Types of anesthesia in surgical dentistry. Anesthesia in dentistry: types, description and methods. Classifications of local anesthetics

Severe pain can cause a shock-like state of the body. Local anesthesia in dentistry ensures patient comfort. It blocks nerve impulses in a specific area (operation area) and lasts from 40 minutes to 2 hours. During this time, the dentist manages to carry out all the necessary manipulations, and the treatment takes place without tangible discomfort.

Anesthesia methods in dentistry

Local anesthesia

Considered the safest. It affects only the peripheral nervous system (does not turn off the human consciousness). After the introduction of an analgesic, there is a feeling of numbness in the gums, tongue and lips. Over time, the anesthetic breaks down and sensation is restored. Used for all kinds of therapeutic and surgical procedures in dentistry.

General anesthesia (narcosis)

General anesthesia puts the person in a state of deep sleep turning off consciousness.

For this, apply narcotic analgesics(Sevoran, Xenon). They are administered intravenously or through a face mask (inhalation). This type of anesthesia is indicated in dentistry for complex surgical operations, as well as in the case of dental phobia (fear of dental treatment).

Another indication for general anesthesia is an allergy to local anesthesia preparations.

Sedation

Sedation ( superficial sleep) is an alternative to anesthesia. This method removes emotional stress, relaxes the person. But at the same time, the patient is conscious and able to follow all the instructions of the doctor. Nitrous oxide is used as a sedative. This is an anesthetic gas that must be inhaled through a nasal mask.

Types of local anesthesia in dentistry

Application anesthesia

This is a superficial anesthesia that is performed without an injection. The doctor treats the gum with a gel or spray based on lidocaine, after which the sensitivity of the mucosa decreases. The method is used for the treatment of periodontitis, cleaning of gum pockets (ultrasonic scaling), as well as for the removal of highly mobile teeth.

Injection (carpool)

The anesthetic solution is injected under the mucous membrane with an injection (prick). To do this, use carpool syringes with thin needles. The dosage of the drug is selected individually depending on the patient's health, age and weight. As a rule, one cartridge (1.7 ml) or half is enough.

The drug begins to act 2-3 minutes after administration.

There are several types of injection anesthesia in dentistry:

What drugs are used for pain relief?

In dentistry, novocaine is rarely used, since there are more effective means based on articaine and mepivacaine, they are 4-5 times stronger.

Articaine preparations (Articaine, Ultracaine, Ubistezin)

In addition to the main component (analgesic), they contain vasoconstrictive substances (adrenaline, epinephrine), with vasoconstriction in the injection zone, the anesthetic leaching decreases. This increases the effectiveness and duration of the analgesic effect. it generic drugs which have a wide range of applications.

Drugs with mepivacaine (Scandonest, Mepivastezin, Carbocaine)

Do not stimulate the cardiovascular system, do not contain vasoconstrictor components and preservatives. Suitable even for patients with heart disease, pathologies endocrine system, diabetes as well as for patients with bronchial asthma.

Anesthesia during pregnancy

Local anesthesia is indicated during pregnancy and breastfeeding. The main thing is to choose drugs that do not overcome the placental barrier. Most safe means-Ultracain DS and Ubistezin (1:200000). They do not affect the fetus and do not pass into breast milk.

Anesthesia in pediatric dentistry

The child's body is more sensitive to anesthetics, especially in early age(up to 4 years). Therefore, after anesthesia, allergies and other complications often occur. But it is impossible to treat teeth without anesthesia.

Dentists use the same drugs as for adult patients, while reducing the dosage. The dose of the analgesic depends on the age of the child:

• 1 month - 1/10 of the adult dose;
• 6 months - 1/5;
• 1 year - 1/4;
• 3 years - 1/3;
• 7 years - 1/2;
• 12 years - 2/3.

Side effects of anesthesia

After injection anesthesia in dentistry, the following complications often occur:

• allergic reaction - severe swelling mucous;
• the formation of a hematoma (bruise) - when blood from the capillaries enters soft tissues;
• loss of sensitivity - occurs if during the injection the doctor touched the nerve;
• spasm chewing muscles- happens with accidental damage to muscles or blood vessels.

