Every person experiences painful sensations while in the dental chair. Most people then become afraid of going to the dentist. Therefore, anesthesia for tooth extraction is a common procedure. The use of painkillers relates to surgical operations, but not on a large scale.

To quickly and painlessly cure or remove a tooth, you need to choose the right anesthesia. Today there are a large number of painkillers. They have been so improved that a person does not feel any pain.

Tooth extraction is always performed under anesthesia

Anesthesia methods

Anesthesia can be local or general. Local form divided into external and injection methods.

The external method allows you to anesthetize superficial tissues using medicinal substances. These can be special ointments, gels, devices with electromagnetic waves just applications. The last method is used most often. The application is a cooling plate. It is applied to the gums, and the patient does not feel pain. This method is usually used to remove baby teeth in children.

The injection method involves injecting an anesthetic substance through a needle.

Injection anesthesia is the most common method

There are 4 types of anesthesia:

Conductor. The method allows you to anesthetize several teeth at once. An anesthetic is injected into the area of the last tooth where the branch of the nerve is affected, resulting in blockage of the entire nerve.
Infiltration. An anesthetic substance is injected into the projection area of the apex of the tooth root.
Intraligamentous. The medicine is administered through the gum. As a result, the tooth and the surrounding gum area are numbed. For this method, a special syringe with a dispenser is used. It allows you to administer a minimum of anesthetic substance.
Intraosseous. It is the best anesthesia. IN in this case the injection is made directly into the spongy bone. It is she who covers the dental alveoli.

Intraosseous anesthesia is administered between the teeth

General anesthesia (anesthesia) is done very rarely.

It should not be used for people who have heart problems. Apply this method anesthesia only in the most difficult cases. Dentistry must be equipped with a special office and all the necessary equipment. And also during surgical operations, the presence of an anesthesiologist next to the patient is mandatory.

Carpule - one-slave injection anesthesia

Only the doctor decides which anesthesia is best for tooth extraction. Everything will depend on the complexity of the procedures and the general condition of the tooth.

Basic painkillers

Not any anesthesia can be used when extracting a tooth. In dentistry, only the most common and effective medications are used. And almost every hospital has Novocaine.

But in modern treatment novocaine is used much less frequently. If previously not a single operation could be done without it, now this drug causes an allergic reaction in most people. It has a number of side effects:

dizziness;
lethargy;
lowering blood pressure.

Local anesthetics

Today there are more intense anesthetics, and therefore novocaine is used only in combination. It is injected into the body with a small dose of adrenaline. In combination, these drugs have the best analgesic functions. But such a mixture should not be prescribed to people whose blood pressure is off the charts.

Anesthetic Lidocaine in the form of a spray

For infiltration anesthesia, a 0.5% lidocaine solution is used. This drug can be used for the conduction method; only a 1–2% solution is required. For an adult, the norm is 300–400 mg. TO side effects This medicine includes:

headache;
fatigue;
loss of sensation in the lips and tongue;
heart rhythm is disturbed;
blood pressure decreases;
there may be hives.

The most modern anesthesia is a medicine based on the substance articaine. Such drugs can provide long-term and reliable pain relief. It is used by a large number of dental surgeons. The substance reaches its maximum effect after 10 minutes and maintains its result for 1–3.5 hours. But no matter how good the drug is, it always has side effects:

muscle twitching;
headache;
tremor;
nausea;
vomiting reflex;
diarrhea.

Complications of anesthesia during tooth extraction

These are the most common side effects. But sometimes others happen:

blood pressure decreases;
cardiac arrhythmia is disturbed;
rashes appear on the skin;
angioedema may occur.

These painkillers cannot be used for meningitis, tumors, osteochondrosis, spondylitis, tuberculosis, metastatic lesions of the spine, heart failure, tumors in the abdominal area, severe arterial hypotension, hemostasis disorders.

Use with caution during pregnancy. The drug may cause a decrease in the fetal heart rate.

Ultracaine is one of the most effective anesthetics

Very good drug based on articaine is Ubistezin. It also contains adrenaline. It reduces blood vessels in the area where anesthesia was administered. This makes it difficult to absorb the substance. As a result, the analgesic effect begins to act within 3 minutes. In addition to the above-mentioned side effects that articaine-based drugs have, Ubistezin also adds the likelihood of an ischemic zone in the area where anesthesia was administered. This occurs if a blood vessel has been hit or a nerve has been damaged.

Removing wisdom teeth

Anesthesia for the removal of a wisdom tooth is no different from conventional means for the treatment of other teeth. The doctor decides independently how to administer the medicine depending on the specific situation.

Most often, wisdom teeth are removed not because they are affected by caries, but because of their abnormal location. As a result, these teeth have the pathology dystopia or retention.

Dystopia is the process of eruption of a wisdom tooth that is displaced towards the cheek or tongue.
Retention is when a wisdom tooth has formed but has not erupted through the gum. In this case, the dentist makes an incision in the gum, removes the wisdom tooth and stitches the incision. Typically, such surgical procedures are performed under local anesthesia.

