot (or rather a piece of it remains there), what should I do? How will the treatment proceed? What type of anesthesia will be offered to me? Can general anesthesia be applied?
Good day! After a visual examination and X-ray diagnostics, we will be able to determine the methods of treatment for your tooth. Treatment in our clinic takes place under both local and general anesthesia. We ask you not to postpone the treatment of this tooth, so that there is no complication of the situation. We invite you for a consultation at our clinic. You can make an appointment by calling the clinic
I am very much afraid of any pain during dental treatment. During my previous treatments, I was given an injection, and it was terribly painful, and it seemed that the needle was so long. For a long time I did not visit the dentist because of this fear. And now there is a reason. A wisdom tooth began to grow, and because of this, the tooth that was before it began to crumble and collapsed to such an extent that half of it remained. The nerve was exposed. And in general, due to the fact that I have not been to the dentist for a long time, it is necessary to treat many teeth with caries. Tell me, is it possible for you to cure everything under anesthesia? What will be needed for this? How much will it cost?
In our clinic, you can really quickly and efficiently cure all your teeth both under local anesthesia and under anesthesia. We guarantee absolutely painless and safe treatment. We use the latest medical equipment, the most modern medicines. Highly qualified medical personnel will achieve a high result of treatment, both aesthetic and functional. In order to determine what kind of treatment you need and its cost, you need to make an appointment with us for a consultation and diagnosis. The cost of a consultation in our clinic is 500 rubles. We will be glad to see and help you in our clinic.
I am terribly afraid to treat teeth since childhood I have not been to the doctor for 10 years. Now a lot of teeth need to be treated. Any treatment with anesthesia or anesthesia will be absolutely painless for you? And even without that, what will be a little unpleasant?
Yes, indeed, in our clinic we carry out any treatment only with anesthesia. We use two types of anesthesia: general (anesthesia) and local. Before using local anesthesia, we numb the mucous membrane so that you feel comfortable while performing local anesthesia. With any type of anesthesia, people treated in our clinic not only do not experience pain, but also do not feel any unpleasant sensations. We invite you to undergo consultation and treatment in our clinic
What pain reliever is indicated for children with toothache?
Most painkillers are approved for use by children from the age of 12, and up to this age, without a doctor's recommendation, only children's ibuprofen derivatives can be used, and then, in extreme cases.
I am interested in how children are treated for teeth - under local or general anesthesia?
Basically, children receive dental treatment under local anesthesia, but there are cases when sedation or anesthesia is used. But for such procedures, weighty indications are needed: the need to perform long-term manipulations, the psychological state of the child, etc.
On the site I read about a way to relieve fear and pain: sedation in dentistry. Was your site given, but did not find a word about this method? Are you using?
Yes, we use sedation for adults and children, but for this you need to consult with our anesthesiologists and consult with our dentists. We invite you for treatment to our clinic.
There are several types of pain relief in modern dentistry. Recently, in addition to local anesthesia, dentists have suggested using general anesthesia. But how safe and objective is the choice of general pain relief?
Alexander Evgenievich Potapov, Doctor of Medical Sciences of the Moscow State University of Medicine and Dentistry, will help us to understand the peculiarities of treatment with the use of anesthesia.
- What is general anesthesia and what is its main difference from local anesthesia?
Practicing dentist with 15 years of experience, Ph.D. MGMSU A.E. Potapov
Local anesthesia guarantees selective anesthesia of the required sector for a short period, during which the person is awake. With general anesthesia, the effect of drugs occurs on the entire body.
A person is put into a state of sleep for a long time, in which he does not feel pain and tactile influence. This allows you to perform large dental work in one visit.
The drugs used for anesthesia tend to reduce salivation, which has a positive effect on the quality of work. Also on the positive side, general anesthesia does not have a defrosting period.
- In what cases is the use of general anesthesia indicated in dentistry?
In dentistry, such anesthesia has a wide range of indications. It is prescribed for a large amount of work, for example, when it is necessary to remove a group of teeth, and when treating teeth in children.
Anesthesia of a general type, indispensable if the patient has or mental illnesses characterized by increased excitability. Also, general anesthesia is used in case of ineffectiveness of local anesthesia or detection of allergic reactions to pain medications.
If the patient has a pathological manifestation of the gag reflex, then anesthesia is also used for pain relief. The need for anesthesia is determined by the dentist and anesthesiologist.
- Are there any contraindications to the appointment of general anesthesia?
Since anesthesia affects the entire body as a whole, there are, of course, contraindications for its appointment. Anesthesia is contraindicated:
- with acute pathologies of the endocrine system, as well as diseases of the heart and blood vessels;
- with drug and alcohol intoxication;
- if there are deviations in blood counts (low coagulability, severe anemia) and its pathology;
- in the postoperative state;
- with confirmed dystrophy;
- in the post-vaccination period;
- with diseases of the lower and upper respiratory tract;
- at low-grade fever;
- children under 2 years old;
- at low or high pressure;
- with neurological pathologies, for example, epilepsy.
- What types of general anesthesia are used in dentistry?
In dentistry, two types of anesthesia are most often used: intravenous and inhalation or, in another way, mask. With intravenous anesthesia, special drugs or their combinations are injected, which turn off the consciousness and pain reflexes of a person.
For this, drugs such as sombrevin, propofol, hexenal and others are used. This anesthesia takes effect a couple of minutes after administration and lasts about an hour. In case of prolongation of the procedure, it is possible to re-administer anesthetics.
In case of inhalation anesthesia, a special anatomical mask is used for the administration of drugs, which is applied to a part of the patient's face. Through the mask, the patient inhales a gaseous anesthetic mixture, which enters the bloodstream.
For the introduction, fluorothane, methoxyflurane, nitrous oxide, xenon are used. These drugs are used alone or in combination. With the inhalation method, the patient can be put into a state of superficial sleep, being aware of the whole process of treatment, but at the same time without feeling pain.
- What type of general anesthesia is preferable: intravenous or mask?
The use of one or another type of anesthesia is decided individually. Each case requires an objective approach to the choice of anesthesia, because they have their own characteristics.
Intravenous anesthesia quickly puts a person into a state of sleep and is well controlled. Since the use of this type of anesthesia requires vein puncture, it is most often prescribed for adults or children from 10 years old. Intravenous anesthesia begins to act quickly and guarantees full access to the oral cavity.
