Local anesthesia in dentistry. Anesthesia in dentistry: dental treatment without fear and pain. Local anesthetics used in Imperial dentistry

It's no secret that many people associate a dentist with the worst nightmare in life. Extraction of teeth at the first problems, pain during treatment, many complications, violation of the aesthetics of a smile - today, all these points are gone far into the past.

Modern dentistry is able to restore a tooth completely destroyed by caries. With the help of the latest equipment, knowledge and experience, complex endodontic procedures are carried out. The use of laser, ultrasound, ozone helps to cope with many pathologies. oral cavity.

One of the main components modern dentistry is its painlessness. Depending on the type of treatment and the desire of the patient, local or general anesthesia is used.

From this article you can learn more about the methods of anesthesia in dentistry.

What is anesthesia?

- lack of sensitivity in a separate part of the body or in the body as a whole. Pain relief is achieved through the action of special drugs.

Types of anesthesia in dentistry:

Used during difficult surgical operations. Often this method is preferred in the treatment of teeth in young children. There are 2 methods of administering anesthesia: by inhalation or intravenous injection. After the entry of medicinal substances into the body, a person plunges into a deep artificial sleep. He completely lacks consciousness and pain sensitivity. During the treatment, in addition to dentists, there are doctors in resuscitation and an anesthesiologist in the office.

Local anesthesia

It is used in most dental procedures and is divided into infiltration and application.

Application anesthesia achieved through the use of special gels, ointments, sprays. The preparations are applied directly to the gum mucosa. The composition of local anesthetics includes: lidocaine, tetracaine, bumecaine, anestezin.

After application, medicine quickly penetrates into periodontal tissues, blocks nerve endings, resulting in high-quality anesthesia. The advantages of the method include: safety, the minimum number of complications. The disadvantages are: a short period of action, the lack of deep anesthesia.

Infiltration, conduction, intraligamentous, intraosseous anesthesia refer to injectable local anesthesia. They are used in the treatment of teeth and surgical operations of hard and soft tissues, in the area of the jaw apparatus. medicinal product can be injected under or periosteum, into the submucosal, spongy tissue of the upper or mandible. Allocate intraseptal, mandibular, torusal anesthesia.

The drug is injected with a special dental cartridge syringe with a thin disposable needle. To make the injection less painful, the doctor pretreats the injection site with an anesthetic gel or spray.

The patient can independently choose the method of anesthesia. Depending on the presence of contraindications, the dentist supports the patient's decision or refuses him, arguing his point of view from the scientific side.

Some people are terrified of having their teeth treated, so they opt for general anesthesia. Despite the benefits this method, a person must be aware of all his shortcomings. Anesthesia can be applied for a period of not more than 1.5 hours, but most often it is used for 30-40 minutes. In principle, this time is enough for the doctor to treat 1 tooth. To sanitize the oral cavity completely, it will be necessary to immerse the patient in anesthesia not 1 or 2 times. That is why, if the treatment can be carried out with the help of local anesthesia, it is worth giving preference to it.

Side effects of general anesthesia: nausea, headache, dizziness, vomiting, a sharp increase or decrease in pressure. In children, capriciousness, tearfulness, unreasonable fun, delight, tantrums, lethargy are observed. Inappropriate behavior is very scary for parents. However, do not worry, within a day the condition of the baby is completely normal.

Before treatment under general anesthesia, it is necessary to undergo a preliminary examination: pass a detailed blood test, urine test, conduct an ECG, obtain a certificate of consent from a cardiologist. The health certificate must show all chronic diseases that the patient suffers from. Do not hide any facts, because they can cause the development of unpleasant complications during the treatment.

Who should be wary of general anesthesia?

The risk group includes:

Persons suffering from hypertension and hypotension;
Children under 3 years of age;
Patients with prolonged subfebrile condition (slight increase in temperature) of unclear etiology;
People with a tendency to allergic manifestations;
Persons suffering from heart, kidney, liver failure;
Patients with blood diseases.

A full-time doctor will tell you more about contraindications after a preliminary diagnosis and acquaintance with the medical history.

Indications for the use of anesthesia in dentistry

Despite people's fear of dentists, not all procedures are accompanied by pain. Removal of dental deposits, treatment of superficial caries, fluoridation and whitening of teeth - is carried out without the use of anesthetics and is completely painless!

Anesthesia is necessary for the following manipulations:

Treatment of medium and deep caries.
Nerve depulpation, root canal filling.
Opening of abscesses.
Removal of teeth.
Root apex resection.
Flap operations, open and closed curettage.
Implantation of a dental implant;
Operations in orthodontic treatment.

Drugs used for local injection anesthesia: Ultracain, Scandonest, Septanest, Ubestezin. Anesthetics are characterized by a high therapeutic effect, fast and long-lasting effect, they are not absorbed into the blood and do not have general action on the body. In the presence of pregnancy, chronic diseases, allergies, the anesthetic is selected by the doctor individually.

Anesthesia in dentistry during pregnancy and breastfeeding

During pregnancy and breastfeeding, a woman's body is subjected to double stress. It is not surprising that at this very moment, the teeth of young mothers begin to rapidly deteriorate.

Is it possible to treat teeth and gums while waiting for a baby or breastfeeding?

