Local anesthetics in dentistry. Types of anesthesia in modern dentistry. What is used in modern dentistry

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 really cause discomfort. 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, the application the only way anesthesia 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 mandible", - explained Gudkova.

To reduce pain, dentists give an injection using special carpool 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. He has a very large latency 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.

"AT public clinics Lidocaine is mainly used 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 are essentially adrenaline, can affect people with severe pathology thyroid gland, hypersensitivity to adrenaline, as well as in 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.

Anesthetics in dentistry is a necessary measure in the treatment of teeth. With the help of them, it is possible to block the sensitivity and carry out the necessary manipulations.

Classification of anesthetics in dentistry

All painkillers are divided into groups according to their chemical properties - into amides and esters.

• Among the amides used are lidocaine, trimecaine, articaine.
• Among the esters are novocaine, anestezin.

Each of them has specific side properties.

They also differ in the method of injection: superficial and deep. The latter include infiltration (the injection is sequentially placed under the skin, under the fatty tissue, under the fascia, reducing sensitivity in the area where the solution has spread) and conduction (introduced into the nerve trunk or sheath, or into nearby tissues, so pain is not felt there, where this nerve passes) anesthesia.

• With superficial anesthesia, dikain, pyromecaine, anesthesin is taken.
• The second list includes lidocaine, novocaine, trimecaine.

Surface anesthetics are classified into a separate category. Their action is already provided by irrigation of the oral surface by means of a spray. The main component of these drugs is lidocaine. Such application is often necessary before the procedure of infiltration anesthesia for painless administration.
The last item in the classification is the time of action. local anesthetic.

• Weak effect - novocaine.
• Medium - lidocaine, mepivacaine, trimecaine, articaine.
• Long-term - etidacaine, bupivacaine.

Modern anesthetics in dentistry

The history of local anesthetics used in dentistry is divided into before and after, that is, other drugs and methods were previously used, which, with the advent of new technologies, became outdated and began to represent the least effective pain relief.

What local painkillers does modern medicine offer?

Present dental clinics use innovative carpool technology. Its essence lies in the fact that the active substance is not contained in a glass ampoule, but in a special cartridge (karpul), intended for single use. This device is inserted into a disposable syringe with a very thin needle.

This mechanism offers a number of advantages:

Modern local anesthetics are represented by drugs based on articaine and mepivacaine.

Artikain - surpasses all drugs in its properties. It is available in the form of carpool capsules under such names as Ultracain, Ubistezin, Septanest.

In addition to articaine, the cartridge contains an auxiliary substance - adrenaline, which contributes to vasoconstriction. Its content is due to the fact that with vasoconstriction, the action of the main substance is prolonged, and the possibility of its leakage into the general bloodstream is reduced. This contributes to the least harm to the body. The dosage is selected for each patient individually. Preparations based on it are 2 times more effective than lidocaine, and 5-6 times more effective than novocaine.

"Ultracain D" - recommended for patients with endocrine disorders such as thyroid disease and diabetes, as well as with bronchial asthma or allergies. It contains no preservatives and stimulants (epinephrine, adrenaline).

Mepivastezin and Scandonest are also compatible with endocrine disorders.

"Ultracain DS" and "Ubestezin" are indicated for use in patients with cardiovascular problems. The concentration of epinephrine in it is 1:200,000. With a vivid picture of hypertension, drugs that do not have vasoconstrictor components are shown.

With absolute health, you can put anesthetics with a ratio of epinephrine 1: 100,000. With a weight of 70 kg, it will not be dangerous for a person to deliver up to 7 doses. Examples: "Ultracain DS forte", "Ubistezin forte".

A special category includes pregnant and lactating women. To remove their sensitivity, "Ultracain DS" (1: 200,000) or "Ubestezin" (1: 200,000) is used, both of them are equally harmless. It is impossible to exclude adrenaline from an anesthetic for a pregnant woman, since it is he who prevents the further spread of active substances into the bloodstream. It is important that with increasing concentration increases the possibility of penetration into the bloodstream.

Mepivacaine is not as effective as articaine. It does not include adrenaline, because it already has a vasoconstrictor effect. The main advantage is that it is suitable for injection in children, pregnant women, people with heart disease, poor health, or those who have an individual intolerance to adrenaline. Produced under the name "Scandonest".

Despite the availability of highly effective and safe local anesthetics, their use is usually limited to private dental practices. In state clinics, lidocaine and novocaine are used. Their distribution is decreasing due to low scores effectiveness and frequent allergic reactions, but their risk of development does not decrease with the use of new generation drugs. Therefore, it is important to discuss everything with the doctor before the operation, to provide a complete history.

More about methods of administration

Among anesthetics, there are three routes of administration.

infiltration

It happens direct and indirect. Direct affects the place where the injection was placed, indirect - freezes the surrounding tissue. By methods it is divided into intraoral and extraoral. Active in the area upper jaw, due to the spongy contents located there.

How is intraoral anesthesia administered?

A needle is inserted into the transitional fold at an angle of 45 degrees to the vertical dental axis. The cut end should rest against the bone. The introduction into the periosteum is also used, for this the syringe plunger is squeezed out with greater strength.

Pros: due to the use of low concentrations, it is safer and more controllable (re-injection if necessary), fast onset time, rapid excretion from the internal environment, the area of ​​action is slightly larger than the problematic nerve.

Conductor

Popular for mandibular injections. It has a finger and fingerless method.

How is the process going?

With the finger method, the needle is guided index finger on the left hand, focusing on upper edge terminal phalanx. The ampoule is emptied upon reaching bone tissue.

