home Auditorium 8 Painkillers in dentistry. Methods of pain relief in dental treatment - the pros and cons of each type of anesthesia in dentistry Modern painkillers in dentistry

Painkillers in dentistry. Methods of pain relief in dental treatment - the pros and cons of each type of anesthesia in dentistry Modern painkillers in dentistry

Local anesthetics in dentistry are a group of compounds that can cause a reversible blockade of the conduction of nerve impulses in a specific area of the body. The mechanism of action of these drugs is based on the direct blockade of specific lithium-sodium channels in the nerve membrane, which leads to a decrease in the amplitude and growth rate of the action potential, an increase in the threshold of excitability and the refractive period, up to the complete abolition of excitability. The strength, speed and duration of action, as well as toxic properties, depend mainly on the physicochemical characteristics of the substances, as well as the dose, injection site, alkalization of the solution or the addition of vasoconstrictors. Now let's figure out what anesthetics are used in dentistry.

The history of the discovery of local anesthetics is quite interesting, check out the classification of local anesthetics by generation below.

The first people who discovered local anesthesia were the inhabitants of Peru. They learned that coca leaves cause numbness in the oral mucosa. Until the second half of the 19th century, research on this effect was carried out in Europe. This led to the first eye surgery under local anesthesia in Vienna in 1884. Anesthesia was achieved using cocaine. Since this initial successful trial, cocaine has been increasingly prescribed as a local anesthetic. Exactly cocaine is a first generation anesthetic. Cocaine's disadvantages soon became apparent. Toxicity, short-term effects and addiction are a big problem that developed after taking cocaine, but we should not forget that it was highly regarded in its time as the first effective anesthetic.

However, there is a need to find alternatives to cocaine as a local anesthetic due to the negative side effects of use. And such an alternative appeared in 1905 in the form of procaine. It was sold under the trade name Novocaine and remained the most important local anesthetic until the 1940s. Novocaine is an ether and local anesthetic of the second generation, which is chemically related to cocaine, has similar characteristics but without significant toxicity, with a longer lasting effect and without addiction problems. Novocaine is a substance that breaks down into crumbs and thereby leads to the formation of certain products that can cause an allergic reaction. This is just one of the disadvantages of ester-type local anesthetics.

The issue of hypersensitivity reactions with ester anesthetics contributed to the decline in their popularity, which stimulated the search for new substances that would not cause allergic reactions.

A new substance, lidocaine, was first synthesized in 1943, and entered the market in 1947 under the name Xylocaine. This was the first amide that decomposed in the liver, and not in the blood, like ethers. Breaking down such substances in the liver rather than in the bloodstream is beneficial because the byproducts that are formed will not cause allergic reactions. Lidocaine is a third generation anesthetic, is usually well tolerated by patients, it is mildly toxic, has a fairly long-lasting effect and is not addictive. The only downside to lidocaine is that it is slow to take effect.

Lidocaine soon became widely used in dental practice. However, this continued until prilocaine was synthesized in the late 1950s. Prilocaine is a fourth generation anesthetic, it has a weak anesthetic effect, but at the same time has minimal toxicity. Prilocaine is sold under the brand name Cytonest.

In 1976, Ultracaine was developed, which began to be sold under the brand name of the same name (Ultracaine), and then under the name Septanest - by the French pharmaceutical company Septodont. Soon Ultracaine and Septanest were used by virtually every third dentist in the world and captured 40-45% of the European market. Exactly Ultracaine can be considered the latest generation anesthetic.

However, a little later Scandonest was synthesized, which also found approval in dental practice. The active ingredient in Scandotest™ is scandicaine (carbocaine, mepivacaine). Mepivacaine was originally used in regional anesthesia (epidural anesthesia) as a local anesthetic that has no negative side effects. This substance does not contain vasoconstrictors, which means it does not require preservatives, which often cause the development of allergic reactions.

Requirements for local anesthetics

To be used effectively, an anesthetic must present certain functional properties:

Do not irritate tissue at the injection site or damage nerves
Have low systemic toxicity
Create anesthesia as soon as possible before surgery.

Classification of local anesthetics

Patients are often unaware that there are several types of anesthetics available on the market and that each has its own advantages and disadvantages. Quite often, the doctor will use only a few anesthetics, so the patient does not have much choice. It should be noted that the younger generation of dentists is generally much more open to the topic of anesthetics than the older generation.

Chemical classification of local anesthetics

The ether structure is at the top of the image and the amide structure is at the bottom.