Today, hardly anyone treats teeth without anesthesia. However, remember that anesthesia in dentistry is carried out only after the consent of the patient. It is important that the doctor chooses an anesthetic that is right for you.

If you are looking for an experienced dentist, we suggest you look at the list of specialists, which is presented on our website.

Almost every person visits the dentist. In addition, very often the process of treatment itself can bring discomfort and severe pain.

That is why it is difficult to imagine the work of a dentist without using. On the one hand, anesthesia eliminates everything negative emotions and fear in the patient, on the other hand, allows the doctor to work according to the treatment plan.

Appointment of anesthesia in dentistry

Many people ask themselves: when exactly and in what situations is anesthesia used in dentistry? Contrary to many misconceptions, it is used not only.

In fact this is not true. will allow the dentist to carry out all the manipulations in a calm environment, since he will be absolutely sure that the patient will not twitch at an unnecessary moment, since there will be no sensation of pain.

And the patient himself will be much calmer and more comfortable, because he will not constantly be in a state of expectation of pain.

Most often, local anesthesia is used during treatment,. However, it was also found that the third part of the pain effect itself creates the noise of the drilling machine.

In modern dental clinics it is difficult to find it, as lasers and sandblasters are increasingly used. Nevertheless, local anesthesia remains an integral part of the dental operation, which is inevitably accompanied by pain.

What does modern anesthesia offer?

Regardless of the type and form of the anesthetic, their principle of action is the same: the chosen agent acts directly on the nerve impulse, which is responsible for the pain.

A feature of anesthesia is that after a while it begins to dissolve and be excreted from the body, during which a person may feel pain, which will pass with successful treatment.

Several types of local anesthesia are currently used in dentistry:

Increases the effect of any type of anesthetic prior intake of valerian, peony, motherwort and other similar drugs.

In addition, there are features in the anesthesia of the upper and mandible. This is due to the structure of each of them (it is much easier to anesthetize the upper jaw).

Often numb in the complex and the cheek, and lips, and tongue. This is due to the fact that the exits of the nerves of these organs are in close proximity.

How long does it take for anesthesia to wear off?

The duration of action of the anesthetic depends on the type of drug:

1. For example, those who applied to the surface of the cheeks or gums, work for only a few minutes.
2. When an anesthetic is injected into upper jaw the freezing effect can last up to 2.5 hours, depending on individual features organism (the age of the patient, the activity of his kidneys and liver, and others), the depth of the injection and the amount of the drug that was injected.
3. When working with lower teeth , the anesthetic needs to be injected more deeply. Because of this, the drug is excreted much more slowly and the freezing effect can last about 4 hours, sometimes longer, depending on which tooth is being anesthetized (the further it is, the more the drug is required).

At different people the duration of anesthesia is different and this is due to the characteristics of his body. But if the numbness does not go away for more than a day, this is an occasion to consult a doctor.

allergic reactions

Very often, when using local anesthesia, individual intolerance to the components of complex anesthetics occurs.

Simply put, there is an allergy to anesthesia, in dentistry there are two types of reactions to an anesthetic:

• contact dermatitis, which is characterized by swelling in the place where the drug was injected;
• urticaria and anaphylactic shock- this manifestation of an allergy is quite rare.

That is why, when using anesthesia, the doctor conducts a test for the possibility of an allergic reaction to a particular drug.

Many patients confuse palpitations, chills, dizziness, and increased sweating with an allergic reaction. However, a true allergy is the result of a hypersensitive state of the body, which is caused by the ingestion of an allergen, which is one of the components.

Symptoms of such a reaction are:

All seriousness of an allergy is in many respects exaggerated. With a tendency to it, the doctor selects the drug to minimize backfire. Possible itching and the redness usually disappears after a few minutes.