Fingerless technology involves the introduction of a needle in the gap between the lower canine and the second molar on opposite side, it plunges 1.5 - 2 cm deep until hard tissues are detected. In this case, the patient's mouth opens very wide.

The extraoral method is successful in that the manipulation area becomes more accessible. Easier to plan where to stab . But such activity is possible only with a high knowledge of the location of the necessary tissues. Wrong actions lead to such consequences as impaired speech, inconsistency in breathing, and eating.

mental

Blocks the nerve of the chin coming out of the mandibular canal. It is localized between the roots of the first and second small molar. Produced both inside the mouth and outside.

• External method: determine the location of the hole, the injection is placed relative to it laterally or above the projection. Having reached the bone, 0.5 ml is injected, moving the remaining 1 ml into the canal.
• Intraoral method: the lower lip is retracted, a needle is inserted into the transitional fold near the first molar and directed downward, forward and inward, 2 ml is injected.

At the same time, incisor, canine and premolar teeth, the mucous membrane of this area, and the muscles of the chin are anesthetized.

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

There are six methods of anesthesia in dentistry:

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

Conduction anesthesia provides the deepest anesthesia (but it is not always possible to achieve it on the first try). From a safety point of view, this method gives the most complications.

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

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

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

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

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

Mepivacaine without adrenaline is the most safe anesthetic from those presented in Russia. But its effectiveness and duration of action are significantly inferior to articaine with adrenaline.

The problem of pain and anesthesia in dentistry is very important. Most of the manipulations of the dentist are accompanied by pain syndrome of varying severity, up to very intense pain, which is associated with the fear of visiting the dentist that occurs in many patients. Thus, the negative experience associated with the lack of adequate pain relief in such patients entails the impossibility of full-fledged dental treatment in the future due to untimely appeal patient to the dentist.

In addition, modern patients place increasing demands on the comfort of dental treatment. The quality of anesthetic support of dental intervention plays the most important role in creating an environment of comfort and largely determines it. The fact that the implementation of anesthesia is a necessary and integral part of dental treatment today is no longer in doubt.

Methods of anesthesia in dentistry can be:

• non-drug
• medical.

To non-drug pain relief methods include:

1. psychotherapy (hypnosis),
2. electroanaesthesia (electroanalgesia),
3. audioanalgesia and others.

To carry out these methods of anesthesia, additional training of doctors and the availability of special equipment, and the resulting effect is not always significant for the clinic, therefore, these methods are not widely used in practice ( ).

medical pain relief methods are:

1. local anesthesia
   1. injection anesthesia
   2. application anesthesia
2. general anesthesia.

In dentistry, for the purpose of pain relief, the most widely used medical methods, among which the most common in the clinic received local anesthesia which includes injection and application methods. About generalanesthesia (anesthesia) in dentistry are used to a limited extent and strictly according to indications.

Preparing a patient for a dental procedure includes psychological preparation and premedication(if necessary) ( ;).

Features of local anesthesia in patients at risk

Before proceeding to the consideration of the actual local anesthetic drugs, it should be noted that local anesthesia is one of the most significant for general condition patient dental procedures.

The introduction of a local anesthetic into the internal environment of the body can cause allergic reactions, as well as general toxic effect in case of its overdose or insufficiency of its metabolism and excretion systems.

The ingestion of catecholamines in the composition of local anesthesia, which are used as vasoconstrictors, in sufficient concentrations can lead to an increase blood pressure(BP) and heart rate (HR), hyperglycemia and other undesirable consequences ( ; ; Malamed S., 2000).

Particularly dangerous can be the components of the local anesthetic drug in the so-called risk group patients( ; ; ).

Patients at risk include the following categories:

• patients with concomitant general somatic pathology,
• patients experiencing increased anxiety and fear of treatment,
• pregnant and lactating women.

According to statistics, among patients of an outpatient dental appointment, at least 30% suffer from various general somatic diseases in a compensated form (). According to other data (), 45.9% of patients have risk factors, and the frequency of complications of local anesthesia in these patients is significantly higher (4.5% versus 3.5% in practically healthy people according to the same authors). Especially many somatically burdened patients (up to 70-80%) can be found among the elderly ().

We, on the basis of the Department of Therapeutic Dentistry in the city dental clinic No. 30 (chief physician - Bodyakina E.A.), surveyed 406 dental patients (before starting dental treatment) using a questionnaire developed by us (see Appendix) to collect a general somatic history ( ). According to the results of the survey, about 68% of the respondents could be classified as patients at risk. Moreover, more than 30% of those who applied noted fear and a negative attitude towards treatment. Among comorbidities, cardiovascular diseases and allergic reactions were most frequently reported (29.3 and 27.1%, respectively), which is consistent with the data. Drug allergy was noted by 16.5% of patients. Among them, novocaine intolerance occurred in 9.1% of patients.

Despite all the above dangers of local anesthesia, the lack of adequate anesthesia in patients at risk is even more dangerous and can lead to various complications due to the body's stress response to pain. This is supported by the data that have established that when performing dental interventions without anesthesia, patients experience a more significant rise in blood pressure than those who used local anesthesia(they had only a transient rise in blood pressure at the time of needle injection). Therefore, when conducting anesthesia, the doctor needs to solve the following tasks:

• Firstly, local anesthesia should be as effective as possible and completely eliminate pain sensitivity in the area of ​​intervention.
• Secondly, it is necessary to minimize the systemic exposure to the body of substances that are part of the local anesthetic drug (local anesthetic, vasoconstrictor, preservatives and stabilizers).

