Anesthetic injections in dentistry. Conductive anesthesia in dentistry

There are 3 main criteria for the quality of anesthesia: 1) efficiency; 2) safety; 3) simplicity and minimal pain of implementation.

There are six methods of administering anesthesia in dentistry:

1. Appliqué
2. Infiltration
3. Conductor
4. Intraligamentary
5. Intrapulpar
6. Intraosseous

The most profound anesthesia is provided by conduction anesthesia (but it is not always possible to achieve it on the first try). From a safety point of view, this method gives the most complications.

The safest and most painless application anesthesia (no injection is given). But it is also the most ineffective. In this case, the sensitivity of the teeth is not turned off at all, only the mucous membrane is anesthetized.

Based on the ratio of benefits and ease of implementation/potential harm, infiltration anesthesia is preferable. For most dental procedures it is quite sufficient, but the lower chewing teeth are difficult to relieve pain in this way.

Intraligamentary, intrapulpal and intraosseous techniques are highly effective, but very painful. They are carried out after preliminary infiltration or conduction anesthesia.

Of the drugs, articaine is the most effective. Commercial names: “Ultracain”, “Ubistezin”, “Septanest”, “Alfacain”, etc. Of these brands, “Ultracain” remained the leader for a long time - this name is still more popular than “articaine”. However, with the purchase of the German company Hoechst with the French Sanofi and the opening of the latter plant in Russia (Sanofi-Aventis Vostok), the quality of this anesthetic on the Russian market has fallen. Today, Ubistezin is more effective than Ultracain.

The concentration of adrenaline in the anesthetic solution also plays an important role - the higher it is, the stronger the anesthesia. The most effective is 4% articaine in combination with adrenaline in a ratio of 1:100,000. Under the brand name "Ubistezin" a drug is produced with a vasoconstrictor content of 1:200,000. "Ubistezin forte" contains just a concentration of 1:100000 - this is the most effective anesthetic today.

Mepivacaine without adrenaline is the safest anesthetic available in Russia. But its effectiveness and duration of action are significantly inferior to articaine with adrenaline.

Good day, dear readers of our site. The topic of today's article will be of interest to most of you.

This is anesthesia in dentistry, its types, as well as modern drugs used in public and private clinics.

Let's try, first of all, to figure out whether the devil is as terrible as people who are far from medicine, science and this field in particular paint him.

The media often exaggerates the problem, creating a real cult of fear towards dentists and the techniques that they use in daily practice. At the same time, the overall percentage of negative outcomes after administration is within the statistical norm. In fact, the chance of getting hurt is about the same as getting hit by a car on the way to the clinic. You won't sit at home all your life after reading this, will you?

The problem is that people do not understand chemistry and physiology. For them, the only difference between the “injections” is the price. Therefore, when they come to the doctor, they say “make a good one” or “cheaper”. At the same time, the compositions of the drugs differ significantly. Some may simply not suit you, others will cause itching or swelling.

Why is anesthesia necessary?

Pain is nerve impulses from the areas that are affected. Even adults and brave people are afraid of her. No one is surprised by a policeman or paratrooper who bravely walks under bullets, but is not afraid of anything related to teeth and visiting the dentist. Amazing fact. People do not want to endure discomfort, and do not want to seek help, believing that they will get even more discomfort in the process.

Everyone is scared. On the other hand, not everyone is willing to endure it, and it is not realistic to perform some procedures “live”. For example, if you need to make a hole in the jaw bone for installation.

Few people know which anesthesia in dentistry is more reliable and safe. Therefore, we have created a detailed description indicating areas of application, risks and other nuances.

Drugs and their features

Do you know the names of the drugs used by doctors? Most patients can remember a few offhand. First of all, these are lidocaine and novocaine. The latter, by the way, has not been used in dental treatment for a long time.

But many new tools have appeared that are more effective.