Removing baby teeth

Milk teeth that can no longer be cured, but they provoke the development acute inflammation bones or periosteum must be removed. Which method to use will depend on the specific situation.

For example, deleted baby tooth It is already well loosened and the pain when tearing it out will be minimal. In this case, the doctor may advise putting on an application, gel or aerosol.

Lidocaine aerosol is used quite often. There are 3 mg per 1 kg of body weight. For children, it is better to apply this substance using a cotton swab.

Removing baby teeth does not cause severe pain

With more serious problems with teeth, children are given infiltration anesthesia. Lidocaine, Ubistezin Forte and similar medications are used. Two injections are made - from the gum and from the tongue.

Children tolerate these painkillers well. But before using them, it is necessary to undergo tests to identify allergens. It is also worth clarifying whether the child has problems with the cardiovascular system.

Anesthesia after tooth extraction

After the tooth has been removed and the anesthesia has begun to wear off, pain may occur. Sometimes pain symptoms They can be very strong and unbearable to endure. In this case, they resort to repeated anesthesia. The most common pain reliever offered by dentists is Ketanov.

Ketanov is able to relieve a person from severe and sharp pain.

It is often prescribed after surgery. The drug can be used every six hours, but not more than one week.

Ketanov tablets relieve pain well

Like any medicine, Ketanov has side effects. These include:

drowsiness;
dyspeptic disorders;
the appearance of dry mouth;
accelerated heartbeat.

The drug should not be taken by people who have:

bronchial asthma;
ulcer of the duodenum and stomach;
kidney diseases.

It is also undesirable for women to use during lactation and pregnancy.

If after three days pain or swelling occurs again, you should immediately consult a doctor.

Medicines you shouldn't take

Many people use homemade medications for pain relief. But they have low efficiency and can provoke undesirable results:

Aspirin. The medicine is intended to perform an antipyretic function. The analgesic effect is minimal. Aspirin is a good blood thinner. This may lead to delayed bleeding. Although this medicine included in many painkillers.
Paracetamol. The drug can only cope with mild headaches. It has no anti-inflammatory effect and has a negative effect on the liver. Included in painkillers as an adjuvant.
No-shpa. Many people think that this medicine is a pain reliever. But that's not true. No-spa is an antispasmodic drug that only eliminates pain associated with spasms. The pain after tooth extraction is completely different and no-spa will not be able to cope with it.

Anesthesia doesn't work

There are cases when the anesthesia does not work and the person feels pain. There are several factors why this happens:

Alcohol. Chemical composition ethyl alcohol can block the effects of the anesthetic. Therefore, it is not recommended to go to the dentist if you have recently consumed strong drinks.
Using large amounts of painkillers. If a person is taking medications that contain painkillers, they should not be taken before seeing a doctor.
A person may have individual immunity to certain anesthetics. This factor is very rare.

If the anesthesia does not work, then it is worth understanding the reason. Having received the result, the treatment is postponed to another day.

Eating after removal

It is not recommended to eat salty and spicy foods after tooth extraction. They irritate the mucous membrane and increase pain. Consuming hot food and drinks can cause bleeding and increase swelling.

Many people have been afraid to eat ice cream for a long time, claiming that they will catch a cold. Cold food has no effect on this. provoke this problem There may be general hypothermia of the body or a draft. The main thing is to eat the ice cream slowly and not bite into large pieces. This delicacy is even recommended, because it forces you to contract blood vessels, which means there is no risk of bleeding.

Statistics show that more than half of the country's population is afraid to visit the dentist due to perceptions of inadequate treatment, a high risk of complications, etc. Pain management deserves special attention. Anesthesia in dentistry is a complex, independently functioning section. During scientific research many points and routes of administration of anesthetics have been identified, the composition of which also varies and is always selected strictly individually, taking into account somatic diseases, medical history and degree of damage to the oral cavity.

Complicated forms of caries;
Periodontitis;
Removal of teeth (one or a group);
Removal of dental debris;
Changing the location or growth zone of a tooth;
Any purulent-inflammatory processes on the part of the bone frame or soft tissues of the jaws and oral cavity;
Contractures of the temporomandibular joint;
Minor plastic surgical interventions, these include: piercing, botulinumplasty, etc.;
Neuritis and other inflammatory and degenerative lesions of the peripheral nervous system;
As palliative therapy for severe damage to oral tissues due to radiation sickness or malignant neoplasms.

In many cases, dental treatment requires anesthesia.

Pain medications

There are many different local anesthetics widely used in dentistry. Each of them must meet the following criteria:

Low ability to cause allergic reactions (including irritation of nerve trunks and fibers);
Minor systemic toxicity (especially dangerous effects on the cardiovascular and central nervous systems);
Rapid development of analgesic effect.

Types of anesthesia in dentistry

Both in the therapeutic and surgical branches of dentistry, various types of anesthesia are used, differing in the technique of administration, the list of indications and contraindications, as well as the drugs used.

All methods of pain relief are divided into two large groups:

General anesthesia is a suppression of the central nervous system, which allows you to get rid of all types of sensitivity and briefly “turn off” consciousness.
Local anesthesia is a local effect of the drug on nerve fibers, blocking the conduction of impulses. It is a priority due to the low number of complications and side effects.

