Painkillers in dentistry. Conduction anesthesia in dentistry

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

There are six methods of anesthesia in dentistry:

1. Application
2. infiltration
3. Conductor
4. Intraligamentary
5. Intrapulpal
6. Intraosseous

Conduction anesthesia provides the deepest 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 topical anesthesia (no injection). But it is also the most inefficient. At the same time, the sensitivity of the teeth is not turned off at all, only the mucous membrane is anesthetized.

In terms of benefits and ease of implementation / potential harm, infiltration anesthesia is preferable. For most dental procedures, it is quite enough, but the lower chewing teeth are anesthetized in this way with difficulty.

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

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

An important role is played by the concentration of adrenaline in the anesthetic solution - the higher it is, the stronger the pain relief. The most effective is 4% articaine in combination with adrenaline in a ratio of 1:100,000. Under the trademark "Ubistezin" a drug is produced with a vasoconstrictor content of 1: 200,000. "Ubistezin forte" contains just a concentration of 1: 100,000 - this is the most effective anesthetic to date.

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 area in particular paint him.

The media often inflate the problem, creating a real cult of fear of dentists and the methods 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 that you will be harmed is about the same as getting hit by a car on the way to the clinic. You won't be sitting 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 "shots" is the price. Therefore, when they come to the doctor, they say “make a good one” or “cheaper”. At the same time, the formulations of the preparations differ significantly. Some may simply not suit you, others will cause itching or swelling.

Why is anesthesia needed?

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

It's scary for everyone. On the other hand, not everyone is ready to endure, and it is not realistic to perform some procedures “on the fly”. For example, if you need to make a hole in the jaw bone for installation.

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

Preparations and their features

Do you know the names of drugs used by doctors? Most patients can remember offhand several. First of all, it is lidocaine and novocaine. The latter, by the way, has not been used in dentistry for a long time.

But there are many new tools that are more effective.

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

Who is contraindicated for injections of painkillers?

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

• Bronchial asthma;
• Mental deviations 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 adrenoblockers;
• Angina pectoris, tachycardia, a number of other pathologies of the cardiovascular system.

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

Do not inject on an empty stomach. 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. Asthmatics are recommended Ultracain D. It is also effective for allergy sufferers;
2. Thyroid problems or diabetes are a similar choice;
3. Hypertension and core 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 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. During the process, the patient does not feel anything. Such freezing in dentistry is often used in children's clinics and for allergies to an injection. The action is local, the duration is not 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. After injecting articaine, trimecaine, or another similar substance, the doctor can continue the manipulation.

The third is conductor. How is conduction anesthesia performed in dentistry and what are the varieties?

• Popular mandibular anesthesia in dentistry, during which anesthesia is performed by blocking the reactions of the lower alveolar nerve. The drug is injected into the opening of the lower jaw. Access from the area under the lower jaw is possible if the intraoral method is excluded for any reason. Application requires great care on the part of the doctor. If you make a mistake, numbness of the pharynx, damage to the pterygoid muscle and other unpleasant consequences that require long-term treatment are possible. Not uncommon - damage to blood vessels and hematomas. Less common blockade of the facial nerve with paresis of facial muscles.
• Torusal anesthesia in dentistry - the introduction of an anesthetic composition into the area of ​​\u200b\u200bconnection of the bone scallops on the patient's lower jaw. It affects three nerves at once - buccal, lingual and lower alveolar. As a result, several teeth from the side of the injection, the jaw area and the mucosa lose sensitivity at once. The injection must be carried out as accurately as possible so as not to damage the nerve endings. The modern technique of carrying out allows you to enter the needle 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 necessary, removing the pulp, opening an abscess.

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

0.3-0.5 ml are introduced. anesthetic agent. After 3-5 minutes, the sensitivity of the area is significantly reduced. If the doctor makes a mistake, then the numbness will spread to the soft palate. This leads to a violation of the swallowing function and the appearance of a sensation of a foreign body. In many patients, this causes bouts of vomiting. 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 zone.

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

• fangs;
• incisors;
• Medial root of the first molar;
• Adjacent areas of bone and soft tissues.