The most modern drugs that are used as anesthesia in dentistry are Ultracain, and a number of others. If you compare them with those that were injected in municipal clinics 20 years ago, the difference is colossal. The power is 5-6 times higher, and the health hazard is several times lower.

Who is contraindicated for painkiller injections?

There are medical contraindications, the violation of which can lead to the most severe consequences for the patient. Let's list the main ones:

• Bronchial asthma;
• Mental abnormalities and disorders;
• Recent heart attack, stroke, heart surgery;
• Reduced blood clotting, including those caused by the use of anticoagulants;
• Diabetes mellitus and other endocrine diseases;
• The use of various antidepressants and adrenergic blockers;
• Angina pectoris, tachycardia, a number of other pathologies of the cardiovascular system.

Some side effects may affect the condition of the liver and kidneys. Therefore, it is not recommended to use several types of anesthetics for persons with liver and kidney failure.

You cannot give the injection on an empty stomach. They also pay attention to the general condition and age of the patient. This is especially true for children and pensioners.

What drugs are used for medical contraindications:

1. Ultracaine D is recommended for asthmatics. It is also effective for allergy sufferers;
2. Thyroid problems or diabetes are similar choices;
3. For hypertension and heart patients - Ubistezin 1:200000;

In other situations, the choice is individual.

Types of local anesthesia in dental practice

Modern anesthesia in dentistry is divided into local and general, which, in turn, are divided into several types.

The first one is application. Lidocaine in the form of a spray or gel is applied to the area where the anesthetic will be injected. An excellent solution for those who are afraid of injections. The patient does not feel anything during the process. Such freezing in dentistry is often used in children's clinics and for allergies to injections. The effect is local, lasting no more than 15 – 20 minutes. But negative consequences rarely occur.

The second is infiltration. It is used in therapeutic practice when it is necessary to treat pulpitis and eliminate pain in a small area. Once you have injected articaine, trimecaine or another similar substance, the doctor can continue manipulation.

The third is conductor. How is conduction anesthesia performed in dentistry and what types are there?

• Mandibular anesthesia is popular in dentistry, during which pain relief is performed by blocking the reactions of the inferior alveolar nerve. The drug is administered in the area of ​​the opening of the lower jaw. Access is possible from the area under the lower jaw if the intraoral method is excluded for some reason. Application requires great caution on the part of the physician. If you make a mistake, you may experience numbness in the pharynx, damage to the pterygoid muscle, and other unpleasant consequences that require long-term treatment. Vascular damage and hematomas are not uncommon. Less common is facial nerve block with paresis of facial muscles.
• Torusal anesthesia in dentistry is the introduction of an anesthetic composition into the area of ​​​​the junction of the bone ridges on the patient’s lower jaw. It affects three nerves at once - buccal, lingual and inferior alveolar. As a result, several teeth on the injection side, an area of ​​the jaw and the mucous membrane lose sensitivity at once. The injection must be carried out as accurately as possible so as not to damage the nerve endings. Modern techniques allow the needle to be inserted to a depth of 2 to 20 mm.

These methods are relevant when working with several teeth at once, including in the area of ​​inflammation, accumulation of pus, if it is necessary to remove pulp, or open an abscess.

There are also other methods. For example, palatal, necessary to block the greater palatine nerve.

0.3-0.5 ml are administered. anesthetic substance. After just 3-5 minutes, the sensitivity of the area is significantly reduced. If the doctor makes a mistake, the numbness will spread to the soft palate. This leads to impaired swallowing function and the appearance of a foreign body sensation. This causes vomiting in many patients. You also need to monitor the pressure under which the solution is supplied. Otherwise, there is a high risk of damage to blood vessels and the appearance of areas of necrosis in the injection area.

In some cases, infraorbital anesthesia is used in dentistry (intraoral and extraoral). Pain relief:

• Fangs;
• Incisors;
• Medial root of the first molar;
• Adjacent areas of bone and soft tissue.

