Anesthesia at the dentist. Local anesthetics in dentistry: composition, classification. Types of anesthesia in dentistry

More recently, the procedures for the treatment and extraction of teeth were accompanied by painful sensations, but today dentistry has every opportunity to ensure that the patient does not feel the slightest discomfort even with complex interventions. Anesthesia in dentistry is designed to guarantee the painlessness of any procedure.

Anesthesia is a decrease in the sensitivity of a certain area of ​​\u200b\u200btissues to pain. Various methods allow you to achieve a complete loss of sensitivity for a certain period of time. It is widely used during most manipulations in therapeutic, surgical dentistry, during implantation and prosthetics, and even during ordinary brushing of teeth.

Indications for the use of anesthesia

Regardless of the types of anesthesia in dentistry , they are used for the following reasons:

• the need for surface anesthesia before the introduction of the main injection,
• treatment of dental diseases - of any degree, pulpitis, periodontitis and many others,
• treatment of gum and periodontal diseases,
• removal of teeth and their roots,
• , i.e. installation of a large number of artificial metal roots,
• performing surgical operations,
• treatment of acute purulent inflammation of the bone tissue of the jaws,
• neuritis, neuralgia of the facial nerve.

In addition, pain relief is indicated even for minor interventions, for example, during ultrasonic cleaning of teeth, when the patient has increased sensitivity or nervousness.

The main types of anesthesia in dentistry

There are three types of anesthesia: local, general and sedation. Local is to anesthetize a certain area of ​​tissue for comfortable procedures, while the patient is conscious. General anesthesia or anesthesia is performed with the use of analgesics, which are introduced into the body by inhalation or intravenously, while the patient is unconscious. With sedation, gas is injected by inhalation, this variety involves staying conscious.

Types of local anesthesia in dentistry

Modern local anesthesia is called carpool anesthesia - the composition is supplied in disposable containers (carpules or ampoules), where the necessary components are already mixed in the right dosage. The doctor inserts the cartridge into a special syringe - compared to disposable syringes, his needle is thinner, so the process of administering the drug is less painful.

1. Application anesthesia

Application is widely used when performing simple operations that do not take much time. The drug is applied with a cotton swab or fingers to the desired area, impregnates soft tissues, as a result of which their sensitivity decreases. It penetrates to a depth of no more than 3 mm. Action time - from 10 to 25 minutes. Very often it precedes another type of anesthesia.

2. Infiltration anesthesia

Infiltration is provided by an injection that is injected around its non-medical name - "freeze". It is more often used in the treatment of teeth of the upper jaw, since the alveolar process has a more porous structure, which means that anesthesia will be more effective. The action time is about 60 minutes, enough to perform rather complex manipulations - endodontic treatment, pulp removal, deep caries therapy.

3. Conduction anesthesia

Conduction anesthesia in dentistry is focused on blocking the nerve that transmits the pain signal. This allows you to "turn off" not only one tooth, but also a certain part of the jaw that is associated with this nerve. Most often, this type is used when it is necessary to cure or remove several teeth at once, located nearby, especially in the lower jaw. Action time - 90-120 minutes. The most common option is conductive mandibular. It makes it possible to effectively anesthetize the lower jaw and perform complex interventions in the area of ​​molars.

4. Intraligmentary (intraligamentous) anesthesia

Intraligmentary is also called intraperiodontal. The specificity of this type is to exert more pressure during the introduction. This allows the agent to be evenly distributed in the periodontal space and penetrate into the intraosseous. Begins to act immediately - after 15-45 seconds. Action time - from 20 minutes to half an hour.

5. Intraosseous anesthesia

Indications - the impossibility or inefficiency of other types. As a rule, it is used in the treatment and removal of lower molars, operations on the alveolar process. Its implementation involves the dissection of the mucous membrane, the creation of a hole in the bone using boron, after which a needle is inserted into the hole and the drug is fed to the spongy substance under high pressure. The advantage of this type is efficiency even with small volumes of a weak agent. Action time - from 60 minutes.

6. Stem anesthesia

Stem involves blocking the branches of the trigeminal nerve at the base of the skull. This is advisable when performing extensive surgical interventions in maxillofacial surgery. The action of this type of anesthesia covers both jaws.