Other possible troubles and consequences

In addition to allergies, other unpleasant side effects can occur. Sometimes it is not possible to avoid them, due to the fact that it is quite difficult to predict the body's reaction to a particular drug.

However, there is no need to worry about this, since the safety of the clinic in without fail contains paragraphs that spell out the rules of conduct in the event that anesthesia does not pass for a long time after tooth treatment.

Among side effects the most frequent are:

• disturbances in the work of the stomach;
• sore throat and oral cavity, headache;
• chills;
• general malaise, which is accompanied by aching bones and drowsiness;
• loss of ability to concentrate;
• skin reactions: itching and redness.

More serious and dangerous consequences, for example:

• infection in the lungs;
• damage healthy tooth, tongue, lips or their partial killing;
• premature withdrawal of anesthesia.

In the event that the amount of the drug was incorrectly calculated, and there were violations in the procedure for administering the anesthetic, the following possible consequences:

To avoid these consequences, it is necessary to apply for qualified help. To do this, the patient must clearly know the features of the action of the anesthetic that the doctor uses, namely, how long the tooth freezes and the time it takes to recover from anesthesia after the manipulations.

As a rule, sensitivity is fully restored within 2-4 hours. You need to consult a doctor for help if after this time (plus 30 minutes) the condition has not returned to normal.

The doctor needs to tell which remedy was used, whether other medications were taken, whether there are any chronic diseases, in particular, renal or heart failure, diabetes mellitus.

Based on these data, the doctor decides on the methods of providing assistance. In some cases, hospitalization or administration of an antidote may be required, which will eliminate the freezing effect within half an hour. It is also necessary to inform the doctor if the pain after the tooth is too strong.

Refraining from food for two hours after the frost has passed will help prevent the occurrence of complications. This rule, as well as other instructions of the doctor, is not recommended to be neglected, since in most cases unpleasant consequences arise precisely through the fault of the patient himself.

Local anesthetics in dentistry are a group of compounds that can cause a reversible blockade of conduction. nerve impulses in a specific area of ​​the body. The mechanism of action of these drugs is based on the direct blockade of specific lithium-sodium channels in the nerve membrane, which leads to a decrease in the amplitude and growth rate of the action potential, to an increase in the excitability threshold and refractive period, up to the complete abolition of excitability. Strength, speed and duration of action, as well as toxic properties depend mainly on the physicochemical characteristics of the substances, as well as the dose, injection site, alkalization of the solution or the addition of vasoconstrictive agents. Now let's see what anesthetics are used in dentistry.

Discovery history local anesthetics quite interesting, check out the classification of local anesthetics by generation below.

The first people who discovered local anesthesia were the inhabitants of Peru. They learned that coca leaves numb the oral mucosa. Until the second half of the 19th century research this effect were carried out in Europe. This led to the first eye surgery under local anesthesia in Vienna in 1884. Anesthesia was achieved with cocaine. Since this first successful trial, cocaine has been increasingly prescribed as a local anesthetic. Exactly cocaine is a first generation anesthetic. Soon the disadvantages of cocaine became apparent. Toxicity, short-term effect and addiction - a big problem, which developed after taking cocaine, but do not forget that it was highly regarded in its time as the first effective anesthetic.

However, there is a need to find alternatives for cocaine as a local anesthetic due to the negative side effects of use. And such an alternative appeared in 1905 in the form of procaine. It was sold under trade name Novocain remained the most important local anesthetic until the 1940s. Novocain is an ether and second generation local anesthetic, which is chemically related to cocaine, has similar characteristics but without significant toxicosis, with a longer lasting effect, and without addiction problems. Novocaine is a substance that breaks down into crumbs and thereby leads to the formation certain products which may cause an allergic reaction. This is just one of the disadvantages of ester-type local anesthetics.

The question of the hypersensitivity reaction of ether anesthetics influenced the decline in their popularity, which stimulated the search for new substances that would not cause allergic reactions.