Intraligamentous and intraosseous anesthesia in dentistry is used in the treatment of periodontitis, or its nerve - the pulp. The average action time does not exceed 20 minutes.

In maxillofacial surgery, trunk anesthesia has proven to be most effective. In dentistry, it is used exclusively in hospital settings.

When choosing a technique, patients are interested in which is better and how long this or that type of pain relief lasts. The average operating time is from 30 minutes to 2 hours. There are procedures that are more and less painful. Based on this, it is determined what, where and how much to inject. Based on the number of teeth that need to be treated and other nuances of the work, the doctor determines the method of administering the drug.

General anesthesia. Indications, pros and cons

In what cases is general anesthesia used in dentistry, and how effective is it?

There are still rumors among people that such a similar procedure can shorten a person’s life by five years.

Believe me, this is a myth. There are people who have undergone 20 or more operations. After the procedure, many lived a very long time. Yes, the load on the body is high, but not greater than the disease itself.

There are several options. In the first case, intravenous administration is carried out, in the second - inhalation (recommended choice). Moreover, we are not talking about a complete blackout of consciousness, but about depression of the central nervous system. In this condition, the patient can breathe independently. He does not need a breathing tube that prevents the doctor from working in the oral cavity. Complete immersion in an unconscious state is rarely used. Usually - in cases where a long and painful procedure is ahead, such as implantation of several teeth in a row.

This technique is even used for children. It is considered the safest for health. After a person comes to his senses, the consequences are minimal. After some time, he can do his usual activities.

The question of how long general anesthesia lasts in dentistry can only be answered by the anesthesiologist who prepares you for the procedure. It depends on the substances used and their concentration. If necessary, the doctor revives the patient ahead of schedule. First, he must make sure that there are no allergies or other contraindications.

Pain relief during pregnancy and breastfeeding

It is known that during pregnancy, many drugs can harm the health of the fetus and negatively affect its development.

If a patient applies in the early stages of pregnancy (the first two months), she may be refused, since the placenta cannot yet provide effective protection for the baby. The second trimester is the optimal time for treatment with pain relief.

Modern anesthesia in dentistry, used during breastfeeding, also has disadvantages. Therefore, if it cannot be avoided, children are temporarily transferred to artificial nutrition until the drug is removed from the mother’s body naturally.

If the treatment is superficial, for example, caries that has not reached the pulp chamber, then there is no danger. The doctor does not need to administer an anesthetic solution to the patient. In general, it is recommended to seek help in a timely manner. So that toothache does not occur during the period when you are prohibited from receiving an injection for medical reasons.

To minimize risks, the doctor makes a pinpoint injection with a small amount of the active substance. In this case, a small amount of the drug enters the blood, which does not cross the placental barrier.

Not for use in pregnant women:

• General anesthesia;
• Adrenaline containing substances. They affect the muscle tone of the uterus, which leads to premature birth.

It is recommended to use Ultracaine, since it is not dangerous to the fetus, and Primacaine, which is quickly eliminated from the mother’s body. Both drugs contain a small amount of adrenaline, which is not dangerous for a pregnant woman.

Anesthesia in dentistry in childhood

Anesthesia methods in dentistry used for children take into account the characteristics of the nervous system at a young age.

The child's body is more susceptible to allergic reactions with unpredictable consequences.

If there is a severe allergy to injection anesthetics, general anesthesia or sedation is used. Doctors perform the latter using a breathing mask. The child will be calmer and will not have to be restrained. The question is especially relevant for the little ones, for whom it is difficult to explain that they need to sit still in a chair. The inhaled mixture relaxes, and its effect lasts no more than ten minutes.

Dosages depend on age. For example, a one-month-old baby can be injected with a tenth of the adult dose, at six months - twice as much, a one-year-old child can be injected with a quarter of the standard volume of the drug, a three-year-old - a third, a seven-year-old - half, a twelve-year-old - two-thirds.