To perform these tasks, the dentist needs to be able to navigate the whole variety of local anesthetics offered by various manufacturers, namely:

• evaluate the main pharmacological parameters of the action of various local anesthetics (duration of action, half-life, toxicity, etc.),
• the possibility of their combination with various vasoconstrictors in various concentrations,
• the possibility of using an anesthetic without a vasoconstrictor,
• pay attention to the presence or absence of preservatives and stabilizers in the composition of the local anesthetic preparation.

Components of a modern local anesthetic drug

The constituent components of a modern local anesthetic drug () are four groups of substances.

1. Local anesthetics
   • Novocaine,
   • Lidocaine
   • Trimecain,
   • prilocaine,
   • mepivacaine,
   • Artikain,
   • Bupivacaine
   • Etidocaine
2. preservatives
   • Parahydroxybenzoates
3. Vasoconstrictors
   • Adrenaline (epinephrine)
   • norepinephrine (norepinephrine),
   • Mezaton,
   • Felypressin (octapressin)
4. Stabilizers
   • Sodium and potassium sulfites

A local anesthetic preparation does not have to contain all of these components. To block the conduction of impulses nerve fibers only a local anesthetic is sufficient, however, vasoconstrictors are used to prolong its action and enhance the effect. This is due to the fact that almost all modern local anesthetics, although to varying degrees, have a vasodilating effect. The vasoconstrictor helps to create and maintain a higher concentration of local anesthetic locally in the area of ​​intervention. If there are contraindications to the use of vasoconstrictors, a local anesthetic can be used without vasoconstrictors, but with a shorter duration of the analgesic effect. Preservatives and stabilizers serve to increase the shelf life of local anesthetics ( ).

Local anesthetics

Classifications of local anesthetics

By duration of action

1. short range
   • Novocaine,
   • Artikain
2. Average duration of action
   • Lidocaine
   • mepivacaine,
   • Trimecain,
   • prilocaine
3. Long acting
   • Bupivacaine
   • Etidocaine

By chemical structure

1. Essential
   • Novocaine,
   • Decain,
   • Anestezin
2. Amide
   • Lidocaine
   • Trimecain,
   • pyromecaine,
   • prilocaine,
   • Artikain,
   • mepivacaine,
   • bupivacakin,
   • Etidocaine

Comparative characteristics of local anesthetics for injection anesthesia ()

Novocaine (Procaine)- until recently, the most commonly used local anesthetic drug in Russia, but now it is gradually being squeezed out of the market and is giving way to more modern drugs. This is due to the following disadvantages of novocaine:

First, among modern local anesthetics, novocaine is the least effective. According to the data, the success rate of local anesthesia using novocaine is about 50% for teeth with intact pulp, and when it is inflamed, the effect is reduced by another 20%.

Secondly, novocaine is characterized by the greatest vasodilating properties among local anesthetics. This, in turn, requires high concentrations of the vasoconstrictor. The standard concentration of adrenaline when used in conjunction with novocaine (1: 50,000), according to modern ideas, is very high and is fraught with the development of complications.

Thirdly, novocaine has the highest allergenicity (according to our data, obtained by questioning using a questionnaire to collect a general somatic history, 9.1% of patients are allergic to novocaine).

The only advantage of novocaine over other local anesthetics is its low toxicity, so this drug continues to be used in surgical dentistry and maxillofacial surgery, when it is necessary to anesthetize a large amount of tissues in the area of ​​surgical intervention, which, moreover, have a much higher threshold pain sensitivity compared to dental pulp.

In therapeutic dentistry, novocaine is now used less and less.

Lidocaine (xylocaine, lignocaine)- much more efficient and reliable drug than novocaine. The success rate of anesthesia is 90-95% for infiltration anesthesia and 70-90% for conduction anesthesia. The drug is less allergic (according to our data - 1.2%), but inferior in this indicator to the most modern local anesthetics. In addition, the disadvantage inherent in lidocaine is the significant vasodilating effect of this drug, so lidocaine is used with high concentrations of epinephrine (1:50,000) and norepinephrine (1:25,000). Such concentrations of catecholamines are highly undesirable in patients with cardiovascular diseases, thyrotoxicosis, diabetes mellitus, glaucoma, concomitant drug therapy with tricyclic antidepressants, MAO inhibitors, chlorpromazine (and other drugs with a-adrenergic blocking activity), during pregnancy. When using lidocaine without a vasoconstrictor, the duration of anesthesia does not exceed 10-15 minutes.

Trimecaine (mesocaine)- a drug similar in its properties to lidocaine, comparable to lidocaine in terms of the effectiveness and duration of the local anesthetic effect, as well as the severity of the vasodilating effect. The disadvantage of the drug is often occurring local reactions (pain during and after injection, swelling, infiltration, purulent-necrotic phenomena in the injection area, difficulty opening the mouth). As a result, the drug is practically not used at present.

prilocaine- this drug is approximately 30-50% less toxic compared to lidocaine, low-allergic, but also somewhat less active. It is possible to use its 4% solution without a vasoconstrictor. A 3% solution of prilocaine is used in combination with the vasoconstrictor felipressin (octapressin) at a dilution of 1:1850000, so the drug can be used if there are contraindications to the use of catecholamine vasoconstrictors. However, it should be noted that currently local anesthetics based on prilocaine are practically not represented on the Russian market. The disadvantage of the drug is the danger of methemoglobin formation when using the drug at a dose of more than 400 mg. In this regard, the drug is contraindicated in pregnancy, congenital or idiopathic methemoglobinemia.

mepivacaine- in terms of efficiency comparable to lidocaine, low-allergic. A feature of the drug is its minimal vasodilating effect ( ), and according to the data, the drug even has a vasoconstrictor effect. Therefore, it is possible to use its 3% solution without a vasoconstrictor, which makes it the drug of choice for severe forms cardiovascular diseases, thyrotoxicosis, diabetes mellitus, glaucoma, that is, in cases where there are contraindications to the use of a vasoconstrictor. The duration of anesthesia in this case reaches 20-40 minutes, which is enough for small volumes of interventions.