Yes, dentists give an affirmative answer, and allow the use of modern anesthetics in pregnant and lactating women. The safest drugs are Ultracaine DS and Ubistezin. Medicines do not enter the blood breast milk through the placenta and cannot harm the baby.

Anesthesia in pediatric dentistry

When treating a child's teeth, local or general anesthesia is used.

Choice of injectable local anesthesia safe drugs with minimal side effects. The doctor injects with Ultracain, Scandonest, Articain with a special carpool syringe. Within a few minutes, the drug begins to act, the young patient's jaw becomes numb, and the dentist calmly begins treatment.

Application anesthesia with gels, sprays and ointments is used if necessary:

Anesthetize the injection site;
Treat superficial or medium caries;
Remove hard dental deposits;
Remove a loose milk tooth.

General anesthesia is used if immediate dental treatment is required, but none of the dentists can find an approach to a young patient. Indications for general anesthesia may be: mental illness, phobias, chronic depression, seizures and tantrums.

Prices for anesthesia in clinics in Moscow and the region

Depending on the clinic, the availability of modern equipment and the experience of doctors, the prices for treatment and the provision of services vary significantly.

Approximate cost of anesthesia in dentistry:

The price of application local anesthesia within 1 tooth ranges from 50 to 1000 rubles.
The price of injection local anesthesia within 1 tooth ranges from 150 to 3800 rubles.
The cost of sedation varies from 3,000 to 15,000 rubles.
The price of general anesthesia ranges from 4000 to 30 thousand rubles.

Question answer

What is sedation in dentistry?

Sedation - allows you to calm the patient and relax him. The method is widely used in children. During treatment with the use of xenon gas, a person's consciousness is preserved, but he feels maximum relaxation and peace. Xenon anesthesia is used in patients suffering from dental phobia, and experiencing significant emotional overstrain in connection with the upcoming medical dental intervention.

Why is adrenaline present in anesthetics?

Adrenaline and epinephrine constrict the blood vessels at the injection site and prevent the drug from being washed out into the blood. Due to this action, the time and strength of anesthesia increases.

Are there drugs without adrenaline?

Scandonest and Mepivastezin are non-adrenaline anesthetics that do not contain vasoconstrictors and preservatives. Used in dental procedures on patients elevated group risk (bronchial asthma, allergies, vascular, nervous, cardiac pathologies).

Which sedatives can be used before visiting the dentist?

Sedative medicinal substances help to eliminate the patient's anxiety. The disadvantage of soothing tablets and drops is their cumulative power. In order for the drug to work, it is necessary to take the medicine in a course, for 2 to 3 weeks, until the visit to the doctor. Safe herbal sedative preparations include: tablets and drops of Valerian, Motherwort, Peony.

Anesthesia or local anesthesia in dentistry allows you to treat teeth without pain, which provides the patient with comfort and the dentist the convenience of working. Please note that in this article we will talk about anesthesia, and not about anesthesia. Anesthesia (sometimes also called general anesthesia, which is not entirely true) is a complete shutdown of a person’s consciousness, in dentistry it is now commonly called “dental treatment in a dream.” This can only be done by an anesthesiologist.

In the same article, I want to talk specifically about anesthesia, (sometimes it is also called local anesthesia). This type of anesthesia acts only on a limited area and is usually carried out by the dentist himself.

Currently, dental treatment without anesthesia is nonsense. Modern medical standards require not only high-quality, but also the most comfortable and painless treatment for the patient. The dentist, if necessary, together with the anesthesiologist, individually decides how and what kind of anesthesia will be carried out, taking into account the amount of work, area, depth and individual characteristics patient.

Many of us often delay a visit to the dentist, because. they are afraid of them since childhood, but “neglected” caries can cause serious complications that may even require surgical intervention. The less destruction and the earlier the patient went to the doctor, the better, faster and less painfully, the treatment can be carried out.

pulpitis and periodontitis;

diseases of cardio-vascular system and joints, because caries is a source of infection;

chronic allergic reactions;

if the tooth is completely destroyed, it will affect the quality of chewing food and, as a result, may lead to gastrointestinal diseases

Yes, I will say right away: there are medications and non-drug methods anesthesia in dentistry. The latter include:

hypnosis (psychotherapy);
electrical neurostimulation;
audio analgesia.

To be honest, I, like most of my colleagues, are very skeptical about all of the above, and therefore I will tell you about medical methods anesthesia.

Local anesthesia in dentistry

In dentistry, the following types of local anesthesia are distinguished, below we will briefly consider each of them, and if you want to know more, follow the links:

Intraosseous
Intraligamentary (intraligamentous)
stem
Combined.
Computer

All modern methods anesthesia in dentistry have their own characteristics, indications and contraindications.

In pediatric dentistry, the same types of local anesthesia are used, but for very young patients (2-3 years old), who simply will not let the dentist work, we do short-term anesthesia, for example, with propofol. This is a very modern and safe drug.

Application anesthesia

Allows you to anesthetize superficial soft tissues: skin and mucous membranes to a depth of approximately 1-3 mm. The drug quickly penetrates the tissues and temporarily disables the nerve endings located there. During the procedure, a high concentration of local anesthetic is used in the form of a gel, aerosol or emulsion. Dried mucosa is lubricated with the drug or a solution is sprayed onto it with a spray bottle.

Local application anesthesia in dentistry (in other words, anesthesia without an injection) is used:

to anesthetize the point of injection of the needle before injecting anesthesia;
for the removal of milk teeth;
when removing small neoplasms of soft tissues.