A new substance, lidocaine, was first synthesized in 1943, and entered the market in 1947 under the name Xylocaine. It was the first amide to break down in the liver and not in the blood like esters. Degradation of such substances in the liver rather than in the bloodstream is advantageous because by-products, which are formed, will not be able to cause allergic reactions. Lidocaine is a third generation anesthetic, is usually well tolerated by patients, it is mildly toxic, has enough lasting effect and is not addictive. The only downside to lidocaine is that it is slow to take effect.

Lidocaine soon became widely used in dental practice. However, this continued until prilocaine was synthesized in the late 1950s. Prilocaine is a fourth-generation anesthetic, it has a weak anesthetic effect, but it has minimal toxicity. Prilocaine is marketed under the brand name Cytonest.

In 1976, ultracain was developed, which began to be sold under the brand name of the same name (Ultracain), and then under the name Septanest - by the French pharmaceutical company Septodont. Soon Ultracain and Septanest were used by virtually every third dentist in the world and filled 40-45% of the European market. Exactly Ultracaine can be considered the latest generation of anesthetic.

However, a little later, Scandonest was synthesized, which also found approval in dental practice. Active ingredient in Scandotest™ is scandicaine (carbocaine, mepivacaine). Mepivacaine was originally used in regional anesthesia (epidural anesthesia) as a local anesthetic that has no negative side effects. This substance does not contain vasoconstrictors, which means it does not need preservatives, which are often the cause of allergic reactions.

Requirements for local anesthetics

Anesthetic for effective use must represent certain functional properties:

• Do not irritate tissues at the injection site and do not damage nerves
• Have low systemic toxicity
• Create anesthesia in short time before the operation.

Classification of local anesthetics

Patients are often unaware that there are several types of anesthetics available on the market and that each has its own advantages and disadvantages. Quite often, the doctor uses only a few anesthetics, so the patient does not have much choice. It should be noted that the younger generation of dentists generally react much more openly to the topic of anesthetics than the older generation.

Chemical classification of local anesthetics

Ether structure at the top of the image and amide structure at the bottom.

The molecular structure of the ether can be very easily destroyed, but the same cannot be said about the amide molecules! Esters are very unstable in solutions, for this reason they cannot be stored for as long as amides. Absolutely all amides are thermostable and can tolerate the autoclaving process, from which the ester molecules simply disintegrate. The composition of the esters includes aminobenzoic acid, which very often provokes allergic reactions. In turn, amides cause such reactions quite rarely, for this reason they are widely used in dentistry. Especially often seen in the arsenal of a dentist latest generation anesthetics.

A typical anesthetic molecule consists of a lipophilic group (benzene ring) and a hydrophilic group (tertiary amine) that is separated from the intermediate chain. Lipophilic groups are required for the passage of the molecule through the membranes of nerve cells.

The classification of local anesthetics by duration of action should be on the note of every dental practitioner! The duration of bupivacaine is 90+ minutes, soft tissue numbness will pass in 240-720 minutes. long time action increases the likelihood of self-injury of soft tissues in postoperative period and therefore, the use of bupivacaine is not recommended in pediatric patients and patients with special needs.

Maximum doses of local anesthetics
The table shows the maximum recommended doses of local anesthetics according to the American Academy of Pediatric Dentistry (AAPD)

Dosage of local anesthetic for children up to 11 years old.

Anesthetic- substance numbing and loss of sensation. This process reversible. The feeling returns after 1-1.5 hours, depending on the type of anesthetic and the anesthesia performed.

Vasoconstrictors used in combination with local anesthetics
The addition of a vasoconstrictor causes the blood vessels to constrict, which allows the anesthetic to be held in a certain location and prevent it from “leaving” to other parts of the body. The use of vasoconstrictors means that the patient will receive a smaller dose of anesthetic, which is highly toxic! Due to the vasoconstrictor action, vasoconstrictors can minimize or completely eliminate bleeding in the postoperative period. This is due to the stenotic effect. Adding a vasoconstrictor to a local anesthetic may also have ill effects. The disadvantages of using vasoconstrictors include side effects caused in the cardiovascular and nervous system.