Artikain- one of the most highly effective modern local anesthetics, has a slight vasodilating effect, therefore it is used with adrenaline in dilutions of 1:100,000 and 1:200,000. Its important quality is a short (about 20 minutes) half-life () and high percent its binding to plasma proteins (up to 90-95%), that is, this drug is the least likely to have a toxic effect if accidentally administered intravascularly. In addition, articaine is characterized by the maximum diffusion ability in soft tissues and bones and, accordingly, early attack anesthesia after injection. Due to these features, articaine has become the most widely used in the market of carpular preparations for dentistry and is currently the anesthetic of choice for most therapeutic, surgical and orthopedic interventions.

Bupivacaine (Marcaine) and Etidocaine (Duranest)- effective long-acting (up to 4 hours) local anesthetics. The disadvantage of these drugs is their high toxicity and prolonged paresthesia of soft tissues after dental procedures, which creates discomfort for the patient. 0.5% solutions with adrenaline at a dilution of 1:200,000 and without a vasoconstrictor at a higher concentration (1.5%) are used for long-term interventions (mainly in surgical dentistry), as well as if prolonged postoperative analgesia is necessary.

Contraindications and limitations to the use of local anesthetics

All contraindications and restrictions to the use of a local anesthetic come down to three main positions (Specialites Septodont, 1995;):

1) allergic reactions to local anesthetic

A history of allergic reaction is an absolute contraindication to the use of a local anesthetic. For example, according to our data obtained using a questionnaire, novocaine intolerance was noted by 9.1% of patients. However, it should be noted that intolerance to local anesthetic, indicated by many patients, is often not a true allergic reaction, but is of a stressful nature, or is associated with intravascular administration of a vasoconstrictor. This fact is pointed out by various authors (). These states should be clearly differentiated. Most often, allergic reactions to novocaine and other local anesthetics of the ester group are observed; with such an allergy, it is allowed to use anesthetics of the amide group. However, it should be noted that, in principle, an allergic reaction to any local anesthetic is possible, cross-reaction to several local anesthetics, for example, to amide group anesthetics ( ) is possible, as well as a polyvalent allergy to various local anesthetics and other substances.

2) insufficiency of metabolic and excretion systems

Local anesthetic drugs can have a toxic effect in case of their overdose, as well as insufficiency of their metabolism and excretion systems. Essential local anesthetics are inactivated directly in the bloodstream by the enzyme pseudocholinesterase. The metabolism of amide local anesthetics occurs in the liver. In a small amount (no more than 10%), both amide and ether local anesthetics are excreted unchanged by the kidneys. Thus, relative contraindications to the use of amide local anesthetics are - liver disease, ether - deficiency of plasma pseudocholinesterase, and (for all local anesthetics) - kidney disease. In these cases, you should use a local anesthetic drug in small doses, observing all necessary precautions.

3) age restrictions

Please note that for children the minimum toxic doses of all local anesthetics is much less than for adults. To achieve guaranteed complete pain relief and minimize the likelihood toxic action the most effective and safe modern local anesthetic drugs based on articaine, mepivacaine or lidocaine, limiting the dosage of the drug used.

Lidocaine - maximum dose 1.33 mg of the drug per 1 kg of the child's weight.

(As an example: a child weighing 20 kg, which corresponds to the age of five.

1.33 mg * 20 \u003d 26.6 mg., Which corresponds to 1.3 ml. 2% lidocaine solution)

Mepivacaine - the maximum dose of 1.33 mg of the drug per 1 kg. baby mass

Articaine - the maximum dose of 7 mg of the drug per 1 kg. baby mass

Articaine is contraindicated in children under 4 years of age.

Vasoconstrictors

Adrenalin- is the most powerful catecholamine vasoconstrictor. May cause undesirable effects due to the action on the adrenoreceptors of the heart (tachycardia), blood vessels (vasoconstriction), liver (increased blood sugar), myometrium (causes uterine muscle contractions) and other organs and tissues. It is especially dangerous due to the action on the b-adrenergic receptors of the heart, it can cause decompensation of cardiac activity with concomitant diseases of the cardiovascular system. Also, a possible increase in intraocular pressure under the influence of exogenous adrenaline in narrow-angle glaucoma.

Based on this, one can distinguish relative contraindications to the use of epinephrine as a vasoconstrictor in local anesthesia:

• cardiovascular diseases (hypertension (AH), ischemic disease heart disease (CHD, heart failure)
• pregnancy
• concomitant drug therapy glucocorticosteroids, tricyclic antidepressants, MAO inhibitors, chlorpromazine (and other drugs with a-blocking activity)

At the same time, a relatively safe dilution of adrenaline is 1: 200,000. According to the data, already at an adrenaline concentration of 1: 100,000, after local anesthesia, tangible changes in systemic hemodynamics (raising blood pressure by 10-30 mm Hg) can be observed. Some foreign authors provide data on the absence of recorded changes in systemic hemodynamics even when diluting adrenaline 1: 100,000 (). However, according to most domestic authors, the dilution of adrenaline 1:200000 is the maximum at which its use in the above groups of patients (patients at risk) is acceptable.

Such low concentration can only be provided in carpulated (finished) preparations, adding adrenalineextempore does not provide accurate dosing and is therefore extremely dangerous! For the treatment of patients at risk who are contraindicated high concentrations adrenaline is recommended to use only karpulirovannye preparations.