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

In maxillofacial surgery, stem anesthesia proved to be the most effective. In dentistry, it is used exclusively in a hospital setting.

When choosing a technique, patients are interested in which one is better and how much this or that type of anesthesia works. Average working time - from 30 minutes to 2 hours. There are procedures more and less painful. Based on this, it is determined what, where and how much to inject. Based on the number of teeth to be treated, and other nuances of the work, the doctor determines the method of administration of the drug.

General anesthesia. Testimony, "for" and "against"

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

To this day, there are rumors among the 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 had 20 or more surgeries. After the procedure, many lived for a very long time. Yes, the load on the body is high, but not more 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 shutdown of consciousness, but about depression of the central nervous system. In this state, the patient can breathe on his own. He does not need a breathing tube that interferes with the doctor's work in the oral cavity. Full immersion in an unconscious state is rarely used. Usually - in cases where a long and painful procedure is ahead, such as the implantation of several teeth in a row.

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

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, their concentration. If necessary, the doctor brings the patient to life ahead of schedule. First, he must make sure that there are no allergies and other contraindications.

Pain relief during pregnancy and breastfeeding

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

If the 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 a toothache does not overtake during a period when it is forbidden for you to give an injection for medical reasons.

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

Do not 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 for the fetus, and Primacaine, which is rapidly excreted 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 children's body is more prone to allergic reactions with unpredictable consequences.

If there is a pronounced allergy to injectable anesthetics, general anesthesia or sedation is used. The last doctors carry out with the help of a breathing mask. The child will be calmer, he will not have to be held. The issue is especially relevant for the smallest, who find it difficult to explain that it is necessary to sit still in the chair. The inhaled mixture relaxes, and its action lasts no more than ten minutes.

Doses 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 is 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 the normal perception of the administered drug by his body.

Allergy. Individual reactions

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

Such components, harmful in themselves, are enough in any medicine. This must be taken into account in advance. Because after that you have to deal with side effects.

Symptoms vary. It can be itching, redness, the appearance of persistent swelling at the injection site. Such problems are local in nature, and therefore rarely dangerous.

It is much worse when the edema passes to the upper respiratory tract. Then doctors must administer an antihistamine to stop the swelling from developing.

Some patients may feel pain in the chest area, weakness, 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 the doctor about them in a timely manner, there is a risk not only for health, but also for life.

Real efficiency. Why might an injection not work?

It should be understood that anesthesia in dentistry must be performed taking into account many factors that are 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. The location of the nerves;
2. Psychological condition;
3. Features of the body's perception of a particular substance that affects the nerve.
4. The release of adrenaline due to stress;

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

Every substance has physical and chemical properties. For example, fat solubility. It depends on it how quickly you can get through the cell membranes. Another factor is protein binding. It depends on it, with what speed it will be possible to influence the passage of nerve impulses. If a 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 remedy that you were injected with turned out to be expired or its amount was incorrectly selected. The same compositions may differ in concentration.

Another big mistake is related to the actions of the patients themselves. They use alcohol "for courage". Under the influence of alcoholic beverages, nerve tissues lose their sensitivity to the administered anesthetic.

If you need to calm down before going to the doctor, use mint, lemon balm, other sedatives in the form of tea, decoctions, tinctures. It is better not to experiment with tablets. Some doctors prescribe Afobazole. It is sold without a prescription. Drink 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 faces during his life. Such painful sensations serve as a sign of the presence of a disease of the organs of the dentition. 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.

Consider 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, therefore, of course, it is not surprising that many people are very afraid of visiting the dentist's offices. When a person postpones a meeting with a dentist until the last moment, having a common carious lesion, he risks waiting for the occurrence of more serious complications of his disease, which will subsequently force him to turn to surgical treatment.

Today, absolutely in all clinics, as well as dental offices, doctors perform dental treatment without pain, for which various types of anesthesia are used in dentistry.

This is a decrease or complete elimination of sensitivity in the entire body of the patient or in its individual parts. In most situations, this can be achieved through the introduction of drugs that contribute to the disruption of the transmission of pain impulses to the brain from the site of intervention. In dentistry, anesthesia is required so 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

• Carrying out the treatment of deep caries.
• The process of depulping, that is, performing an extirpation or amputation of the pulp.
• Teeth extraction procedure.
• Other surgical intervention.
• 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, as well as the dentin layers, are very sensitive, so pain in this situation is noted very often.