Only compliance with this rule and taking into account the general condition of the young patient can guarantee normal perception by his body of the injected drug.

Allergy. Individual reactions

Even the most modern anesthesia in dentistry is associated with certain risks. After all, each person has specific characteristics of metabolic processes.

A significant percentage of people may be allergic to lidocaine.

It is connected not so much with the substance itself, but with the preservative methylparaben in its composition.

Therefore, private clinics have long abandoned it, as well as novocaine and its derivatives.

There are plenty of such components, harmful in themselves, in any medicine. This must be taken into account in advance. Because afterwards you will have to deal with side effects.

Symptoms vary. This may include itching, redness, and persistent swelling at the injection site. Such problems are local in nature and therefore rarely dangerous.

It is much worse when the swelling spreads to the upper respiratory tract. Doctors must then administer an antihistamine to stop the swelling from developing.

Some patients may feel pain in the chest, weakness, and tingling sensations in the face. These may be the first signs of anaphylactic shock - the most dangerous of allergic manifestations. If you do not inform your doctor about them in a timely manner, there is a risk not only to your health, but also to your life.

Real efficiency. Why might the injection not work?

It should be understood that anesthesia in dentistry must be performed taking into account many factors individual for each patient. Often, many people complain that even after three injections the anesthetized area does not lose sensitivity. There are many reasons for this:

1. Location of nerves;
2. Psychological condition;
3. Features of the body’s perception of a specific substance that affects the nerve.
4. Release of adrenaline due to stress;

It may often turn out that a particular patient’s body is immune to a particular substance. In this case, the doctor needs to decide on further actions. There are two ways - increase the dose or change the drug.

Every substance has physical and chemical properties. For example, fat solubility. It depends on how quickly it can be reached through cell membranes. Another factor is protein binding. It determines the speed with which it will be possible to influence the passage of nerve impulses. If purulent exudate has collected at the injection site, it can block the action of the anesthetic.

It should be understood that anesthesia in dentistry is no less delicate than the East. For example, the drug you were injected turned out to be expired or the amount was incorrectly selected. The same compositions may differ in concentration.

Another big mistake relates to the actions of the patients themselves. They drink alcohol “for courage.” Under the influence of alcoholic drinks, nerve tissues lose sensitivity to the injected anesthetic.

If you need to calm down before going to the doctor, use mint, lemon balm, and other sedatives in the form of tea, decoctions, and tinctures. It is better not to experiment with tablets. Some doctors prescribe Afobazole. It is sold without a prescription. Drink in a course of 20 days. An excellent solution for those who have to visit the dentist’s office several times.

Toothache is an ailment that almost every person experiences during his life. Such painful sensations are a sign of the presence of one or another disease of the dental organs. Such pathologies require not only therapeutic, but in many situations, surgical intervention. It often happens that patients postpone their visit to the dentist due to fear of pain during dental treatment.

Let's look at the most famous types of anesthesia in dentistry.

Painless dental treatment

Relatively recently, a number of therapeutic actions that are associated with unpleasant sensations for a person could be carried out without a preliminary anesthesia procedure, so, of course, it is not surprising that many people are very afraid of visiting dentists. When a person postpones an appointment with the dentist until the last minute, having a common carious lesion, he risks waiting for more serious complications of his disease to arise, which will subsequently force him to seek surgical treatment.

Today, in absolutely all clinics, as well as dental offices, doctors carry out dental treatment without pain, for which purpose they use various types of anesthesia in dentistry.

This is a decrease or complete elimination of sensitivity in the patient’s entire body or in its individual parts. In most situations, this can be achieved through the introduction of medications that help disrupt the transmission of pain impulses to the brain from the site of the intervention. In dentistry, anesthesia is required to ensure that the patient does not experience pain during dental treatment. The calm state of the patient gives the doctor the opportunity to carry out therapeutic or surgical actions quickly enough, and most importantly - with high quality and in the required volume.

