What is application anesthesia in dentistry? Application (surface) anesthesia

Application anesthesia is most often a viscous substance that is rubbed into the skin in the form of an ointment, gel or spray with an aerosol. The analgesic effect is a consequence of the effect of chemical elements, medicinal preparations and the anesthetics contained in them on the nerve endings of the tooth root.

Scope of application anesthesia

Application analgesia (anesthesia) is used to reduce the susceptibility at the injection site and to have an analgesic effect on the mucosal layer. Application anesthesia is used mainly by dentists to eliminate caries, remove milk or loose teeth, open mucous inflammations, get rid of tartar, when soldering crowns and common bridge-type prostheses that are attached to the gums. It is also used to reduce nausea during the production of an impression and to reduce pain in many diseases of the mucous layer of the oral cavity (gingivitis and stomatitis pathologies).

This method of anesthesia is practically harmless and extremely effective for the patient. The analgesic effect of this remedy begins in just a couple of minutes and does not go away within an hour.

According to the nature of the analgesic effect, anesthetic drugs are divided into 4 types:

1. Means that have features that allow you to cauterize the necessary areas (acidic nitrogen, zinc chloride solution, potassium hydroxide, carbolic acid, dissolved silver nitrate, etc.). But all of them have not gained wide distribution in the field of applied dentistry due to the fact that they have a pronounced toxicity and a high risk of damaging the pulp region and other tissues involved in the formation of the tooth cavity.
2. Dehydration substances (sodium, potassium, magnesium and other carbonate and hydrocarbonate materials of mineral origin). These medicines reduce the vulnerability of hard parts of the tooth to painful reactions by removing fluid from there.
3. Preparations of physiological effects (pastes from fluorine, strontium, aspirin, sulfidine; paste from calcium glycerol subphosphate and others). These drugs, when in contact with the tissues of the tooth, have a special effect on the receptors of the dentinal passages, preventing the reception of a pain signal. These and other biologically related chemicals have a pronounced therapeutic effect. Therefore, they are used in the treatment of a qualitative increase in the susceptibility of the hard zone of dental tissue.
4. Local anesthetics (Platonic liquid, Shinkarevsky's substance, Hartmann's liquid, Groshikov's solution, etc.). When covering hard areas of dental tissues, these drugs block the conduction of external nerve endings. In this situation, the anesthetic is almost always applied in liquid form.

Features of the use of certain drugs

Application medicines, when using which the analgesic result is obtained due to the effect of temperature-lowering substances (for example, ethyl chloride), are not used in dentistry because of the danger of their getting into the respiratory organs, as well as interaction with too sensitive teeth, a sudden drop in temperature of which can cause incredibly intense pain.

The main disadvantage of using aerosol painkillers is the large area of ​​anesthetic spray, which entails the almost complete impossibility of accurate dosage. Due to the high concentration of drugs and their characteristic effect on vasodilation, once in the blood, they accumulate there to toxic volumes as rapidly as with subcutaneous injection. Another disadvantage of this method is usually considered the psychological inconvenience of patients due to a long-term decrease in the susceptibility of the mucosa, as well as a high chance of biting tissues in the oral cavity, especially in preschoolers. Local anesthetic in this case can be any.

The doctor can eliminate pain when a tissue is punctured with a needle using such methods as: distracting the patient's attention with something; squeezing the soft tissues supported by the palm during an injection; asking the patient to take a deep breath before the injection; injection of small volumes of anesthetic only in the area of ​​​​the intended entry of the needle.

Indications for the use of topical analgesia

Application anesthesia (analgesia) is a subtype of local analgesia.

It is used in dental procedures so as not to use general anesthesia. Application anesthesia in the dental field is considered to be an effect in which the mucous layer of the oral region is impregnated with a local anesthetic. This remedy causes a change and inhibition of the activity of nerve endings, which entails a blocking of pain and spasmodic sensations.

Typically, this type of anesthesia is used in the following cases:

• extraction of tartar and harmful plaque;
• operational actions at the border of teeth and gums;
• disclosure of inflammation;
• analgesia of the injection site;
• extraction of the affected pulp;
• disclosure of suppuration;
• pulling out milk teeth;
• fixing bridge implants and crowns, acting as substitutes for part of the tooth.

Medicines that are intended for application analgesia have various forms: liquid, gel, viscous ointments, aerosol preparations, sprays.

The anesthetic drugs used in topical analgesia include:

• tetracaine (dicaine); applied in the form of powders for sprinkling, liquids and ointments. This tool is poisonous because its use is limited;
• lidocaine drug; used in the form of liquids, gel and ointments;
• pyromecaine solution (otherwise it is called bumecaine); produced in the form of ointment, gel and liquid ampoules;
• anesthetic drug (benzocaine); most commonly sold as glycerin or oily liquids;
• an alcoholic solution of a propolis substance that has an analgesic effect.

How Anesthesia Works

Cauterization is carried out with a thirty percent solution of silver nitrate. Active substances remove water from tissues, thereby reducing susceptibility and eliminating pain.