Types of anesthesia in dentistry

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

So, there are several types of non-drug anesthesia, which include audio analgesia along with electroanalgesia, as well as anesthesia due to hypnotic and computer effects. The types of local anesthesia in dentistry will be discussed below.

The procedure of drug anesthesia involves the injection of an anesthetic, which blocks the conduction of an impulse for a certain time required for the implementation of medical intervention. After a certain time period, the agent is split, and the sensitivity is fully restored. Modern pain medications make it possible to completely avoid the appearance of discomfort during treatment.

General anesthesia as part of dental treatment is used relatively rarely. Most often it is used in the field of maxillofacial surgery.

Types of local anesthesia in dentistry

Most medical procedures are preceded by local anesthesia. For the body, this type of anesthesia is much safer than anesthesia. More recently, the most common anesthetics were Novocain along with Lidocaine, but now even more effective agents are being used. So, there are such types of local anesthesia as application type, infiltration, conduction, intraligamentary, as well as intraosseous and stem.

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

Performing topical anesthesia

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

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, which are located in the cervical region. In orthopedic medicine, this anesthesia is used in preparing 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 ​​\u200b\u200bthe mucosa. 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 administered in 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 anesthesia of the upper teeth is performed in this way. This is due to the fact that the small thickness of the jawbone gives the anesthetic the ability to easily get inside the nerve endings.

Performing conduction anesthesia

Conduction anesthesia is needed when infiltration does not have the necessary effect, or anesthesia of several adjacent teeth is required. In addition, it is used for extirpation of teeth. 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 in the process of draining a purulent focus. Thus, the injection of an anesthetic makes it possible to temporarily disable the entire nerve branch.

Quite often, immediately before surgery on the upper jaw, palatal conduction anesthesia is performed, which, if necessary, is supplemented with an incisive one. To anesthetize the lower jaw, torusal or mandibular anesthesia is used.

Intraligamentous anesthesia

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

Injection of the agent is performed in the region 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 excludes the child from accidentally biting the tongue and lips.

Conducting intraosseous anesthesia

This anesthesia is recommended for dental extirpation operations. First, an anesthetic is injected into the gums, and upon reaching local numbness, the injection is performed in the region of the jaw bone in its spongy layer, which is located in the interdental space. In this case, only the sensitivity of a particular tooth and a small area of ​​\u200b\u200bthe gum disappears. This effect occurs almost instantly, but lasts a short time.

Stem type of anesthesia

The performance of stem anesthesia in the field of dentistry is done exclusively in a hospital. Indications for its implementation are high-intensity pain along with neuralgia of the facial nerve, as well as serious injuries of the zygomatic bone and jaw. This type of anesthesia is also practiced in preparation for surgical interventions.

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

When is the technique of anesthesia in dentistry prohibited?

Contraindications

Before performing the anesthesia procedure, the dentist must definitely find out if the patient has serious somatic diseases or allergic reactions to drugs. So, the main contraindications to the use of painkillers can be:

• The occurrence of allergies after the introduction of an anesthetic.
• The presence of diabetes 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 ailments 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, the patient should be treated only in a hospital. Particular caution is recommended when performing anesthesia for children and pregnant women.

Anesthesia in pediatric dentistry

Unfortunately, to date, there are no anesthetics that can be called completely safe for children. In childhood, the body is too sensitive to any drugs, so the risk of complications after injection is very high.

Previously, Lidocaine and Novocain were used for pain relief, and now Arikain and Mepivacain are considered to be the safest means for children. In the dental treatment of children, such types of anesthesia are practiced as application, infiltration, intraligamentary and conduction.