What types of anesthesia in dentistry exist?

Indications for anesthesia

• Treatment of deep caries.
• The process of depulping, that is, performing extirpation or amputation of the pulp.
• Teeth extraction procedure.
• Other surgery.
• Preparation for dental prosthetics.
• Various types of orthodontic therapy.

It should be noted that moderate caries is also an indication for anesthesia, since the boundaries of the enamel and dentinal layers are very sensitive, so pain in this situation is noted quite often.

Types of anesthesia in dentistry

Anesthesia is divided into local and general anesthesia. In addition, in medicine it is customary to distinguish between medicinal and non-medicinal pain relief.

Thus, there are several types of non-drug anesthesia, which include audio analgesia along with electroanalgesia, as well as pain relief through hypnotic and computer effects. We will consider the types of local anesthesia in dentistry below.

The procedure for drug anesthesia involves the injection of an anesthetic, which blocks the conduction of the impulse for some time required for medical intervention. After a certain period of time, the product breaks down, and sensitivity is fully restored. Modern painkillers make it possible to completely avoid the occurrence of unpleasant sensations during treatment.

General anesthesia is used relatively rarely for dental treatment. It is most often used in the field of maxillofacial surgery.

Types of local anesthesia in dentistry

Before most medical procedures, local anesthesia is performed. This type of anesthesia is much safer for the body compared to anesthesia. Until recently, the most common anesthetics were Novocaine along with Lidocaine, but now even more effective agents are used. Thus, there are such types of local anesthesia as application type, infiltration, conduction, intraligamentary, as well as intraosseous and stem.

All types of local anesthesia are most often used in dentistry.

Performing topical anesthesia

This type of anesthesia provides superficial anesthesia, which is performed by spraying a spray or applying an ointment to the mucous membrane of the oral cavity. Most often, ten percent “Lidocaine” is used in the form of aerosol cans.

Application anesthesia is recommended to eliminate the sensitivity of soft tissues in the area where the injection is planned, as well as as part of the treatment of the mucous membrane against the background of stomatitis, gingivitis, and during the procedure for opening minor suppurations. In medical practice, such anesthesia can be used before getting rid of mineralized deposits that are located in the cervical region. In orthopedic medicine, this anesthesia is used to prepare teeth for prosthetics.

What other types of anesthesia are there in dentistry?

Infiltration type of anesthesia

The infiltration option allows you to anesthetize one tooth or a small area of ​​the mucous membrane. It is practiced, as a rule, as part of the elimination of the neurovascular bundle, and, in addition, for the treatment of deep caries.

Types of infiltration anesthesia in dentistry are also very popular.

Usually the injection is given into the projection of the root apex. In this situation, the anesthetic agent blocks pain impulses at the level of nerve branches. Often, the procedure for anesthetizing the upper teeth is performed in a similar way. This is explained by the fact that the small thickness of the jaw bone allows the anesthetic to easily penetrate the nerve endings.

Performing conduction anesthesia

Conductive anesthesia is needed when infiltration anesthesia does not have the necessary effect, or anesthesia for several adjacent teeth is required. In addition, it is used for tooth extraction. In addition, conduction anesthesia is used to open abscesses against the background of periostitis, as well as exacerbation of chronic periodontitis. Sometimes it is performed during the process of draining a purulent focus. Thus, an injection of an anesthetic makes it possible to temporarily turn off the entire nerve branch.

Quite often, immediately before surgery on the upper jaw, palatal conduction anesthesia is performed, which, if necessary, is supplemented with incisal anesthesia. To numb the lower jaw, torus or mandibular anesthesia is used.

Intraligamentous anesthesia

This anesthesia technique in dentistry is often used in children to treat deep caries, as well as its complications. In addition, it is used when a tooth is to be removed.

Injection of the product is performed in the area of ​​the periodontal ligament, located between the root of the tooth and the wall of the alveolus. As a result, the mucous membranes do not lose their sensitivity, which prevents the child from accidentally biting his tongue and lips.