Absolute contraindications to the use of adrenaline:

• diabetes
• glaucoma (narrow-angle form)
• thyrotoxicosis
• decompensated forms of cardiovascular disease Stage III, paroxysmal tachycardia, tachyarrhythmias).

Norepinephrine- similar to adrenaline, but the effect is weaker, therefore it is used in high concentrations. The effect on a-adrenergic receptors (vasoconstriction) prevails, therefore, when using norepinephrine, the risk of developing a hypertensive crisis with concomitant hypertension is higher.

The use of norepinephrine instead of adrenaline is possible with thyrotoxicosis and diabetes mellitus. However, a number of authors indicate that norepinephrine gives much more side effects due to strong peripheral vasoconstriction () and its use should be avoided.

The use of noradrenaline in glaucoma (narrow-angle form) is contraindicated.

Mezaton- catecholamine with properties similar to adrenaline and norepinephrine, but only affects?-adrenergic receptors (vasoconstriction). The vasoconstrictive effect is 5-10 times weaker than that of adrenaline. Contraindicated in hypertension and hyperthyroidism. Used in dilution 1:2500 (0.3-0.5 ml of 1% solution per 10 ml of anesthetic solution).

Felipressin(Octapressin) is not a catecholamine, it does not act on adrenoreceptors, therefore it is devoid of all the above disadvantages. It is an analogue of the hormone of the posterior pituitary gland - vasopressin. It causes only venuloconstriction, so the hemostatic effect is not pronounced, as a result of which it is little used. It is contraindicated in pregnancy, as it can cause contractions of the myometrium, it also has an antidiuretic effect, so patients with coronary heart disease and heart failure should not be given more than one cartridge of the drug containing Felipressin.

Please note that the use of all of the above vasoconstrictors is contraindicated in children under 5 years of age ()

preservatives and stabilizers

The most commonly used preservatives are esters of parahydroxybenzoic acid (parabens), they have antibacterial and antifungal effects. These substances may be allergens. Parabens are part of various cosmetic preparations, creams, toothpastes and can provoke contact dermatitis so these patients have real danger allergies and to a local anesthetic drug. In addition, related chemical compound- PABA (para-aminobenzoic acid) is very active in terms of allergies. This substance is a metabolite of novocaine (that is, people who cannot tolerate novocaine are especially likely to be allergic to parabens). It should also be noted that many medications, in particular, sulfonamides, oral antidiabetic, furosemide, etc., are derivatives of PABA, therefore, in case of drug allergy to these drugs, the use of parabens as part of local anesthesia is also undesirable. The presence or absence of parabens in the local anesthetic preparation is indicated by the manufacturer. Parahydroxybenzoates are absent in the most modern carpulated preparations.

Stabilizers (sodium or potassium disulphite) are used in conjunction with vasoconstrictor cathalamines and protect them from oxidation. They can cause allergic reactions when hypersensitivity to sulfites. Allergy to sulfites is most common in patients with bronchial asthma (frequency - about 5%), so when treating such patients, you should be especially careful (Specialites Septodont, 1995;).

Criteria for choosing a local anesthetic drug

When choosing a local anesthetic drug, it is necessary to consider:

Preparations for application anesthesia

For application anesthesia in most commercial preparations manufactured by various companies, the following local anesthetics are used as the active principle:

• Decain(tetracaine) in the form of 0.5-4% solutions and ointments. Dikain is 10 times more toxic than novocaine. Therefore, children under 10 years of age are not given pain relief with dicaine. For adults, the maximum single dose is 20 mg.
• Anestezin(benzocaine) in the form of 5-20% solutions (oily or in glycerin) and ointments, pastes, and also in the form of powders. The maximum single dose for adults is 5 g.
• Lidocaine in the form of 5-15% aerosol solutions and 2-5% ointments and gels. The maximum single dose for adults is 200 mg (0.2 g).
• Pyromecaine(bumecaine) in the form of 5% ointment and 2% solution in ampoules. Pyromecaine is an amide anesthetic, similar in structure to trimecaine. It is not inferior to dicaine in terms of depth and duration of anesthesia, but is less toxic. The maximum single dose for adults is 400 mg (0.4 g).

The duration of anesthesia when using application anesthesia is 10-20 minutes. The depth of anesthesia of the mucosa is 1-3 mm. The anesthetic effect usually develops in 1-2 minutes.

Forms of application: aqueous solutions, solutions based on alcohol, polyethylene glycol and glycerin, ointments, gels. In addition, antiseptics are often added to a commercial preparation: chlorhexidine, furacillin, cetrimide, etc. Hyaluronidase, dimethyl sulfoxide, and other substances can be used to increase diffusion activity. Various aromatic additives, plant extracts, sweeteners, dyes, etc. can be added to the finished product.

Widespread drugs for application anesthesia in the form of aerosols. The disadvantage of using an aerosol preparation is a poorly controlled spray area, the possibility of getting into the upper respiratory tract, as well as professional allergization of the doctor. Therefore, in any case (solution, gel, ointment, aerosol), it is better to apply the drug with a cotton swab.

Table 7 presents the means for application anesthesia offered by various manufacturers.

Indications for use

Anesthesia of the injection site, surface anesthesia for the removal of milk and permanent mobile teeth, fitting of crowns and bridges, removal of hypertrophied areas of the gums (“hood” over the wisdom tooth, mucous membrane growing into the carious cavity), removal of tartar, opening of submucosal abscesses, suppression gag reflex when taking impressions, fitting crowns, performing radiography, as well as in the treatment of gingivostomatitis (Specialites Septodont, 1995,).

Contraindications

Children under 10 years of age (when using dicaine).