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

Complications due to the use of local anesthesia

Possible complications from the anesthesia procedure include:

• The appearance of allergic reactions with special hypersensitivity to these drugs.
• The likelihood of toxic reactions as a result of an overdose.
• Prolonged loss of sensation due to a nerve injury with a needle, which sometimes occurs due to a violation of the rules for performing an injection.
• Burning and pain at the injection site. This phenomenon is quite common and is considered the norm 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 an injection due to damage to blood vessels.
• Broken needle during injection, which is extremely rare.
• If the dentist does not follow the rules of asepsis when injected into the affected area of ​​the mucosa, tissue infection may occur.
• The appearance of transient spasms of masticatory muscles as a result of damage to the nerve or muscle fibers
• Accidental biting of the tongue, lips, or cheeks due to momentary 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, it is necessary to refrain from drinking alcoholic beverages, since ethyl alcohol reduces the analgesic effect of most medicines. In case of emotional stress at night, it is advisable to take a sedative, 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 delaying dental treatment, if possible. In this period, nervous excitability increases greatly, as well as susceptibility to drugs. Therefore, tooth extraction along with other surgical interventions during menstruation can cause prolonged bleeding.

General anesthesia

General anesthesia in dentistry is understood as a complete loss of sensitivity, which is accompanied by various impairments of consciousness. General anesthesia during dental treatment is used quite rarely and only for strict indications, since this method of anesthesia is extremely dangerous. It is used in the implementation of serious surgical manipulations in the maxillofacial region.

It should be noted that inhalation anesthesia, that is, nitrous oxide, is increasingly used in dental treatment. So, 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. Better if it's not in the first trimester.

Contraindications in this case include:

• Diseases of the respiratory organs.
• The presence of serious pathologies of the cardiac system
• General intolerance to drugs for anesthesia.

Immediately before the planned intervention, which involves the introduction of the patient into a state of anesthesia, the patient is recommended to undergo an examination, which will include:

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

We reviewed the methods of anesthesia in dentistry.

Going to the dentist causes a feeling of fear in many people, but modern pain relief methods help to 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 are and what are the contraindications to 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. An anesthetic helps to block the nerve impulse and numb a specific area of ​​the mucosa. After some time, the sensitivity is restored.

Anesthesia in orthopedic dentistry is used for prosthetics. In order to make it easier for the patient to endure some manipulations, sedatives, antipsychotics and non-narcotic analgesics are used in orthopedic dentistry.

There are two types of anesthesia in dentistry: local anesthesia and general anesthesia. Also, dental anesthesia is medicated and non-pharmacological. Local anesthesia is divided into:

• application;
• infiltration;
• stem;
• conductive;
• intraligamentous.

Application anesthesia is used to open an abscess, treat caries, anesthetize a mucosal area before injection, and to remove a tooth. Such methods of anesthesia can be used with different anesthetics: gels, ointments, aerosols, pastes, etc. An anesthetic is applied to a specific area of ​​the mucous membrane and has an almost instantaneous effect. A contraindication to such anesthesia is individual intolerance to the drugs used, heart attack and diabetes mellitus. Dentists-orthopedists use this anesthesia for tooth turning before prosthetics.

Infiltration anesthesia is considered the most popular in dental practice. It is used during 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 drug to the mucous membrane so that the injection is less painful. Such anesthesia will help relieve the sensitivity of the nerves in the upper jaw.

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

Video

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

Previously, dentists of the past did not care much 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 discomfort not only for adults, but also for children.

At the same time, they can be administered both by injection and without the use of a needle.

Local anesthesia is the introduction of an anesthetic drug, due to which sensitivity gradually decreases in a certain area that needs dental manipulations. The active substances block the impulses that the nerve endings transmit to the brain.

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

Indications

Perhaps it is easier to list dental procedures that are performed without anesthesia. Local anesthesia is applied:

• during the treatment of advanced caries;
• before removing the root system or the tooth as a whole;
• during the treatment of periodontitis;
• 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 personal desire of the patient 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 should be selected for each patient individually. After all, the active means of painkillers, as in other drugs, have certain contraindications.

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

Local anesthesia is not suitable for patients:

• who 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 thyroid diseases, diabetes mellitus, which makes it impossible to use drugs containing vasoconstrictive components;
• a history of cardiac pathology or arterial hypertension. In this case, patients are contraindicated in local anesthesia, in which Epinephrine is present at a dosage above 1:200,000;
• bronchial asthma needs treatment. The anesthetic drug in this case should not contain sodium disulfide, which is a preservative.