Local

Local administration of anesthetic solutions is a priority, as it allows:

Achieve anesthesia in a short time;
Quickly carry out surgical intervention or treatment of teeth, gums, mucous membranes;
Avoid systemic complications.

With local anesthesia, a special solution is injected into the area

Appliqué

At this method anesthesia is performed on the surface layers of the mucous membrane and submucosa (depth - about 3 mm). Recommended for performing simple surgical or therapeutic operations (suturing a rupture, removing tartar, temporary pain relief during an inflammatory process). The duration of action, as a rule, does not exceed 10–20 minutes. Medicines used include:

"Lidocaine";
"Dikain";
"Anestezin."

It is important! To increase the local effect, reduce the rate of absorption into the systemic circulation and prevent the appearance of unwanted toxic effects A vasoconstrictor is added to the solution.

The procedure is extremely simple:

The anesthetic is used to wet a bandage, gauze or cotton swab. Excess medication should be squeezed out to avoid the solution getting into unwanted areas.
Apply the tampon to the lesion for 2–3 minutes.

Infiltration

The variation is the most common in dental practice. Used when performing any dental interventions. There are 2 main methods:

Straight. A solution of the medicinal substance is injected under the mucous membrane in the affected area.
Indirect. The medication is used on a remote proximal segment (more than 2 cm from the primary lesion) and causes a block in nerve impulse transmission.

The main advantages of the technique:

Ease of execution and quick learning personnel;
Low incidence of complications after the intervention (less than 0.02%);
Zero probability of the needle breaking off (since it is immersed superficially and does not come into contact with bone tissue and muscle fibers);
There is no possibility of the solution getting into large vessels (in peripheral tissues, the diameter of the lumen of arteries and veins is insignificant).

Infiltration anesthesia in dentistry is used for various types of operations

Carrying out anesthesia is not difficult:

Selecting the location of the needle insertion site (depending on the affected tooth or area of the mucous membrane).
Advance the needle to a depth of 2 to 5 mm.
Introduction of the medicinal component. Up to 5 ml of anesthetic can be used.

Region	Needle insertion site	Depth	Name of medicinal solutions approved for use
Upper jaw: 13, 12, 11, 21, 22, 23 teeth.		2–3 mm.	"Ultracaine", "Lidocaine".
Upper jaw: 17, 16, 15, 14, 24, 25, 26, 27 teeth.	The area of the transitional fold of the preceding tooth. The needle is inserted parallel to the fold to the projection zone of the middle of the crown of the next chewing element.	3–6 mm.	"Lidocaine", "Trimecaine", "Articaine".
Upper jaw: 35, 34, 33, 32, 31, 41, 42, 43, 44, 45 teeth.	Transitional fold in the projection zone of the middle part of the crown of the affected tooth.	3–5 mm.	"Lidocaine", "Trimecaine".

There are also separate types of infiltrative anesthesia. For example, the subperiosteal method of anesthesia allows the anesthetic to be deposited in the area of the periosteum, which increases the effectiveness and duration of anesthesia several times.

Subperiosteal anesthesia is indicated during heavy dental operations and for persons with a low pain threshold. The phasing can be represented as follows:

Injection of a needle into the mucous membrane of the alveolar process in the area of the projection of the middle of the crown of the tooth that requires anesthesia. It is necessary to retreat from the transition fold by 1–3 mm.
Creation of a minor anesthetic depot.
Piercing the periosteum, placing a thin needle at an angle of 40–45 degrees relative to the long axis of the tooth.
Advance the needle towards the root apex until it stops.
Administration of medication.

Intraligamentary

This variety has earned the attention of dentists only in the last 10 years. The anesthetic is injected into the soft tissues of the dental ligaments under high pressure, as a result of which the medicinal substances quickly enter the bone tissue alveolar process, through which the medication spreads to the apex of the tooth.

Intraligamentary anesthesia can be considered as an option for intraosseous

To carry out pain relief you should:

Perform processing antiseptic solutions teeth and periodontal pocket.
Inject the needle into the area of the gingival sulcus, the needle should be in contact with the side surface of the tooth and form an angle of 30 degrees with its root.
Insert the needle until you feel an obstacle, turn it 180 degrees, inject the drug (0.2 to 1 ml) in 30–40 seconds.

Intraligamentous anesthesia is rarely used and is indicated when it is impossible to perform other types of anesthesia:

Anesthesia in children with intolerance to other types;
Treatment of diseases of hard dental tissues, including complications;
The presence of individual drug intolerance (this type of anesthesia requires several times less anesthetic solution).

Conductor

Conduction anesthesia in dentistry is the administration of an anesthetic away from the lesion. As a result, a block of nerve impulse transmission occurs on a separate segment of the nerve fiber. It has several undeniable advantages:

Anesthesia of large areas innervated by one nerve trunk with just 1 injection;
Use of small volumes of anesthetic solution;
Low invasiveness and, as a consequence, low risk of complications after the intervention;
The ability to administer the drug far from the source of infectious and inflammatory lesions, where the effectiveness is several times lower;
Possibility of using high concentrations of the drug to prolong the effect;
Absence mechanical damage tissues in the place where the surgical intervention will be performed;
Safety of use among patients of older age groups (60 years and more);
Making the dentist's work easier: with this type of anesthesia, autonomic nerve fibers are also blocked, as a result, salivation is reduced to zero.