Mask anesthesia does not require any physical impact and prolongation. That is, the patient sleeps while the mixture enters the lungs. This makes this method convenient for dental treatment in children. preschool age.
But there are some disadvantages of inhalation pain relief: it is designed for short-term dental procedures and the mask limits the working space.
In dentistry, a combination of these methods is most often used. This allows for complete anesthesia and more dental surgeries. In any case, the type of general anesthesia should be selected by the anesthesiologist, but not the patient.
- How safe is the use of general anesthesia? Especially in children?
Modern drugs used for general anesthesia are no more dangerous than drugs for local anesthesia. After them, not a person comes to his senses a maximum of a quarter of an hour after treatment and does not experience drowsiness or any discomfort.
For anesthesia of children, the inhalation anesthetic "Sevoflurane" is most often used. This avoids injections, and hence the psychological discomfort of the child.
Most of the inhaled anesthetic is rapidly eliminated from the body through the lungs. Even in combination with other drugs, anesthetics do not irritate Airways, do not affect the growth of hepatic and renal failure, and do not increase intracranial pressure.
The safety of the use of general anesthesia is influenced by the correct organization of the procedure and the qualifications of doctors. General anesthesia can be performed only by specially licensed dental clinics. For this, a separate equipped office should be allocated.
During treatment, standard monitoring of life-supporting organs should be used, which allows you to control pressure, body temperature, and heart rate. In addition to the dentist, the presence of an anesthesiologist and a resuscitator is mandatory.
The safety of use does not always depend only on specialists. The patient must strictly adhere to all training requirements and communicate all information about his health. This is especially true for young patients.
Parents need to be attentive and inform specialists about all changes in the child's condition. In any case, if anesthesia poses a danger to the patient, then the resuscitator will definitely inform about this and will not allow the procedure.
- What is the preparation for the treatment or extraction of teeth under anesthesia?
Like any other surgical procedure, dental treatment with anesthesia requires a complete examination of the patient and his careful preparation. Before the procedure, a detailed clinical blood test is performed no more than 10 days before the procedure.
The time of blood clotting and the duration of bleeding are determined. If general anesthesia is indicated for a child, then a health certificate is additionally required.
In the case of any pathologies, a certificate with a diagnosis and a list of prescribed medications is required from the specialist in whom the patient is being observed. In addition, the following may be prescribed: X-ray, sugar analysis, ECG and some other examination methods. All methods are determined on an individual basis.
A few days before using general anesthesia, you should stop taking alcohol and exclude heavy and fatty foods from the diet. Food should be taken at least 6 hours before the procedure, and fluid intake should be at least 4 hours.
- How is the treatment done under general anesthesia?
Before using anesthesia, premedication is prescribed, which includes some sedative drugs. It aims to relieve fear and anxiety. Soothing drugs are most often injected intramuscularly, but for children, it is possible to use tablets and mixtures.
After the patient has calmed down, he assumes a lying position on the dental chair. If anesthesia is used in a preschool child with an increased level of anxiety, he should be placed on his lap, where he will be temporarily until the anesthesia works.
If anesthesia is carried out by the inhalation method, then the doctor brings a special anatomical mask to the patient's face, smoothly repeating the part of the face. Through this mask, the anesthetic drug in a gaseous state begins to be delivered.
After a minute, the person begins to fall asleep. During immersion in sleep, most often in children, there is a stage of excitement, in which disorientation and disturbance of the breathing rhythm are observed.
These phenomena quickly disappear, and the child enters a state of deep sleep. The complete phase of pain relief begins.
In the case of intravenous anesthesia, a catheter is inserted into a vein in the elbow or hand through which an anesthetic drug is delivered. The site of catheter insertion is pre-treated with anesthetic gel.
Unlike the inhalation method, intravenous anesthesia does not have a stage of arousal, so deep sleep occurs within 1 minute.
In the deep sleep stage, the dentist performs the necessary procedures, after which the supply of anesthetic is stopped, and the patient returns to his normal state within 15 minutes. The permissible maximum time of anesthesia is 1.5 hours, but most often anesthesia is used for no more than 30 minutes.
After general anesthesia, children may experience some agitation or lethargy, which disappears after an hour.
- What procedures can be performed in 30 minutes of anesthesia?
With high qualifications of specialists and a favorable course of treatment, within 30 minutes of general anesthesia, you can carry out:
- turning from 1 to 5 teeth;
- removal of 1 to 10 teeth;
- formation of carious cavities on 5 crowns, without filling;
- the formation of one affected cavity and its further filling with a light-curing composite;
- depulpation of a single-rooted tooth;
- osteotomy in the area of 5 teeth;
- opening and processing of the abscess;
- curettage of the gingival holes with alveolitis.
- How often can teeth be treated under general anesthesia?
Since all drugs used for general anesthesia are precisely dosed and selected individually, their use has no negative consequences. Therefore, frequent treatment of dental problems under general anesthesia is possible.
To avoid side effects and consequences in the future, it is necessary to undergo a thorough examination before each procedure. Depending on the state of the body, the anesthesiologist prescribes the necessary treatment regimen each time.
- What are the negative consequences of treatment with general anesthesia?
During treatment using general anesthesia, negative consequences such as a sharp increase or decrease in pressure, short-term dizziness, agitation, and nausea may occur.
TO negative consequences Poor-quality treatment can also be attributed to the absence of an X-ray apparatus in the office. Therefore, decide on a procedure with general anesthesia only in specialized clinics with properly equipped rooms.
And, if the dentist, without any reason, only offers you local anesthesia, you should think about visiting another dentist.
- Thank you for taking the time and giving us detailed answers that helped to understand all the intricacies of using general anesthesia in dentistry.
Interviewed Angelina Tkacheva, interviewer for the online magazine "Your Stomatologist".
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A visit to the dentist causes unpleasant associations in many people and a reluctance to go to the clinic. In most cases, this is due to previously experienced pain with insufficient quality treatment.
However, modern medicine has many ways to safely and accurately relieve pain. Local anesthesia, which is now used in dental clinics ah, capable of completely relieve the patient of not only painful, but also unpleasant sensations.
What is the procedure?
By this phrase, doctors call the complete loss of tissue sensitivity to any irritation in a certain area with the help of injection of certain drugs. That is, exactly in the place that will be subjected to medical manipulations, the patient ceases to feel anything, while remaining conscious.