Pastes based on strontium, sulfidine, aspirin, and fluorine have a physiological effect. Means of local analgesia reduce the conductivity of nerve endings, stopping pain syndromes. Surface anesthesia is quite effective for minor operations.

This area is represented by a huge selection of anesthetics. The main characteristic feature of application analgesia is that the tissues are pre-treated with a disinfectant, dried and eliminate the possibility of salivary secretions at the site of application of this type of analgesia.

The analgesic effect is usually manifested after spreading, rubbing or applying an anesthetic to the tissues.

The duration of analgesia with this method of anesthesia is usually no more than 25 minutes, the depth of the anesthetized tissues is no more than 4 mm, the result is felt after 3 minutes.

Since anesthesia goes only to a shallow depth, then, if necessary, the manipulations are repeated.

The effect can be enhanced if an agent with a strong penetrating effect (Dimexide, Lidazine, and others) is added to the anesthetic. During application analgesia of the hard tissue of the tooth, it must be remembered that the dental region has a different susceptibility in some areas. The side effects of analgesia should be taken very seriously. The same applies to contraindications.

Modern dentistry provides patients with a large number of services for the correction of dental defects. However, not all procedures can be considered painless. That is why during the majority of them application anesthesia is used.

What is the procedure?

It consists in the impact of special on the terminal nerve endings of the tooth without the use of a syringe. Naturally, different drugs provide different effects. Pain relief is superficial. The drug is applied to the desired area in the form of a gel, ointment or spray.

It should be noted that application anesthesia is not always allowed. Therefore, the type of anesthesia should be chosen by the doctor, depending on the operation to be performed, as well as on the characteristics of your body.

Indications for use

Local application anesthesia is usually done in such cases:

• in the treatment of caries.
• To reduce pain sensitivity in the area where you need to make an injection.
• To painlessly remove a loose tooth.
• To remove tartar.
• In order to restore the natural shape of the crown.
• To prevent the action of the gag reflex during the operation to remove the cast from the dentition.

Advantages and disadvantages of the procedure

Application anesthesia has some advantages:

1. High efficiency of action.
2. Safety for the patient.
3. No discomfort during anesthesia. The fact is that the drugs are applied with a cotton swab, so it does not cause any pain.

However, there are also disadvantages. For example, the duration of most drugs is limited to 30 minutes, and the doctor may not have time to do everything necessary for this time period. Despite the safety of the use of drugs, they still penetrate the systemic circulation and can cause side effects. Another disadvantage of using such anesthesia is the inability to control the dosage of drugs that are made in the form of an aerosol.

Contraindications and side effects

Before application anesthesia is applied, it is necessary to study all contraindications that make it impossible to use this method of anesthesia. Among them are the following:

• Individual intolerance to the drug or its components.
• The occurrence of an allergic reaction.
• Acute forms of heart disease and blood vessels, as well as a recent heart attack or stroke.
• Diabetes.
• Violation of the endocrine system.

The most important side effect of this pain relief is allergies. If the drugs used are dosed correctly, then complications can be avoided. Please note that you can not use such drugs at home. The presented type of anesthesia can be replaced. There are other ways to administer drugs.

Application and infiltration anesthesia are two types of local anesthesia. In this case, the second of them is used in cases where it is impossible to use the first. differs in that it is administered by injection.

Types of application anesthesia

Before you carry out anesthesia, you need to figure out how it will be done. Most often it is classified according to the mechanism of action. Anesthesia can be divided into four groups:

1. Moxibustion. For its implementation, a nitrogen solution and other substances are used. However, this method is not always used, as it can severely damage tissues and pulp.
2. Dehydration. In this case, special agents are used that can reduce the sensitivity of tissues to pain by reducing the amount of fluid in them.
3. Means of physiological action. These include aspirin paste, strontium paste and other substances. After the agent is applied to the dental tissue, it blocks the conduction of pain sensations through the receptors of the dentinal tubules. The therapeutic effect in this case is very pronounced.
4. Local anesthetic. It can block the conduction of peripheral nerve endings. Such a substance should be used to treat hard dental tissues.

What drugs are used?

If you need topical anesthesia, the preparations for its implementation should be chosen by the attending physician. There are enough of them. The most common are the following:

• "Dicain" ("Tetracain"). This tool can be sold in the form of ointments, solution or special powder. It is used quite rarely, as it has a high degree of toxicity. For the treatment of teeth in children, it is better not to use it.
• "Lidocaine". This is the most common drug that is used in pediatric and adult dentistry. It can also be purchased in the form of an ointment and gel. There is also a liquid solution of this drug.
• "Pyromecain". The medicine provides a good analgesic effect. It is available in ampoules or in the form of an ointment.
• "Benzocaine". The presented drug is sold in the form of an oil or glycerin solution.
• Alcohol solution of propolis. This substance is also able to eliminate pain.

Features of the procedure

So, before using a drug, such as a gel, for topical anesthesia, you need to make sure that the patient does not have an allergic reaction to it.