The molecular structure of an ether can be very easily destroyed; the same cannot be said about amide molecules! Esters are very unstable in solutions; it is for this reason that they cannot be stored for as long as amides. Absolutely all amides are heat-stable and can withstand the autoclaving process, which will cause the ester molecules to simply disintegrate. The esters contain aminobenzoic acid, which very often provokes allergic reactions. In turn, amides cause such reactions quite rarely, which is why they are widely used in dentistry. Especially often seen in the dentist's arsenal latest generation anesthetics.

A typical anesthetic molecule consists of a lipophilic group (benzene ring) and a hydrophilic group (tertiary amine), which is separated from the intermediate chain. Lipophilic groups are required for the passage of the molecule through the membranes of nerve cells.

The classification of local anesthetics by duration of action should be on the note of every practicing dentist! The duration of bupivacaine is 90+ minutes, the soft tissue numbness will subside in 240-720 minutes. The long duration of action increases the likelihood of self-injury to soft tissue in the postoperative period and, therefore, the use of bupivacaine is not recommended in pediatric patients and patients with special needs.

Maximum doses of local anesthetics
The table shows the maximum recommended doses of local anesthetics according to the American Academy of Pediatric Dentistry (AAPD)

Anesthetic	Maximum dosage		Maximum total dose	mg/1.7 ml in carpool
Anesthetic	mg/kg	mg/kg	Maximum total dose	mg/1.7 ml in carpool
Lidocaine 2% 1:000,000 epinephrine	4.4	2.0	300 mg	34 mg
Mepivacaine 3% plain	4.4	2.0	300 mg	51 mg
Articaine 4% 1:100,000 epinephrine	7.0	3.2	500 mg	68 mg
Prilocaine 4% regular	8.0	3.6	600 mg	68 mg
Bupivacaine 0.5% 1:200,000 epinephrine	1.3	0.6	90 mg	8.5 mg

Dosage of local anesthetic for children up to 11 years old.

Maximum quantity 1.7 ml (cartridge)
Age	Kg	Kg	2% lidocaine	3% Mepivicaine	4% Articaine
	7.5	16.5	0.9	0.6	0.7
2-3 years	10.0	22.0	1.2	0.8	1.0
2-3 years	12.5	27.5	1.5	1.0	1.2
4-5 years	15.0	33.0	1.8	1.2	1.5
4-5 years	17.5	38.5	2.1	1.4	1.7
6-8 years	20.0	44.0	2.4	1.6	2.0
6-8 years	22.5	49.5	2.8	1.8	2.2
9-10 years	25.0	55.0	3.1	2.0	2.4
9-10 years	30.0	66.0	3.7	2.4	2.9
11 years	32.5	71.5	4.0	2.6	3.2
	35.0	77.0	4.3	2.9	3.4
	37.5	82.5	4.6	3.1	3.7
	40.0	88.0	4.9	3.3	3.9

Anesthetic– a substance that causes numbness and loss of sensitivity. This process is reversible. The feeling returns after 1-1.5 hours, depending on the type of anesthetic and anesthesia performed.

Vasoconstrictors used in combination with local anesthetics
The addition of a vasoconstrictor causes a narrowing of the blood vessels, which allows the anesthetic to be kept in a certain location and prevent it from “leaving” to other parts of the body. The use of vasoconstrictors means that the patient will receive a smaller dose of anesthetic, which has high toxicity! Due to the vasoconstrictor effect, vasoconstrictors can minimize or completely eliminate bleeding in the postoperative period. This is due to the stenotic effect. Adding a vasoconstrictor to a local anesthetic may also have detrimental effects. The disadvantages of using vasoconstrictors include side effects caused in the cardiovascular and nervous system.

The most commonly used vasoconstrictors for local anesthetics are adrenaline (epinephrine) and norepinephrine (norepinephrine) - these are hormones that are produced in the body and have the effect of constricting blood vessels and increasing blood pressure. Felypressin is a synthetic vasoconstrictor with almost the same functions as epinephrine or norepinephrine, but weaker. Felipressin is used only in combination with prilocaine!

Parabens in anesthetics
To prevent early oxidation of vasoconstrictors, preservatives are used in the anesthetic. The most common substances are sulfite compounds:

sodium sulfite in Ultracaine
methylparaben and metabisulfite in Xylocaine
sodium metabisulfite in Cytanest (prilocaine)

All three of the above sulfite mixture products are used to prevent vasoconstrictor oxidation. However, it is known that sulfite compounds can cause allergic reactions, especially in patients with asthmatic bronchitis.

Diluent acts as a preservative for vasoconstrictor agents. Vasoconstrictors are unstable in solution and can oxidize, especially with prolonged exposure to sunlight.