The most commonly used vasoconstrictors for local anesthetics are epinephrine (epinephrine) and norepinephrine (norepinephrine), hormones produced in the body that have the effect of constricting blood vessels and increasing blood pressure. Felipressin is a synthetic vasoconstrictor, with almost the same functions as epinephrine or norepinephrine, but to a lesser extent. Felipressin is used only together with prilocaine!

Parabens in anesthetics
Preservatives are used in the anesthetic to prevent early oxidation of vasoconstrictors. The most common substances are sulfite compounds:

• sodium sulfite in Ultracaine
• methylparaben and metabisulphite in Xylocaine
• sodium metabisulfite in Cytanest (prilocaine)

All three of the above sulfite mix products are used to prevent vasoconstrictor oxidation. However, sulfite compounds are known to cause allergic reactions, especially in patients with asthmatic bronchitis.

Diluent acts as a preservative for vasoconstrictor agents. Vasoconstrictors are unstable in solution and may oxidize, especially when long-term exposure sun rays.

Nitrogen: bubble 1-2 mm. in diameter is present in the cartridge to prevent the ingress of oxygen, which can destroy vozakonstrictors.

Vehicles: all of the above components are dissolved in the modified Ringer's solution. This isotonic solution minimizes discomfort during injection.

The composition of the local anesthetic Lidocaine-Adrenaline

1. Local anesthetic agent: lidocaine hydrochloride - 2% (20mg/ml)
2. Vasoconstrictor: Adrenaline (epinephrine) 1:100.000 (0.012 mg)
3. Diluent: sodium metabisulphite - 0.5 mg
4. Preservatives: methylparaben - 0.1% (1 mg)
5. Isotonic solution: sodium chloride - 6 mg
6. "Vehicles": Ringer's solution
7. Fungicide: thymol
8. Thinner: distilled water
9. For pH adjustment: sodium hydroxide
10. Bubble Nitrogen

Contraindications to the use of local anesthetics

Complications from local anesthetic

Local anesthetics can cause various side effects, among which are and. As a rule, these side effects develop after the administration of the drug without prior collection. allergic history. It is for this reason that you should always monitor the main parameters of life, take special care and take into account the patient's history. General state may present as a disorder of the central nervous system(CNS) or of cardio-vascular system(CCS).

Neurotoxicity

Typical symptoms of the development of neurotoxicity caused by local anesthetics:

• paresthesia of lips, tongue and hands
• metallic taste in the mouth
• drowsiness
• tinnitus
• slurred speech
• muscle tremor
• visual impairment
• generalized convulsions

These are the so-called warning symptoms that may occur with the introduction minimum doses local anesthetic. When similar symptoms necessary:

• immediately stop the injection of the drug
• give 100% oxygen
• recommend to the patient deep breathing” (to create hyperventilation)
• prevent the development of hypoxia and acidosis, which increase the toxicity of the local anesthetic (an “ion trap” develops)
• in case of seizures, propofol or benzodiazepines can be used
• to prevent the development of hypoxia and acidosis, consideration should be given to the provision of muscle relaxants, intubation and initiation artificial ventilation lungs.

Cardiotoxicity

Local anesthetics, in case of overdose, affect the cardiovascular system by reducing myocardial contractility, disrupting automation, reducing the speed of impulse conduction and vasodilatation. After initial phase stimulation as a result of excitation of the central nervous system, a phase of depression sets in. In the event of signs of toxicity, standard procedures should be implemented as soon as possible to prevent circulatory disorders of the cardiovascular system.

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 means and methods in order to ensure 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 degree of severity pain etc. It is important to know that all practiced methods of anesthesia in dentistry involve fast recovery patient after. After a while (about half an hour), he can even drive a car.

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

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 dental services the doctor could communicate with the patient.