You can apply drugs with a cotton swab. In this case, the substance is either rubbed into the mucous membrane of the mouth, or simply applied to a specific area. If the anesthetic effect was not achieved the first time, then the procedure can be repeated. During anesthesia, it must be taken into account that each tooth differs from the other in the degree of pain perception. Therefore, in each individual case, a different dosage of the drug can be applied.

If the doctor decides to use an aerosol, then it is applied to the required area by spraying. It should be taken into account that the drug will also get to other parts of the oral mucosa. This may be highly undesirable.

If you need to undergo a dental procedure using anesthetics, you should not drink alcohol the day before your visit to the doctor. They can reduce the analgesic effect.

If you have fear at the mere thought of visiting a doctor, then at night you can take mild herbal sedatives. In case of infectious or inflammatory diseases in the body, it is better to postpone the treatment procedure.

Women should not go to the dentist during menstruation. This period is accompanied by increased excitability of the nervous system, and susceptibility to certain drugs becomes stronger. This can cause severe bleeding.

In any case, the application (we have already considered the drugs) is very common. But only a qualified doctor can use it. Only he is able to assess the patient's condition, take into account the characteristics of the patient's body and determine the dosage of the drug. Be healthy!

Visiting the dentist is always uncomfortable. Today, problems are solved with the help of anesthesia. It is presented in a wide range of types, among which application anesthesia is used. It makes visiting the dentist much easier.

In other words, this type of anesthesia is called superficial or terminal. It is done without injection, anesthetizes the mucous membrane.

The local anesthetic comes into contact with the tissues and the pain disappears. This is a simple and affordable method in the execution technique. To achieve anesthesia, the skin is lubricated with a gel, ointment or sprayed with an aerosol. Chemicals, anesthetics, drugs affect the nerve endings of the teeth.

Application anesthesia is applied directly to the gum

In dentistry, the method is especially popular among pediatric dentists. Before the injection, superficial anesthesia is applied to soft tissues and the child does not feel pain. For children, gels with the addition of fruit or other flavors are most often used.

Anesthesia technique

Before using anesthetics, it is necessary to pay attention to contraindications so that allergies do not occur. The oral mucosa is frozen under surface anesthesia using chloroethyl. Its jet hits a certain area. After the action of the remedy, the pain is not felt.

Anesthetic spray spray

This method is somewhat dangerous. When used, tissue necrosis may occur. Freezing is used in case of removal of the root, which is located on the surface or cutting of suppuration.

Lidocaine preparation - spray and gel

Means that lubricate the skin are applied with cotton swabs. They treat the surface of the oral mucosa. If after the first treatment the desired effect is not obtained, the procedure is repeated with the addition of lidase or dimexide. It must be remembered that the sensitivity of the teeth is very different, so the dose of anesthesia is not always the same.

A popular remedy for pain relief in dentistry is Emla gel. It is rubbed in ten minutes for an hour. The effect of anesthesia lasts twenty minutes.

Emla gel is used in pediatric dentistry

Tetracaine can be used as a powder and solution. It is characterized by high toxicity, caution and attention will not interfere during its use.

Penetrates anesthesia to a depth of 3 mm, begins to act in two minutes.

Desensil drug for topical anesthesia for adults

Anesthesia methods

Application anesthesia in parallel with drug methods also has non-drug methods. These include:

• Moxibustion agents (nitric acid, potassium hydroxide, silver nitrate 10–30% solution, carbolic acid). Substances have not received active use in dentistry as they damage the pulp, as well as the tissues around the tooth.
• Dehydration agents. After their introduction, dehydration of the hard tissues of the teeth occurs, as a result of which the pain decreases. These include potassium, magnesium, sodium carbonate, bicarbonates, and other mineral elements.
• Substances of physiological action, including toothpastes, which include fluorine, strontium, aspirin, sulfidine, calcium glycerophosphate. When in contact with tissues, they do not allow the manifestation of pain perceptions. They create a therapeutic effect. Used to treat hyperesthesia.

Toothpaste for the treatment of hyperesthesia in adults

• Means of local anesthesia. These include liquids. The nerve endings located on the surface lose their conductivity after applying the substance to hard dental tissues.
• Freezing agents that perform cooling are not used in dentistry. Their danger is manifested when they get in the way of breathing and susceptible teeth. With a sharp cooling, severe pain is felt.

Aerosols, when sprayed, cover a considerable area, so it is difficult to determine the dosage. This is a minus of the substance used.

Application anesthesia has another drawback, which is expressed in the toxic process of local agents. Entering the blood, they form a strong toxic concentration.

When is anesthesia used?

In dentistry, the freezing method is used in the following cases:

• when removing tartar or plaque;
• in the treatment of caries;
• during fixation of the prosthesis;
• to open suppuration;
• when removing the pulp.

Contraindications:

• application anesthesia with the use of dikain is prohibited for children who are under ten years old;
• patients who have a strong sensitivity to anesthesia or to the components used;
• if general anesthesia is administered, the individual diseases of the patient are taken into account.