Allergic reactions to the local anesthetic and other components of the finished product (see the product instructions).

Premedication

The most widely used is the so-called sedative premedication:

Drugs used for sedative premedication:

• sedatives plant origin(tincture of valerian, motherwort, corvalol, valocordin, valoserdin, etc.)
• benzodiazepine tranquilizers (diazepam, phenazepam, midazolam, etc.)
• preparations of other chemical groups(trioxazine, etc.)

Indications for the use of sedative premedication

Pronounced (irresistible) fear of treatment, coronary heart disease, hypertension, bronchial asthma, diabetes mellitus, thyrotoxicosis, parkinsonism, epilepsy, persistent desire of the patient.

DRUGS USED FOR PREMEDICATION

Herbal sedatives

• Valerian tincture - 60 drops
• Motherwort tincture - 30 drops
• Corvalol, valocordin or valocerdin - 30 drops

Method of application

Orally 15-20 minutes before treatment

• benzodiazepine tranquilizers

Diazepam(sibazon, seduxen, relanium, valium) - is the drug of choice for sedative premedication before dental surgery, including in the treatment of children ().

Pharmacological action: has a calming, anti-anxiety effect, reduces muscle tone, has an anticonvulsant effect.

Method of application: according to various authors ( ) a single dose for adults when taken orally (30-45 minutes before dental procedures) is 5-15 mg, for children from 3 to 7 years - 2 mg, from 7 years and older - 3 -5 mg (or 0.1 mg / kg body weight -). .

According to our observations, when premedicating adults, taking one tablet of diazepam (5 mg) usually provides the desired result.

In addition, one of the options for prescribing diazepam is taking? diazepam tablets in the evening before bed and then another? in the morning before a visit to the dentist is also in most cases sufficient to achieve the desired sedative effect.

With intravenous or intramuscular injection in a dental hospital, the average dose is 2 ml of a 0.5% solution. A sedative effect is observed within a few minutes after intravenous or 30-40 minutes after intramuscular administration.

Side effect: in high doses can cause muscle weakness, drowsiness, lethargy, ataxia, dizziness, dry mouth. At intravenous administration possible phlebitis.

Contraindications: do not use in severe forms of renal and hepatic pathology, myasthenia gravis and during pregnancy. Caution is required for outpatient use. In these cases, it is necessary to observe patients in the clinic after treatment, until the speed of psychomotor reactions is restored, or invite them with escorts. After using the drug (the duration of the effect of diazepam is 4-6 hours), it is not recommended to engage in work requiring physical and mental stress, speed of reactions (including driving a car is not recommended).

Drug Interactions: alcohol, hypnotics, anticonvulsants, painkillers and antipsychotics of the phenothiazine group dramatically increase the effect of diazepam.

Phenazepam- similar to diazepam, more strong drug, is used at a dosage of 0.5-1 mg 30-45 minutes before the intervention (). Increasing the dose to more than 1 mg does not increase sedative action drug, but only provokes the progression of side effects. recommends taking fenozepam at a dosage of 0.25 mg in children of primary school age (if indicated), since in this category of children this drug has a more acceptable effect than diazepam. Taking diazepam can cause tearfulness, loss of the child's ability to concentrate and communicate adequately with the doctor.

Midazolam(Dormicum) - hypnotic drug, nevertheless, a number of authors ( ) recommend it for premedication, as the drug is convenient in that sedation occurs almost immediately (after 30-60 seconds, maximum after 3-5 minutes). However, in the future, severe drowsiness develops. The duration of the effect is 2-4 hours. Adult dose 7.5 mg (1/2 15 mg tablet) orally.

Preparations of other chemical groups

Trioxazine - has a moderate tranquilizing effect without drowsiness and intellectual retardation, does not relax skeletal muscles. The drug can be used in the presence of contraindications to the use of benzodiazepines. It is produced in tablets of 0.3 g. 30-40 minutes before the intervention, an adult patient is given 1-2 tablets of the drug (). For children, the dosage is 1/4 - 1/2 tablet according to age.

Carrying out general anesthesia (anesthesia) in dentistry

Anesthesia is a method of anesthesia based on turning off the patient's consciousness due to deep inhibition of the cerebral cortex. Carrying out anesthesia in dentistry on an outpatient basis has its own specifics and some characteristics. Most lethal complications during anesthesia are due to asphyxia and hypoxia. If during operations in a hospital the problem of patency of the upper respiratory tract is solved with the help of tracheal intubation and endotracheal anesthesia, then with outpatient interventions, respiratory failure is still a source of dangerous situations leading to hypoxia. This is primarily due to the possibility of retraction of the tongue, aspiration of solid and liquid foreign bodies in the oral cavity (saliva, blood, fragments of teeth to be removed, cotton or gauze swabs, small endodontic instruments, burs, removable dentures etc.) that can obstruct the upper airways. There is also a danger of the glottis being closed by the lobular epiglottis. The use of anesthesia for pain relief in dentistry should be carried out strictly according to indications, since the risk of any dental intervention is less than the risk of general anesthesia ( ).

Anesthesiological assistance should be carried out by a trained anesthesiologist in conditions of sufficient hardware anesthesia support, and it is the anesthesiologist who should be involved in the comprehensive protection of the patient during dental procedures. With the participation of an anesthesiologist, a mandatory Exploratory survey patient, including laboratory control(clinical blood test, biochemical indicators), electrocardiography, fluorography, as well as the choice of a rational method of intravenous anesthesia. During dental procedures under anesthesia, the anesthesiologist conducts constant minimal monitoring of the patient's condition (BP, heart rate, respiratory rate, pulse oximetry). Also, the tasks of the anesthesia team include effective protection respiratory tract from foreign bodies (dust, blood, mucus, fragments of teeth, etc.). Follow-up of the patient by the anesthesiologist continues post-anesthetic period. The patient can be discharged home after the restoration of adequate consciousness, orientation in time and space, restoration of stability in the Romberg position. In this case, an accompanying person () is required.