Nitrogen: bubble 1-2 mm. in diameter is present in the cartridge to prevent the entry of oxygen, which can destroy the restrictors.

Vehicles: all of the above components are dissolved in a modified Ringer's solution. This isotonic solution minimizes discomfort during injection.

Composition of the local anesthetic Lidocaine-Adrenaline

Local anesthetic agent: lidocaine hydrochloride – 2% (20 mg/ml)
Vasoconstrictors: Adrenaline (epinephrine) 1:100,000 (0.012 mg)
Diluent: sodium metabisulfite – 0.5 mg
Preservatives: methylparaben – 0.1% (1 mg)
Isotonic solution: sodium chloride – 6 mg
“Vehicles”: Ringer's solution
Fungicide: thymol
Thinner: distilled water
To adjust pH: sodium hydroxide
Nitrogen Bubble

Contraindications to the use of local anesthetics

Medical problem	Drugs to avoid	Type of contraindication	Alternative drug
	All local anesthetics in the same class (for example, esters)	Absolute	Local anesthetics of various chemical classes (eg, amides)
Bisulfite allergy	Local anesthetics containing vasoconstrictors	Absolute	Local anesthesia without a vasoconstrictor
Atypical plasma cholinesterase	Esthers	Relative	Amides
Methemoglobinemia, idiopathic or congenital	Ultracaine, prilocaine - topical anesthetics in children under 2 years of age	Relative	Other amides or esters
Significant liver dysfunction	Amides	Relative	Amides or esters, but reasonable
Significant renal impairment	Relative	Amides or esters, but reasonable
Significant cardiovascular dysfunction		Relative
Clinical hyperthyroidism	High concentrations of vasoconstrictors	Relative	Local anesthetics at a concentration of 1:200,000 or 1:100,000 or mepivacaine 3% and prilocaine 4% (nerve blocks)
Definitions: Absolute contraindication- implies that under no circumstances should this drug be administered to a patient due to the risk of potentially toxic or fatal consequences. Relative contraindication– suggests that a drug may be prescribed to a patient after carefully weighing the risks of using the drug. If the potential benefits outweigh the risks and there are no alternative medications, then this contraindication can be neglected.

Complications from local anesthetic

Local anesthetics can cause various side effects, including: As a rule, these side effects develop after administration of the drug without first collecting an allergy history. It is for this reason that vital signs should always be monitored, extreme caution taken, and the patient's medical history taken into account. The general condition can manifest itself in the form of disorders of the central nervous system (CNS) or cardiovascular system (CVS).

Neurotoxicity

Typical symptoms of neurotoxicity caused by local anesthetics:

paresthesia of the lips, tongue and hands
metallic taste in mouth
drowsiness
tinnitus
slurred speech
muscle tremors
visual impairment
generalized seizures

These are the so-called warning symptoms that may occur when minimal doses of local anesthetic are administered. If such symptoms occur, you must:

stop injecting the drug immediately
give 100% oxygen
Recommend “deep breathing” to the patient (to create hyperventilation)
prevent the development of hypoxia and acidosis, which increase the toxicity of the local anesthetic (an “ion trap” develops)
in case of seizures, you can use propofol or benzodiazepines
To prevent the development of hypoxia and acidosis, the possibility of providing muscle relaxants, intubation and initiation of artificial ventilation should be considered.

Cardiotoxicity

Local anesthetics, in case of overdose, affect the cardiovascular system by reducing myocardial contractility, disrupting automation, reducing the speed of impulse conduction and vasodilation. After the initial phase of stimulation as a result of excitation of the central nervous system, a phase of depression begins. If signs of toxicity occur, standard procedures should be implemented as quickly as possible to prevent circulatory disorders of the cardiovascular system.

Until recently, treatment and tooth extraction procedures were accompanied by painful sensations, but today dentistry has every opportunity to ensure that the patient does not feel the slightest discomfort even during complex interventions. Anesthesia in dentistry is designed to ensure that any procedure is painless.

Anesthesia is a decrease in the sensitivity of a certain area of tissue to pain. Various methods can achieve complete loss of sensitivity for a certain period of time. It is widely used for most manipulations in therapeutic and surgical dentistry, for implantation and prosthetics, and even for routine teeth cleaning.

Indications for the use of anesthesia

Regardless of the types of anesthesia in dentistry , they are used for the following indications:

the need for superficial anesthesia before the main injection,
treatment of dental diseases of any degree, pulpitis, periodontitis and many others,
therapy of gum and periodontal tissue diseases,
removal of teeth and their roots,
, i.e. installation of a large number of artificial metal roots,
performing surgical operations,
treatment of acute purulent inflammation of the bone tissue of the jaws,
neuritis, neuralgia of the facial nerve.