Also, the names "local anesthesia" and "local anesthesia" are quite common. With the help of special drugs that are injected into the body directly in the desired area, the nerve cells there for some time cease to conduct impulses.
Classification
At this stage, all local anesthesia in dentistry is divided into two main types - injection and non-injection. Each of them has several separate specific techniques.
Non-injection local anesthesia
All these methods are united by the fact that there is no need to produce an injection or injection to achieve the result.
- Application method... Also called chemical. Quite often it is used to relieve the oral mucosa. In this case, the drug is applied or simply rubbed into the desired area.
- Physical... It is used very rarely due to its rather weak, superficial action. When using this method, the desired area of tissue is frozen by spraying various substances that have a very low boiling point. By evaporating quickly, they cool the tissues, thereby blocking the nerve endings.
- Physicochemical... Anesthetic is injected into the desired tissue site using electrophoresis. In most cases, this technique is used for neuralgia.
Injection local anesthesia
The techniques listed here show better results than pain relief without injections. Moreover, the effect of painkillers in this case lasts much longer.
That is why doctors prefer injections for local anesthesia in dentistry.
This type of pain relief can be divided into four types, depending on the method and specific site of the injection. It is worth describing each of them in more detail.
Conductor
In this case the medicine must be injected right near the nerve thus, the drug covers by its action the tissues surrounding the nerve and itself. It is most often used by dentists when carrying out complex operations with localization in the lower part of the oral cavity and lower jaw.
The peculiarity of this type is that the nerve needs to be blocked in soft tissues. It turns out to be "locked", therefore impulses from this area do not reach the brain and the patient "does not know" that he is experiencing any sensations.
Infiltration
In this case the injection is made in the area where the projection of the apex of the root of the diseased tooth is located... Several injections can be made from different sides.
After that, the drug gradually spreads through the hole that exists in the plate of the alveolar process, after which it reaches the inner part of the tooth and acts from the inside.
Intra-ligamentous
It also has another name - intraligamentary. Injections are made here from the outside and inside into the ligament of the periodontium through the gum groove... In this case, numbness of the gums from all sides and the tooth itself occurs instantly.
Quite often, this method is used to relieve pain in children. In this case, both the needle itself and the special-sized drug cartridges are used - reduced. This method in adults can be combined with other methods of drug administration.
Intraosseous
The injection is made directly into the bone between two teeth.... This bone has a special structure and is called spongy. So that the injection itself does not cause discomfort or pain, before that, the doctor injects a few drops of an anesthetic directly into the gum.
This method has several features. First, the anesthesia lasts for a fairly short time. Secondly, the numbness affects only the teeth and gum surfaces in the desired area.
At the same time, the lips, tongue and cheeks are fully felt by the patient, which is very important for short-term dental operations - there are no inconveniences after their completion.
Another method of injection anesthesia should be described separately, since in most cases it is used in inpatient treatment if the patient has neuralgia or a low pain threshold, that is, increased sensitivity.
It consists in the fact that with the help of a medicine, all branches of the trigeminal nerve are blocked... To do this, the injection should be made at a special point located at the base of the skull.
Instruments and preparations for
To achieve the desired result from local anesthesia, it is important to choose not only the drug, but also the instruments with which they will be injected.
Tools
The majority of clinics practice carpool anesthesia. For them, the same methods and preparations are used as for other species.
The main difference is that the drug is not enclosed in ampoules, but in separate vials... They are inserted into special injector syringes. When putting on the needle, the capsule is pierced and the drug can be injected.
The advantage of this method is complete guaranteed sterility, since the capsules with the medicine are hermetically sealed. And also a more gentle injection of the drug due to the very small thickness of the needle.
In addition, the carpules (i.e., capsules) may further comprise vasoconstrictor drug(most often adrenaline) so that the effect of the anesthetic is longer.
However, conventional syringes with needles are also used in dentistry. For the most part they are disposable, however, reusable can also be used. The effectiveness of these instruments is less than that of carpool injectors. This is due to some design and size flaws.
For example, conventional syringes have a needle diameter of about 0.7–0.8 mm. The tissues in the mouth are very saturated blood vessels, and when using such needles, hematomas and other unpleasant complications may occur.
Also, during the procedure for recruiting anesthetic from the ampoule, a violation of sterility may occur, which is unacceptable.
Dental local anesthesia preparations
There are several of the most effective and common drugs used in dental practice for local anesthesia.
- Ultracaine... Produced by a French company based on articaine. There are three main forms, which differ in the presence and concentration of an additional vasoconstrictor component - epinephrine. The drug is produced with the markings "D", "DS" and "DS Forte". In the first case, epinephrine and preservatives are not added to it.
- Ubistezin... An analogue of ultracaine, produced in Germany. It has two forms of release with different concentrations of components.
- Septanest... A proven and high-quality anesthetic, but it contains a high concentration of preservatives, so there is a high likelihood of allergies in patients prone to this.
- Scadonest... Produced by Septodont, France. The drug is based on three percent Mepivacaine. Does not contain preservatives and various vasoconstrictor additives. Suitable for patients at risk.
Indications
By and large, indications for local anesthesia in dental practice are almost any intervention that is usually accompanied by pain. They can be submitted as a list.
- Treatment of complex caries.
- Periodontitis.
- Removal of one or more teeth, as well as separate roots.
- Purulent inflammation and similar processes in the jaw bones.
- Inflammatory lesions of the jaw joint.
- Neuralgia, neuritis of the facial nerve.
- The impossibility of performing complex interventions under general anesthesia.
In addition to this list of exclusively dental indications, one can also name the patient's strong fear of any manipulations.
Contraindications
Before the treatment procedure, it is mandatory to interview the patient. The answers are very great importance to select a specific method of pain relief, as well as certain drugs.
Some diseases, in particular, infections previously suffered by the patient, may be contraindications to some types of injection pain relief.
List of contraindications
- Postponed no more than 6 months ago, stroke or heart attack.
- Individual allergy.
- Diseases of the thyroid gland, diabetes mellitus and other diseases of the endocrine system suggest the absence of vasoconstrictor components in the anesthetic.
- If the patient has heart disease and high blood pressure, then it is highly undesirable to use drugs in which the concentration of epinephrine is higher than 1: 200,000.
- Increased allergies or the presence of bronchial asthma require the absence of a preservative in the preparation. Most often it is sodium disulfide.