Benefits of Surface Anesthesia

The use of application anesthesia gives a fast-acting effect. The operation can be carried out after a minute operation of the drug. The method of anesthesia provides complete safety. This makes it possible to administer anesthetics to children before injection with other painkillers.

The duration of anesthesia is sufficient to perform the necessary procedures associated with dental diseases.

Complications caused by surface anesthesia

Sometimes it happens that freezing can cause complications that are of a local or systemic type. The first causes damage to the soft tissues of the skin, with systemic skin itching and burning, or Quincke's edema occurs.

Quincke's edema is a rare complication

Side effects are manifested in the toxicity of the drugs used. Penetrating into the tissue, the anesthetic becomes highly concentrated.

Subject to contraindications using the application method, dental treatment is performed painlessly for both adults and children. The patient has the opportunity to choose the remedy that suits him.

Surface anesthesia is one of the modern and effective methods of anesthesia.

The development of the pharmaceutical industry has made it possible today to minimize any discomfort for the patient during a dental appointment.

The use of various methods of anesthesia by the doctor guarantees the high-quality and complete implementation of all the manipulations necessary for the sanitation (improvement) of the oral cavity.

In most clinical cases, local anesthesia is performed, which involves the impact on the peripheral parts of the nervous system.

During treatment, only the area of ​​medical intervention in the oral cavity is anesthetized and the patient remains conscious. One of the methods of local anesthesia is application, by applying medications to the mucous membranes of the oral cavity.

General ideas about the methodology

The area of ​​the oral cavity is achieved in two ways:

1. Injection.
2. By superficial impact on the mucosa without damaging its integrity. Methods for carrying out this manipulation can be:

• physical;
• physical and chemical;
• chemical.

The scientific name for application anesthesia is non-injection terminal anesthesia. It refers to chemical methods of temporary reversible desensitization only in the superficial layers of the oral mucosa.

The essence of this technique is the application, lubrication or rubbing of an anesthetic drug into the tissues to be anesthetized.

The advantages of application anesthesia are ease of implementation, atraumaticity, high efficiency and safety. A wide range of modern painkillers allows this technique to be used not only in adults, but also in children.

Mechanism of action

Application anesthesia is the simplest method of local anesthesia.

Its peculiarity lies in the fact that the impregnation of tissues with an anesthetic is carried out from the surface layers of the mucous membrane, on which the pharmaceutical preparation is applied.

Modern painkillers are available in the form of:

• liquid solutions for applications;
• ointments;
• gels;
• pastes;
• aerosols;
• cachets (tablet forms).

High efficiency and speed of application anesthesia is achieved due to a significant concentration of painkillers contained in local anesthetics. The active components of the pharmaceutical agent quickly penetrate into periodontal tissues and block the activity of receptors and peripheral nerve fibers.

The mechanism of development of local anesthesia depends on the type of drug used for application.

An anesthetic effect can develop due to:

• blockage of microscopic periodontal pores, as a result of which the effect on nerve fibers is stopped;
• narrowing of the lumen of blood vessels and pores of the mucous membrane.

Also, local anesthetics include fluoride varnishes, for anesthesia of hard tissues of the tooth.

Indications and contraindications

Application anesthesia is carried out in the following clinical cases:

• preliminary anesthesia before injection anesthesia;
• removal of milk and permanent mobile teeth (III degree);
• orthopedic treatment - during fitting (fitting) of crowns and bridges;
• removal of hypertrophied areas of the gums ();
• opening of submucosal abscesses;
• as part of complex therapy and stomatitis;
• relief of a pronounced gag reflex.

Some types of local anesthetics are applied directly to the hard tissues of the tooth.. Such anesthesia is used to treat caries.

Application anesthesia is prohibited for:

• if the patient has hypersensitivity to the action of any component of the local anesthetic;
• children under the age of 10 years - when using certain painkillers.

A possible side effect of application anesthesia is the development of allergic hypersensitivity of varying degrees of burden. However, the preliminary collection of a general somatic and allergic history helps to avoid complications during the dental process.

Application anesthesia technique

The high efficiency of local anesthesia is ensured by strict adherence to the algorithm for its implementation:

1. Preliminary disinfection of the oral cavity - rinsing the mouth with an antiseptic, for example, a solution of furacilin.
2. Isolation and drying of the mucosal area from saliva that needs to be anesthetized (covering with gauze napkins).
3. Application of a pharmaceutical agent to the mucous membrane. Liquid anesthetics are applied using a cotton or gauze ball soaked in a medicinal solution. Gel-like preparations are distributed on the surface of the surgical field in a thin layer with a spatula. Aerosols are sprayed within a few seconds.
4. The local anesthetic is left on the surface of the surgical field for 1-3 minutes, after which its remains are removed with a gauze cloth and the sensitivity of the treated area is checked with a needle or probe. If the quality of anesthesia is unsatisfactory, it is repeated.