Indications for the use of anesthesia in outpatient dentistry

Intellectual disorders (violation of the patient's contact with the doctor),

Allergy to local anesthetics,

Failure of local anesthesia ( ).

Considering modern tendencies in practical dentistry, these indications can also be supplemented by the patient's insistence on treatment under general anesthesia. However, in order to make an informed decision, the patient must be informed about all the possible dangers and complications of general anesthesia.

Contraindications to the use of general anesthesia in outpatient dental practice ():

• sharp infectious diseases(influenza, hepatitis, etc.)
• acute diseases of the lungs, liver, kidneys, decompensated diabetes mellitus, acute blood diseases, etc.
• heart defects in the stage of decompensation, severe bradycardia, arrhythmia
• adrenal tumor - pheochromocytoma
• alcohol intoxication

Relative contraindications:

• post-infarction and post-stroke periods (from 6 months to one year)
• hypertension with high rates BP (more than 160 mm Hg)
• adrenal insufficiency
• thyrotoxicosis
• coagulation disorders and long-term use anticoagulant drugs (phenylin, aspirin and others)
• anemia (hemoglobin level less than 100 g/l)
• addiction

PRODUCTS FOR GENERAL ANESTHESIA (ANESTHESIA)

Two types of general anesthesia can be used to relieve outpatient dental interventions:

• inhalation anesthesia
• non-inhalation anesthesia

For inhalation anesthesia, which is usually carried out through a nasal mask, nitrous oxide with oxygen and halothane or methoxyfluorane is used.

Dental treatment under inhalation anesthesia finds less and less enthusiast among dentists, as the doctor is forced to breathe the fumes of the drug, being in very close contact with the patient. In addition, a more thorough examination and provision of patient rest after anesthesia or deep premedication is necessary. It is desirable to observe the patient after using this type of anesthesia in a hospital for one day.

The dentist must be aware of the fatal dangerous combination halothane with catecholamines; it is unacceptable to use a local anesthetic solution with adrenaline for the purpose of local vasoconstriction against the background of halothane anesthesia

Most often in dental treatment under general anesthesia used non-inhalation anesthesia, namely the method of total intravenous anesthesia (TVA). To do this, use such non-inhalation anesthetics as hexenal and sodium thiopental (a group of barbiturates), propanidide (sombrevin), ketamine (ketalar, calypsol), diprivan (propofol), these drugs provide a short-term stage of surgical anesthesia (from 3 to 30 minutes). The dosage of the drug and the scheme of premedication is selected individually by the anesthetist ( ).

ANTIHISTAMINES AS ANESTHETIC MEDICINES

Method of application: it is possible to carry out infiltration or conduction anesthesia according to standard methods, using a 1% solution of diphenhydramine in a volume of 2-3 ml without a vasoconstrictor. The effectiveness of anesthesia with these drugs is similar to anesthesia with a 1% novocaine solution without a vasoconstrictor and increases in combination with premedication with benzodiazepine tranquilizers.

Indications: allergic to all local anesthetics

Conclusion

In this work, the authors attempted to summarize the literature data on the features clinical application various local anesthetics, premedication preparations, general anesthetics and cooling anesthesia agents, indicating their main pharmacological parameters, indications and contraindications for use, methods of application, as well as advantages and disadvantages in various clinical situations.

Based on this knowledge, it is possible to choose the optimal painkillers for a particular patient in each case.

When choosing a drug for pain relief, it is very important, along with the dental status, to take into account all the features of the general somatic condition of the patient. This is possible only with a thorough history taking (once again, we focus on the need to use the questionnaire - see Appendix). This approach will help prevent possible complications that may be associated with anesthesia.

Why are we so afraid of going to the dentist? Many try to find all sorts of reasons to postpone a visit to this doctor. Probably you will agree that they are afraid to visit the dentist precisely because dental treatment is associated with pain. But modern dentistry has reached such a level of anesthesia that almost any manipulation can be performed without pain. We will consider the main methods of anesthesia in dentistry, its types, as well as possible contraindications.

It is hard to disagree with the fact that the suffering that causes toothache are among the most powerful. This kind of pain is hard enough to endure. Because anesthesia in dentistry is used in many procedures. Unfortunately, it is pain that becomes the decisive factor that prompts us to go to the dentist. But it is much better to visit this doctor regularly. Going to the dentist just twice a year can keep your teeth and gums healthy. And if there are any problems, the doctor will be able to detect them on initial stage disease development. For example, caries is much easier to treat when it has not yet had time to destroy most tooth. But, unfortunately, we often run it so much that the infection penetrates the pulp, destroys it and causes unbearable pain. At the same time, we, exhausted by pain, finally go to the dentist. And he, in turn, is faced with the fact that caries has destroyed tooth enamel and penetrated deep into the tissues of the tooth. Often in such cases it is necessary to remove the dental nerve. Such a tooth becomes dead, it changes its color and ceases to function, as it simply does not receive any nutrition. Therefore, do not delay a visit to the dentist. It is always better to prevent dental diseases than to treat them later. In addition, such treatment is quite expensive.