Types of drugs for local anesthesia

Modern anesthesia in dentistry is carried out using ready-made anesthetic formulations. The most common are drugs based on articaine - this is the main active ingredient of many anesthetics. They are 1.5-2 times more effective than lidocaine, and 6 times more effective than novocaine. The big advantage is that such drugs are very safe today.

1. "Ultracain"

The result of the development of the French pharmaceutical company Sanofi Aventis. This drug based on articaine is available in three versions, differing in the concentration of the component and the presence / absence of a vasoconstrictor component:

• "Ultracain DS forte" - the concentration of epinephrine 1: 100.000,
• "Ultracain DS" - the concentration of epinephrine is 1: 200.000, can be used during pregnancy, feeding the baby, as well as the presence of cardiovascular diseases,
• "Ultracain D" - without epinephrine, can be used in patients prone to allergic reactions, since it does not contain preservatives necessary to stabilize drugs with a vasoconstrictor component.

2. "Ubistezin"

A German-made anesthetic, the composition is similar to Ultracain, or rather, its two forms containing epinephrine.

3. Mepivastezin or Scandonest

Scandonest is an anesthetic produced by the French company Septodont, the main component of which is mepivacaine 3%. It does not contain vasoconstrictor components and preservatives. This explains its demand for dental procedures in patients at risk. Mepivastezin is a hollow analogue of Scandonest, but already of German production (3M).

4. "Septanest"

It is produced in two forms by the Septodont company:

• articaine + epinephrine 1:100.000,
• articaine + epinephrine 1:200.000.

The difference between this drug and others lies in the relatively larger number of preservatives in the composition, which increases the likelihood of developing allergic reactions.

5. "Novocain"

"Novocaine" in combination with a vasoconstrictor component is much weaker than articaine preparations. In addition, its effectiveness is reduced if it is necessary to anesthetize the area of ​​​​inflamed tissues. "Novocaine" has a vasodilating effect, and therefore is very "dependent" on vasoconstrictors. It is difficult to call such a manipulation safe, especially if it is necessary to anesthetize a part of the oral cavity for a patient at risk, a pregnant or lactating patient, a child.

Complications due to the use of local anesthesia

Complications are quite rare, but it is impossible to completely exclude them from practice. They are divided into two groups:

1. local: damage to soft tissues with a needle, breakage of a needle, infection of tissues with poorly disinfected instruments, damage to the vessel (as a result - a hematoma), tissue necrosis, paresis of the facial nerve, contracture of the temporomandibular joint,
2. general: allergic reactions, toxic reactions, changes in blood pressure, dizziness.

General anesthesia (narcosis)

Anesthesia is performed only by an anesthesiologist. According to the method of drug delivery, it is divided into inhalation (preparations "Prichlorethylene", "Sevoran") and intravenous ("Geksenal", "Propanidide", "Propofol", "Ketamine", etc.). The drugs are put to sleep and the patient does not feel pain. How long a particular anesthesia lasts is determined by the doctor, taking into account how much time the dentist will need.

Anesthesia requires certain indications:

• pronounced dental phobia and mental disorders,
• pronounced gag reflex
• complex surgical procedures,
• a large number of teeth to be removed or complex treatment,
• failure of local anesthetics.

Such anesthesia is fully justified if the child needs to be cured of a lot of milk teeth - it is very difficult for babies to “force” to be in the doctor’s chair, especially for a long period of time.

Contraindications to anesthesia are as follows:

• relative - exacerbation of chronic diseases, viral infections, pregnancy and lactation, respiratory infections, etc.,
• absolute - heart, kidney failure, some types of heart defects, decompensated diabetes mellitus and other severe endocrine diseases, respiratory dysfunction.

In order to decide on the possibility of using anesthesia, the doctor will prescribe an extensive diagnosis of the state of health.

Side effects of anesthesia can be reversible and severe, requiring immediate medical attention. The first group includes nausea, vomiting, confusion, fainting, behavioral disorders, coordination of movements. As a rule, they pass with little intervention from specialists and with peace of mind. Serious complications are disorders of cardiac activity and respiratory function: they require immediate medical attention.

On a note! Lack of attention to the advice of an anesthesiologist regarding preparation for anesthesia can lead to a serious complication - airway aspiration. The doctor must explain the day before, during what time it is forbidden to eat and drink - it is important to strictly follow the recommendation.

Sedation in dentistry

Sedation is an immersion in a state similar to drowsiness or intoxication - the patient is conscious, but feels calm and relaxed. There are three types of sedation: inhalation, intravenous, oral. Sedation is effectively used for both children and adults. It is effectively combined with local anesthesia.