Despite the wide prevalence and convenience of using painkillers in the form of aerosols, it is undesirable to use them. Disadvantages of such anesthetics: - poor control of the spray area and dosage of the drug, the risk of the drug getting into the patient's upper respiratory tract, professional allergization of the dentist. In any case, painkillers are best applied with a cotton swab.

Regardless of the type of local anesthetic, the analgesic effect appears 1-3 minutes after its application and lasts 15-20 minutes.

Drugs used for topical anesthesia

The main local anesthetics used in dental practice:

• - used in the form of 5-15% aerosol solutions, 2-5% ointments and gels;
• Silver nitrate, carbolic and trichloroacetic acids are available in solid form (lapis) or as a solution. They have a cauterizing property, so their use in children is limited;
• Septodent (Anekstopulpa) is a fibrous paste that has an anesthetic and disinfecting effect. It is applied to the hard tissues of the tooth for pain relief in caries;
• Dikain (Tetracain) - is available in the form of 0.5-4% solutions and ointments. Due to high toxicity, it is not used in children under 10 years of age;
• Pyromecaine (Bumecaine) - is available in the form of a 5% ointment and a 2% solution. The intensity and duration of the analgesic effect is not inferior to Dikain, but less toxic;
• Anestezin - used in the form of 5-20% oil solutions, ointments, pastes, powders;
• Kalgel - a dental gel used for painful teething, as part of the complex therapy of gingivitis and stomatitis;
• Sensigel is a gel containing fluorinol and potassium. It is used to reduce the sensitivity of teeth, to protect them from external stimuli;
• Fluoridine, Bifluoride 12 - fluorine-containing varnishes used for the treatment of high sensitivity (hyperesthesia), prevention of caries, pain relief during the removal of dental plaque;
• Carbamide, soda slurry, hypertonic solution are drugs used for hyperesthesia of hard tooth tissues. Decreased tooth sensitivity is due to dehydration of their tissues after the application of the drug;
• Drill - lozenges for resorption, which have analgesic and antiseptic effects.

You cannot buy and use painkillers on your own. The choice of anesthetic agent is carried out by the dentist, based on the data of the collected anamnesis and taking into account the complexity of the necessary medical intervention.

In dental practice, various anesthetics are widely used, which are suitable for both adults and children. Modern painkillers help to effectively reduce or completely eliminate pain during dental treatment. A type of local anesthesia that is used in dentistry is application anesthesia (superficial anesthesia).

Benefits of local anesthesia

Application anesthesia in dentistry is used to relieve sensitivity in the area of ​​skin puncture with a needle, as well as to anesthetize the mucosa. For this purpose, a local preparation is used, which impregnates the mucous membrane of the oral cavity. This method of anesthesia is excellent for any low-traumatic intervention.

Application anesthesia will help young patients stop being afraid of dentists

Anesthetics lead to a disruption in the functioning of nerve receptors, as a result of which pain sensations are blocked. The advantages of this technique include high efficiency and safety for the patient, provided that the dosages are strictly observed. Local anesthesia has a selective effect and does not lead a person into a state of artificial sleep, as with general anesthesia.

In pediatric dental practice, most often anesthetics look like a gel, which can be produced with fruit or other flavors (berries, bananas, pineapple, etc.). Means in the form of solutions, ointments or aerosols can also be used.

In dentistry, topical anesthesia is used for the following indications:

• extraction of teeth;
• caries treatment;
• removal of tartar;
• opening of an abscess;
• fixation of the prosthesis;
• pulp removal.

According to the type of their action, all local application anesthetics are divided into caustic agents, local anesthetic preparations, dehydration agents and anesthetics of physiological action. Dehydration agents dehydrate the tissue and help reduce their sensitivity. Fluoride paste or strontium paste are commonly used to obtain a physiological effect.

Surface anesthesia in dentistry most often involves lubricating or freezing an area of ​​skin with an anesthetic. Dentistry under general anesthesia is performed only if there is an allergy to a local gel (ointment, spray), a strong gag reflex, or to remove a large number of teeth at once.

Advice: it is necessary to choose anesthetics for pain relief in dentistry taking into account the pain sensitivity of the teeth and indications.

How anesthesia is performed

Before using anesthetics, it is recommended to exclude possible contraindications to them in advance in order to avoid an allergic reaction. Superficial anesthesia is performed by freezing the oral mucosa and consists in the use of chloroethyl, which is directed by a jet to its specific area. In this case, a certain area of ​​\u200b\u200bthe skin is frozen and stops responding to pain.

The danger of this method of anesthesia lies in the fact that there is a possibility of developing tissue necrosis. Freezing is used mainly to open an abscess or remove a superficial root.

Preparations for lubricating the skin are applied with a cotton swab. Anesthetics are used to treat the surface of the oral mucosa: they are rubbed into the mucous membrane, or they are lubricated with a certain area. If necessary, this procedure is repeated again, and to obtain a greater effect, lidase or dimexide is added to the preparations. It should be borne in mind that each tooth has a different sensitivity and needs a certain amount of anesthetic.