Carrying out intraosseous anesthesia

This anesthesia is recommended for tooth extraction operations. First, an anesthetic is injected into the gums, and after achieving local numbness, the injection is performed in the area of ​​the jaw bone in its spongy layer, which is located in the interdental space. In this case, only the sensitivity of a specific tooth and a small area of ​​​​the gum disappears. This effect occurs almost instantly, but lasts for a short time.

Trunk type of anesthesia

Stem anesthesia in the field of dentistry is performed exclusively in a hospital. Indications for its implementation are pain of high intensity along with neuralgia of the facial nerve, as well as serious injuries to the zygomatic bone and jaw. This type of anesthesia is also practiced in preparation for surgery.

An anesthetic injection is performed at the base of the skull, which makes it possible to disconnect the maxillary and mandibular nerves simultaneously. The effect of such anesthesia differs from other options in power, as well as in its significant duration.

When is anesthesia technique prohibited in dentistry?

Contraindications

Before performing an anesthesia procedure, the dentist must find out whether the patient has serious somatic diseases or allergic reactions to medications. Thus, the main contraindications to the use of painkillers may be:

• The occurrence of allergies after the administration of an anesthetic.
• The presence of diabetes mellitus and a history of acute heart disease, for example, heart attacks or strokes six months ago.
• A number of other hormonal disorders against the background of diseases of the endocrine system, for example, thyrotoxicosis and so on.

It is important to note that against the background of decompensated forms of endocrine diseases, treatment of the patient should be carried out only in a hospital. Particular caution is recommended when performing anesthesia on children and pregnant women.

Anesthesia in pediatric dentistry

Unfortunately, today there are no anesthetics that can be called completely safe for children. In childhood, the body is overly sensitive to any medications, so the risk of complications after injections is very high.

Previously, Lidocaine and Novocaine were used for pain relief, but now Aricaine and Mepivacaine are considered to be the safest for children. In dental treatment of children, such types of anesthesia as application, infiltration, intraligamentary and conduction are practiced.

It is important to consider that among young patients there is a very high risk of psychogenic complications, since the child’s psyche is not fully formed. A particularly common complication is short-term loss of consciousness, which is associated with strong emotions and fear.

Complications associated with the use of local anesthesia

Possible complications during the anesthesia procedure include:

• The appearance of allergic reactions with special hypersensitivity to these drugs.
• Possibility of toxic reactions as a result of overdose.
• Prolonged loss of sensitivity due to nerve injury from a needle, which sometimes occurs due to violation of the injection rules.
• Burning and pain at the injection site. This phenomenon occurs quite often and is considered normal for all types of anesthesia in dentistry. The technique must be strictly followed.

In addition, there is a possibility of the following complications:

• The occurrence of swelling and bruising after the injection due to damage to the blood vessels.
• The needle breaks during the injection, which happens extremely rarely.
• If the dentist does not follow the rules of asepsis when injecting into the affected area of ​​the mucosa, tissue infection may occur.
• The appearance of transient spasms of the masticatory muscles as a result of damage to the nerve or muscle fibers
• Accidental biting of the tongue, lips or cheeks due to temporary loss of sensation.

The use of modern painkillers makes it possible to minimize the likelihood of most complications.

On the eve of treatment, before visiting the dentist, you must refrain from drinking alcoholic beverages, since ethyl alcohol reduces the analgesic effect of most medications. In case of emotional stress, it is advisable to take a sedative at night, for example, Afobazol, motherwort or valerian extract. If you feel unwell, especially with otolaryngological diseases or flu, it is best to postpone a visit to the dentist.

Women during menstruation would also be better off holding off on dental treatment, if possible. During this period, nervous excitability greatly increases, as well as susceptibility to medications. Therefore, tooth extraction along with other surgical interventions during menstruation can cause prolonged bleeding.