Unlike general anesthesia, sedation is safer and does not entail unpleasant consequences of treatment.

Features of anesthesia in pediatric dentistry

Effective anesthesia in pediatric dentistry must necessarily take into account a number of features:

• most local anesthetic drugs are approved for use from the age of 4,
• dosage calculation is carried out taking into account the weight,
• children often suffer from allergic reactions to anesthetics.

The correct selection of the method of anesthesia is very important - the child's attitude to dental procedures in the future, trust in the dentist depends on this.

Features of the use of anesthesia during pregnancy

Today, there are ample opportunities to ensure maximum comfort for a pregnant woman. Local anesthetics with a minimum content of vasoconstrictor components are approved for use in expectant mothers. Restrictions apply to general anesthesia and drugs with a maximum content of adrenaline or epinephrine.

Related videos

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

In dentistry, there are four methods of local anesthesia:

• Application anesthesia: used as an initial agent for superficial anesthesia of the oral cavity. Usually it is a gel or spray with an anesthetic: lidocaine or benzocaine.
• Infiltration anesthesia: the drug is injected into the gum with several injections next to the tooth. This is the most common type of pain relief in dentistry. It is used in the treatment of caries, dental pulpitis, surgical operations in dentistry.
• Conduction anesthesia: the drug is injected in close proximity to the nerve, after which it saturates the area around the nerve and the nerve itself. It is usually used in surgical dentistry for major operations in the lower part of the mouth.
• Stem anesthesia: this method consists in injecting a drug into the base of the skull to block all branches of the trigeminal nerve. It is used in a hospital with increased pain sensitivity of the patient, neuralgia and some other rare cases.

Carpool anesthesia in dentistry

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

• Fine needle - maximum comfort. We use 0.3 mm thick carpule needles, while the needle thickness of a conventional disposable syringe is about 0.6 mm. Therefore, an injection into the area previously treated with the gel does not cause absolutely no pain.
• Complete sterility of treatment due to the tightness of the drug cartridges.
• Prolonged action. In addition to the anesthetic itself, the carpula may contain an additional vasoconstrictor drug (adrenaline), which significantly increases the duration of anesthesia.

Used drugs

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

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

Anesthesia during pregnancy

Sedation

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

Sedation has practically no contraindications and side effects. It is only necessary to exclude alcohol the day before a visit to the dentist.

FAQ

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

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

I have to have implants, how do I prepare for dental implants?

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

My gums are swollen, and my tooth hurts a lot (more precisely, a piece of it remains there), what should I do? How will the treatment take place? What type of anesthesia will be offered to me? Can general anesthesia be used?

Good afternoon! After a visual examination and x-ray diagnostics, we will be able to determine the methods of treatment for your tooth. Treatment in our clinic takes place under both local and general anesthesia. We ask you not to postpone the treatment of this tooth so that there is no complication of the situation. We invite you for a consultation at our clinic. Appointments can be made by calling the clinic.

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

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

I have been terribly afraid of treating my teeth since childhood. I have not been to the doctor for 10 years. Now a lot of teeth need to be treated. Do you have any treatment with anesthesia or under anesthesia will be absolutely painless? And even without that, what would be a little unpleasant?

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

What pain reliever is indicated for children with toothache?

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

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

Basically, children receive dental treatment under local anesthesia, but there are cases when sedation or anesthesia is used. But for such procedures, weighty indications are needed: the need to perform long-term manipulations, the psychological state of the child, etc.

On the site I read about a way to relieve fear and pain: sedation in dentistry. Was given your site, but did not find a word about this method? Do you use?

Yes, we use sedation for adults and children, but for this it is necessary to consult with our anesthesiologists and consult with our dentists. We invite you for treatment in our clinic.

Pain that occurs during dental treatment is a factor that often becomes decisive for a person making a decision about whether to make a visit to the dentist. That is why the issue of anesthesia in dentistry is constantly studied by doctors and is very important. Modern doctors have a lot of tools and methods in order to provide high-quality and effective pain relief. Pain-free dentistry is the ideal that doctors aspire to.

Features of anesthesia

Pain relief in dentistry is always carried out taking into account the individual characteristics of the patient, the problem that needs to be eliminated, the severity of pain, etc. It is important to know that all practiced methods of anesthesia in dentistry involve a quick recovery of the patient after. After a while (about half an hour), he can even drive a car.

In both surgical dentistry and therapeutic dentistry, anesthesia is practiced that can reduce pain to the desired minimum. Initially, the doctor analyzes all the problems of the patient and chooses exactly those types of anesthesia that are optimal in this case.

Adequate anesthesia in dentistry involves eliminating pain to a minimum. However, most dentists are of the opinion that there is no need to anesthetize to such an extent that the patient is unconscious during treatment. Moreover, it is very important that during the provision of dental services, the doctor can communicate with the patient.

On the other hand, severe pain can cause a shock-like state of the human body. Therefore, severe pain during dental treatment undoubtedly harms a person. Thus, the main task of a doctor who performs anesthesia before dental treatment is to make it so that pain relief is as effective as possible and does not pose a danger to a person.

Local anesthesia

Modern doctors practice different types in dentistry. Anesthesia is divided into general , local and combined . Local anesthesia involves anesthesia of only a specific place in which manipulations will be carried out. A small area is determined in which, with the help of the introduction of medications, the sensitivity of the nerve endings is removed. Local anesthesia, in turn, is divided into several types. Application anesthesia (another name is superficial anesthesia) is used if superficial anesthesia is needed. It is carried out without using a syringe. The doctor applies an anesthetic drug to the area that requires anesthesia using an applicator. Sometimes an aerosol is also used in this case. In this case, only a few millimeters of tissue are anesthetized. Such anesthesia in dentistry is used only for minor interventions, it is often practiced in pediatric dentistry.

Infiltration anesthesia - this is pain relief, in which the appropriate drugs are administered using a syringe. At the same time, soft tissues are impregnated. This type of anesthesia is practiced by modern dentists very often, as the procedure is well tolerated by patients and at the same time allows you to effectively relieve a person of pain.

Conduction anesthesia in dentistry allows the doctor to save the patient from pain in a relatively large area. For example, in this way you can anesthetize half of the jaw. This method is optimally suited for major operations, and is also practiced if complications arise after treatment that require urgent intervention. This procedure is distinguished by a more complex technique of execution.

All the described methods are practiced by doctors taking into account the individual characteristics of the patient, the disease, etc. So, during pregnancy in a woman, the dentist always uses the most gentle method of local anesthesia.

At the same time, the disadvantage of local anesthesia is, first of all, that the sensitivity of nerve endings disappears only for a relatively short period of time. As a result, this method can be used if the doctor treats one tooth. But with the defeat of several teeth and, accordingly, the need to treat them, you immediately have to practice other methods.

As a side effect of this method, sometimes manifested cardiopalmus or there are fluctuations. This occurs under the influence of anesthetics, which are part of anesthetics with the aim of vasoconstriction.

General anesthesia

If you need to completely get rid of pain sensitivity of the whole body, then general anesthesia is practiced. Anesthesia in dentistry is used much less often than local anesthesia. The fact is that dentistry under general anesthesia has a lot of contraindications. In addition, a person treated with general anesthesia may later experience side effects that last several days after the procedure. Reviews indicate that after anesthesia, the patient may notice very frequent breathing, disturbed breathing rhythm, bronchospasm, changes in motor activity, muscle twitching. In addition, as a side effect that provokes dentistry under anesthesia, psychomotor agitation can develop, blood pressure rises, and in especially severe cases, partial memory loss is noted. That is why general anesthesia in pediatric dentistry is rarely used.

The advantages of general anesthesia are the provision of complete rest and the absence of shocks for the patient, the ability of the doctor to perform a large number of different procedures in one session. When using general anesthesia, the patient has much less salivation, so the quality of treatment during dental filling increases. With general anesthesia, there is a lower risk of developing inflammatory processes after tooth extraction.

Anesthesia for teeth must be selected by the doctor, taking into account not only the physical, but also the emotional state of the patient. It is sometimes advisable to treat teeth under general anesthesia if a person demonstrates pronounced emotional stress and severe anxiety before starting the procedure. Therefore, dental treatment under general anesthesia is prescribed for those people who show signs of panic fear in relation to everything related to dentistry. Especially often in this case it is practiced under general anesthesia. In addition, the use of general anesthesia is advisable during prosthetics, with very complex dental lesions, and with some chronic concomitant diseases.

In other cases, as a rule, the doctor does not see the need to treat teeth under anesthesia of this type.

If a person has serious diseases of the cardiovascular system, before starting treatment under general anesthesia, he must initially undergo all the necessary examinations, and in the process of dental treatment, only an experienced anesthesiologist should monitor the condition of such a patient. When used in the treatment of general anesthesia, next to the doctor should be all the necessary equipment, the use of which may be needed in an emergency.

Combined anesthesia

Combined anesthesia involves a combination of incomplete general anesthesia and very effective local anesthesia. In this case, local anesthesia is performed after the patient has previously received pharmacological preparations for relaxation and sedation. In this case, the patient remains fully conscious. This dental anesthesia is much safer than general anesthesia and in severe cases can be used even during pregnancy or serious illness. Accordingly, the severe consequences described above are absent with combined anesthesia.

Anesthesia during pregnancy

In modern dentistry, anesthesia for teeth may not be used at all only if laser treatment is practiced. In this case, when processing the tooth, the patient does not feel any particular discomfort, so anesthesia is not needed for dental treatment by this method. That is why doctors advise practicing this method of treatment during pregnancy.

However, dentists strongly recommend that pregnant women visit a dentist even if only traditional treatment is possible. Local anesthetics, which are used in modern dentistry, do not adversely affect the expectant mother and the unborn child. Most importantly, the doctor must know about the woman's pregnancy before starting treatment and select the drug for pain relief, taking into account this important point. Most often, it is used as such a drug, which is completely safe and at the same time produces a pronounced effect. The drug is relatively quickly excreted from the human body and practically does not get to the fetus through the placenta. Therefore, it is used both for filling and for tooth extraction in pregnant women. The use of other drugs is also practiced on an individual basis, but only under the strict supervision of a doctor and taking into account the individual characteristics of the woman's body.

The most important thing is that a pregnant woman should visit a dentist as soon as necessary and be sure to tell the doctor in detail before treatment about all the features of her condition.

From this article you will learn:

• anesthesia in dentistry - drugs,
• types of anesthesia in dental treatment,
• pain relief during pregnancy and breastfeeding.

The article was written by a dental surgeon with more than 19 years of experience.

Local anesthesia is a type of anesthesia, the meaning of which is to block the transmission of pain impulses from the area where the intervention is performed. Options for local anesthesia in dentistry include infiltration, conduction or application anesthesia. They allow you to anesthetize only the area where the intervention is planned (this can be a group of teeth or a fragment of the jaw), while the patient is conscious.

For local anesthesia in dentistry, medicines are used, which are called the term "local anesthetics". But in some cases, for example, with major surgical interventions or a person’s panic fear of treatment or tooth extraction, it can also be used, in which, along with pain sensitivity, the patient’s consciousness is temporarily turned off. General anesthesia is carried out with the help of narcotic analgesics administered intravenously or by inhalation (Fig. 3).

Local and general anesthesia in dentistry -

The very first local anesthetic in dentistry is, which, however, did not allow to achieve pronounced anesthesia, and practically did not anesthetize the inflamed tissues. Later, it appeared, which in terms of effectiveness was already about 2-2.5 times stronger, but like novocaine, it did not allow achieving great depth and duration of anesthesia. The real revolution occurred with the advent of anesthetics of the articaine series (based on articaine hydrochloride), which additionally contained vasoconstrictors.

The most popular local anesthetics in dentistry based on articaine are Ultracaine, Ubistezin, Alfacaine, Septanest and others. To further increase the depth and duration of anesthesia, vasoconstrictors began to be added to these drugs. The latter constrict blood vessels at the injection site of the anesthetic, thereby reducing the rate of its leaching from the tissues. The most commonly used vasoconstrictor is epinephrine at a concentration of 1:100,000 and 1:200,000.

Local anesthesia in the treatment and extraction of teeth -

If earlier novocaine and lidocaine were produced in the form of vials or ampoules, and injections with these drugs were performed using ordinary 5.0 ml disposable syringes, now all modern anesthetics are produced in the form of disposable carpool(cartridges). Each cartridge usually contains 1.7 ml of anesthetic, and before anesthesia it is inserted into a special cartridge syringe. Next, a very thin needle is screwed on (many times thinner than conventional needles for disposable syringes), after which the syringe is ready for use.

What does a carpool syringe look like?

The cost of anesthetics and anesthesia –
the cost of one anesthetic cartridge at the end of 2020 (be it ultracaine, ubistezin, septanest or others) will be approximately 40-50 rubles. It is at this price that dental clinics buy anesthetics. But the total cost of anesthesia in the treatment of teeth in a dental clinic will be about 400-500 rubles for 1 cartridge of anesthetic.

It is also worth noting that anesthesia in the treatment and extraction of teeth in dentistry is included in the guarantee program of the health insurance fund. Therefore, anesthesia in state dental clinics should be free of charge, but only when using Lidocaine or Novocaine (imported anesthetic will be paid). Next, we will talk about the types of anesthesia in dentistry.

Types of anesthesia in dentistry - infiltration, conduction, application

As we said above, local anesthesia can be applied, infiltration or conduction. Application anesthesia in dentistry is used to anesthetize the oral mucosa by applying 10% lidocaine in the form of a gel or spray. Especially often this type of anesthesia is used in children to preliminarily anesthetize the injection site of the needle. Lidocaine spray is often sprayed on the root of the tongue in patients with an increased gag reflex.

Infiltration anesthesia in dentistry is most often performed during the treatment and removal of any teeth of the upper jaw, as well as in the area of ​​the anterior teeth of the lower jaw. In this case, the injection is carried out in the area transitional fold in the projection of the root of the tooth, which we will remove or treat (the transitional fold is the zone of transition of the tightly attached mucous membrane to the mobile mucous membrane of the cheek or lip). After the introduction of an anesthetic into the tissues, an infiltrate is formed in them, from which the anesthetic quickly penetrates into the jaw bone tissue.

Conduction anesthesia - in dentistry it is most often used to anesthetize 6-7-8 lower teeth (less often than other teeth). This is due to the fact that the bone tissue of the lower jaw is denser and thicker - especially in the last teeth. And therefore, if we do infiltration anesthesia in the lower molars, then the anesthetic simply will not penetrate into the bone and, accordingly, the patient will experience pain. And in this case, conduction anesthesia (mandibular or torusal) will help us - the injection is made into the nerve trunk, passing approximately in the middle of the inner surface of the lower jaw branch.

Infiltration and conduction anesthesia (video 1-2) -

How long does dental anesthesia take?
the effect of infiltration anesthesia in the upper jaw occurs within a few minutes, and lasts from 15 to 45 minutes (this depends on the type of anesthetic and the concentration of the vasoconstrictor in it). The onset of anesthesia is signaled by the appearance of numbness in the cheek or upper lip. The effect of conduction anesthesia on the lower jaw occurs in 5-10 minutes, but it can last from 1 hour to several hours. The following symptoms will tell us about the onset of anesthesia - there must be a pronounced numbness of half of the lower lip, as well as the tip of the tongue.

Important : if, after conduction anesthesia in the lower jaw, the numbness of half of the lip is weak or completely absent, then the doctor missed and could not remove the anesthetic near the lower lunar nerve (it is this nerve that passes on the inner surface of the lower jaw branch, providing pain sensitivity of the teeth on this side). And in this case, you should either ask the doctor to repeat the anesthesia, otherwise the treatment will be painful.

Yes, and I would like to note that in most cases, poor anesthesia is associated only with the doctor's mistakes, i.e. with violation of the technique of conduction anesthesia. This type of anesthesia is the most difficult in a general dental appointment, and not all doctors confidently perform conduction anesthesia. Nevertheless, there are a number of patients in whom it is impossible to achieve good anesthesia in principle. These include patients who abuse analgesics, as well as alcohol and drugs.

What to do if you are afraid of anesthesia -

Indeed, an anesthetic injection can be painful. Soreness will depend both on the pain threshold of the patient himself, and on the technique of anesthesia by the doctor. According to the rules, a solution of one anesthetic cartridge (1.7 ml) is excreted into the tissues within 40-45 seconds. If the doctor saves time, then it is logical that the rapid introduction of the solution will cause pain.

2) Ubistezin - instructions for use

3) Septanest: instructions for use

4) Scandonest: instructions for use

Which anesthetic is right for you - summary

• With bronchial asthma or high allergies –
  here you need an anesthetic without preservatives (usually sodium disulfite is used in anesthetics, which is needed to stabilize epinephrine or adrenaline). Therefore, the anesthetic "Ultracain D", which does not contain preservatives at all, is best for such patients.