The most famous drugs for pain relief in dentistry include a remedy called Emla. The gel can be rubbed in every 10 minutes for one hour. The anesthetic works for about 20 minutes.

Tetracaine is used in the form of powders and solutions, which should be used with caution due to its high toxicity. An anesthetic effect is given by an alcohol solution of propolis or an anesthesin oil solution.

Advice: if you are allergic to the anesthetic, a severe allergic reaction may occur, so you need to make sure in advance that there are no contraindications to anesthesia.

Complications after topical anesthesia

The anesthetic should be only in a strict dosage

In some cases, surface anesthesia can cause side effects or complications. They are either local or systemic. A local complication is a lesion of the skin, namely soft tissue. As a systemic complication, an allergy to the anesthetics used may appear. Depending on the amount of the injected substance, burning and itching of the skin, or even Quincke's edema, may appear. During freezing anesthesia, skin damage may occur.

Side effects of local anesthesia include the toxicity of the drugs used (water-soluble application drugs). After penetration into the tissues, the anesthetic can reach high concentrations.

Contraindications

It is forbidden to carry out superficial anesthesia with hypersensitivity to anesthetics. It is also not recommended to use such a drug on its own at home.

If there are contraindications to the use of topical anesthesia, infiltration and conduction anesthesia can be used as local anesthesia (for example, torusal anesthesia in dentistry, tuberal, mandibular or palatal). Such anesthesia is performed using a needle with a drug that is injected into the branches of the trigeminal nerve or into another area on the mucous membrane.

With the help of surface anesthesia, it is possible to carry out painless dental treatment for adults and children. The anesthetic comes in a variety of forms, so you can choose the right one for each patient.

When is topical anesthesia used in dentistry?

The development of the pharmaceutical industry has made it possible today to minimize any discomfort for the patient during a dental appointment.

The use of various methods of anesthesia by the doctor guarantees the high-quality and complete implementation of all the manipulations necessary for the sanitation (improvement) of the oral cavity.

In most clinical cases, local anesthesia is performed, which involves the impact on the peripheral parts of the nervous system.

During treatment, only the area of ​​medical intervention in the oral cavity is anesthetized and the patient remains conscious. One of the methods of local anesthesia is application anesthesia in dentistry, by applying medications to the mucous membranes of the oral cavity.

General ideas about the methodology

1. Injection.
2. By superficial impact on the mucosa without damaging its integrity. Methods for carrying out this manipulation can be:

• physical;
• physical and chemical;
• chemical.

The scientific name for application anesthesia is non-injection terminal anesthesia. It refers to chemical methods of temporary reversible desensitization only in the superficial layers of the oral mucosa.

The essence of this technique is the application, lubrication or rubbing of an anesthetic drug into the tissues to be anesthetized.

Mechanism of action

Application anesthesia is the simplest method of local anesthesia.

Its peculiarity lies in the fact that the impregnation of tissues with an anesthetic is carried out from the surface layers of the mucous membrane, on which the pharmaceutical preparation is applied.

Modern painkillers are available in the form of:

• liquid solutions for applications;
• ointments;
• gels;
• pastes;
• aerosols;
• cachets (tablet forms).

High efficiency and speed of application anesthesia is achieved due to a significant concentration of painkillers contained in local anesthetics. The active components of the pharmaceutical agent quickly penetrate into periodontal tissues and block the activity of receptors and peripheral nerve fibers.

The mechanism of development of local anesthesia depends on the type of drug used for application.

An anesthetic effect can develop due to:

• blockage of microscopic periodontal pores, as a result of which the effect on nerve fibers is stopped;
• narrowing of the lumen of blood vessels and pores of the mucous membrane.

Also, local anesthetics include fluoride varnishes, for anesthesia of hard tissues of the tooth.

Indications and contraindications

Application anesthesia is carried out in the following clinical cases:

• preliminary anesthesia before injection anesthesia;
• removal of milk and permanent mobile teeth (III degree);
• orthopedic treatment - during fitting (fitting) of crowns and bridges;
• removal of hypertrophied areas of the gums (hood over the wisdom tooth);
• removal of dental deposits;
• opening of submucosal abscesses;
• as part of the complex therapy of gingivitis and stomatitis;
• relief of a pronounced gag reflex.

Some types of local anesthetics are applied directly to the hard tissues of the tooth.. Such anesthesia is used to treat caries.

Application anesthesia is prohibited for:

• if the patient has hypersensitivity to the action of any component of the local anesthetic;
• children under the age of 10 years - when using certain painkillers.