General anesthesia

General anesthesia in dentistry means a complete loss of sensitivity, which is accompanied by various disturbances of consciousness. General anesthesia during dental treatment is used quite rarely and only for strict indications, since this method of pain relief is extremely dangerous. It is used when carrying out serious surgical manipulations in the maxillofacial area.

It should be noted that nowadays, inhalation anesthesia, that is, nitrous oxide, is increasingly used during dental treatment. Thus, the indications for performing general anesthesia in dental practice are:

• Allergic reactions of the body to local anesthetics.
• Mental illnesses.
• Panic fear of dental procedures. Anesthesia in dentistry during pregnancy is used, but mostly local and in the most extreme cases. It is better if it is not in the first trimester.

Contraindications in this case include:

• Respiratory diseases.
• The presence of serious pathologies of the cardiac system
• General intolerance to anesthetic drugs.

Immediately before a planned intervention, which involves putting the patient under anesthesia, the patient is recommended to undergo an examination, which will include:

• An electrocardiogram for an objective assessment of the condition of the heart.
• Taking a general blood test, as well as hepatitis and HIV.

We looked at anesthesia methods in dentistry.

Going to the dentist causes a feeling of fear for many people, but modern pain relief methods help get rid of negative emotions during a visit to the dentist. In order to choose the appropriate type of anesthesia, you need to know what types of anesthesia there are and what contraindications exist for their use.

Types and methods of anesthesia

Anesthesia in dentistry is used as a way to relieve sensitivity to pain during treatment and perform all necessary manipulations. The anesthetic substance helps block the nerve impulse and cause numbness in a certain area of ​​the mucosa. After some time, sensitivity is restored.

Anesthesia in orthopedic dentistry is used for dental prosthetics. To make it easier for the patient to endure certain manipulations, sedatives, neuroleptics and non-narcotic analgesics are used in orthopedic dentistry.

There are two types of anesthesia in dentistry: local anesthesia and general anesthesia. Dental anesthesia can also be medicinal or non-medicinal. Local anesthesia is divided into:

• application;
• infiltration;
• stem;
• conductor;
• intraligamentous.

Topical anesthesia is used to open an abscess, treat caries, numb the mucosal area before injection, and for tooth extraction. Such methods of pain relief can be used with different anesthetics: gels, ointments, aerosols, pastes, etc. The anesthetic is applied to a specific area of ​​the mucous membrane and has an almost instantaneous effect. Contraindications to such anesthesia are individual intolerance to the drugs used, heart attack and diabetes mellitus. Orthopedic dentists use this anesthesia for dental grinding before prosthetics.

Infiltration anesthesia is considered the most popular in dental practice. It is used during root canal treatment, pulp surgery, deep caries treatment and nerve removal. The dentist makes an injection into the tissue near the tooth. You can first apply an anesthetic to the mucous membrane to make the injection less painful. This anesthesia will help relieve the sensitivity of the nerves in the upper jaw.

A truncal injection blocks all branches of the trigeminal nerve and is often used during major jaw surgery. The upper and lower jaw are immediately anesthetized.

Video

Attention! The information on the site is presented by specialists, but is for informational purposes only and cannot be used for independent treatment. Be sure to consult your doctor!

Previously, dentists of the past were not particularly concerned about the feelings of patients in the chair.

Today, there are many methods of local anesthesia that allow you to treat teeth of any complexity without pain and fear.

Modern painkillers make it possible to block unpleasant sensations not only for adults, but also for children.

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

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

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

Indications

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

• during treatment of advanced caries;
• before removing the root system or the tooth as a whole;
• during the periodontitis treatment;
• in the treatment of inflammatory processes and purulent foci;
• for the treatment of neuritis of the facial nerve;
• when it is impossible to perform complex operations under general anesthesia.

It is worth noting the patient’s personal desire to resort to local anesthesia even in cases where it is possible to do without it. Pain relief suppresses the feeling of fear of unpleasant sensations.

Functional features, their positive and negative qualities.

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Contraindications

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

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

Local anesthesia is not suitable for patients:

• have had a stroke or heart attack less than six months ago;
• with individual intolerance to painkillers.

Dentists adhere to some restrictions if:

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

Varieties

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

Appliqué

This method makes it possible to temporarily numb the area being treated by superficially treating the oral mucosa with an ointment or spray. The drug is applied to the tissue by applying a gauze swab to the gum.

Application anesthesia allows you to achieve an immediate effect. Sometimes, this type of pain relief is used to reduce the discomfort from a future injection.

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

Infiltration

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

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

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

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

Conductor

Pain relief is achieved by introducing the active composition into the surrounding nerve tissue, due to which pain impulses transmitted to the brain are blocked. Anesthesia spreads not only through the tissues, but also along the length of the nerve itself.

As a rule, in dentistry the technique is used for manipulations in the lower part of the oral cavity.

Intraligamentary (intraligamentous) local

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

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

It is worth noting that the drug is administered both through a needle and a reduced cartridge. For the treatment of oral diseases in adults, the technique can be combined with other methods of pain relief.

Intraosseous

Anesthesia is used for short-term dental procedures, since in comparison with other methods of pain relief, its duration is not long-term.

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

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

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

Stem

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

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

Indications for such strong pain relief are:

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

For children

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

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

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

Note! Due to fears and an immature psyche, a child may lose consciousness during an injection in the dental chair. You should not attribute the reaction of a child’s body to the unprofessionalism of a specialist.

Drugs

The following drugs are used in modern dentistry:

1. Ultracaine. The drug is produced under three types of labeling: “D”, “DS” and “DS Forte”. The last two are distinguished by an increased concentration of the vasoconstrictor component - epinephrine. Under the “D” label, the French manufacturer produces a product without preservatives and vasoconstrictors.
2. Ubistezin. In terms of the composition of the active ingredients, the drug is an analogue of Ultracaine. The anesthetic is produced in Germany and is available in various dosages of the main components.
3. Septanest. It has a significant concentration of preservatives. Therefore, its administration is quite often accompanied by an allergic reaction.
4. Skadonest. The drug contains up to 3% Mepivacaine. Vasoconstrictors and preservatives are completely absent in the anesthetic produced in France, and therefore the drug is suitable for patients who need restrictions on the composition.

Possible complications

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

1. Needle fracture. Despite the fact that the element of the injection instrument is made of durable metal, if the patient moves suddenly, part of it may remain in the mucosa or periosteum. It is worth noting that the probability of removing a small metal fragment without complications is much higher than when removing part of an element inserted along its entire length.
2. Possibility of infection. Modern dentistry has made it possible to reduce the likelihood of this complication to a minimum through the use of disposable syringes. However, anesthesia of a pre-infected area of ​​the oral cavity may result in infection of a healthy area due to the pushing of pathogenic bacteria by the anesthetic.
3. Hematoma or bruise. Complications result from blood vessels entering the tissues, which is most often observed during conduction anesthesia.
4. Swelling of tissues. A complication occurs when there is an individual intolerance to the components of the drug.
5. Loss of sensation. Sometimes, blocking the transmission of impulses to the brain by nerve endings lasts for several days or weeks due to nerve damage.
6. Burning or pain during the administration of the anesthetic. An unpleasant temporary reaction is absolutely safe for the patient’s body.
7. Spasms of the masticatory muscles or trismus. The complication is the inability to fully open the oral cavity. The phenomenon occurs due to damage to the muscles or blood vessels located in the infratemporal fossa and, as a rule, goes away within 2-3 days without any intervention.
8. Damage to soft tissues. Due to the lack of sensation in the tongue and some facial muscles, patients, especially children, may bite their lip or cheek. Therefore, it is recommended to refrain from eating until the effect of the drug has completely worn off.

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

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

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

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