Anesthesia for stomatitis in children with the use of special pastes and gels is also an application.

Tissue infiltration with anesthetic solution

Conduction anesthesia in dentistry

Much less often than infiltration, conduction dental anesthesia is used. An anesthetic solution is injected near the peripheral nerve trunk, while the entire area for which it is responsible is anesthetized. After 10-15 minutes after the injection, the desired effect occurs and it lasts for 1-2 hours.

It is used when you need to anesthetize a large area at once or if infiltration anesthesia has not worked. Unlike infiltration anesthesia, a smaller amount of anesthetic is used here, but in a higher concentration.

On the lower jaw, torusal and mandibular anesthesia are performed.

Injection site for mandibular anesthesia

In this case, the lower alveolar and lingual nerves are turned off, therefore, during the action of the anesthetic, the patient feels numbness of the entire half of the lower jaw, lips, chin and tongue. Conducting tuberal anesthesia in dentistry is often accompanied by the formation of a hematoma. It is this inconvenience, combined with the complexity of the technique and the high likelihood of complications, that has forced dentists to abandon this type of anesthesia.

Intraosseous anesthesia

For intraosseous administration of an anesthetic solution during the injection, the doctor perforates the dense outer cortical plate of the jawbone and injects the solution into the spongy substance itself, where the terminal branches of the dental plexus are located. The effect appears after 1-2 minutes, the teeth and alveolar process are anesthetized. This manipulation is performed using a special syringe with a short needle of large diameter and is a kind of carpool anesthesia in dentistry.

Intraligamentary anesthesia

Intraligamentary anesthesia involves the dentist injecting a solution into the periodontal ligament, which connects the tooth root to the bone alveolus. Thus, you can anesthetize only one tooth and do it with the help of a record small amount of anesthetic, which is why this type of anesthesia remains very popular. It should be noted that the injection into the periodontium is quite painful and slight discomfort persists in the tooth for a day after the injection.

Stem anesthesia in dentistry

This type of anesthesia in dentistry is rarely performed. This technique is also called (according to the author) “according to Bershe-Dubov”. This technique is used for strong pain syndrome in a patient, for the treatment of serious injuries and operations on the jaw and zygomatic bone, as well as for neuralgia and only in a hospital.

The anesthetic is injected into the base of the skull (brain stem), and the pain medication is distributed along both trigeminal nerves and their branches. This allows you to immediately turn off the mandibular and maxillary nerve. The effect of stem anesthesia lasts long enough.

Combined anesthesia

Combined or sedative anesthesia in dentistry is used more and more often. In order for the treatment to be not only painless, but also completely comfortable, it is not enough just to eliminate the pain, it is necessary to cope with fear, emotional stress. It is this effect that allows potentiated anesthesia to be achieved. It is a combination of superficial sedation and local anesthesia, performed with the participation of an anesthesiologist. This is one of the best on this moment types of anesthesia for children in dentistry.

Superficial sedation is a state of stunning, slight depression of consciousness. In this case, the patient does not experience fear or anxiety before the upcoming intervention, but remains conscious. Of course, the advantage of this anesthesia is not only in its comfort. Anxiety and fear, among other things, cause a significant decrease in the pain threshold. That is, the elimination of negative emotions allows you to achieve a good level of anesthesia with smaller doses of anesthetic.

What is computer anesthesia?

Anesthesia, controlled by a computer, is carried out by a special electronic system, which consists of system block and tip. The needle has a special design, which allows absolutely painless piercing of soft tissues and perforation of the cortical bone plate. Another plus is the dosed administration of an anesthetic drug: the amount and speed of this process is regulated by a computer.

Carpool anesthesia

For carrying out carpool anesthesia in dentistry, special tools are used - carpool syringes. They are a reusable metal device that has a body, a plunger and a needle that is much thinner than a conventional injection needle. The preparations are supplied in special containers-karpules and placed in the syringe body.

Preparations for local anesthesia in dentistry

Local in dentistry are divided into:

Novocaine;
Anestezin;
Dekain.

Lidocaine;
Pyromecaine;
Trimecain;
prilocaine;
mepivacaine;
Articain;
Etidocaine;
Bupivacakin.

In addition to the main analgesic component, most anesthetics contain vasoconstrictor substances, such as, for example, adrenaline or epinephrine. Due to the effect of vasoconstriction in the injection site, the anesthetic is washed out more slowly. This allows you to increase the strength and duration of anesthesia.

For carrying out in pediatric dentistry, drugs should be chosen with the lowest level of toxicity, but at the same time effective. The choice in this case falls on the preparations of the amide group: ultracaine and scandonest in children's dosages. The first of these, in principle, is considered the best anesthetic in dentistry. The analgesic effect of ultracaine comes on quickly and lasts a long time.

Do not endure pain and refuse. Local anesthetics are excreted in small amounts with milk, which means they can enter the child's body. IN this case I recommend expressing a few servings of milk before a visit to the dentist and not breastfeeding the baby for 24 hours after dental treatment.

If a woman decides not to treat or remove a bad tooth, then sooner or later complications will arise that will already require emergency treatment, which can even more affect the baby.

If you are planning a pregnancy, be sure to visit the dentist in advance, because. doctors categorically do not recommend using anesthesia, especially in the first trimester. Because it is in the first trimester that the main organs of the child are laid, and the use of anesthetics or anesthesia drugs can adversely affect further development baby.

Anesthesia without adrenaline in dentistry

As I already said, to enhance the effect, vasoconstrictor drugs are added to the anesthetic solution - this increases the duration of action and reduces the level of absorption of the drug into the blood. But the accidental entry of the vasoconstrictor itself into bloodstream associated with serious side effects. That is why when conducting anesthesia in dentistry, anesthetics without adrenaline are used for pregnant women, in pediatric practice and in the treatment of patients with diseases of the cardiovascular system.

Contraindications for anesthesia in dentistry

Contraindications to are:

Allergic reactions to substances that make up anesthetics;
History of cardiovascular disease;
Diabetes;
Organ pathology endocrine system;
Some species severe injuries maxillofacial area.

Side effects of anesthesia in dentistry

If the doctor is a professional in his field, complications with local anesthesia in dentistry are very unlikely. There are some points that worry patients after dental treatment and, in principle, are a variant of the norm: or, or even for several hours.

However, all these symptoms should go away within 1-3 days after treatment. If you see that the situation is not improving or even getting worse, contact the dentist who performed the procedure.

Rarely, but more serious complications can occur, these include:

Allergic and toxic reactions. Hypersensitivity organism to medicines due to allergic predisposition. May manifest as urticaria, Quincke's edema, anaphylactic shock, etc.;
Injury to the vessels with an injection needle, as a result of which hematomas and bruises may appear;
Pain and burning at the injection site (quite common and considered normal);
Lockjaw. Spasm of chewing muscles. Occurs when a muscle fiber or nerve is damaged;
Loss of sensation. Occurs when a nerve is damaged during an injection;
Soft tissue injury. With loss of sensitivity, the patient may bite the tongue, lip, cheek;
Infection. In case of non-compliance with the rules of antiseptics.

Pain during the anesthetic injection and treatment will depend on several factors:

from your sensitivity;
the professionalism of the dentist and the equipment of the clinic;
on the degree of tooth decay and the depth of caries.

If you are planning a visit to the doctor, I advise you to observe a number of points:

do not drink alcohol the day before, this can worsen the effect of the anesthetic;
if you have colds, cough, runny nose, it is better to postpone the visit until complete recovery;
women and girls are not recommended to visit the dentist during menstruation, because. during this period, blood clotting worsens (by the way, do not be surprised if the anesthesiologist asks you such a question before the operation, operations are not performed during menstruation.
If you are very worried, try to calm down and sleep well. Of course, there are sedatives, such as Afobazole or the well-known "valerian", but I would not recommend taking any medications once again, most of us are able to cope with our emotions without them.
choose your clinic carefully! Now their choice is very large, but very few comply with the important requirements and all the requirements of antiseptics!

When choosing a clinic, pay attention to:

Legal name and registration documents, the same name must be in the service agreement.
Keep all checks and receipts for payment, pay only through the cash desk (also follow the legal name of the clinic in them).
Go to the clinic's website (certificates, licenses and certificates of specialists should be presented there), read reviews on the Internet, talk with friends.
Visit the clinic itself, sign up for an initial appointment.
If you are planning to treat your teeth “in your sleep”, i.e. under anesthesia, be sure to check the availability of an anesthesiologist in the staff of the clinic!
Please note that the doctor must put on new gloves and print out all disposable instruments with which he will carry out treatment and examination!!! In addition, the clinic should have air sterilizers.
Be wary of dental offices located on the first floor of residential buildings, it is better to give preference to large clinics with good equipment, but remember that expensive does not mean high quality.

For information on how to choose dentistry and what to look for, see the investigation of Channel 1 Dentists: a conspiracy theory.

Going to the dentist always makes us negative emotions and fear. Perhaps it’s just that in our memory there are still memories of Soviet clinics, where they didn’t stand on ceremony with patients. But modern dentistry takes care of us and offers many safe methods local anesthesia.

Anesthesia in dentistry

Anesthesia in dentistry is the removal of sensitivity from tissues for the time necessary for the dentist to perform all medical manipulations. It is widely used for the following procedures:

deep filling,
removal of a tooth,
nerve removal,
crown installation,
orthodontic treatment.

The principle of action of the anesthetic drug: the anesthetic blocks the nerve impulse, which indicates the effect on the tooth. This impulse had to reach from the pulp to the brain.

This blockage causes a sensation of numbness in the cheek, tongue, or lip (depending on where the injection was made). Over time, the drug breaks down and sensitivity is gradually restored.

Anesthesia can be medical or non-pharmacological. We also recommend reading about, and when it can be used.

Non-drug is divided into several types:

audioanalgesia,
electroanalgesia,
hypnosis,
computer anesthesia.

Varieties of local anesthesia in dentistry

In dentistry, in most cases, local anesthesia is used, which is safer for the body than general anesthesia. General anesthesia in dentistry is used extremely rarely and only for compelling medical reasons.

Local anesthesia allows you to remove sensitivity only from that part of the mucosa where treatment is necessary. There are several types of local anesthesia:

infiltration

This type of anesthesia is most commonly used in dentistry. Main indications:

pulp surgery,
nerve removal,
canal filling.

Before giving you an injection, the doctor will treat the place with a special solution that will cause a slight numbness of the tissues. As a result, you will not feel the injection and the anesthesia will be comfortable. And after that, you can inject an anesthetic drug into the area of \u200b\u200bthe apex of the tooth root.

This type of anesthesia makes it possible to remove sensitivity from the branching of the nerves, and not from the trunk. Most often, it is used to treat the teeth of the upper jaw, since its bone is quite thin, and the anesthetic easily penetrates inside.

Conductor

You won't even feel the pain of the injection

This type of anesthesia is used in the case when infiltration anesthesia did not work or it did not give the desired effect. Conduction anesthesia is also effective when it is necessary to anesthetize several adjacent teeth at the same time.

Conduction anesthesia anesthetics act on the following areas:

mandibular teeth,
lower lip area
the gum adjacent to the lower teeth and the side of the tongue.

When the patient is numb underlip, the doctor can start treatment.

intraligamentous

This type of anesthesia is mainly used for the treatment of children, since the anesthetic is injected into the periodontal area, which is located between the root and the hole. Not every child is able to endure numbness of the tongue, cheeks, lips. Often babies bite hard on the numb area, which is why intraligamentous anesthesia in this case is the best solution.

Indications:

deep,
pulpitis,
removal of a tooth.

Intraosseous

This type of anesthesia is most often used when a tooth needs to be extracted. Anesthesia is carried out as follows: a little anesthetic is injected into the gum so that the subsequent injection is painless. The dentist then injects the drug into the spongy layer of bone between the teeth. As a result, only the tooth and gum become numb, but the tongue, cheeks and lips do not. The anesthetic does not last long, but it works almost instantly.

stem

Stem anesthesia is used in inpatient treatment. Main indications:

neuralgia,
various injuries of the jaws and teeth,
severe pain syndrome
various operations.

The drug in this case is not injected into the mouth area, but near the base of the skull to block the nerves (mandibular and maxillary). The effect of such anesthesia is very strong and long lasting.

Application

This is superficial anesthesia, when sensitivity is removed only from the surface of soft tissues (gums most often). For these purposes, you do not need a needle, special sprays or ointments are available, which are very easy to apply with a cotton swab.

Indications:

to anesthetize the place where you need to make a painful injection,
at the base of the teeth
for processing the edge of the gums,
to open an abscess.

Contraindications

Before starting treatment, the doctor will ask you a few questions about your health. You need to answer honestly, as some diseases or past infections can become a contraindication to certain kind anesthesia.

Contraindications:

heart attack or stroke less than 6 months old
allergy to painkillers,
diabetes and other diseases of the endocrine system.

For local anesthesia, the following drugs are most often used:

articaine,
lidocaine,
mepivacaine,
ubestizin,
ultracain.

Anesthesia for pediatric dentistry

If you need to extract a tooth, only the gum and tooth will be frozen.

The child's body is very sensitive to any painkillers, therefore, complications on this basis in babies occur more often. For this age, there are still no absolutely safe anesthetics.

Most often, dentists use painkillers based on articaine and mepivacaine to treat babies. These drugs are the safest and least likely to cause complications.

In pediatric dentistry, the following types of anesthesia are most often used:

applique,
infiltration,
conductive.

What complications can occur with local anesthesia in children:

Psychogenic complications

Since babies have not yet fully formed the psyche, they are not able to independently control their emotions and fears. The kid can just be scared of the needle. The most common complication in this case is a short-term loss of consciousness.

Such a reaction of children is in no way connected with the effect of the anesthetic on the body, but is caused by the very fact of the injection. That is why the main task of the dentist in such cases is to distract the baby from the syringe and inconspicuously administer the drug.

allergic reactions

This type of complication is much less common because modern drugs as safe as possible (especially anesthetics of the amide group). Usually the cause of the allergy is not the drug itself, but the antioxidants that are present in it.

drug overdose

An overdose of the drug leads to a toxic reaction in the body. But in the conditions of modern dentistry, this is almost impossible, since for babies the dose of anesthetic is calculated strictly individually.

How can the quality of anesthesia be improved?

If you are very worried, take a small dose of a sedative the night before bed.

A day before the visit to the doctor, refrain from alcohol, as it significantly reduces the effect of the anesthetic on the body.

If you are allergic to any medications, be sure to tell your dentist.
If you are sick, postpone your visit to the dentist.
Women are not recommended to visit the dentist during menstruation and before it begins, when the body's susceptibility is increased, and nervous system a little unstable.

What are the possible complications

Complications may occur during and after anesthesia. Of course, if the doctor is a professional in his field, this is unlikely, but it happens. So, very rarely, but the following complications and unforeseen situations may occur during or after anesthesia in dentistry:

During the injection, the needle may break. This happens extremely rarely, since the needles are made of reliable durable materials. But if the patient makes a sudden movement at the moment when the needle touches the periosteum, the needle can easily break. Even if this happened to you, do not worry: the doctor will get the chip without difficulty.
Infection.

Infection with a needle is almost impossible, since all syringes are disposable. But this is quite possible if the injection is carried out in the infected area of the mucosa. In this case, under pressure, the anesthetic will push the infection into a healthy area of \u200b\u200bthe tissue.

Bruising (hematoma).

If blood from the vessels enters the soft tissues, a bruise will form.

Loss of sensation

This can happen if a doctor injures or grazes a nerve during an injection.

Soft tissue swelling

This complication occurs if the patient has developed an allergic reaction to the drug.

Pain and burning during the administration of the drug

This is normal, don't worry.

Lockjaw

This is a spasm of the chewing muscles. This complication occurs if muscles or blood vessels are damaged. It's not a big deal, trismus usually goes away on its own after a few days.

Soft tissue injury

Since the sensitivity decreases during the freezing process, you can easily bite your tongue, cheek, or lip.

Prices for different types of anesthesia

Estimated prices for local anesthesia

Almost every person in his life encounters a toothache and knows how unpleasant this sensation is. It may indicate that there is some kind of pathology in the area of \u200b\u200bthe teeth or jaw that requires the intervention of a dentist. However, a visit to the dentist is often postponed due to fear of experiencing the same pain, but already with therapeutic measures. Consider everything modern views anesthesia for dental treatment.

Several decades ago, anesthesia during dental procedures was performed relatively rarely. Therefore, many people who were treated back in Soviet years, there was a persistent association between dental treatment and the obligatory feeling of pain. Such patients are often afraid of going to the doctor and procrastinate before making a visit. Unfortunately, in this case, the situation only worsens and the patient's condition requires more and more intervention.
Modern dentistry involves pain relief during any treatment that may be associated with discomfort. For the purpose of pain relief, local anesthesia methods are used.
Local anesthesia involves a complete loss of sensation in a certain area of the human body. Most often, for the purpose of anesthesia, drugs are injected that make it difficult for the human brain to receive pain impulses from this area. Quality pain relief is important for both the patient and the attending physician. The patient, without experiencing pain, is in a comfortable state and does not strain. The dentist, in turn, is much more comfortable to treat if the patient behaves calmly.

Anesthesia is the reduction or complete disappearance of sensitivity in the oral cavity. This is achieved by introducing medications that disrupt the transmission of a pain impulse to the brain from the area of intervention.

When anesthesia is required

In the following cases, anesthesia before the procedure is mandatory:

treatment of deep caries;
treatment of pulpitis;
some measures to correct the bite;
preparation before prosthetics;
tooth extraction and other surgical interventions.

Varieties of anesthesia

Anesthesia is general and local, and is also divided into drug and non-drug. Non-drug pain relief rarely used and include:

electroanalgesia;
audioanalgesia;
computer anesthesia;
hypnosis.

Attention! Medication anesthesia consists of injecting an anesthetic drug that blocks the penetration of pain impulses into the brain. Thus, for some time, sensitivity is completely lost in a certain area.

After a certain period of time, the drug will be completely removed from the tissues, and the sensitivity will be fully restored. This is the most common method of anesthesia, which allows you to effectively relieve the patient of pain during medical measures.
General anesthesia (narcosis) is used infrequently. Usually the indication is the need for a very extensive list of procedures with poor tolerance of local anesthetics. Anesthesia is also sometimes necessary for pediatric patients, as well as during maxillofacial operations.

Local anesthesia

Local anesthesia is preferred over general anesthesia. An anesthetic injection is given before most dental procedures. The time-tested drugs Lidocaine and Novocaine are the most common, but there are now many more modern anesthetics.
Local anesthesia is divided into varieties:

application anesthesia;
infiltration anesthesia;
infiltration anesthesia;
conduction anesthesia;
intraosseous anesthesia;
intraligamentary anesthesia;
stem anesthesia.

Application anesthesia is the use of an anesthetic without introducing it into the tissues, but only applying it to the surface of the area that needs to be anesthetized.

Application anesthesia

Pain relief with this type of anesthesia is superficial. A preparation based on 10% lidocaine is applied to the mucous membrane in the form of a spray or gel.
Application anesthesia is often used at the site of the mucosa where the injection will be given. This makes the injection painless for the patient.

Important! Superficial anesthesia is relevant when carrying out therapeutic measures associated with stomatitis, gingivitis, as well as purulent infections. Application anesthesia is used for hygiene procedures to remove hard dental deposits, as well as during preparatory activities for grinding and prosthetics.

Infiltration anesthesia

Gentle injection anesthesia is carried out with the help of an injection in the region of the upper part of the tooth root. Such anesthesia is used in the treatment of deep caries and anesthetizes only a limited area of \u200b\u200bthe mucosa or one tooth. It is usually used for the upper jaw, as anatomical features bones contribute to the effective distribution of the anesthetic.

Conduction anesthesia

Conduction anesthesia is a type of anesthesia in which nerve transmission is blocked in the area of the body where the operation is planned, which is manifested by complete immobilization and anesthesia.

This type of anesthesia is used for a larger scale pain relief. Conduction anesthesia makes it possible to anesthetize several adjacent teeth at once. It is used in the treatment of pulpitis, the opening of suppuration, the treatment of periodontitis and other serious conditions that require severe anesthesia. With anesthesia of this type, the injection makes the entire area related to this nerve bundle insensitive.

Intraligamentary anesthesia

Such anesthesia is common in pediatric dentistry, as well as during tooth extraction in patients of any age. The injection is made into the area of the periodontal ligament between the tooth root and the alveolus. A feature is the absence of loss of sensitivity of the mucous membranes, which helps to avoid accidental injury, for example, when biting.

Stem anesthesia

Held only in stationary conditions.

Important! Stem anesthesia is used for very severe pain associated with neuralgia or maxillofacial trauma. This type of anesthesia is also used during jaw surgery.

The injection is made in the area at the base of the skull bones. Thus, the nerves of both jaws lose their sensitivity. Stem anesthesia is characterized by maximum efficiency and a long period of action.

Intraosseous anesthesia

Intraosseous anesthesia is used in cases where infiltration or conduction anesthesia is ineffective in the treatment, extraction of teeth, and operations on the alveolar process.

Most often used for tooth extraction. The injection is made in several stages. First, the anesthetic is injected into the gum, and after loss of sensitivity, the injection is deepened to the jawbone in the gap between the teeth. The analgesic effect appears immediately, but also quickly passes.

Restrictions on the use of anesthesia

Before giving an injection, the dentist necessarily clarifies whether the patient has contraindications to local anesthesia. These include, for example:

cases allergic reaction that occurred after an anesthetic injection;
diabetes;
condition after a heart attack or stroke (if less than six months have passed);
individual cases of hormonal disruptions caused by endocrine pathologies, such as thyrotoxicosis, etc.

At acute stage diseases of the endocrine system, anesthesia can be used exclusively in stationary conditions. Increased caution from the doctor also requires pain relief in pediatric patients, as well as in pregnant women.

Doctors recommend that women treat all their teeth at the stage of pregnancy planning in order to avoid contact with anesthesia and x-rays. But if a tooth aches during pregnancy, then they need to be treated in order to eliminate the source of infection in the oral cavity.

Modern anesthetics

Lidocaine and Novocain are considered traditional drugs for pain relief. Lidocaine for injection is used at a concentration of 2%, and for application anesthesia, a 10% solution of the drug is used. Novocaine in dental practice is used less and less. Anesthetics based on these drugs usually contain adrenaline so that the pain relief effect is more pronounced and lasts longer.
New generation anesthetics are:

ultracaine;
septonest;
mepivacaine;
scandonest;
articaine.

Anesthetic drugs of this series are enclosed in special cartridges, which, when injected, are placed in a special metal syringe. The syringe uses a disposable needle, which is much thinner than conventional injection needles. The injection is practically painless.

This image shows the anesthetics of the modern generation, among them: ultracaine, septonest, mepivacaine, scandonest, articaine ...

Some of these drugs also contain adrenaline to enhance the effect, but there are also non-adrenaline anesthetics indicated for use in children and pregnant women.

Anesthesia for pediatric patients

The use of any anesthetic drugs cannot be absolutely safe in childhood. The child's body is very sensitive to any intervention, including the introduction of anesthetic drugs, so the likelihood of negative consequences increases.
Currently, Novocaine and Lidocaine have been replaced by safer drugs that are recommended for use in young patients.
For children, the following types of anesthesia are used:

infiltration;
application;
intraligamentary;
conductive.

Psychogenic reactions are the most common complication in very young children. The child does not fully understand what is happening and can be very frightened. Having become very nervous, the baby may even lose consciousness for a short time.

When treating children's teeth, remember that children's body sensitive to any interference, therefore, the likelihood of negative consequences in the form of an allergic reaction, temperature increases ...

Possible side effects of local anesthesia

The most common complications are:

toxic poisoning (due to overdose);
allergy to anesthetic components;
soreness at the injection site (refers to normal options);
loss of sensation due to nerve injury during the injection process.

Some of the side effects of anesthesia include:

spasm of the muscles involved in chewing (occurs when the muscle or nerve endings)
breaking off the tip of the injection needle;
infectious inflammation of tissues (in violation of antiseptic standards);
swelling at the site of tissue puncture (in case of damage to blood vessels);
injury to the oral mucosa in case of accidental biting (due to lost sensitivity).

Modern pain medications minimize the risk, however, much also depends on the competence of the doctor performing the injection.

What Patients Need to Know

The day before treatment, patients should not drink alcohol. This is due to the fact that alcohol has the ability to reduce the effectiveness of anesthetics. An anesthetic injection can be practically useless if the patient has not abstained from alcohol the day before.
It is also worth saving your nerves, and in case of stress, take light sedatives at night (extract of valerian, motherwort, etc.).

Important! You should not go to the dentist if you have cold or flu symptoms.
Women should not schedule a visit to the dentist during their period. During menstruation, patients are more prone to stress, and susceptibility to drugs also changes.

If a tooth is extracted, the risk of bleeding increases.

It must be remembered that before the treatment of teeth with the use of anesthesia, in no case should you take alcohol!!! This reduces the effectiveness of the drugs used.

Use of general anesthesia

General anesthesia implies not only a loss of sensitivity, but also a violation of consciousness to varying degrees.
Most often, this type of anesthesia is used in maxillofacial surgery. General anesthesia has many contraindications and is considered less safe than local anesthesia, therefore it is used mainly for surgical interventions.
Anesthesia with nitrous oxide is becoming more and more common. This type of anesthesia has found application in pediatric dentistry.
Additional circumstances that may make it appropriate to use general anesthesia, are:

mental disorders;
allergic reaction to local anesthetics;
panic fear of dental treatment.

It should be borne in mind that general anesthesia has absolute contraindications:

pathology of the respiratory organs;
allergic reaction to drugs for general anesthesia;
cardiovascular diseases.