During pregnancy
The bulk of drugs used for local anesthesia in dentistry cannot cross the placental barrier. It means that they do not enter the child's body and are safe for him.
That is why anesthesia can be done both during pregnancy and during lactation.
During pregnancy, the excessive pain of the mother can damage the baby much more than the drugs used to get rid of the pain. However, the choice of a particular drug is still important, because once again expose the child to danger (even hypothetical) is not worth it.
The only period when the use of such drugs is undesirable is the first trimester of pregnancy.
The safest for women in the "position" are considered Ultracaine DS, as well as Ubistezin. In both of these drugs, the concentration of epinephrine is 1 in 200,000.
Pain relief is an essential part of many dental procedures that involve pain. Today dentistry is a painless and quick treatment.
In conclusion, a video in which a dentist of one of the clinics talks about local anesthesia:
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Previously, the dentists of yesteryear did not really care about the feelings of the patients in the chair.
Today, there are many methods of local anesthesia that allow you to treat teeth of any complexity without pain and fear.
Modern pain relievers make it possible to block discomfort not only for adults, but also for children.
Moreover, they can be administered both by injection and without the use of a needle.
Local anesthesia is the introduction of an anesthetic drug, due to which sensitivity gradually decreases in a specific area that needs dental manipulations. The active ingredients block impulses that nerve endings transmit to the brain.
In this case, the patient remains conscious and does not feel pain even during surgery. The blockage of nerve endings only causes a feeling of numbness in the area into which the drug was injected.
Indications
It is perhaps easier to list the dental procedures that are performed without anesthesia. Local anesthesia is used:
- during the treatment of advanced caries;
- before removing the root system or the tooth as a whole;
- during the periodontitis treatment;
- during therapy inflammatory processes and purulent foci;
- for the treatment of neuritis of the facial nerve;
- if it is impossible to carry out complex operations under general anesthesia.
It is worth noting the patient's personal desire to resort to local anesthesia, even in cases where it is possible to do without it. Pain relief suppresses feelings of fear of discomfort.
Functional features, their positive and negative qualities.
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Contraindications
The drug for local anesthesia should be selected individually for each patient. After all, the active agents of anesthetic compositions, as in other drugs, have certain contraindications.
Therefore, before giving an injection, a professional in his field must make sure that the patient does not have an allergic reaction to any medicinal substances and concomitant diseases.
Local anesthesia is not suitable for patients:
- have had a stroke or heart attack less than six months ago;
- with individual intolerance to pain medications.
Dentists adhere to some restrictions if:
- the patient suffers from diseases of the thyroid gland, diabetes mellitus, which makes it impossible to use drugs containing vasoconstrictor components;
- a history of cardiac pathology or arterial hypertension. In this case, patients are contraindicated for local anesthesia, in which Epinephrine is present in a dosage higher than 1: 200,000;
- bronchial asthmatic needs treatment. The anesthetic drug in this case should not contain sodium disulfide, which is a preservative.
Varieties
You can anesthetize a specific area of the oral cavity by injection or by acting on the nerve endings in a way that does not involve puncturing the periodontal tissues.
Application
This method makes it possible to temporarily anesthetize the area to be treated by surface treatment of the oral mucosa with an ointment or spray. The drug is applied to the tissue by applying a gauze swab to the gum.
Application anesthesia provides an immediate effect. Sometimes, this type of pain relief is used to reduce the discomfort of a future injection.
However, most often, a spray or ointment is used before professional cleaning or opening of abscesses located on the gum surface.
Infiltration
The introduction of the drug is carried out by injection into the upper area at the root of the tooth. In this case, the injection is made both from the lingual (inner) and outer side of the gum.
The introduced composition in this case is distributed in inner cavity tooth gradually.
Experts use this method of anesthesia most often. Dentists use infiltration anesthesia to treat caries, pulpitis and other dental diseases.
For more information on infiltration anesthesia in children, see the video.
Conductor
Pain relief is achieved through the introduction the current composition into the surrounding nerve tissue, due to which pain impulses transmitted to the brain are blocked. Anesthesia spreads not only along the tissues, but also along the length of the nerve itself.
As a rule, in dentistry, the technique is used for manipulations in the lower part of the oral cavity.
Intraligamentary (intra-ligamentous) local
The injection is carried out into the periodontal ligament. The gums are cut on both sides of the mucous membrane.
The difference between intra-ligamentous injection anesthesia lies in the instantaneous action of the drug. Therefore, intraligamentary anesthesia is often used in pediatric dentistry.
It should be noted that the drug is injected both through a needle and a reduced cartridge. For the treatment of diseases of the oral cavity in adults, the technique can be combined with other methods of pain relief.
Intraosseous
Anesthesia is used for short-term dental procedures, since in comparison with other methods of anesthesia, its duration is not long-term.
The injection is carried out into the cancellous bone between two adjacent teeth. The main feature of the technique is that the patient's cheeks and lips do not grow numb. Therefore, at the end of the action of the drug, discomfort and discomfort are absent.
To reduce the sensitivity of the injection, dentists usually perform pre-application anesthesia.
In the video, see how anesthesia is performed using intraosseous anesthesia.
Stem
This method of anesthesia is carried out only in a hospital in the dental department. Anesthesia has the longest duration of action.
In addition, the injection is not carried out in the mouth, but at the base of the skull. Blocking of impulses of nerve endings is performed immediately throughout the lower or upper jaw.
The indications for such strong pain relief are:
- complex surgical interventions;
- facial bone injuries;
- neuralgia;
- unbearable pain syndrome.
For kids
All drugs used in children's local anesthesiology, to one degree or another, harm a small organism. Younger patients are especially sensitive to the effects of pain medications.
Previously, in order to block the impulses of nerve endings, Lidocaine and Novocaine were used. Today, Mepivacaine and Arikaine have the smallest list of side effects.
If we talk about the types of anesthesia used, then mainly application, intraligamentary, infiltration and conduction methods are used in pediatric dentistry.
Note! Due to fears and because of the unformed psyche, during the injection in the dental chair, the child may lose consciousness. You should not write off the reaction of the child's body to the unprofessionalism of a specialist.
Drugs
The following drugs are used in modern dentistry:
- Ultracaine. The drug is produced under three types of labeling: "D", "DS" and "DS Forte". The last two are distinguished by an increased concentration of the vasoconstrictor component - epinephrine. Under the “D” label, the French manufacturer produces a product without preservatives and vasoconstrictor agents.