On the other hand, strong pain can cause shock 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 medicines, sensitivity is removed nerve endings. Local anesthesia, in turn, is divided into several types. Application anesthesia (other name - superficial anesthesia) is used when superficial anesthesia is required. 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, 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. Consequently, 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 want to get rid of pain sensitivity the whole body, then practiced holding general anesthesia. Anesthesia in dentistry is used much less often than local anesthesia. The point is that dentistry 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 can notice very rapid breathing, disturbed respiratory rhythm, bronchospasm, changes motor activity, muscle twitching. In addition, as side effects, which provokes dentistry under anesthesia, can develop psychomotor agitation, increased blood pressure, and especially severe cases there is a partial loss of memory. 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 for the doctor to perform a large number of different procedures. When using general anesthesia, the patient has much less salivation, so the quality of treatment during dental filling increases. With general anesthesia, there is more low risk development inflammatory processes after tooth extraction.

Anesthesia for the teeth the doctor must select taking into account not only the physical, but also emotional state 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.

When a person has a serious illness of cardio-vascular system before starting treatment under general anesthesia, he must initially go through all 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. Wherein local anesthesia produced after the patient has previously received pharmacological preparations for relaxation and tranquility. In this case, the patient remains fully conscious. Such dental anesthesia much safer than general anesthesia and can be used in severe cases even during pregnancy or serious illnesses. Respectively, severe consequences described above are absent with combined anesthesia.

Anesthesia during pregnancy

AT modern dentistry anesthesia for the teeth may not be used at all only if practiced laser treatment. 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 possible traditional treatment. Local anesthetics, which are used in modern dentistry, do not negative impact on the future mother and for 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 this into account. important point. Most often, it is used as such a drug, which is completely safe and at the same time produces 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.

Toothache is familiar to many, it is difficult to endure, but some people put off visiting the dentist for fear of getting even more discomfort. As a result, you will have to meet with the doctor, but you will need more difficult treatment due to complications. Therefore, if a tooth is sick, you should not pull, because today there are new types of anesthesia in dentistry that allow you to quickly and painlessly eliminate the problem.

Anesthesia in dentistry makes treatment comfortable

Indications

Anesthesia is the reduction or complete loss of sensation in certain areas or throughout the body. The condition occurs due to the introduction of a drug that prevents the passage of a pain impulse from the nerve to the brain centers in the area of ​​intervention. In dentistry, anesthesia is required so that a person does not feel pain during sanitation.

The calm state of the patient allows the procedure to be carried out qualitatively on the required scale.

Dental anesthesia is performed when performing procedures:

• treatment of complex caries;
• depulping;
• tooth extirpation;
• other surgical interventions;
• preparation of teeth for the installation of prostheses;
• in the treatment of dental anomalies.

Sometimes, even with average caries, freezing of the tooth is used, since the area of ​​​​the enamel layer bordering the dentin is also sensitive, so patients often experience pain manipulations in this area.

Types of anesthesia

Anesthesiology distinguishes two types of anesthesia in dentistry: it can be local, and general anesthesia is also used. The drug type of anesthesia of the teeth differs, when the anesthetic is injected, the drug temporarily blocks the flow of an impulse to the centers of the brain. Through certain time it collapses and sensitivity returns. To non-drug method painkillers include:

• anesthesia with sound (audioanalgesia);
• electronarcosis, the loss of sensation occurs through exposure to electric current(electroanalgesia);
• apply innovative technologies- computer anesthesia: hypnosis.

General anesthesia is rarely used, it is usually used during surgical intervention in maxillofacial region. But modern methods able to fully eliminate pain at the local level.

Local anesthesia

In the bulk, local anesthesia is performed, it is safer for human health, does not harm the body. Previously, Novocaine and Lidocaine were widely used, and today modern, more quality drugs. Local anesthesia in dentistry involves several methods of drug administration, they differ in the breadth of the impact on the site of intervention.

Application

The method allows you to practically instantly anesthetize the surface of the gum area, it is used:

• for tissue preparation to prepare the patient for injection;
• opening of abscesses on the mucosa;
• during procedures on the edge of the gums;
• when cleaning from tartar;
• during tooth grinding.