With conduction anesthesia, the drug is administered at a distance from the object of intervention

Mandibular

The technique is as follows:

Place the syringe at the level of the premolar of the opposite side and inject into the outer slope of the fold, which is located on the border between the n/3 and c/3 parts (each part is equal to 1/3 of the fold).
Advance the needle until it reaches the bone tissue.
Turn the needle towards the premolars and plunge to a depth of 1.5 to 2 cm.
Injection of anesthetic solution.

The following medications can be used: “Trimecaine”, “Novocaine”, “Lidocaine”, “Articaine”.

Torusal

A type of mandibular anesthesia is torusal, in which the main orientation is on the mandibular ridge. Both options allow anesthesia of all branches trigeminal nerve.

Thorusal anesthesia is a simple and effective method

Innervation zone for both types of anesthesia:

Alveolar process, mucous membrane or teeth of the half lower jaw on the administration side;
1/2 of the tongue and sublingual area from the side where the medicinal solution is introduced;
Skin and mucous membrane of the cheek on the injection side, half of the lower lip;
Chin area: all - on the side of insertion, partly - from the opposite area.

Tuberal

This option involves the introduction of an anesthetic between the tubercles. upper jaw. In this area there are alveolar nerve fibers that provide innervation to the alveolar ridge from 1 to 3 molars. Tuberal anesthesia is the most dangerous and is characterized by a high incidence of complications (up to 10%) associated with anatomical structure jaws (location of large-caliber vessels and nerve fibers).

The method is not currently used.

Stem

Indicated for extensive operations that require simultaneous anesthesia of the entire jaw. The introduction of an anesthetic leads to a block of everything maxillary nerve. This intervention can be implemented in 2 areas:

Oval hole in the mandibular fossa;
A round hole in the pterygopalatine cavity.

More than 10 techniques have been proposed. An example is the subzygomatic route of pain relief:

Inserting a needle into the area of intersection of the lower surface of the zygomatic bone with the vertical axis, which is carried out at the lateral edge of the orbit.
Direct the needle upward and inward until it touches the tubercle of the upper jaw.
Advance the needle inward and backward 4–6 cm, sliding along the bone.
The needle gets into the pterygopalatine fossa (feeling of failure).
Administration of 1 to 3 ml of drug solution. Used: “Novocaine”, “Trimecaine”, “Lidocaine”, “Articaine”.

General anesthesia is a reversible depression of consciousness, accompanied by complete analgesia, amnesia and relaxation of all muscles. The route of administration can be:

Inhalation;
Non-inhalation.

Through the first method, gaseous and vaporous drugs are administered. Nowadays, Ftorotan, Methoxyflurane, Xenon, and Enflurane are widely used.

General anesthesia in dentistry is used in exceptional cases

Sodium oxybutyrate, Propofol, Ketamine, Calypsol and others are used as intravenous anesthetics.

Oral, rectal, and intramuscular routes of administration are less common (however, they are not common in dentistry).

Indications for general anesthesia are severe general state(massive jaw injuries, multiple fractures, etc.) or individual intolerance to local anesthetics.

Contraindications

Any medicinal product has a list of diseases for which its use is strictly prohibited. Stand out:

Individual genetically determined intolerance to individual components of the anesthetic solution;
Pathology of the muscular-articular system (myasthenia gravis, hypotension);
Severe disruption of vital functions important organs, especially kidneys and liver (amyloidosis, cirrhosis, etc.).
Pathological processes in the area of injection; this group includes infiltrates, any cavity formations with accumulation of pus, ulcers, erosions and other defects.

Anesthetics containing a vasoconstrictor component are additionally contraindicated for:

Pregnancy (at any stage);
During breastfeeding;
Arrhythmias (sinus bradycardia, paroxysmal tachycardia, atrial fibrillation);
Angle-closure glaucoma;
Heart failure;
Diabetes mellitus;
Reception of individual medicines(beta blockers, TAGs, MAO inhibitors).

Side effects and complications

Among the undesirable effects are:

Local allergic reactions (itching, burning, hyperemia, appearance of vesicles). General allergopathologies (anaphylactic shock, urticaria) are extremely rare.
Irritation reactions to the administration of anesthetics (manifestations are similar to allergies, but disappear within 1–2 hours).

Complications:

Incorrect introduction of aggressive liquids (hydrogen peroxide, formaldehyde) due to violation of storage conditions. Any consequences: from allergic reactions to necrosis of massive areas of the maxillofacial region.
Intravascular administration of anesthetic. Causes vascular spasm, severe pain and ischemia of tissues located distally.
Injury to a vessel with a needle (a hematoma or bleeding occurs).
Nerve damage from a needle. Consequences: paresis or paralysis.
Any violation of the integrity of the facial muscles.
Perforation of the nasal cavity and paranasal sinuses.
Wound eyeball needle.
Dislocation of the temporomandibular joint. Caused by too wide opening of the mouth during anesthesia against the background of weakness of the articular, muscle and tendon apparatus.
Development of infectious and inflammatory pathologies at the site of needle insertion.
Cicatricial contractures in areas of primary inflammation.

Anesthesia for children

For children under 3 years of age, the only way to solve dental problems is general anesthesia. The use of local anesthetics is not advisable due to aggressive behavior child in relation to the doctor.

The behavior of young patients can be unpredictable, so general anesthesia is used for them

General anesthesia is also indicated for children with severe developmental defects and anomalies, autism, epilepsy, chromosomal pathologies (Down syndrome, Klinefelter).

It is important! From 3 to 14 years of age, it is possible to use infiltrative anesthesia, but before the procedure it is necessary to apply applications with analgesics, additionally containing pleasant flavoring substances.

From the age of 14, the use of any method of pain relief is permitted.

For pregnant women and breastfeeding

During the period of bearing a child, it is prohibited to use anesthetic solutions that contain vasoconstrictors (adrenaline). Systemic vasoconstrictor effects can lead to disturbances in the complex “mother-placenta-fetus” system and cause fetal hypoxia, premature abruption of a normally located placenta and other disorders.

During pregnancy, anesthesia is used only in case of emergency

Mepivacaine can be considered the only safe medication, which does not dilate the vessels of the microvasculature and also has a low list of side effects.

Price

Cost of holding various types pain relief varies depending on the region and the profile of the clinic (private or public).

Video: anesthesia in dentistry

Thus, in the modern dental services market there are many different types and methods of local anesthesia or general anesthesia. Each method has a separate list of indications and contraindications. When choosing an anesthetic, it is imperative to take into account the patient’s allergic history in order to avoid unwanted complications.

Fear of dentists is such a common phenomenon that this phobia has several names: dental phobia, odontophobia and dentophobia. Most of the procedures that dentists perform actually cause discomfort. This is not surprising; the sensitivity of oral tissues is on average six times higher than the sensitivity of the skin. That is why visits to this specialist are rarely done without anesthesia.

To prick or not to prick?

There are two types of anesthesia: general and local. Most often, dentists prefer the latter.

“General anesthesia is essentially anesthesia. Dentists primarily work with local anesthesia, that is, only a certain area is anesthetized,” said Anna Gudkova, head of the dental department of one of the private clinics in Moscow.

There are several types of local anesthesia: application, infiltration, conduction, mandibular, torus and trunk. At the same time, application is the only method of pain relief that does not require the use of a needle.

“With topical anesthesia, a gel or ointment is applied directly to the mucous membrane and only freezes it,” the expert noted, adding that this method of pain relief is suitable, for example, for removing tartar.

Other types of anesthesia differ from each other only in the technique of administration.

“They differ only in the insertion technique. For example, specialists know that conduction anesthesia cannot be given to the upper row of teeth; the injection is given precisely in the corner of the lower jaw,” Gudkova explained.

To reduce pain, dentists give injections using special carpule syringes, which have a thinner needle. In addition, the device is designed in such a way that no foreign substances enter the anesthetic.

Substitute for cocaine

The safety of anesthesia largely depends on which drug the doctor chooses. Local anesthetics are divided into amide and ether. One of the oldest painkillers is novocaine. It was first synthesized back in 1898 by the German chemist Alfred Einhorn and replaced cocaine used at that time for local anesthesia.

“Today, novocaine is used extremely rarely as an anesthetic drug. It has a very long latent period, that is, it acts after 10, 15, or even 20 minutes. Currently, too little time is allocated to see a patient, so it is not possible to wait 20 minutes for the anesthesia to take effect,” the candidate said medical sciences, Associate Professor of the Department of Pain Management in Dentistry, Moscow State Medical and Dental University (MGMSU) Elena Zorian.

According to the specialist, novocaine is usually contained in ampoules, which means it is almost impossible to maintain the sterility of the anesthetic. The drug has other disadvantages.

“Novocaine dilates blood vessels, so before the anesthesia was very weak and did not last long. To increase the duration of action, adrenaline was added. However, it was, of course, impossible to confirm the accuracy of the dosage in this case,” explained the dentist with 50 years of experience.

Amide instead of ether

Modern doctors prefer to use drugs from the amide group. According to the expert, they act faster and their effect lasts longer. Most often, dentists use lidocaine, articaine and mepivacaine for pain relief. Each of these drugs has its own advantages and disadvantages, the doctor noted.

“Public clinics mainly use lidocaine because it is cheaper. This is the first drug from the group of amides that was introduced into practice. It begins to act within 2-5 minutes after application. And this is the only drug that provides all types of pain relief. That is, it can not only be injected inside, but also applied to the mucous membrane,” Zoryan said.

However, like novocaine, lidocaine is available in ampoules and is sold in various concentrations.

“Dentists can only use it in a 2% concentration, but there are ampoules of lidocaine with a 10% concentration,” the doctor explained.

In addition, the drug penetrates tissues and is quickly absorbed into the blood, which can negatively affect patients with disorders of the cardiac and nervous systems.

“Lidocaine, like other local anesthetics, dilates blood vessels, so it should be used together with drugs that narrow them - vasoconstrictors. Therefore, the doctor can only use a 2% solution for injection. Higher concentrations are sometimes used for superficial anesthesia. However, even in this case, it is important to remove excess anesthetic,” the expert warned.

Lidocaine should not be used by people with severe liver and kidney dysfunction, and should also be used with caution during pregnancy, lactation and diseases of the hematopoietic organs.

Choosing a Dentist

According to Candidate of Medical Sciences Zoryan, doctors use articaine much more often. It is also known as ultracaine.

“It breaks down faster and is eliminated from the body faster. In addition, it is less absorbed into the blood and almost does not pass into breast milk. That is, there are significantly fewer contraindications for use. The drug is used only for injection types of local anesthesia,” the expert said.

It is also often used in conjunction with vasoconstrictors. According to the dentist, due to the latter, a person’s heart rate may increase and blood pressure may increase.

“This alone should alert the doctor when he is dealing with patients with cardiovascular failure", the doctor warned.

Vasoconstrictors, which are essentially adrenaline, can have a negative effect on people with severe pathology thyroid gland, hypersensitivity to adrenaline, as well as for patients with open-angle glaucoma.

“That is, an anesthetic containing a vasoconstrictor has a number of contraindications. In addition, these drugs are not combined with all medications and can provoke allergic reactions, especially in patients with hypersensitivity to sulfur. These, for example, include people with bronchial asthma,” the dentist warned.

If a person does not tolerate an anesthetic with a vasoconstrictor, doctors use mepivacaine.

The main thing is not to be silent

It is worth noting that before proceeding directly to the procedure, the dentist must ask the person what he is allergic to, whether there is any drug intolerance and whether there have been diseases of cardio-vascular system. In order to choose the right anesthetic, it is also important for the specialist to know the condition of the patient’s liver and kidneys.

“In case of allergies to medications, we refer the patient for allergy tests. The results of this test are usually ready within three days. In some clinics, the analysis is ready within 24 hours,” said Anna Gudkova.

However, according to her, most often people feel ill during a visit to the dentist not because of the anesthetic, but because many patients are afraid of the upcoming procedure or do not have time to eat before the appointment.

The success of the procedure depends not only on the doctor, but also on the patient himself, Elena Zoryan is sure. The candidate of medical sciences advises to approach the dentist responsibly and always inform the specialist in advance about your diseases and allergies.

“The patient must inform the doctor about the presence of complications from the cardiovascular system, gastrointestinal tract And immune system. In addition, it is worth talking about allergic reactions to drugs and food. Because very often food products Sulfites are used as an antioxidant, which are also added to local anesthetics,” the doctor warned.

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MODERN METHODS OF LOCAL ANESTHETICS IN DENTISTRY

Department of Propaedeutics of Dental Diseases

Department surgical dentistry

T.D. Fedosenko, A.P. Grigoryants,M.M. Soloviev.

Introduction

Painlessness of dental procedurescenturies was just a dream of humanity. Discovery of local anestheticsproperties of cocaine, the synthesis of adrenaline and other drugs led to the developmentke various anesthesia techniques, indications for their use and definitioncontraindications. Over the past years, local anesthetics of the fifth generation have appeared, and patients’ demands for painless and comfortable performance of various types of dental procedurescontinues to grow.

In this regard, the purpose of these guidelines isdeepening and expanding students' knowledgeIII, IVAndVcourses about local anesthe latest generation of thetics, modern techniques of local anesthesiaand prevention of complications when using them.

Local anesthesia or local anesthesia- these are methods of influencing the tissues of a certain area of the human body, in which you do notconsciousness switches off and tissues lose pain sensitivitythis area. Modern methods local anesthesia in dentistry include the use of fifth-generation anesthetics (articaine series), the carpule system and the rational use of various anesthesia techniques.

CLASSIFICATION OF LOCAL ANESTHESIA METHODS

Non-injection methods:

physical (use low temperatures, laser beams, electromagnetic waves);

physico-chemical (introduction of anesthetics using electrophoresis);

chemical (application anesthesia).

Injection methods:

infiltration anesthesia (soft tissue, subperiosteal, intraligamentary, intraseptal, intrapulpal);

conduction anesthesia (extraoral, intraoral).

Non-injection methods

The use of non-injection anesthesia methods in modern dental practice is very limited. The use of liquids with low boiling points (chlorethyl, pharmacoethyl) leads to rapid cooling of tissues, at which the nerve endings lose their sensitivity and it becomes possible to drain subcutaneous or submucosal abscesses and remove mobile teeth. The anesthesia is immediate but wears off quickly. The disadvantages of this method include the danger of the drug getting into Airways patient and doctor, the likelihood of tissue burns and the development of a toxic reaction. The introduction of an anesthetic by electrophoresis leads to anesthesia of soft tissues to a depth of about 5 mm. This technique has previously been used in the treatment of trigeminal neuralgia and during free skin grafting. The main indication for the use of topical anesthesia is to ensure painlessness of needle insertion, especially in children and patients with a labile psyche.