Application anesthesia technique

The high efficiency of local anesthesia is ensured by strict adherence to the algorithm for its implementation:

1. Preliminary disinfection of the oral cavity - rinsing the mouth with an antiseptic, for example, a solution of furacilin.
2. Isolation and drying of the mucosal area from saliva that needs to be anesthetized (covering with gauze napkins).
3. Application of a pharmaceutical agent to the mucous membrane. Liquid anesthetics are applied using a cotton or gauze ball soaked in a medicinal solution. Gel-like preparations are distributed on the surface of the surgical field in a thin layer with a spatula. Aerosols are sprayed within a few seconds.
4. The local anesthetic is left on the surface of the surgical field for 1-3 minutes, after which its remains are removed with a gauze cloth and the sensitivity of the treated area is checked with a needle or probe. If the quality of anesthesia is unsatisfactory, it is repeated.

Despite the wide prevalence and convenience of using painkillers in the form of aerosols, it is undesirable to use them. Disadvantages of such anesthetics: - poor control of the spray area and dosage of the drug, the risk of the drug getting into the patient's upper respiratory tract, professional allergization of the dentist. In any case, painkillers are best applied with a cotton swab.

Drugs used for topical anesthesia

The main local anesthetics used in dental practice:

• Lidocaine - used in the form of 5-15% aerosol solutions, 2-5% ointments and gels;
• Silver nitrate, carbolic and trichloroacetic acids are available in solid form (lapis) or as a solution. They have a cauterizing property, so their use in children is limited;
• Septodent (Anekstopulpa) is a fibrous paste that has an anesthetic and disinfecting effect. It is applied to the hard tissues of the tooth for pain relief in caries;
• Dikain (Tetracain) - is available in the form of 0.5-4% solutions and ointments. Due to high toxicity, it is not used in children under 10 years of age;
• Pyromecaine (Bumecaine) - is available as a 5% ointment and 2% solution. The intensity and duration of the analgesic effect is not inferior to Dikain, but less toxic;
• Anestezin - used in the form of 5-20% oil solutions, ointments, pastes, powders;
• Kalgel - a dental gel used for painful teething, as part of the complex therapy of gingivitis and stomatitis;
• Sensigel is a gel containing fluorinol and potassium. It is used to reduce the sensitivity of teeth, to protect them from external stimuli;
• Fluoridine, Bifluoride 12 - fluorine-containing varnishes used for the treatment of high sensitivity (hyperesthesia), prevention of caries, pain relief during the removal of dental plaque;
• Carbamide, soda slurry, hypertonic solution - drugs used for hyperesthesia of hard tissues of the tooth. Decreased tooth sensitivity is due to dehydration of their tissues after the application of the drug;
• Drill - lozenges for resorption, which have analgesic and antiseptic effects.

You cannot buy and use painkillers on your own. The choice of anesthetic agent is carried out by the dentist, based on the data of the collected anamnesis and taking into account the complexity of the necessary medical intervention.

Related video

Application anesthesia in modern dentistry

Treatment of dental diseases rarely takes place without an injection into the affected area. Most patients are afraid of the injection no less than the treatment procedure itself.

To make the process of administering the anesthetic more comfortable, application anesthesia is used before the injection.

What it is?

Application-type anesthesia is a non-injection method of pain relief of oral tissues, which is achieved by applying a concentrated anesthetic to a limited area of ​​​​the intended effect.

As an anesthetic application, not only medicines are used, but also methods of physicochemical influence, in which the tissues of the oral cavity are cooled or cauterized, due to which their sensitivity decreases.

For dental intervention most often used drug application anesthesia in the form of an ointment, spray, gel. Many of these products have additional aromatization, which makes the process of use more comfortable.

Mechanisms of action

Application anesthesia is characterized by a rapid action, which is achieved due to the instant penetration of the drug into the periodontal tissues. The mechanism by which sensitivity blockage develops will depend on the type of application.

When applied to the mucosa of an anesthetic, it is absorbed into the mucosa and quickly distributed throughout its cells. In a few seconds, the agent reaches and blocks the nerve endings, which leads to pain relief.

If fluoride or strontium paste was used as an application anesthesia, then the blockade of pain sensations is carried out due to blockage of periodontal micropores, thereby eliminating the effect on nerve fibers.

When using silver nitrate or dehydration agents, pain relief occurs due to the narrowing of the vessels and pores of the mucosa.

Regardless of the mechanism of action of surface anesthesia, the analgesic effect appears after a few seconds or minutes, and can last up to half an hour.

Based on the mechanisms of development of the anesthetic effect, several types of application anesthesia have been identified.

Moxibustion

One of the first types of superficial anesthesia, in which potent aggressive drugs were used: nitric and carbolic acid, zinc chloride, silver nitrate. These funds were used not only for freezing the periodontium, but also for dental tissues.

At the time of application, there was blockage and narrowing of the pores that closed the nerve endings from any impact. Cautery gave results in a short period of time, but never gained popularity due to the aggressiveness of the substances used.

They are highly toxic and, when applied directly, damage tooth tissues, pulp, and the surrounding periodontium.

Dehydration

This type is relief of tooth sensitivity, due to the use of substances with dehydration properties. Basically, they use bicarbonate or carbonate: sodium, magnesium, potassium, as well as other trace elements with similar properties.

Means can slightly reduce sensitivity due to dehydration of enamel and dentin. This method is often used for professional cleaning of teeth or for minor manipulations on them.