Application anesthesia - superficial application of an anesthetic

Gel is applied cotton swab, and there is also an anesthetic in the form of a spray, it is applied by spraying.

infiltration

A method common and familiar to all patients of the dentist is an injection. The doctor injects an anesthetic into the gum at the root apex and after 2 minutes the surgical field will be frozen. Duration of exposure: about an hour the patient does not experience pain.

The method is effective and comfortable, allowing the doctor to work calmly. Used:

• in the treatment of dental canals during the removal of the nerve bundle;
• extirpation of teeth;
• pulp operations.

Infiltration intraosseous anesthesia

Conductor

This type of procedure allows you to block the entire nerve branching, so anesthesia extends to a significant area, covering several teeth and soft tissues. The duration of anesthesia is two hours. It is used during volumetric operations on large molars and gums, when draining a purulent abscess.

The upper jaw is subjected to tuberal and palatine anesthesia, when necessary, they are supplemented with an incisive one. Below, a mandibular or torusal method of anesthesia is required.

Intraligamentary (intraligamentous)

It is used in the treatment of children as an alternative to mandibular anesthesia, as it causes numbness and increases the risk of injury to the soft tissues of the oral cavity. In the case of an intraligamentous injection, the drug is injected into the periodontal ligament located between the root of the tooth and the alveolar wall. During the procedure, numbness does not occur, so biting is excluded. In adults, the method is not always effective, and it cannot be done if there is a purulent periodontal pocket.

Intraosseous

Produced at difficult removal tooth. First, the gums are anesthetized, after the onset of local numbness, the medicine is injected into the interdental space in the spongy layer of the bone. The patient immediately feels the result, but its duration is short. Moreover, the sensitivity of the tooth disappears along with part of the gum.

stem

Anesthesia is carried out strictly in the hospital, the injection is carried out at the base of the skull, in this case, the nerve branches in the upper and lower jaws are turned off.

Applicable:

• with injuries;
• during operations;
• with severe pain;
• with trigeminal neuralgia.

Pain relief has a longer duration of action due to the introduction of a vasoconstrictor.

Capsules for carpool anesthesia

Some patients worry if anesthesia is harmful? Pain relief procedures are dangerous for those who have contraindications to its implementation. And also in the treatment of teeth, it is worth choosing a competent professional, then there will be no threat to health.

Contraindications

Before starting treatment, the dentist finds out if the patient has chronic diseases or intolerance to medications. When anesthesia for dental treatment is contraindicated:

• with allergies to anesthetics;
• in the presence of acute pathology cardiovascular system in history (if the patient
• suffered a stroke or heart attack no more than six months ago);
• at hormonal changes and failures in the endocrine system;
• at high sugar in blood;

AT advanced cases at endocrine disorders treatment is carried out in a hospital. A serious approach requires the use of anesthesia when working with children and pregnant women.

Allergy - contraindications for anesthesia

Local anesthesia drugs

Modern dentistry has practically abandoned novocaine, due to its insufficient effectiveness, moreover, the agent does not affect the lesion. Now new local anesthetics are being produced, the result of which comes instantly, they are less toxic.

The drugs are used:

• Lidocaine. For external anesthesia, a 10% solution in the form of a spray is suitable, injections are made with a 2% concentration of the drug.
• Ultracain. It is often used in dental treatment, especially in people suffering from allergies and bronchial asthma. The pharmaceutical industry produces the drug in the form of: "Ultracain DS forte" and "Ultracain DS" with epinephrine, the additive increases the duration of the effect of the main drug. "Ultracain D" does not contain preservatives and epinephrine.
• Artikain. Indicated for infiltration and conduction methods of introduction. The tool is not used to treat children under 4 years old, during pregnancy it is allowed in special cases.
• mepivacaine. It is intended for conduction anesthesia, it is allowed in the treatment of children and pregnant women.
• Ubistezin. Combined remedy contains Epinephrine, 2 times more effective than Lidocaine. Recommended for administration to the elderly as it does not cause surges blood pressure and acceleration heart rate, is an analogue of Ultracaine.
• Septanest. Injections are used with caution in diabetes, tachycardia, bronchial asthma.
• Scandonest is a two-component drug that contains adrenaline to prolong the effect. It contains no additives or preservatives.

For dental purposes, a carpool syringe is used.

Effective drugs for anesthesia

In this case medications are produced in special cartridges, ampoules with a finished dose of medicine. The thinnest needle is screwed onto them, which is inserted into the tissue. This approach ensures compliance antiseptic conditions, and the patient does not experience vivid discomfort. For those who are afraid of an injection, the area before the introduction of the needle is anesthetized with a spray.

Pediatric dentistry and anesthesia

AT given period acceptable drugs for children are Mepivacaine and Articaine. All of the above methods of dental anesthesia are applicable, except for intraosseous and stem anesthesia.

Anesthesia for children - only the safest

1. The child's body is sensitive to medications, so completely safe anesthetics for childhood not yet. After using injections, there is a risk of developing complications:
2. psychogenic nature. Due to age, the baby is not yet able to control emotions, often being frightened of a needle, the child may lose the creation. To prevent complications, the doctor's task is to divert the attention of a small patient.
3. Allergies. The situation rarely occurs, but its development cannot be ruled out, usually the body does not respond to the anesthetic, but to the antioxidants that make up it.
4. Medication overdose. Excess drug in children's body lead to its reaction to toxins.

But the dose in modern dentistry is calculated individually for each child. Therefore, such a development of events is practically excluded.

Possible Complications

Sometimes complications may develop during analgesic measures, the most common include:

• allergic reactions occur with intolerance to the components of the drug;
• with excessive dosage, toxic poisoning develops;
• if the needle insertion technique is violated, nerve injury and loss of sensitivity are possible;
• trismus of masticatory muscles, if a nerve or muscle tissue is affected;
• broken needle, rare;
• due to damage blood vessel bruising or bruising is formed with a needle;
• infection of nearby tissues occurs when the doctor does not comply with aseptic and antiseptic conditions;
• biting of tissues in the mouth as a result of loss of sensation.

Usually when modern anesthesia complications are extremely rare, and pain and burning at the injection site is not a pathology.

A few tips for a dentist patient:

• For the freezing of the painful area to be effective, before visiting dental office refuse to drink alcohol. They are powerless from a toothache, and they are quite capable of reducing the effect of an anesthetic drug.
• If it is difficult to cope with excitement, before going to bed you can take a tincture of soothing herbs, motherwort or valerian, you can take a tablet of Afabazol.
• When not acute pain, treatment is planned, you should not go to the dentist during menstruation. For a woman, this is a period when nervous excitability is increased, sensitivity to drugs increases. And also menstruation can provoke bleeding after tooth extraction.

General anesthesia

General anesthesia means complete loss sensitivity at which varying degrees disturbances of consciousness. This procedure rarely used during dental intervention, since the method is not safe, not every clinic receives permission to conduct general anesthesia. Its use is only permitted under medical indications, usually its use is justified in operations.

General anesthesia in dentistry is a last resort

When sanitizing teeth and eliminating inflammatory processes, including in children, inhalation anesthesia is now used.

The gas is represented by nitrous oxide, at a certain concentration of it in the body, a person loses consciousness, when the surgical stage is reached, manipulations are carried out.

Indications for carrying out:

• allergic to medicines local impact;
• mental illness;
• panic conditions during dental procedures.

There are also contraindications to anesthesia:

• diseases of the respiratory system;
• serious disorders in the work of the heart and blood vessels;
• severe pathologies of the kidneys and liver;
• drug intolerance.

The procedure is carried out under the guidance of an anesthesiologist.

Do not be afraid of visiting the dentist, medicine has stepped forward, dental treatment with anesthesia has become completely painless procedure. Timely sanitation will prevent the development of complications, will become the key not only to the health of the oral cavity, but also to overall well-being.