In addition, pain relief is indicated even for minor interventions, for example, during ultrasonic teeth cleaning, when the patient has increased sensitivity or nervousness.

Main types of anesthesia in dentistry

There are three types of anesthesia: local, general and sedation. Local involves anesthetizing a specific area of tissue for comfortable procedures, while the patient remains conscious. General anesthesia or anesthesia is performed using analgesics that are introduced into the body by inhalation or intravenously, during which the patient is unconscious. During sedation, gas is administered by inhalation; this type involves remaining conscious.

Types of local anesthesia in dentistry

Modern local anesthesia is called carpule - the composition is supplied in disposable containers (carpules or ampoules), where the necessary components are already mixed in the required dosage. The doctor inserts the capsule into a special syringe - compared to disposable syringes, its needle is thinner, so the process of administering the drug is less painful.

1. Application anesthesia

The applique machine is widely used when performing simple operations that do not take much time. The drug is applied with a cotton swab or fingers to the desired area, permeates the soft tissues, as a result of which their sensitivity is reduced. It penetrates to a depth of no more than 3 mm. Action time is from 10 to 25 minutes. Very often it precedes another type of pain relief.

2. Infiltration anesthesia

Infiltration is provided by an injection that is injected around its non-medical name - “freezing”. It is more often used in the treatment of teeth in the upper jaw, since the alveolar process has a more porous structure, which means pain relief will be more effective. The action time is about 60 minutes, enough to perform quite complex manipulations - endodontic treatment, pulp removal, therapy of deep caries.

3. Conduction anesthesia

Conduction anesthesia in dentistry is aimed at blocking the nerve that transmits the pain signal. This allows you to “disable” not only one tooth, but also a certain area of the jaw that is connected to this nerve. Most often, this type is used when it is necessary to cure or remove several teeth located nearby, especially in the lower jaw. Action time: 90-120 minutes. The most common option is conductive mandibular. It makes it possible to effectively anesthetize the lower jaw and perform complex interventions in the area of molars.

4. Intraligmentary (intraligamentous) anesthesia

Intraligmentary is also called intraperiodontal. The specificity of this type is to apply more pressure during the insertion process. This allows the product to be evenly distributed in the periodontal space and penetrate into the intraosseous space. Begins to act immediately – after 15-45 seconds. Action time is from 20 minutes to half an hour.

5. Intraosseous anesthesia

Indications – impossibility or ineffectiveness of other types. As a rule, it is used in the treatment and removal of lower molars and operations on the alveolar process. Its implementation involves dissecting the mucous membrane, creating a hole in the bone using a bur, after which a needle is inserted into the hole and the drug is supplied to the spongy substance under high pressure. The advantage of this type is its effectiveness even with small volumes of a weak product. Action time – from 60 minutes.

6. Brainstem anesthesia

Stem involves blocking the branches of the trigeminal nerve at the base of the skull. This is advisable when performing extensive surgical interventions in maxillofacial surgery. The effect of this type of anesthesia covers both jaws.

Types of drugs for local anesthesia

Modern anesthesia in dentistry is carried out using ready-made anesthetic compounds. The most common are drugs based on articaine - this is the main active ingredient of many anesthetics. They are 1.5-2 times more effective than lidocaine, and 6 times more effective than novocaine. A big advantage is that such drugs are very safe today.

1. "Ultracaine"

The result of developments by the French pharmaceutical company Sanofi Aventis. This drug based on articaine is available in three versions, differing in the concentration of the component and the presence/absence of a vasoconstrictor component:

"Ultracaine DS forte" - epinephrine concentration 1:100,000,
"Ultracaine DS" - epinephrine concentration 1:200,000, can be used during pregnancy, breastfeeding, and the presence of cardiovascular diseases,
"Ultracaine D" - without epinephrine, can be used in patients prone to allergic reactions, since it does not contain preservatives necessary to stabilize drugs with a vasoconstrictor component.

2. "Ubistezin"

A German-made anesthetic, the composition is similar to Ultracaine, or more precisely, to its two forms containing epinephrine.

3. "Mepivastezin" or "Scandonest"

Scandonest is an anesthetic produced by the French company Septodont, the main component of which is mepivacaine 3%. It contains no vasoconstrictor components or preservatives. This explains its popularity when performing dental procedures in patients at risk. "Mepivastezin" is a hollow analogue of "Scandonest", but already made in Germany (3M).