Varieties

It is possible to anesthetize a certain part of the oral cavity by injection or by influencing the nerve endings in a way that does not imply a puncture of periodontal tissues.

Application

This method makes it possible to temporarily anesthetize the area being treated, due to the surface treatment of 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 instant effect. Sometimes, this type of anesthesia is used to reduce the discomfort from a future injection.

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

infiltration

The introduction of the drug is carried out by injection into the upper region at the root of the tooth. In this case, the injection is made both from the lingual (inner) and outer side of the gum.

The introduced composition in this case spreads into the internal cavity of the tooth gradually.

This method of anesthesia is used by specialists 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

Anesthesia is achieved by introducing the active composition into the surrounding tissues of the nerve, due to which the 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 made into the periodontal ligament. Gingival puncture is carried out on both sides of the mucosa.

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

It should be noted that the drug is administered both through a needle and a reduced cartridge. For the treatment of diseases of the oral cavity in adults, the technique can be combined with other methods of anesthesia.

Intraosseous

Anesthesia is used for short-term dental manipulations, since, in comparison with other methods of anesthesia, 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, at the end of the drug, there are no unpleasant sensations and a feeling of discomfort.

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

In the video, see how anesthesia is performed using intraosseous anesthesia.

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This method of anesthesia is carried out only in a hospital dental department. Anesthesia has the longest duration 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 of nerve endings is carried out immediately throughout the lower or upper jaw.

Indications for such strong anesthesia are:

• complex surgical interventions;
• injuries of the facial bones;
• neuralgia;
• intolerable pain syndrome.

For kids

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

Previously, Lidocaine and Novocain were used to block nerve impulses. Today, Mepivacaine and Arikain have the smallest list of side effects.

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

Note! Due to fears and due to the unformed psyche, during the injection in the dental chair, the child may lose consciousness. You should not write off the reaction of the child's body to the unprofessionalism of a specialist.

Preparations

In modern dentistry, the following drugs are used:

1. Ultracain. 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 label "D", the French manufacturer produces a product without preservatives and vasoconstrictors.
2. Ubistezin. According to the composition of active substances, the drug is an analogue of "Ultracaine". The anesthetic is produced in Germany and is available in various dosage variations of the main components.
3. Septanest. It has a significant concentration of preservatives. Therefore, its introduction is often accompanied by an allergic reaction.
4. Skadonest. The composition of the drug includes 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

An ordinary, at first glance, injection can turn into a number of unpleasant consequences. Among them are:

1. Needle fracture. Despite the fact that the element of the injection tool is made of durable metal, with a sharp movement of the patient, part of it may remain in the mucosa or periosteum. It should be noted that the probability of removing a small metal fragment without complications is much higher than when extracting a part of an element inserted to its full length.
2. Possibility of infection. Modern dentistry has reduced 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 can result in infection of a healthy area due to the pushing of pathogenic bacteria by the anesthetic.
3. Hematoma or bruise. The complication is the ingress of blood vessels into the tissues, which is most often observed during conduction anesthesia.
4. Swelling of tissues. A complication occurs with individual intolerance to the components of the drug.
5. Loss of sensation. Sometimes, blocking the transmission of impulses to the brain by nerve endings is delayed for several days or weeks against the background of 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 masticatory muscles or trismus. A complication is the inability to fully open the oral cavity. The phenomenon occurs due to damage to the muscles or vessels located in the infratemporal fossa and, as a rule, passes without any intervention in 2-3 days.
8. Soft tissue injury. Due to the lack of sensitivity of the tongue and some facial muscles, patients, especially children, may bite their lip or cheek. Therefore, until the complete end of the drug, it is recommended to refrain from eating.

At least a day before visiting a specialist, you should refuse to take alcoholic beverages. Ethyl alcohol, which is the main component of these products, reduces the effectiveness of many local anesthesia techniques.

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

With dental treatment, it is better to wait in case of weakness during SARS. It is undesirable to carry out dental manipulations on the days of menstruation. During this period, increased nervous excitability is observed.

In addition, surgical intervention on "critical days" for patients can result in prolonged bleeding.