If the patient is to undergo medical intervention using general anesthesia, then a number of studies and analyzes must first be carried out:

blood test for hepatitis;
blood test for HIV;
removal of an ECG;
general blood analysis.

If the patient has diseases in the acute stage, then surgery should be postponed until recovery.

Attention! A few days before the procedure, it is forbidden to drink alcohol and smoke cigarettes. Do not eat or drink on the eve of the operation.

General anesthesia in the implementation of dental manipulations has the right to conduct only a certified anesthesiologist-resuscitator.

A visit to the dentist causes many people unpleasant associations and 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 of accurate and safe pain relief. Local anesthesia, which is now used in dental clinics, capable completely relieve the patient not only from painful, but also unpleasant sensations.

What is the procedure?

Doctors call this phrase a complete loss of tissue sensitivity to any irritation in a certain area with the help of injecting certain drugs. That is, it is in the place that will be subjected to medical manipulations that the patient stops feeling anything, while remaining conscious.

Also quite common are the names local anesthesia and local anesthesia. By using specific drugs, which are introduced into the body directly at the desired site, nerve cells there for a while stop conducting impulses.

Classification

On 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 in order to achieve a result there is no need to make an injection or injection.

Application method. Also called chemical. Quite often used to anesthetize the oral mucosa. The drug in this case is applied or simply rubbed into the desired area.
Physical. It is used very rarely due to a rather weak, superficial effect. When using this method, the desired tissue area is frozen by spraying. various substances, who have very low temperature boiling. Evaporating quickly, they cool the tissues, thereby blocking the nerve endings.
Physico-chemical. An anesthetic is injected into the desired tissue area using electrophoresis. In most cases, this technique is used for neuralgia.

Injectable local anesthesia

The techniques listed here show top scores than pain relief without injections. Besides, the effect of painkillers in this case lasts much longer.

That is why doctors prefer injections for local anesthesia in dentistry.

This type of anesthesia can be divided into four types, depending on the method and specific injection site. It is worth describing each of them in more detail.

Conductor

In this case the medicine must be injected right next to the nerve Thus, the drug covers with its action the tissues surrounding the nerve, and itself. Most commonly used by dentists for complex operations with localization on 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", so the impulses from this area do not reach the brain and the patient "does not know" that he is experiencing some sensations.

infiltration

In this case an injection is made in the area where the projection of the top 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 inside of the tooth and acts from the inside.

intraligamentous

It also has a different name - intraligamentary. Injections here are made from the outside and inside into the periodontal ligament through the gingival sulcus. At the same time, numbness of the gums from all sides and the tooth itself occurs instantly.

Quite often, this method is used for pain relief in children. In this case, both the needle itself and the cartridges with medicine of a special size 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, anesthesia lasts for a fairly short time. Secondly, numbness covers 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 reduced pain threshold, that is, increased sensitivity.

It consists in the fact that with the help of the drug all branches are blocked trigeminal nerve . To do this, an injection should be made at a special point located at the base of the skull.

Instruments and preparations for carrying out

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 administered.

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 syringes-injectors. When dressing the needle, the capsule is pierced and the drug can be administered.

The advantage of this method is complete guaranteed sterility, since the drug capsules are airtight. As well as a more gentle injection of the drug due to the very small thickness of the needle.

In addition, carpules (i.e., capsules) may additionally contain 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, can be used and reusable. The effectiveness of these tools is less compared to carpool injectors. This is due to some design and size flaws.

For example, the needle diameter of conventional syringes is about 0.7–0.8 mm. The tissues in the oral cavity are highly saturated blood vessels, and when using such needles, hematomas and other unpleasant complications may occur.

Also, during the procedure for drawing anesthetic from the ampoule, sterility may be violated, which is unacceptable.

Preparations for dental local anesthesia

There are several of the most effective and common drugs that are used in dental practice for local anesthesia.

Ultracain. Produced by a French company based on articaine. There are three main forms that 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 probability of allergies in patients prone to this.
Skadonest. Produced by Septodont, France. The drug is based on 3% Mepivacaine. It 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 caries in a complex form.
Periodontitis.
Extraction of one or more teeth, as well as separately the roots.
Purulent inflammations and similar processes in the bones of the jaws.
Inflammatory lesions of the jaw joint.
Neuralgia, neuritis of the facial nerve.
The impossibility of carrying out 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 manipulation.

Contraindications

It is mandatory to interview the patient before the treatment procedure. The answers are very great importance for the choice of a specific method of anesthesia, as well as certain drugs.

Some diseases, in particular, the patient's previous infection, may be a contraindication to some types of injection anesthesia.

List of contraindications

Postponed no more than 6 months ago, stroke or heart attack.
individual allergy.
Diseases 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.
Hypersensitivity or the presence bronchial asthma require the absence of a preservative in the preparation. Most often it is sodium disulfide.

During pregnancy

The bulk of the drugs used for local anesthesia in dentistry cannot overcome the placental barrier. It means that they do not enter the body of the child and are safe for him.

That is why, both during pregnancy and during breastfeeding, anesthesia can be done.

During pregnancy, excessive pain for the mother can harm the baby much more than drugs that are used to get rid of pain. However, the choice of a particular drug is still important, because it is not worth exposing the child to danger (even hypothetical) once again.

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 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 possible pain. Today, dentistry is a painless and fast treatment.

In conclusion, a video in which a dentist of one of the clinics talks about local anesthesia:

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