Means of physiological action

As a means of physiological action, sulfidine, aspirin, glycerophosphate, strontium paste are isolated. They differ in their specific effect on dentinal receptors, blocking the transmission of impulses to nerve endings.

In addition to the analgesic effect, these substances have a pronounced therapeutic effect, and therefore are often used in the treatment of teeth with pathological enamel or dentin. Regular use restores the structure of damaged dental tissue and strengthens healthy areas of the teeth.

Local painkillers

The most common type of surface anesthesia. They allow quickly stop sensitivity and accurately calculate the time of drug exposure.

For the procedure, concentrated anesthetics are used: benzocaine, lidocaine, tetracaine, which can quickly eliminate the conduction of peripheral nerve fibers.

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Indications and contraindications

The main indication for the use of application anesthesia is the patient's increased anxiety before an injection with an anesthetic drug. Even in the absence of excessive stress, pre-treatment with an anesthetic reduces the patient's psychological discomfort, which has a positive effect on the work of the dentist.

Especially often, this type of anesthesia finds its application in pediatric dental practice. According to the observations of doctors, the most terrible or unpleasant moment, children consider not the treatment or extraction of a tooth, but an injection into the gum.

In addition to these factors, indications for the use of superficial anesthesia include:

• professional cleaning;
• removal of the neurovascular bundle of the pulp;
• any effect on the periodontium;
• opening of purulent capsules of gum tissue;
• extraction of temporary or permanent mobile teeth;
• fixation of orthodontic appliances, crowns, prostheses;
• treatment of stomatitis, gingivitis;
• pronounced gag reflex when taking impressions.

A contraindication for superficial anesthesia is sensitivity or an allergic reaction to the components of the agent used. For drugs that contain lidocaine, age up to 10 years is a contraindication.

Advantages and disadvantages

The advantages of this type of desensitization, first of all, include the speed of drugs. In addition, there are a number of positive aspects of applications:

• safety. Since the substances are applied only to the surface of the periodontium, their general negative impact is excluded;
• duration of exposure, which, depending on the concentration of the active substance, lasts from 10 to 30 minutes;
• minimum side effects so that anesthetics can be used in young children.

Despite serious advantages, surface application of anesthetics has certain disadvantages. The main ones include:

• the impossibility of accurate dosing of the drug. As a result of the use of a high concentration of an anesthetic substance, it penetrates into the bloodstream, where it has a toxic effect. Particularly inconvenient in this regard are aerosols;
• lack of deep analgesic effect, due to which the scope of the application method is reduced;
• pronounced vasodilating effect which can lead to bleeding gums.

The listed shortcomings are easily eliminated by substituting one agent for another, and by strictly observing the methodology for conducting the procedure of superficial anesthesia.

What drugs are used?

To relieve the sensitivity of dental and periodontal tissue, agents are used that contain the following substances as an anesthetic:

• lidocaine;
• dikain (tetracaine);
• bumecaine (pyromecaine);
• benzocaine (anesthesia).

Preparations are presented for use in dental purposes in a wide range in different forms: gels, ointments, aerosols, films, oil-based or water-based emulsions.

Often, in addition to the main active ingredient, the composition may include flavors, antiseptics, anti-inflammatory components.

The most popular means include:

It is a film with analgesic and antibacterial properties, intended for sticking to the affected area.. The film consists of a hydrophobic and hydrophilic layer, with sorption capacity.

They are impregnated with chlorhexidine and lidocaine. After sticking the film, the effect appears within 1 minute. The injection is made directly through the film.

It can be left after the intervention, as the layers dissolve after 12 hours.

Topex - benzocaine-based gel

It is applied to the problem area for at least 1-2 minutes. The consistency of the gel allows you to accurately treat the mucosa without affecting the healthy area.

This drug is made in the form of a spray, the main active ingredient of which is also benzocaine. The drug relieves sensitivity for no more than 15 minutes.

A small concentration of the main substance makes it possible to use the product in children from 5 years.

Desensetin

Refers to the fastest acting drugs. It contains lidocaine, which has an effect within 10 minutes after application.

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Methodology

A high effect of anesthetic application will be ensured only if it is carried out correctly, in compliance with a certain technology. Before applying the anesthetic, the mucous membrane and the surface of the tooth are treated with an anesthetic and dried.

Then the drug is rubbed into the mucous membrane or the necessary area is irrigated with it. If the dosage is observed, the depth of anesthesia will reach up to 3 mm. The continuation of the action of the agent will depend on the main substance and its concentration.

The acceptable pain relief range is 10-30 minutes. For a longer relief of sensitivity, the substance is applied repeatedly.

Side effects

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As a side effect, there is a long-term restoration of the full sensitivity of the mucosa. In children, this can lead to injury due to biting.

For adults, this condition is associated with psychological discomfort, which in the future may be the cause of the development of dental phobia.

In conclusion, we suggest watching a video about another type of anesthesia used in modern dentistry: