The best anesthesia in dentistry. Types of anesthesia in dental treatment: what anesthetics and painkillers are used in dentistry? Anesthesia after tooth extraction

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

• Complicated forms of caries;
• Periodontitis;
• Extraction of teeth (single or group);
• Removal of dental debris;
• Change in the location or growth zone of the tooth;
• Any purulent-inflammatory processes from the bone skeleton or soft tissues of the jaws and oral cavity;
• Contractures of the temporomandibular joint;
• Minor plastic surgeries, these include: piercing, botuloplasty, etc.;
• Neuritis and other inflammatory and degenerative lesions of the peripheral nervous system;
• As a palliative therapy for severe lesions of the tissues of the oral cavity with radiation sickness or malignant neoplasms.

In many cases, anesthesia is required during dental treatment.

Pain medications

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

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

Most Popular:

Usually, preparations based on "Artikain" ("Ultracain", "Septanest", "Ubistezin") are used. Such medical devices are more effective.

It is important! To reduce the absorption of toxic substances, all modern anesthetics contain a vasoconstrictor component - epinephrine or adrenaline.

However, vasoconstrictor components have a high allergenic activity, and therefore they are forbidden to be used among patients with bronchial asthma, atopic dermatitis and other allergic or autoimmune disorders. Alternatively, Scandonest or Mepivacain can be used. The active substance has a moderate vasodilating effect, therefore, the addition of additional substances that cause spasm of the smooth muscles of the vascular wall is not required.

Types of anesthesia in dentistry

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

All methods of anesthesia are divided into two large groups:

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

local

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

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

With local anesthesia, a special solution is injected at the site in the form of injections.

Application

With this method, anesthesia is performed on the surface layers of the mucous membrane and submucosa (depth - about 3 mm). It is recommended for performing simple surgical or therapeutic operations (suturing a gap, removing tartar, temporary anesthesia in an inflammatory process). The duration of action, as a rule, does not exceed 10-20 minutes. Medicines such as:

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

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

The procedure is extremely simple:

1. In anesthetic, a bandage, gauze or cotton swab is wetted. Squeeze out excess medication to avoid getting the solution on unwanted places.
2. Applying a swab to the lesion for 2-3 minutes.

infiltration

The variation is the most common in dental practice. It is used when performing any dental interventions. There are 2 main ways:

1. Straight. A solution of a medicinal substance is injected under the mucous membrane in the area of ​​the affected area.
2. Indirect. The drug is applied to a distant proximal segment (more than 2 cm from the primary lesion) and causes a block in the transmission of a nerve impulse.

The main advantages of the technique:

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

Infiltration anesthesia in dentistry is used for various types of operations.

Anesthesia is not difficult:

1. The choice of the location of the needle insertion site (depends on the affected tooth or mucosal area).
2. Advancing the needle to a depth of 2 to 5 mm.
3. The introduction of the medicinal component. Up to 5 ml of anesthetic can be used.

There are also separate types of infiltrative anesthesia. For example, the subperiosteal method of anesthesia makes it possible to deposit an anesthetic in the region of the periosteum, which increases the effectiveness and duration of anesthesia by several times.

Subperiosteal anesthesia is indicated during severe dental operations and for persons with a low threshold of pain perception. The sequence can be represented as follows:

1. Injection of a needle into the mucous membrane of the alveolar process in the area of ​​the projection of the middle of the crown of the tooth, which requires anesthesia. It is necessary to deviate from the transitional fold by 1–3 mm.
2. Creation of a small depot of anesthetic.
3. Periosteal piercing, the location of a thin needle at an angle of 40–45 degrees relative to the long axis of the tooth.
4. Advance the needle towards the top of the root until it stops.
5. The introduction of the drug.

Intraligamentary

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

Intraligamentary anesthesia can be considered as a variant of intraosseous

For anesthesia, you should:

1. Treat teeth and periodontal pocket with antiseptic solutions.
2. Inject the needle in the area of ​​the gingival sulcus, while the needle should be in contact with the lateral surface of the tooth and form an angle of 30 degrees with its root.
3. Insert the needle until you feel an obstruction, turn it 180 degrees, inject the drug (from 0.2 to 1 ml) in 30–40 seconds.

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

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

Conductor

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

• Anesthesia of vast areas, the innervation of which is carried out by one nerve trunk, with just 1 injection;
• The use of small volumes of anesthetic solution;
• Low invasiveness and, as a result, a low risk of complications after the intervention;
• The ability to carry out the introduction of the drug away from the focus of infectious and inflammatory lesions, where the effectiveness is lower at times;
• The possibility of using high concentrations of the drug to prolong the action;
• Absence of mechanical tissue damage in the place where the surgical intervention will be performed;
• Safety use among patients of older age groups (from 60 years and more);
• Facilitating the work of the dentist: with this type of anesthesia, autonomic nerve fibers are also blocked, as a result, salivation is reduced to zero.

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

Mandibular

The technique is as follows:

1. The location of the syringe at the level of the premolar of the opposite side and the implementation of the injection into the outer slope of the fold, which is located on the border between n / 3 and s / 3 of its parts (each part is equal to 1/3 of the fold).
2. Advance the needle until it stops in the bone tissue.
3. Turning the needle towards the premolars and immersing to a depth of 1.5 to 2 cm.
4. The introduction of an anesthetic solution.

As a medicine can be used: "Trimekain", "Novocain", "Lidocaine", "Artikain".

torusal

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

Torusal anesthesia is a simple and effective method

The zone of innervation of both types of anesthesia:

• Alveolar process, mucous membrane or teeth of half of the lower jaw on the insertion side;
• 1/2 of the tongue and sublingual region from the side of the introduction of the drug solution;
• Skin and buccal mucosa on the injection side, half of the lower lip;
• Chin area: all - on the side of insertion, partially - from the opposite area.

Tuberal

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

The method is currently not used.

stem

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

• Oval opening in the mandibular fossa;
• Round hole in the pterygopalatine cavity.

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

1. The introduction of a needle into the area of ​​intersection of the lower surface of the zygomatic bone with a vertical axis, which is carried out at the lateral edge of the orbit.
2. The direction of the needle up and inward until it touches the tubercle of the upper jaw.
3. Advance the needle inward and backward by 4-6 cm, sliding over the bone.
4. Penetration of the needle into the pterygopalatine fossa (feeling of failure).
5. Introduction from 1 to 3 ml of the drug solution. Apply: "Novocain", "Trimekain", "Lidocaine", "Artikain".

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

• inhalation;
• Non-inhalation.

By means of the first method, gaseous and vaporous preparations are introduced. Now "Ftorotan", "Methoxyflurane", "Xenon", "Enflurane" are widely used.

General anesthesia in dentistry is used in exceptional cases.

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

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

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

Contraindications

Any drug has a list of diseases in which its use is strictly prohibited. Stand out:

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

Anesthetics containing a vasoconstrictor component are additionally contraindicated in:

• Pregnancy (at any time);
• During breastfeeding;
• Arrhythmias (sinus bradycardia, paroxysmal tachycardia, atrial fibrillation);
• Angle-closure glaucoma;
• heart failure;
• Diabetes;
• Taking certain medications (beta-blockers, TAGs, MAO inhibitors).

Side effects and complications

Among the undesirable effects are:

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

Complications:

1. Erroneous introduction of aggressive liquids (hydrogen peroxide, formalin) due to violation of storage conditions. Any consequences: from allergic reactions to necrosis of massive areas of the maxillofacial region.
2. Intravascular administration of an anesthetic. Causes spasm of the vessel, severe pain and ischemia of tissues located distally.
3. Injury to the vessel with a needle (a hematoma or bleeding is formed).
4. Needle injury. Consequences: paresis or paralysis.
5. Any violation of the integrity of the muscles of the face.
6. Perforation of the nasal cavity and paranasal sinuses.
7. Wounded eyeball with a needle.
8. Dislocation of the temporomandibular joint. It is caused by too wide opening of the mouth during anesthesia against the background of weakness of the articular, muscular and tendon apparatus.
9. The development of infectious and inflammatory pathologies at the injection site of the needle.
10. Cicatricial contractures in the foci of primary inflammation.

Anesthesia for children

For children under the age of 3, the only way to solve dental problems is general anesthesia. The use of local anesthetics is inappropriate due to the child's aggressive behavior towards the doctor.

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

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

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

Starting from the age of 14, the use of any method of anesthesia is allowed.

For pregnant women and breastfeeding

During the period of bearing a child, it is forbidden to use anesthetic solutions that contain vasoconstrictor substances (adrenaline). Systemic vasoconstrictor influence can lead to violations of the complex system "mother - placenta - fetus" and cause fetal hypoxia, premature detachment of a normally located placenta and other disorders.

During pregnancy, anesthesia is used only in case of emergency.

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

Price

The price for various types of anesthesia varies depending on the region and the profile of the clinic (private or public).

Video: anesthesia in dentistry

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

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 a type 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.

Content

For many people, the dentist is associated with discomfort and pain, so they delay a visit to this doctor for a long time. Manipulations with teeth, regardless of complexity, are painless today. For this, different types of anesthesia are used. It acts during the treatment and for some time after the procedure.

Indications for anesthesia in dentistry

Anesthesia is also prescribed for medium caries, since the border between the enamel and dentin layers is very sensitive. Because of this, a person often experiences pain. Indications for compulsory anesthesia in dentistry:

• treatment of deep caries;
• removal of a tooth;
• orthodontic treatment;
• pulp amputation;
• preparation before prosthetics;
• treatment of pulpitis;
• bite correction.

Types of anesthesia for dental treatment

All types of anesthesia are divided into drug and non-drug. The first group includes general and local anesthesia. Non-drug methods include the following:

• Audioanalgesia. This is pain relief with sound.
• Electroanalgesia. Anesthesia occurs under the influence of electric current.
• hypnotic effect. The patient is introduced into a trance - in this state, you can control and limit his sensitivity.

General anesthesia

With general anesthesia, the body's susceptibility to pain is blocked. Narcosis is an artificially induced and reversible state of inhibition of the central nervous system. The patient falls asleep, loses consciousness and memory. His muscles relax, a number of reflexes decrease or turn off. After waking up, a person does not remember what happened to him.

Analgesics for anesthesia are administered intravenously or by inhalation. General anesthesia is dangerous for a person, but today the number of deaths is only 1 case per 3-4 thousand. Indications for general anesthesia:

• allergy to local anesthetics;
• complex surgical operation;
• pathological fear of a dental procedure.

Local anesthesia

Anesthesia in the treatment of teeth is often carried out locally. This type of anesthesia is safer for a person than general anesthesia. Local anesthesia almost completely relieves pain, but the patient remains conscious.

You may experience touch sensitivity and discomfort during a dental procedure. To minimize these inconveniences, sedatives are prescribed to the patient 1-2 days before treatment. The main types of local anesthesia:

Preparations for anesthesia in dentistry

For general anesthesia in dentistry, intravenous administration of drugs is more often used. With this type of anesthesia, the following means can be used:

• sodium thiopental;
• propofol;
• Ketamine.

These drugs have muscle-relaxant, sedative and hypnotic effects on the body. When the patient is under general anesthesia, there is always an anesthesiologist next to him with all the necessary resuscitation equipment. Also, the patient can be introduced into a state of deep sleep using nitrous oxide, which is inhaled through a mask.

For local anesthesia today, drugs with articaine are used. Anesthetics based on this substance are 1.5-2 times more effective than Lidocaine and 5-6 times better than Novocaine. Articaine includes the following agents:

• Septanest;
• Ultracain;
• Ubistezin, etc.

The advantage of anesthetics with articaine is that they act and, if necessary, anesthetize the area of ​​​​inflammation. With purulent processes, Novocaine has practically no effect, and Lidocaine significantly reduces its effect. Articaine-based preparations contain epinephrine or adrenaline. They have a vasoconstrictive effect. As a result, the strength and duration of anesthesia increase. Examples of commonly used local anesthetics include:

Anesthesia during pregnancy and lactation

You can treat your teeth during pregnancy. Tolerating pain and discomfort is dangerous because an infection can be the cause. It is able to cross the placenta to the fetus. This increases the risk of miscarriage, premature birth and developmental disorders of the child.

The treatment is carried out with anesthesia, since the pain causes stress and increases the tone of the uterus in pregnant women. They are given only local anesthesia. Doctors do not exclude the use of anesthetics with adrenaline. This substance constricts blood vessels and slows down the absorption of the active substance into the blood. The lower its concentration, the lower the risk of penetration through the placenta. The following drugs are considered safe for pregnant and lactating women:

• Ultracaine with an epinephrine content of 1:200,000.
• Ubistezin with epinephrine 1:200000.

At this concentration, epinephrine in the composition of anesthetics does not affect the fetus, does not cross the placenta and is not found in breast milk. The drugs Mepivastezin and Scandonest are not used for the treatment of pregnant women. They do not contain epinephrine and adrenaline, which is why the active substance is absorbed into the blood faster. So it can cross the placenta. Another disadvantage of these drugs is that they are 2 times more toxic than Novocaine.

Anesthetics in pediatric dentistry

There are no drugs that are absolutely safe for children. The child's body is highly sensitive to any medication. For this reason, the risk of complications after injections is especially high. It can also be psychogenic consequences arising from a strong fright or other emotions. More often complications are represented by a short-term loss of consciousness.

For the treatment of children, anesthetics are taken in smaller therapeutic doses than for adults. In pediatric dentistry, application, infiltration, conduction and intraligamentary anesthesia are practiced. Anesthesia is often carried out in stages:

1. Application anesthesia. Using a special gel or aerosol with Benzocaine or Lidocaine, the sensitivity of the mucosal area is eliminated.
2. injection anesthesia. Children are administered preparations based on articaine: Ultracaine, Mepivacaine. Dental anesthetic with this substance in the composition is less toxic and is quickly excreted from the body. The preparations can be used for children older than 4 years.

Dental anesthesia contraindications

Dental treatment of a patient with a decompensated form of endocrine pathologies is carried out in a hospital. Pain relief is carried out with caution in children and pregnant women. Absolute contraindications to anesthesia:

• Allergy to anesthetic. The patient must necessarily warn the doctor about an allergic or other reaction that appeared during previous dental treatment.
• Insufficiency of metabolic systems. Some painkillers have a toxic effect in violation of metabolic processes or excretion of substances from the body. This includes diabetes.
• Reduced blood clotting, including after taking anticoagulants.
• Acute cardiovascular disease in history. These include strokes and heart attacks in the last 6 months, angina pectoris, atherosclerosis.
• Hormonal disorders that occur against the background of diseases of the endocrine system, for example, thyrotoxicosis.
• Other restrictions: bronchial asthma, mental disorders, taking adrenoblockers or antidepressants.

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Fear of dentists is so common that this phobia has several names at once: stomatophobia, odontophobia, and dentophobia. Most of the procedures that dentists perform are really uncomfortable. This is not surprising, the sensitivity of the tissues of the oral cavity is on average six times higher than the sensitivity of the skin. That is why trips to this specialist rarely do without anesthesia.

To prick or not to prick?

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

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

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

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

Other types of anesthesia differ only in the technique of administration.

“They differ only in the technique of insertion. For example, experts know that conduction anesthesia cannot be done on the upper row of teeth, the injection is made precisely in the corner of the lower jaw, ”explained Gudkova.

To reduce pain, dentists inject with special cartridge syringes, which have a thinner needle. In addition, the device is designed in such a way that foreign substances do not get into the anesthetic.

Replacement for cocaine

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

“Today, novocaine as an anesthetic drug is used extremely rarely. It has a very long latent period, that is, it acts after 10, 15, or even 20 minutes. Now, too little time is allocated for a patient’s appointment, so there is no way to wait 20 minutes for anesthesia to take effect, ”said Elena Zoryan, Ph.D.

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

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

Amide instead of ether

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

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

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

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

In addition, the drug penetrates into tissues and is rapidly absorbed into the blood, which can adversely affect patients with impaired functioning of the cardiac and nervous system.

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

Lidocaine should not be used in people with severe disorders of the liver and kidneys, and should also be used with caution during pregnancy, lactation and in diseases of the hematopoietic organs.

Choosing a dentist

According to the candidate of medical sciences Zoryan, doctors use articaine much more often. It is also known as ultracaine.

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

It is also often used in conjunction with vasoconstrictors. According to the dentist, because of the latter, a person can have an increased heart rate and blood pressure.

“Already this should alert the doctor when he deals with patients with cardiovascular insufficiency,” the doctor warned.

Negatively, vasoconstrictors, which, in fact, are adrenaline, can affect people with severe thyroid pathology, hypersensitivity to adrenaline, as well as patients with open-angle glaucoma.

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

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

The main thing is not to be silent

It is worth noting that before proceeding directly to the procedure, the dentist should ask the person what he is allergic to, whether he has intolerance to drugs and whether there have been diseases of the cardiovascular system. To choose the right anesthetic, it is also important for a specialist to know the condition of the patient's liver and kidneys.

“In case of allergy to medicines, we refer the patient to allergy tests. The results of such a test are usually ready in three days. In some clinics, the analysis is ready within a day,” said Anna Gudkova.

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

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

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

Anesthesia is the reduction or even lack of sensitivity body, and often a complete cessation of a person's perception of the world around him, the environment.

Anesthesia happens different types. For example, there is termanesthesia - this type of anesthesia manifests itself in the absence of temperature sensitivity, as well as agvesia, which is justified by the absence of taste sensations, and the complete absence of pain sensation is analgesia.

Now, to the question of a dentist, “with or without anesthesia?”, Everyone answers, of course, with anesthesia. And it is true that this pain reliever is not just, but even helps freeze nerve endings, which leads to a lack of sensitivity for a certain time, mainly for 1 - 1.5 hours.

History of painkillers

Since ancient times, people have wanted to alleviate suffering, torment for themselves and their compatriots.

The first types of anesthesia, or rather ether anesthesia opened around 1776. According to people, nitrous oxide could reduce unbearable pain during surgery, extraction and treatment of a tooth.

And then they appear first types of anesthetics. Such as chloroform, for example. The first time this anesthetic was tested during an operation on an eight-month-old child, and thanks to this painkiller, he remained alive.

The very development of anesthesiology begins closer to the 20th century, by this time the first anesthesia devices.

Anesthesia or local anesthesia?

To begin with, it is worth considering the types of anesthesia.

1. general anesthesia, (narcosis);
2. regional anesthesia (in addition, spinal and epidural anesthesia are also listed);
3. local anesthesia.

Comparison of local anesthesia and general anesthesia:

When choosing between two types of anesthesia, it is better to focus on local anesthesia, due to the fact that it is absolutely harmless, does not have any consequences and side effects, as well as the most important factor anesthesia is good.

Criteria for choosing anesthesia

The choice of anesthesia for the patient is up to anesthesiologist. An experienced specialist, together with the attending surgeon and his patient, decides which type of anesthesia to prescribe to the patient.

Anesthesia method dentist chooses when examining a patient, because the doctor must understand which tooth will have to be removed, since, for example, the removal of either, or is fundamentally different.

For example, if a baby tooth is removed, the baby, if necessary, is given application anesthesia, that is, they “spray” an aerosol, or smear it with a gel, but besides, it is not excluded infiltration anesthesia when the doctor has to give 2 injections to inject an anesthetic drug.

When removing a wisdom tooth, medicine uses the same painkillers as when removing other teeth, but choosing a method of anesthesia is a delicate matter.

The doctor needs to push back on the physical condition of the patient. The difficulty with is that the position in the dentition is not the most successful.

Watch videos of all new in dental anesthesia:

When is local anesthesia used?

In dental treatment, anesthesia is used quite often, as it has tooth freezing effect. That is, the dentist gives the patient an injection in the gum in order to achieve the effect of relieving the sensitivity of the gums.

This type of anesthesia, or rather, application, is used to remove pain, discomfort during tooth treatment.

Infiltration anesthesia, that is, prick in the gum, has its advantages in dental treatment. The doctor injects an anesthetic with a needle, and then the freezing effect acts.

General anesthesia

Dental treatment under general anesthesia is safe, if only for a short time. Maximum general anesthesia time - 1.5 hours.

The safest means

To begin with, consider two types of medicines for pain relief. it anticholinergics and muscle relaxants.

Also widely used inhalants for anesthesia.
For example, such as ether, nitrous oxide, sevoran, propofol, diprivan. They play a huge role in muscle relaxation, temporary loss of consciousness, and loss of reflexes and sensitivity is not excluded.

To medicines for intravenous anesthesia include: ketamine, hexenal, fentanyl, seduxen, relanium and others.

The main advantage of intravenous anesthesia is that a person falls into an unconscious state 20 to 30 minutes after the administration of the drug.

Which anesthesia is better for dental treatment, and which one for removal?

We all feel fear at the word "dentist" or the phrase "tooth extraction", but now medicine is coming in step with progress, and visiting the dentist is not scary even for a small child.

The procedure for treating or extracting a tooth is quite painful if you do not choose one of the methods of local anesthesia. And with a toothache, there are four of them:

Each type of anesthesia has its pros and cons, most often, the advantages include falling asleep, or a complete lack of sensitivity to make it easier to undergo surgery, and the disadvantages are side effects that may appear after anesthesia and do not have the most favorable consequences.

Only one thing can be said for sure - general anesthesia in dentistry is used only in emergency cases, such as mass extraction of teeth or prosthetics with implants. In all other cases it is better give preference to local anesthesia.