• With thyroid disease, diabetes –
  in this case, you also do not want to use anesthetics containing vasoconstrictor components - adrenaline, epinephrine. The drug of choice, for example, "Ultracain D", "Scandonest" or "Mepivastezin". But, choosing between these three anesthetics, I would prefer the first.

• If you have high blood pressure and heart disease –
  with moderate hypertension and compensated heart diseases, the optimal choice is anesthetics containing a concentration of epinephrine (adrenaline) - 1: 200,000. It can be anesthetics "Ultracain DS" or "Ubistezin 1: 200000".

  In severe hypertension, decompensated heart disease, it is necessary to use anesthetics that do not completely contain adrenaline and epinephrine. Suitable then, for example, "Ultracain D".

• If you are a healthy person –
  if you do not have the above diseases, then you can safely put anesthetics containing epinephrine / adrenaline at a concentration of 1: 100,000. Moreover, a person weighing about 70 kg can be given up to 7 cartridges of anesthetic, inclusive. An example of such anesthetics is "Ultracain DS forte", "Ubistezin forte" and analogues.

Anesthesia in dentistry during pregnancy and breastfeeding -

One of the most common questions is whether it is possible to treat pregnant women's teeth with anesthesia. Anesthesia in dentistry during pregnancy and breastfeeding really has its own characteristics. The safest anesthetic here is Lidocaine (safety category "B"), and it is desirable to use it with a small concentration of a vasoconstrictor 1: 200,000.

The presence of the latter not only makes it possible to enhance anesthesia, but also to reduce the peak concentration of the anesthetic in the blood, which will further reduce the effect of the anesthetic on the fetus, as well as reduce its passage into breast milk. Preparations with vasoconstrictors are contraindicated in pregnant women only in the presence of high blood pressure and chronic fetal hypoxia. Therefore, the most optimal anesthetic would be Xylonor(preparation of 2% lidocaine in carpules, with an epinephrine content of 1:200,000), or any similar anesthetics based on lidocaine.

As for drugs based on articaine, they will already belong to the “C” safety category, which, in principle, is also considered to be sufficiently safe, but a little less. Of the anesthetics during pregnancy based on articaine, it is better to choose Ultracaine DS (with an epinephrine content of 1: 200,000). And only if the pregnant woman has high blood pressure or fetal hypoxia, we choose an anesthetic without a vasoconstrictor, for example, Ultracaine D.

Some doctors use anesthetics Scandonest or Mepivastezin for pain relief in pregnant women (they do not contain either adrenaline or epinephrine). But it is undesirable to use such anesthetics in pregnant and lactating women, because. due to the lack of a vasoconstrictor component, they are quickly absorbed into the blood. This results in a high concentration of the anesthetic in the blood, allowing it to cross the placenta more easily. In addition, both Scandonest and Mepivastezin are 2 times more toxic than novocaine. We hope that our article on the topic: Local anesthesia in dental treatment turned out to be useful to you!

Sources:

1. Higher prof. the author's education in surgical dentistry,
2. Based on personal experience as a dental surgeon,
3. National Library of Medicine (USA),
4. "Local anesthesia in dentistry" (Baart J.),
5. "Propaedeutics of surgical dentistry" (Soloviev M.).

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

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

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

When anesthesia is required

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

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

Varieties of anesthesia

Anesthesia is general and local, and is also divided into drug and non-drug. Non-drug pain relief is not commonly used and includes:

• electroanalgesia;
• audioanalgesia;
• computer anesthesia;
• hypnosis.

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

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

Local anesthesia

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

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

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

Application anesthesia

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

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

Infiltration anesthesia

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

Conduction anesthesia

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

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

Intraligamentary anesthesia

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

Stem anesthesia

It is carried out only in stationary conditions.

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

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

Intraosseous anesthesia

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

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

Restrictions on the use of anesthesia

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

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

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

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

Modern anesthetics

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

• ultracaine;
• septonest;
• mepivacaine;
• scandonest;
• articaine.

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

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

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

Anesthesia for pediatric patients

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

• infiltration;
• application;
• intraligamentary;
• conductive.

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

When treating children's teeth, it must be remembered that the children's body is sensitive to any intervention, therefore, the likelihood of negative consequences in the form of an allergic reaction, temperature increases ...

Possible side effects of local anesthesia

The most common complications are:

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

Some of the side effects of anesthesia include:

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

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

What Patients Need to Know

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

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

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

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

Use of general anesthesia

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

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

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

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

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

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

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

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

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