Preparations for topical anesthesia:

Dicaine 0.25%, 0.5%, 1% and 2% solutions

Perylene-ultra"Septodont" - 3.5% dicaine solution

with antiseptic

Railing spray

Pyromecaine 1 -2% solution; 2-5% ointment with methyluracil

Lidocaine 2.5-5% ointment; 10% spray, Xylonor, Xylonor-gel

Injection methods

Drugs used for injection methods include local anesthetics and vasoconstrictors.

Classification of local anesthetics:

esters(in terms of strength of action - weak):

anesthesin (anestalgin), dicaine (tetracaine), novocaine (procaine).

amides

- in terms of strength - average:

lidocaine (xycaine, xylocaine, lignospan, xylonor), trimecaine

(mesocaine), mepivacaine (carbocaine, mepivastezin, scandonest, scandicaine), prilocaine (xylonest);

- by force of action - strong:

articaine (ultracaine, septonest, alfacaine, brilocaine, ubistezin), bupivacaine (marcaine, duracaine, carbostezin), etidocaine

To enhance the effect of local anesthetics, the duration of their action and reduce the amount of administered solution in dentistry, use vasoconstrictors: adrenaline, epinephrine, supranephrine (4 times stronger than norepinephrine), norepinephrine, vasopressin.

In the presence of a vasoconstrictor, preservatives (parahydroxybenzoates) and stabilizers (sodium and potassium sulfites) are used in the composition of local anesthetic drugs to increase shelf life. Stabilizers (antioxidants) protect catecholamines from oxidation, but can cause allergic reactions in patients with hypersensitivity to sulfites.

Considering the possibility of developing adverse reactions, in patients with mild concomitant pathology, vasoconstrictors are used after premedication and in minimal concentrations (1:200,000).

Indications for the use of vasoconstrictors:

at surgical interventions: outpatient surgeries, atypical tooth extraction, pain relief for inflammatory processes (periostitis, osteomyelitis);

when preparing hard dental tissues, depulpation.

Contraindications to the use of vasoconstrictors:

in patients with arterial hypertension, with heart defects, patients with CVD, especially if they were a consequence of rheumatism;

patients with severe form diabetes mellitus in the stage of decompensation;

patients undergoing treatment with tricyclic antidepressants (amitriptyline);

patients who will soon undergo doping control;

patients with thyrotoxicosis;

pregnant women;

patients with angle-closure glaucoma.

The most common type of anesthesia for dental treatment. It reliably relieves pain 100%, so that the patient only has tactile sensitivity. He continues to feel vibrations, touches and pressure, which are often perceived by the patient as unpleasant. These unpleasant sensations intensify if the patient experiences anxiety or nervous tension. Our task in this case is to completely protect the patient not only from pain, but also from discomfort, and stress.

There are four methods of local anesthesia in dentistry:

Topical anesthesia: used as initial remedy for superficial anesthesia of the oral cavity. This is usually a gel or spray with an anesthetic: lidocaine or benzocaine.
Infiltration anesthesia: the drug is injected into the gums using several injections next to the tooth. This is the most common type of pain relief in dentistry. Used in the treatment of caries, dental pulpitis, surgical operations in dentistry.
Conduction anesthesia: the medicine is injected in close proximity to the nerve, after which it permeates the area around the nerve and the nerve itself. Typically used in dental surgery for major operations in the lower part of the mouth.
Truncal anesthesia: This method involves injecting a drug into the base of the skull to block all branches of the trigeminal nerve. It is used in a hospital setting for the patient’s increased pain sensitivity, neuralgia and some other rare cases.

Carpule anesthesia in dentistry

At the Doctor Dent clinic we use so-called carpule anesthetics. Carpules are disposable cartridges with a drug that are inserted into a special syringe injector. Then a needle is put on the syringe, which pierces the carpula with the opposite end. Advantages of carpule anesthetics:

Thin needle - maximum comfort. We use carpule needles with a thickness of 0.3 mm, whereas the needle thickness of a regular disposable syringe is about 0.6 mm. Therefore, an injection into an area pre-treated with gel causes absolutely no pain.
Complete sterility of treatment due to the tightness of the cartridges with the drug.
Prolonged action. In addition to the anesthetic itself, the capsule may contain an additional vasoconstrictor (adrenaline), which significantly increases the duration of anesthesia.

Drugs used

In the past, traditional lidocaine and novocaine were used for pain relief in dentistry, which can still be found in budget clinics. "Doctor Dent" uses modern drugs based on much more effective anesthetics: mepivacaine and articaine.

Ultracaine. Combination drug for local anesthesia, contains articaine and the vasoconstrictor adrenaline (epinephrine) to prolong anesthesia. Manufactured by Sanofi Aventis (France). As an anesthetic, ultracaine is 6 times more effective than procaine, and 2 times more effective than lidocaine. Exist various shapes release of the drug, both with and without epinephrine. It has a very limited range of contraindications and can be used in the treatment of children, elderly people, and pregnant women. The specific form of the drug is chosen by the doctor depending on the presence of contraindications in the patient (allergies, cardiovascular diseases, pregnancy in women, etc.)
Scandonest. A local anesthetic based on mepivacaine, produced by the French company Septodont. Does not contain adrenaline and other vasoconstrictors, as well as preservatives. For this reason it is not used during pregnancy (see below). It is usually used in cases where the patient has serious contraindications to the use of anesthetics with adrenaline.
Septanest. An analogue of ultracaine, produced by Septodont.

Anesthesia during pregnancy

Sedation

Since local anesthesia does not affect tactile sensitivity and the psycho-emotional state of the patient, if necessary, a method of pain relief such as sedation can be used. Sedation increases the pain threshold and calms the patient, but does not put him to sleep. During the treatment, the patient is in a pleasant relaxed state, but remains able to understand and respond to the doctor’s requests.

Sedation has virtually no contraindications and side effects. You just need to avoid alcohol the day before your visit to the dentist.

Questions and answers

Which painkillers, listed in the article, are most preferable as anesthesia for dental treatment if there is a risk of a stroke after using local anesthetics? I ask this question because my friends, unfortunately, had this kind of side complications(lethal, half an hour after treatment). Maybe the medicine was scorched, maybe the dose was too high, or maybe adrenaline should not be used for such people? This is why I'm afraid to go to the dentist

In our clinic we use the method of individual selection of anesthesia for each patient. To do this, we conduct a thorough survey of the patient about his state of health and, if necessary, involve general specialists and anesthesiologists. What list of drugs did you mean?

I am about to have implants installed, how to prepare for dental implantation?

If implantation is performed under local anesthesia, no special preparation is required. The only recommendation is that you should eat an hour before the procedure. But if implantation is carried out under sedation, then the anesthesiologist will give you recommendations.

My gums are swollen, and my tooth hurts very much (or rather, there is a piece of it left there), what should I do? How will the treatment take place? What type of anesthesia will I be offered? Is it possible to use general anesthesia?

Good afternoon After visual inspection and X-ray diagnostics, we will be able to determine treatment options for your tooth. Treatment in our clinic takes place under both local and general anesthesia. We ask you not to delay treatment of this tooth so that there is no complication of the situation. We invite you to a consultation at our clinic. You can make an appointment by calling the clinic

I am very afraid of any pain during dental treatment. During previous treatments, I was given an injection, and it was terribly painful, and it seemed like the needle was so long. For a long time I did not visit the dentist because of this fear. And now there is a reason. The wisdom tooth began to grow, and because of this, the tooth that came before it began to crumble and collapsed to such an extent that half of it remained. The nerve was exposed. And in general, due to the fact that I have not been to the dentist for a long time, I need to treat many teeth with caries. Tell me, is it possible for you to cure everything under anesthesia? What will be needed for this? How much will it cost?

In our clinic, you can really get all your teeth treated efficiently and quickly, both under local anesthesia and general anesthesia. We guarantee absolutely painless and safe treatment. We use the latest medical equipment, the most modern medications. Highly qualified medical staff will achieve high treatment results, both aesthetic and functional. In order to determine what treatment you will need and its cost, you need to make an appointment with us for a consultation and diagnosis. The cost of a consultation in our clinic is 500 rubles. We will be glad to see and help you in our clinic.

I've been terribly afraid of dental treatment since childhood. I haven't been to a doctor for about 10 years. Now there are a lot of teeth that need to be treated. Will any treatment with anesthesia or general anesthesia be absolutely painless? And even without the fact that it will be a little unpleasant?

Yes, indeed, in our clinic we carry out any treatment only with anesthesia. We use two types of anesthesia: general (anesthesia) and local. Before using local anesthesia, we numb the mucous membrane to ensure a comfortable feeling during local anesthesia. With any type of anesthesia, people treated in our clinic not only do not experience pain, but also do not feel any discomfort. We invite you to undergo consultation and treatment in our clinic.

What painkiller is indicated for children with toothache?

Most painkillers are approved for use by children from the age of 12, and before this age, only children's derivatives of ibuprofen can be used without a doctor's recommendation, and only in extreme cases.

I'm interested in how children's teeth are treated - under local or general anesthesia?

Mostly, children have their teeth treated under local anesthesia, but there are cases when sedation or anesthesia is used. But such procedures require significant indications: the need to perform lengthy manipulations, psychological condition child, etc.

On the website I read about a way to relieve fear and pain: sedation in dentistry. I was given your site, but didn’t find a word about this method? Do you use it?

Yes, we use sedation for adults and children, but this requires consultation with our anesthesiologists and consultation with our dentists. We invite you for treatment at our clinic.

Drug name	"Novocaine"	"Lidocaine"	"Mepivacaine"	"Artikain"
Toxicity compared to Novocaine (how many times higher)	1	4	4	5
The severity of the analgesic effect compared to Novocaine (how many times higher)	1	2	1,9	1,5
Time of action of the anesthetic (without a vasoconstrictor substance), in hours	Up to 0.5	Up to 1	Up to 1.5	Up to 1
Rate of onset of analgesia	Slow (3–5 minutes)	Quick (1–2 minutes)	Quick (1–2 minutes)	Very fast (15–30 seconds)