4. "Septanest"

Produced in two forms by Septodont:

articaine + epinephrine 1:100.000,
articaine + epinephrine 1:200.000.

The difference between this drug and others is the relatively larger number of preservatives in the composition, which increases the likelihood of developing allergic reactions.

5. "Novocaine"

“Novocaine” in combination with a vasoconstrictor component is much weaker than articaine drugs. In addition, its effectiveness decreases if it is necessary to anesthetize the area of inflamed tissue. “Novocaine” has a vasodilating effect, and therefore is very “dependent” on vasoconstrictors. It is difficult to call such a manipulation safe, especially if it is necessary to anesthetize an area of the oral cavity for a patient at risk, a pregnant or lactating patient, or a child.

Complications associated with the use of local anesthesia

Complications are quite rare, but it is impossible to completely eliminate them from practice. They are divided into two groups:

local: damage to soft tissues by a needle, breakage of a needle, infection of tissues with poorly disinfected instruments, damage to a vessel (resulting in hematoma), tissue necrosis, paresis of the facial nerve, contracture of the temporomandibular joint,
general: allergic reactions, toxic reactions, changes in blood pressure, dizziness.

General anesthesia (anesthesia)

Anesthesia is performed only by an anesthesiologist. According to the method of drug delivery, it is divided into inhalation (drugs "Prichlorethylene", "Sevoran") and intravenous ("Gexenal", "Propanidid", "Propofol", "Ketamine", etc.). The drugs put you to sleep and the patient does not feel pain. How long a specific anesthesia lasts is determined by the doctor, taking into account how much time the dentist will need.

Anesthesia requires certain indications:

pronounced dental phobia and mental disorders,
pronounced gag reflex,
complex surgical interventions,
a large number of teeth subject to extraction or complex treatment,
ineffective use of local anesthetics.

Such anesthesia is completely justified if a child needs to have a lot of baby teeth treated - it is very difficult to “force” children to be in the doctor’s chair, especially for a long period of time.

Contraindications to anesthesia are as follows:

relative – exacerbation of chronic diseases, viral infections, pregnancy and lactation, respiratory infections, etc.,
absolute – heart and kidney failure, some types of heart defects, decompensated diabetes mellitus and other severe endocrine diseases, respiratory dysfunction.

In order to decide on the possibility of using anesthesia, the doctor will prescribe an extensive diagnosis of your health condition.

Side effects of anesthesia can be reversible and severe, requiring immediate medical attention. The first group includes nausea, vomiting, confusion, fainting, behavioral disorders, and coordination of movements. As a rule, they pass with minor intervention from specialists and with the provision of rest. Serious complications are cardiac and respiratory problems: they require immediate medical attention.

On a note! Failure to pay attention to the advice of an anesthesiologist regarding preparation for anesthesia can cause a serious complication - aspiration of the respiratory tract. The doctor must explain the day before for how long it is forbidden to eat and drink - it is important to strictly follow the recommendation.

Sedation in dentistry

Sedation is an immersion in a state similar to drowsiness or intoxication - the patient is conscious, but feels calm and relaxed. There are three methods of sedation: inhalation, intravenous, and oral. Sedation is effectively used for both children and adults. It is effectively combined with local anesthesia.

Unlike general anesthesia, sedation is safer and does not entail unpleasant treatment consequences.

Features of anesthesia in pediatric dentistry

Effective pain relief in pediatric dentistry must take into account a number of features:

most local anesthetic drugs are approved for use from 4 years of age,
dosage calculation is carried out taking into account weight,
Children often suffer from allergic reactions to anesthetics.

The correct choice of pain relief method is very important - the child’s attitude towards dental procedures in the future and trust in the dentist depend on this.

Features of the use of anesthesia during pregnancy

Today there are ample opportunities to ensure maximum comfort for a pregnant woman. Local anesthetics with a minimal content of vasoconstrictor components are approved for use in expectant mothers. Restrictions apply to general anesthesia and drugs with a maximum content of adrenaline or epinephrine.

Video on the topic

Anesthetics in dentistry are drugs that provide pain relief. All local anesthetic agents must have the following properties: low toxicity, rapid onset of effect, easy permeability through tissue, reversibility, easy permeability, long shelf life. Some products comply more with these standards (modern drugs), others less (as a rule, outdated analogues).

	toxicity	duration min (without adrenaline)	maximum dose (mg/kg) (with and without adrenaline)	other names
Cocaine	4	20-25	1,5	other no name
Novocaine	1	15-20	8/10	Aminocaine, Procaine Cytocaine, Neocaine
Lidocaine	2	50-60	5/7	Lidokart, Lidostezin Xylocard, Solcaine
Mepivacaine	2	40-90	5/7	Mepivastezin, Scandicaine Skandomest, Meaverin
Artikain	1,5	60-120	7	Ultracain, Ubistezin Septanest, Supracain

clarifications: the groups that have the highest and lowest scores are highlighted in bold (so to speak, champion and underdog)

Classification

Classification of local anesthetics in dentistry involves division by chemical structure and generation. According to their chemical structure they are:

Esters (Cocaine, Novocaine, Anestezin)
Amides (Lidocaine, Articaine aka Ultracaine, Mepivacaine)

By generation (counting according to the time of discovery) there are: I - cocaine in 1860, II - novocaine in 1905, III - lidocaine in 1943, IV - mepivacaine in 1957, V - articaine in 1972. All substances will be considered according to this classification of local anesthetics in dentistry. For clarity, look at the table, which discusses toxicity, duration, and maximum dose.

Anesthetics in dentistry without adrenaline

As you know, ephedrine derivatives are added to painkillers to increase the duration of action. They are vasoconstrictors, that is, they narrow blood vessels. In some cases, such exposure is contraindicated (for pregnant women, people with heart and vascular diseases). The following are “safe” anesthetics in dentistry without adrenaline: Ultracaine D (do not confuse with the prefixes D-S and D-S Forte), Mepivastezin 3%, Scandonest CVS 3%. They can be safely used.

Modern anesthetics in dentistry

As you may have guessed, these are V generation drugs. Modern anesthetics in dentistry include Articaine derivatives: Ultracaine, Ubistezin, Septanest. However, Mepivacaine and its analogues are not yet in a hurry to throw them into the dustbin of history, and they are ordered in dental clinics. And what kind the most powerful anesthetic in dentistry? The award goes to Ultracain. To make sure, go to the dentist and ask him to do mandibular anesthesia. They will have time to heal your tooth, you will get home and for another couple of hours you will not feel anything and all this “pleasure” is from 1 ampoule.

Mechanism

The mechanism of action of all drugs is the same. In short, they reduce the penetration of sodium ions into the membranes of nerve cells. In more detail, the scheme looks like this: the membranes of neurons are overcome by molecules of an anesthetic substance in an inactive form. There they become active, attaching (binding) hydrogen ions to themselves, and remain on sodium channels. The transmission of the pain impulse is blocked by stopping the rapid input of sodium ions, which is felt by the body as anesthesia.

Previously, dentists of the past were not particularly concerned about the feelings of 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 painkillers make it possible to block unpleasant sensations not only for adults, but also for children.

Moreover, they can be administered either by injection or without the use of a needle.

Local anesthesia is the administration of an anesthetic drug, due to which sensitivity in a certain area requiring dental manipulation is gradually reduced. The active substances block the impulses that nerve endings transmit to the brain.

In this case, the patient remains conscious and does not feel pain even during surgery. Blocking the nerve endings only causes a feeling of numbness in the area into which the drug was injected.

Indications

It is perhaps easier to list dental procedures that are performed without pain relief. Local anesthesia is used:

during treatment of advanced caries;
before removing the root system or the tooth as a whole;
during the periodontitis treatment;
in the treatment of inflammatory processes and purulent foci;
for the treatment of neuritis of the facial nerve;
when it is impossible to perform 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 the feeling of fear of unpleasant sensations.

Functional features, their positive and negative qualities.

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Contraindications

The drug for local anesthesia must be selected individually for each patient. After all, existing painkillers, like other drugs, have certain contraindications.

Therefore, before giving an injection, a professional must make sure that the patient does not have an allergic reaction to any medications or 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 painkillers.

Dentists adhere to some restrictions if:

the patient suffers from diseases of the thyroid gland, diabetes mellitus, which does not make it possible to use drugs containing vasoconstrictor components;
there is a history of cardiac pathologies or arterial hypertension. In this case, local anesthesia containing Epinephrine at a dosage higher than 1:200,000 is contraindicated for patients;
A bronchial asthmatic needs treatment. The painkiller in this case should not contain sodium disulfide, which is a preservative.

Varieties

You can numb a certain area of the oral cavity by injection or by influencing the nerve endings in a way that does not involve puncture of periodontal tissue.

Appliqué

This method makes it possible to temporarily numb the area being treated by superficially treating 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 allows you to achieve an immediate effect. Sometimes, this type of pain relief is used to reduce the discomfort from a future injection.

However, most often sprays or ointments are used before professional cleaning or opening of abscesses located on the surface of the gums.

Infiltration

The drug is administered by injection into the upper area at the root of the tooth. In this case, the injection is given both from the lingual (inner) and outer sides of the gums.

In this case, the introduced composition spreads into the internal cavity of the tooth gradually.

Experts use this method of pain relief most often. Dentists use infiltration anesthesia to treat caries, pulpitis and other dental diseases.

For more information about infiltration anesthesia in children, see the video.

Conductor

Pain relief is achieved by introducing the active composition into the surrounding nerve tissue, due to which pain impulses transmitted to the brain are blocked. Anesthesia spreads not only through 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 (intraligamentous) local

The injection is carried out into the periodontal ligament. The gums are chipped on both sides of the mucous membrane.

The difference between intraligamentous injection anesthesia is the immediate effect of the drug. Therefore, intraligamentary anesthesia is often used in pediatric dentistry.

It is worth noting that the drug is administered both through a needle and a reduced cartridge. For the treatment of oral diseases 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 pain relief, its duration is not long-term.

The injection is made into the cancellous bone between two adjacent teeth. The main feature of the technique is that the patient’s cheeks and lips do not go numb. Therefore, after the end of the drug’s effect, there are no unpleasant sensations or discomfort.

To reduce the sensitivity of the injection, dentists, as a rule, perform preliminary application of anesthesia.

In the video, watch how pain relief is performed using intraosseous anesthesia.

Stem

This method of pain relief is carried out only in an inpatient dental department. Anesthesia has the longest period of action.

In addition, the injection is carried out not in the oral cavity, but in areas of the base of the skull. Blocking of impulses from nerve endings is carried out immediately throughout the entire lower or upper jaw.

Indications for such strong pain relief are:

complex surgical interventions;
facial bone injuries;
neuralgia;
unbearable pain syndrome.

For children

All drugs used in pediatric local anesthesiology, to one degree or another, cause harm to the small organism. Younger patients are especially sensitive to the effects of painkillers.

Previously, Lidocaine and Novocaine were used to block impulses from nerve endings. Today, Mepivacaine and Aricaine have the shortest list of side effects.

If we talk about the types of anesthesia used, then mainly in pediatric dentistry they use application, intraligamentary, infiltration and conduction methods.

Note! Due to fears and an immature psyche, a child may lose consciousness during an injection in the dental chair. You should not attribute the reaction of a 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 vasoconstrictors.
Ubistezin. In terms of the composition of the active ingredients, the drug is an analogue of Ultracaine. The anesthetic is produced in Germany and is available in various dosages of the main components.
Septanest. It has a significant concentration of preservatives. Therefore, its administration is quite often accompanied by an allergic reaction.
Skadonest. The drug contains up to 3% Mepivacaine. Vasoconstrictors and preservatives are completely absent in the anesthetic produced in France, and therefore the drug is suitable for patients who need restrictions on the composition.

Possible complications

A seemingly ordinary injection can result in a number of unpleasant consequences. Among them are:

Needle fracture. Despite the fact that the element of the injection instrument is made of durable metal, if the patient moves suddenly, part of it may remain in the mucosa or periosteum. It is worth noting that the probability of removing a small metal fragment without complications is much higher than when removing part of an element inserted along 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, anesthesia of a pre-infected area of the oral cavity may result in infection of a healthy area due to the pushing of pathogenic bacteria by the anesthetic.
Hematoma or bruise. Complications result from blood vessels entering the tissues, which is most often observed during conduction anesthesia.
Swelling of tissues. A complication occurs when there is an individual intolerance to the components of the drug.
Loss of sensation. Sometimes, blocking the transmission of impulses to the brain by nerve endings lasts for several days or weeks due to nerve damage.
Burning or pain during the administration of the anesthetic. An unpleasant temporary reaction is absolutely safe for the patient’s body.
Spasms of the masticatory muscles or trismus. The complication is the inability to fully open the oral cavity. The phenomenon occurs due to damage to the muscles or blood vessels located in the infratemporal fossa and, as a rule, goes away within 2-3 days without any intervention.
Damage to soft tissues. Due to the lack of sensation in 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 effect of the drug has completely worn off.

At least a day before visiting a specialist, you should stop drinking alcoholic beverages. Ethyl alcohol, which is the main component of this product, reduces the effectiveness of many local anesthesia techniques.

If there was severe stress on the eve of a visit to the dentist, it would be useful to take a sedative at night - Valerian or Afobazole extract.

It is better to postpone dental treatment if you are weak during ARVI. It is not advisable to perform dental procedures on the days of menstruation. During this period, increased nervous excitability is observed.