- Ubistezine. In terms of the composition of active ingredients, the drug is analogous to Ultracaine. The anesthetic is produced in Germany and is available in various dosages of the main components.
- Septanest. Differs in a significant concentration of preservatives. Therefore, its introduction is quite often accompanied by an allergic reaction.
- Scadonest. The drug contains up to 3% Mepivacaine. Vasoconstrictor agents and preservatives in the anesthetic produced in France are completely absent, and therefore the drug is suitable for patients who need composition restrictions.
Possible complications
An ordinary, at first glance, injection can result in a number of unpleasant consequences. Among them are:
- Needle fracture. Despite the fact that the element of the injection device is made of durable metal, with a sharp movement of the patient, part of it may remain in the mucous membrane or periosteum. It is worth noting that the likelihood of removing a small metal fragment without complications is much higher than when removing a part of an element inserted at its entire length.
- Possibility of infection... Modern dentistry has made it possible to reduce the likelihood of this complication to a minimum through the use of disposable syringes. However, numbing the previously infected area of the oral cavity can result in infection of the healthy area due to the pushing of the pathogenic bacteria by the anesthetic.
- Hematoma or bruise. A complication is caused by the ingress of blood vessels into the tissues, which is most often observed with conduction anesthesia.
- Swelling of tissues. A complication arises from individual intolerance to the components of the drug.
- Loss of sensitivity... Sometimes, blocking the transmission of impulses to the brain by nerve endings is delayed for several days or weeks against the background of nerve damage.
- Burning or painful sensations during the administration of the anesthetic. An unpleasant temporary reaction is absolutely safe for the patient's body.
- Chewing muscle spasms or trismus. A complication is the inability to fully open the mouth. The phenomenon occurs due to damage to the muscles or blood vessels located in the infratemporal fossa and, as a rule, disappears without any intervention in 2-3 days.
- Damage to soft tissues. Due to the lack of sensitivity of the tongue and some facial muscles, patients, especially children, may bite their lip or cheek. Therefore, it is recommended to refrain from eating until the complete end of the action of the drug.
At least one day before visiting a specialist, you should refuse to take alcoholic beverages. Ethyl alcohol, which is the main ingredient in these products, reduces the effectiveness of many local anesthetic techniques.
If on the eve of the visit to the dentist there was severe stress, at night it will be useful to take a sedative - Valerian or Afobazol extract.
It is better to wait with dental treatment in case of weakness during ARVI. It is undesirable to carry out dental procedures on the days of menstruation. During this period, increased nervous excitability is observed.
In addition, surgical intervention in " critical days»For patients can result in prolonged bleeding.
Fear of dental treatment or extraction is largely due to the fact that before anesthetic drugs good quality did not have. Today, polyclinics use a new generation of anesthetics. Painkillers in dentistry completely eliminate painful sensations both during the main actions and at the time of their introduction.
Indications for the use of painkillers in dentistry
Anesthesia is required when carrying out the following manipulations:
What painkillers are used in dental treatment?
The best agents for local anesthesia are articaine anesthetics.... The main substance is much more effective than Novocaine and Lidocaine.
An important feature of Articaine is the possibility of its use for purulent inflammation, when the effect of other drugs is reduced. In addition to the main component, modern anesthetics contain vasoconstrictors.
Epinephrine or epinephrine constrict blood vessels, preventing the drug from being washed out of the injection focus. The pain relief time increases.
The drug is an analogue of Ultracaine, their composition is the same. Produced in Germany in two forms, depending on the epinephrine content.
Mepivastezine or Scandonest
Available in two forms, it contains adrenaline, as well as preservatives that can provoke an allergic reaction. The effect after administration of the drug to the patient occurs in 1-3 minutes. Septanest is suitable for use by children from 4 years of age.
It is included in the group of esters of the second generation. It is used less and less, because in terms of effectiveness, it copes with pain 4-5 times worse than other drugs. Novocaine is more often administered for small dental operations.
How do they relieve pain when removing a wisdom tooth?
When removing a wisdom tooth, ester anesthetics or amide anesthetics can be chosen. The action of the former is quick and short-lived. These include Pyromecaine and Novocaine.
Amide ones include:
- trimecaine- injection, relieves pain for 90 minutes;
- lidocaine- valid up to 5 hours;
- bupivacaine- anesthesia better than novocaine 6 times, but it is 7 times more toxic, lasts up to 13 hours;
- ultracaine D-S- the effect is 5 times higher than after the introduction of Novocaine, it lasts 75 minutes, can be used by pregnant women;
The names of modern anesthetics without adrenaline
Non-adrenaline-free pain relievers include:
- Articaine hydrochloride... The leader among other anesthetics. It is produced with epinephrine, without it and with an increased content of a vasoconstrictor;
- Ubistezin... Patients with an allergic reaction, diabetes mellitus, hypertension, bronchial asthma, heart failure and thyroid disease are prescribed a drug labeled "D", without adrenaline;
- Prilokain... It is used without or with little or no vasoconstrictors. Pregnant women, patients with pathologies of the heart, lungs, liver, the drug is not prescribed;
- Trimecaine... Has a calming effect, is not used so often in dentistry;
- Bupivacaine... It is not used for cardiac pathologies, liver diseases;
- Pyromecaine... It has an antiarrhythmic effect, therefore it is recommended to be administered to people with rhythm disturbances.
Pain relief during pregnancy and breastfeeding
The best option for pregnant and lactating mothers is Ultracaine and Ubisiezin carpula in a ratio of 1: 200,000. The vasoconstrictor does not affect the fetus, since it cannot cross the placenta.
Both carpool anesthetics are safe for breastfeeding babies, since the components of the drug do not pass into milk. Scandonest and Mepivastezine without epinephrine are also often used by doctors. They are 2 times more toxic than Novocaine and are absorbed into the bloodstream faster.
What drugs are used in pediatric dentistry?
In children, pain relief takes place in two stages. First of all, the dentist performs application anesthesia, that is, using an aerosol or gel with Lidocaine and Benzocaine, reduces the sensitivity of the mucous membrane, then injects an anesthetic.
In pediatric dentistry, drugs with Articaine are more often used. It is less toxic and quickly excreted from the body.
According to the instructions, these drugs can be administered to children from the age of 4 years. When the molars are removed, an injection of Mepivacaine can be given.
Contraindications and side effects of local anesthesia
The dentist is obliged to ask the patient about possible somatic diseases or allergic reactions to any drugs before starting treatment.
Contraindications to anesthesia can be:
- allergy to the injected drug;
- hormonal disorders in pathologies of the thyroid gland;
- diabetes.
How much does dental anesthesia cost in the clinic?
The cost of anesthesia in dentistry is determined based on the individual prices of the clinics, the equipment used and the experience of the doctors. The average price for an injection is 800-1200 rubles, the application costs from 100 to 1500, the conduction method - from 250 to 4000.
List of the most powerful medicines for toothache
There are 3 types of pain relievers: opiates, analgesics, and non-steroidal drugs. The latter are mainly used in dentistry. They cope well with pain, are not addictive, and you can buy them without a doctor's prescription.
There are many medications for relieving toothache, but 5 of the most effective can be distinguished:
- Ketonal... Based on ketoprofen, it is prescribed after tooth extraction, as an anti-inflammatory therapy after implantation and other interventions;
- Nurofen... On the basis of ibuprofen, it is also used in pediatric dentistry, has practically no side effects;
- Voltaren... Used as an anti-inflammatory therapy for TMJ;
- Nise... Based on nimesulide, relieves swelling and inflammation;
- Nolodotak... Based on flupirtine, relieves acute and chronic pain.
Related Videos
On the use of anesthetic injections in dental treatment in the video:
Anesthesia in dentistry is a necessary procedure that relieves discomfort during tooth treatment. The main thing is to choose the right drug and warn about possible diseases.
Types of anesthesia in dental treatment: what anesthetics and pain relievers are used in dentistry?
Many people are afraid to visit the dentist. The doctor's actions are associated with pain and discomfort. Suffering from toothache, patients postpone the visit to the dentist until a critical moment and often, having no time left, ask the doctor to perform several extensive procedures at once.
Today in dentistry, several anesthesia methods are used for the extraction and treatment of teeth. An experienced specialist knows which drug will relieve pain better. The patient will not feel pain, and the dentist will have the opportunity to carry out dental treatment at the proper level.
Pain relief methods used in dentistry
Anesthesia during tooth extraction and other dental procedures involves a decrease or complete loss of sensitivity in certain areas of the oral cavity. It is possible to anesthetize the site of surgical intervention due to the use of pharmaceuticals that interrupt the transmission of pain impulses coming from the sources of pain to the brain.
So, it is almost impossible to carry out high-quality treatment of wisdom teeth without anesthesia - therapeutic and surgical actions performed by a doctor will be accompanied by severe pain... That is why all modern dental clinics treat teeth using various types of pain relief.
General anesthesia
Under general anesthesia, the patient falls into a deep sleep, his consciousness is turned off. With this method of anesthesia, narcotic drugs are administered intravenously or by inhalation. During dental treatment, the patient's condition is monitored by an anesthesiologist-resuscitator.
When a person is under general anesthesia, on the one hand, it is easier for a dentist to carry out dental treatment, in particular, a wisdom tooth. But on the other hand, the doctor constantly needs to adapt to the patient, since he is immobilized and cannot fix his head in correct position and open your mouth wider. As a rule, with this type of anesthesia, a person after waking up does not remember what happened to him during the operation.
It is advisable to use this type of anesthesia in the case of:
- complex surgical operation;
- pathological fear of a dental procedure;
- allergies to local anesthetics.
In many cases, general anesthesia is contraindicated for dental procedures. Before the patient is put into a state of anesthesia, he needs to donate blood for analysis and undergo an ECG in order to exclude heart pathologies.
Shortly before the dental surgery, the patient should stop smoking and alcohol. A few hours before immersion in anesthesia, the patient should not eat.
Local anesthesia
Local anesthesia is the safest. The person is conscious, the drug used has an effect only on the peripheral nervous system.
With the introduction of carpool (strictly dosed) anesthesia, the patient begins to feel numbness of the gums, tongue and lips. There are frequent cases when, with an incorrectly calculated dose of the drug, patients complained that the anesthesia was not working. With the advent of carpules (anesthetic ampoules), this problem disappeared. After cleavage of the analgesic, its action ceases, sensitivity is restored.
Preparations for general anesthesia
Is anesthesia harmful when removing wisdom teeth? Under the influence of drugs, a person does not feel pain, but at the same time his body is exposed to serious stress. First of all, the brain suffers, anesthesia affects the conducting system of the heart, the components of the anesthetic can cause allergic reactions. That is why during the operation there is an anesthesiologist next to the patient, who has all the necessary resuscitation equipment at his disposal.
In dentistry, only intravenous general anesthesia is performed using drugs called Ketamine, Propofol, Thiopental sodium, etc., which have a hypnotic, sedative and muscle-relaxant effect. A person can be immersed in a state of deep sleep with the help of nitrous oxide inhaled through a mask.
Types of anesthetics for local anesthesia
To date, the strongest anesthetics of the articaine series are considered the best anesthesia used in dentistry for local anesthesia. The main component of the pain reliever is several times more effective than Lidocaine and Novocaine.
A distinctive feature of Articaine is the possibility of using it for purulent inflammation, when the activity of other drugs decreases. Many patients in such cases do not understand why the anesthetic does not work. In addition to the main component of Articaine, modern preparations contain vasoconstrictors. Due to adrenaline or epinophrine, the vessels narrow, preventing the drug from being washed out of the injection focus. The strength of anesthesia and the duration of action of the intraseptal anesthetic increase.
Ubistezin is an analogue of Ultracaine, the composition of the two drugs is identical. The manufacturing company is registered in Germany. The anesthetic comes in two forms, depending on the concentration of epinephrine: Ubistezin or Ubistezin forte.
Mepivastezine or Scandonest
It is not recommended for hypertensive patients to use anesthetics with vasoconstrictor components; at high pressure, it is worth choosing drugs without adrenaline and epinephrine in the composition. Mepivastezine (produced in Germany) and its full analogue Scandonest (France) are prescribed to patients at risk.
These pharmaceuticals do not contain vasoconstrictors, so they are used to relieve pain in children, pregnant women and patients with bronchial asthma. Also, Mepivastezin and Scandonest are prescribed to patients with adrenaline intolerance.
Dentists have been successfully using Septanest anesthesia for several years. The anesthetic is presented in two forms, each of which differs in the content of adrenaline in the composition. Unlike Ultracaine and its analogues, Septanest contains preservatives, which, according to the instructions for use, can provoke allergic reactions.
After the drug is administered to the patient, the anesthetic effect occurs in 1-3 minutes. Anesthesia works for 45 minutes. As a local anesthetic, Septanest can be used by children from 4 years of age.
Novocaine belongs to the group of second generation esters. The drug with moderate anesthetic activity is inferior in effectiveness to the anesthetics of the articaine and mepivacaine series. It is used less and less, since modern pain relievers are 4-5 times better able to cope with pain during tooth extraction. Novocaine is used for small dental operations and in the treatment of pain syndromes.
Other types of anesthetics
Going to an appointment with a surgeon to extract a tooth, many people think about what anesthesia are? According to their chemical properties, anesthetics are divided into two groups: substituted amides and esters. There are short, medium and long acting drugs. Also, anesthesia in dentistry has its own classification:
- superficial;
- conductor;
- infiltration.
Lidocaine has a deep analgesic effect, but it copes with toothache worse than other intraseptal anesthetics. If we compare it with Novocaine, which is widely used in public hospitals, then the choice of dentists is likely to focus on Lidocaine.
What drugs are allowed during pregnancy?
The best option for pregnant women and nursing mothers is Carpul Ultracaine or Ubistezine with epinephrine at a concentration of 1: 200,000. The vasoconstrictor does not affect the fetus, since it cannot penetrate the placenta. Studies have proven the safety of these carpool anesthetics in relation to children who are on breastfeeding- their components do not pass into breast milk.
During pregnancy, you do not need to refuse an injection with vasoconstrictors. However, in their practice, doctors use Scandonest and Mepivastezin without epinephrine in the composition for anesthesia of women during pregnancy. These drugs are twice as toxic as Novocaine and are absorbed into the blood faster.
The use of anesthesia in children
What anesthesia is used in pediatric dentistry? Dentists treat children in two stages. Initially, application anesthesia is carried out, when the doctor, using an aerosol or a special gel with lidocaine or benzocaine, deprives the sensitivity of the mucosal area, where the anesthetic will be injected later. Also, this type of pain relief is used for intraosseous anesthesia.
Children are injected with drugs with Articaine as the main component. It is less toxic and quickly excreted from the body. According to the instructions for use, such drugs can be used to anesthetize children over 4 years old. Also, when removing molars, an injection of Mepivacaine is often given. In pediatric dental practice, a table with the weight and the maximum allowable dose of the administered anesthetic is often used.
Types of modern methods of anesthesia in dentistry, drugs for pain relief
The fears associated with pain during dental treatment and extraction are due to the fact that there were no high-quality anesthetic drugs before. But today, almost all dentistry clinics use new generation local anesthetics. Modern drugs allow you to completely eliminate pain, not only during the main operation, but even at the time of their introduction.
Anesthesiology in dentistry
Anesthesia is the absolute disappearance or partial loss of sensitivity in the whole body or in some parts of it. This effect is achieved by introducing special drugs into the patient's body that block the transmission of a pain impulse from the area of intervention to the brain.
Types of pain relief in dentistry
According to the principle of influence on the psyche, there are two main types of anesthesia:
- Local anesthesia, in which the patient is awake, and loss of sensitivity occurs exclusively in the field of future medical procedures.
- General anesthesia (general anesthesia). During the operation, the patient is unconscious, the whole body is anesthetized and the skeletal muscles relax.
Depending on the method of supplying the anesthetic to the body in dentistry, injection and non-injection anesthesia are distinguished. With the injection method, the anesthetic drug is injected through an injection. It can be injected intravenously, into the soft tissues of the mouth, bone, or periosteum. In non-injection anesthesia, the anesthetic is delivered by inhalation or applied to the mucosal surface.
General anesthesia in dentistry
General anesthesia is a complete loss of sensitivity of nerve fibers, accompanied by impaired consciousness. In dentistry, anesthesia for dental treatment is used less often than local anesthesia. This is due not only to the small area of the operating field, but also to the large number of contraindications and possible complications.
General anesthesia should only be used in dental clinics that have an anesthesiologist and resuscitation equipment, which may be required in case of emergency resuscitation.
General anesthesia in dentistry is necessary only for long-term complex maxillofacial operations - correction of the cleft palate, multiple implantation, surgery after injury. Other indications for the use of general anesthesia:
- allergic reactions to local anesthetics;
- mental illness;
- panic fear of manipulation in the oral cavity.
Contraindications:
- respiratory system diseases;
- pathology of the cardiovascular system;
- intolerance to anesthetic drugs.
The anesthetic can be delivered by injection or inhalation. The most popular drug for inhalation general anesthesia among dentists is nitrous oxide, also known as laughing gas. With the help of an intravenous injection, the patient is immersed in a drug-induced sleep, for this purpose drugs are used that have a hypnotic, analgesic, muscle-relaxant and sedative effect. The most common are:
- Ketamine.
- Propanidide.
- Hexenal.
- Sodium oxybutyrate.
Local anesthesia in dentistry
In dental treatment, local anesthesia is most in demand, aimed at blocking nerve impulses from the area of the operating field. Local anesthetics have an analgesic effect that prevents the patient from experiencing pain but retains touch and temperature sensitivity.
The duration of anesthesia depends on the way and with what exactly dentists anesthetize the operating field. The maximum effect lasts for two hours.
Local anesthesia is used for the following manipulations:
- turning under a bridge or crown;
- pin augmentation of teeth;
- implantation of implants;
- canal cleaning;
- surgical treatment of the gums;
- removal of carious tissues;
- extraction of teeth;
- excision of the hood over the wisdom tooth.
Types and methods of local anesthesia in dentistry
Depending on what area and for how long it is necessary to deprive the patient of sensitivity, the dentist selects the optimal technology, medicine and its concentration. The main methods of administering anesthetic are:
- infiltration;
- intraligamentary;
- stem;
- intraosseous;
- application.
Infiltration method
Used in dental practice and maxillofacial surgery. The advantage of the method is fast action, long-term analgesic effect, the possibility of repeated administration during prolonged surgery, rapid removal of the anesthetic from the body, deep analgesia of a large area of tissues. About eighty percent of dental procedures are performed under infiltration anesthesia.
The method is used with the following manipulations:
Anesthetic medicine is injected in layers, first under the mucous membrane at the apex of the tooth root, and then into deeper layers. The patient feels discomfort only at the first injection, the rest are absolutely painless.
There are two types of infiltration dental anesthesia - direct and diffuse. In the first case, the site of administration of the anesthetic is anesthetized directly, in the second, the analgesic effect extends to the nearest tissue sites.
For local infiltration anesthesia in dentistry, the following drugs are used:
Intraligamentary (intra-ligamentous) method
It is a modern type of infiltration pain relief. The dose of injected anesthetic is minimal (does not exceed 0.06 ml), which makes it possible to treat and remove teeth in pregnant and lactating women.
The anesthetic is injected into the periodontal space using a special syringe and under high pressure. The number of injections depends on the number of roots in the tooth. The sensitivity to pain disappears instantly without causing a feeling of numbness, so the patient can speak freely and does not experience any discomfort after surgery.
The limitations to using the method are:
- The duration of the manipulation is more than 30 minutes.
- Canine manipulation. Due to anatomical features, it is not always possible to anesthetize them intra-ligamentously.
- Inflammatory processes in the periodontium, periodontal pocket, flux.
- Basal cyst of the tooth.
The intra-ligamentous method of anesthesia is the most painless and safest in dentistry, therefore it is often used in pediatric practice. Ease of implementation, painlessness, safety and high efficiency make the method popular among dentists. The cost of such a procedure is higher than that of infiltration, due to the high prices for injectors.
For intra-ligamentous anesthesia in dental treatment, the following drugs are used:
Stem (conductive) method
Distinctive features of the stem anesthesia method are the power and long duration of the effect. It is used when carrying out long-term surgical operations and in situations where you need to block the sensitivity in the tissue of the entire lower or upper jaw.
Indications for conduction anesthesia are:
- high intensity pain syndrome;
- neuralgia;
- removal of cystic formations;
- endodontic treatment;
- severe injuries to the jaw and zygomatic bone;
- curettage;
- complex tooth extraction.
The injection is injected into the region of the base of the skull, due to which it is possible to block two jaw nerves at once - both the upper and the lower. An injection is performed by an anesthesiologist and exclusively in a hospital.
Unlike all other methods of local anesthesia, the stem does not affect the nerve endings, but completely on the nerve or group of nerves. The time of the anesthetic effect is one and a half to two hours. The basic drugs are Novocaine and Lidocaine, more effective means are used in modern anesthesiology.
Application method (surface, terminal)
It is used mainly in pediatric dental practice to desensitize the place where the injection of the anesthetic will be made, which ensures the absolute absence of pain. As an independent method, it is used in cases where it is necessary:
For application anesthesia in dentistry, pain relievers are used in the form of a spray, ointment, paste and gel. Most often, dentists use ten percent Lidocaine in an aerosol as an analgesic. The drug penetrates 1–3 mm deep into tissues and blocks nerve endings. The effect lasts from a few minutes to half an hour.
Intraosseous (spongy) method
It is used to anesthetize the lower molars, during the extirpation of which infiltration and conduction anesthesia are ineffective. Instantly removes the sensitivity of one tooth and the adjacent gum area. The advantage of the method in the field of dentistry is strong pain relief with low doses of the drug.
Classical intraosseous anesthesia has not been widely used in anesthesiology, due to the complexity of implementation and trauma.
The essence of the method lies in the introduction of anesthetic into the spongy layer of the jawbone between the roots of the teeth. Infiltration anesthesia is preliminarily performed. After numbness of the gums, the mucosa is dissected and the cortical bone plate is trepanned using a drill. The boron is buried into the spongy tissue of the interdental septum by 2 mm, after which a needle with an anesthetic is inserted into the formed canal.
Contraindications to local anesthesia
Before prescribing local anesthesia to a patient, the dentist must find out if there are any contraindications to its implementation. The doctor should take special precautions when prescribing anesthesia for children and expectant mothers.
Contraindications to local anesthesia are:
- a history of allergic reactions to drugs;
- diseases of the cardiovascular system;
- suffered less than six months ago a stroke or heart attack;
- diabetes;
- hormonal disorders and pathologies of the endocrine system.
Modern anesthetics (pain relievers) in dentistry
With the advent of local anesthetics and new generation technologies, the usual Novocaine is almost never used in the field of dentistry, especially in Moscow and others. large cities... In spite of possible complications and a high percentage of allergic reactions, lidocaine remains the main local anesthetic in regional polyclinics.
When visiting the clinic, you must provide the attending physician with a complete and reliable history so that he can eliminate all risks and choose the right drug. Most dental clinics use carpool technology for injecting anesthetics, which means that the active substance is contained in a special disposable cartridge, which, without manually opening it, is inserted into a syringe. The dose of the drug in the cartridge is designed for one injection.
The drugs Articaine and Mepivacaine form the basis of modern means for local anesthesia. In the form of carpool capsules, Articaine is produced under the names Ultracaine, Septanest and Ubistezine. The effectiveness of drugs based on it exceeds the effectiveness of lidocaine by 2 times, and novocaine by 5-6 times.
In addition to Articaine itself, the carpule contains adrenaline (epinephrine) and an auxiliary substance that promotes vasoconstriction. Due to vasoconstriction, the period of action of the anesthetic is prolonged, and the rate of its spread into the general bloodstream is reduced.
Patients with endocrine disorders, bronchial asthma and a tendency to allergic reactions in dentistry are usually prescribed anesthetics without adrenaline. If powerful pain relief is required, it is permissible to use Ultracaine D with a minimum concentration of epinephrine.
Anesthesia without adrenaline in dentistry
For the treatment of patients with contraindications to adrenaline in dentistry, mepivacaine is used. Drug with this active ingredient, marketed under the name Scandonest, is less effective than Articaine. But it does not include epinephrine, so Scandonest is suitable for administration to children, women in position, people with heart disease, individual adrenaline intolerance.
For diseases of the endocrine system, Scandonest and drugs without adrenaline are often used. It is unacceptable to use drugs with vasoconstrictor components in hypertension.
Not only the degree of painlessness of medical intervention depends on what kind of anesthesia dentists use, but also the list of consequences that will have to be faced after the operation. Modern means minimize the risks associated with incorrect administration of the drug, incorrect dosage and the occurrence of allergic reactions to the anesthetic.