In addition, surgery during “critical days” for patients can result in prolonged bleeding.

Anesthetics in dentistry are a necessary measure in dental treatment. With their help, it is possible to block sensitivity and carry out the necessary manipulations.

All painkillers are divided into groups according to their chemical properties - amides and esters.

Among the amides used are lidocaine, trimecaine, articaine.
Among the esters are novocaine, anesthesin.

Each of them has specific side properties.

They also differ in the injection method: superficial and deep. The latter includes infiltration (the injection is sequentially placed under the skin, under the fatty tissue, under the fascia, reducing sensitivity in the area where the solution has spread) and conduction (injected into the nerve trunk or sheath, or into nearby tissues, so pain is not felt in the area which this nerve innervates) anesthesia.

For superficial anesthesia, dicaine, pyromecaine, and anesthesin are taken.
The second list includes lidocaine, novocaine, trimecaine.

Surface anesthetics are classified into a separate category. Their effect is ensured by irrigating the oral surface with a spray. The basic component of these drugs is lidocaine. Such application is often necessary before the procedure of infiltration anesthesia to ensure painless administration.
The last point in the classification is the duration of action of the local anesthetic.

Weak effect - novocaine.
Medium - lidocaine, mepivacaine, trimecaine, articaine.
Long-term – etidicaine, bupivacaine.

Modern anesthetics in dentistry

The history of local anesthetics used in dentistry is divided into before and after, that is, other drugs and methods were previously used, which, with the advent of new technologies, became outdated and began to represent the least effective pain relief.

What local painkillers does modern medicine offer?

Nowadays, dental clinics use innovative carpool technology. Its essence lies in the fact that the active substance is not contained in a glass ampoule, but in a special cartridge (carpule) intended for one-time use. This device is inserted into a disposable syringe with a very thin needle.

This mechanism offers a number of advantages:

Modern local anesthetics are represented by drugs based on articaine and mepivacaine.

Articaine is superior to all drugs in its properties. It is available in the form of carpule capsules under such names as “Ultracain”, “Ubistezin”, “Septanest”.

In addition to articaine, the cartridge contains an auxiliary substance - adrenaline, which promotes vasoconstriction. Its content is determined by the fact that when the blood vessels narrow, the action of the main substance is prolonged, and the possibility of its leakage into the general bloodstream is reduced. This contributes to the least harm to the body. The dosage is selected for each patient individually. Preparations based on it are 2 times more effective than lidocaine, and 5-6 times more effective than novocaine.

"Ultracain D" - recommended for patients with endocrine disorders such as thyroid disease and diabetes, as well as for bronchial asthma or allergies. It contains no preservatives or stimulants (epinephrine, adernaline).

Mepivastezin and Scandonest are also compatible with endocrine disorders.

"Ultracain DS" and "Ubestezin" are indicated for use in patients with cardiovascular problems. The concentration of epinephrine in it is 1:200000. If the picture of hypertension is clear, drugs that do not have vasoconstrictor components are indicated.

If you are in absolute health, you can administer anesthetics with an epinephrine ratio of 1:100,000. With a weight of 70 kg, it will not be dangerous for a person to receive up to 7 doses. Examples: “Ultracain DS forte”, “Ubistezin forte”.

A special category includes pregnant and lactating women. To relieve their sensitivity, use “Ultracain DS” (1:200000) or “Ubestezin” (1:200000), they are both equally harmless. Adrenaline cannot be excluded from painkillers for a pregnant woman, since it is it that prevents the further spread of active substances into the bloodstream. It is important that with increasing concentration, the possibility of penetration into the bloodstream increases.

More information about methods of administration

Among anesthetics, there are three methods of administration.

Infiltration

It can be direct or indirect. The direct one affects the place where the injection was placed, the indirect one freezes the surrounding tissues. According to the methods, it is divided into intraoral and extraoral. It is more active in the area of the upper jaw, due to the spongy contents located there.

How is intraoral anesthesia given?

A needle is inserted into the transitional fold at an angle of 45 degrees to the vertical dental axis. The cut end should rest against the bone. Injection into the periosteum is also used; for this, the syringe piston is squeezed out with greater force.

Pros: due to the use of small concentrations, it is safer and more controllable (re-injection is performed if necessary), fast onset time, rapid removal from the internal environment, the area of action is slightly larger than the problematic nerve.

Conductive

Popular for mandibular injections. It has a finger and fingerless method.

How does the process work?

With the finger method, the needle is directed with the index finger on the left hand, focusing on the upper edge of the terminal phalanx. The ampoule is emptied upon reaching the bone tissue.