Did you know that a tooth is just a bone? Why does he hurt? The thing is that the pulp (in other words, the dental nerve) consists of a large number smallest nerve endings. They are responsible for the nutrition and preservation of teeth. As soon as an infection penetrates the tooth or its tissues are destroyed for some reason, the nerve endings immediately signal the problem with pain. The problem of toothache is rightly considered one of the most common. Almost all of us have experienced it. Moreover, for many, she has been familiar since childhood. There are many reasons for this: malnutrition, genetic predisposition, malocclusion, chronic diseases and much more. All these factors can worsen the condition of our teeth, destroying them every day.

Most of the actions of the dentist are accompanied by severe pain for the patient. Even the most persistent of them are not ready to endure such intense pain. Anesthesia helps to cope with it. All types of anesthesia in dentistry are aimed at eliminating pain as efficiently and safely as possible. Now anesthesia has reached such a level of development that at all stages of treatment the patient practically does not feel any discomfort.

How does anesthesia work, what types it is

So what is anesthesia? How does it generally work? How do you manage to "turn off" the pain? The fact is that anesthesia in dentistry consists in the temporary removal of sensitivity from the tissues. This is required in order to qualitatively perform the manipulations necessary for treatment. Very often they affect rather deep layers, where there are many nerve endings, as well as the pulp itself. General anesthesia is also possible. It is performed for all kinds of operations on the teeth, for example, during their implantation. Without anesthesia, it is almost impossible to perform a deep filling, remove a tooth or nerve, install crowns, perform surgical or orthodontic treatment of the lower or upper jaw. All these manipulations would be accompanied by simply unbearable pain. But it is very important that the patient not only gives the opportunity to perform the necessary manipulations, but sits motionless.

What is the principle of anesthesia? It consists in the fact that when it is introduced, a blocking is performed nerve impulse. And it necessarily occurs even with minimal impact on the tissues of the tooth. As soon as manipulations begin with the tooth, the pulp immediately sends a signal to the brain. During anesthesia, such a signal does not reach the brain. With it, the patient has a feeling that the cheek and gums are numb. This is similar to the freezing effect. But anesthetic substances are very unstable. They are quickly destroyed, because the effect of anesthesia most often disappears after 4-6 hours. Then the sensitivity is very quickly restored.

Local anesthesia in dentistry can be both medical and non-pharmacological. Non-drug has its subspecies:

1. computer anesthesia;
2. electroanalgesia;
3. hypnotic and psychotherapeutic influence;
4. audio analgesia.

This type has other varieties. But they are used quite rarely due to the fact that quite serious additional training of the doctor is necessary. In addition, they do not always bring a sufficiently strong and stable effect. Most often, non-drug methods of anesthesia are only an addition to medical ones. They act as a kind of sedative for those patients who do not really trust medical anesthesia or consider it insufficient. the main task non-drug methods anesthesia - divert the patient's attention from the manipulations performed by the doctor. it good way help the patient relax a little, get distracted, especially if he is rather suspicious. Often the doctor needs to make considerable efforts even to ensure that such patients simply open their mouths for examination. It is also difficult to provide dental care children. But sometimes it is enough to turn on a children's song or a fairy tale so that the child is a little distracted and gives the doctor the opportunity to work. But when performing direct treatment, songs and fairy tales will not be enough to help the child cope with pain. Then the already familiar drug anesthesia comes to the rescue.

How does medical anesthesia work? The doctor injects a substance into the patient's gum area that acts on the nerve and relieves its sensitivity. Such substances are called anesthetics. There are enough of them. The choice of a particular medicine will depend on a number of factors: the patient's age, his state of health, the presence of allergies, the type of manipulation required, etc. Anesthesia can be not only local, but also general. Local anesthesia is pain relief by injection or application. The injection can be conductive, infiltration, etc. General anesthesia is a general anesthesia in which the patient is unconscious.

Local anesthesia: types, benefits

Consider the varieties, as well as the advantages of local anesthesia. It is it that is performed most often in the treatment and extraction of teeth, as well as their prosthetics. It is local anesthesia in dentistry that is considered the safest and most convenient. And this is true. Indeed, local anesthesia in dentistry is the most effective and safe way to eliminate pain. It causes minimal harm to the patient's body. The secret of its advantages is that the sensitivity of only those tissues that are involved in the direct treatment of the tooth or are very close to it is removed. Most often, it is enough to make one injection so that the tooth almost completely loses its sensitivity for several hours. True, for the treatment of some teeth, you will need to make several injections. Most often, when treating wisdom teeth, you need to perform anesthesia more carefully so that the sensitivity is completely gone.

How is the anesthetic administered? Most often, the injection method is used to administer the anesthetic, but it can also be an application. They are performed directly in the area of ​​​​the dentition in which the diseased tooth is located. In other tissues, their sensitivity is completely preserved. The indisputable advantage of local anesthesia is that the patient is fully conscious during the treatment, and can help the doctor in his actions. For example, he can fulfill the doctor's requests to open his mouth, spit, etc. At general anesthesia Naturally, the patient is unconscious.

Anesthesia infiltration

This is a type of pain relief by injection. It is infiltration anesthesia that is used most often. What activities is it used for? Performing infiltration anesthesia is indicated if necessary:

1. remove the nerve
2. perform a certain operation on the pulp;
3. seal channels.

But there are patients who are directly afraid of the injections themselves. It is a real problem for them to open their mouths in order for the doctor to give an injection. It seems to them that an injection into the gum will certainly be very painful. Actually this is a delusion. An injection of an anesthetic drug into the gum is practically not felt. Well, for complete certainty, the doctor can treat the gum with a special tool. It causes temporary numbness, and the patient will not feel any discomfort during the injection. Very often, the gum is treated with an anesthetic before giving an injection to children. But they can also be used to anesthetize adults. After treating the injection site, an anesthetic is injected into the apex at the root of the tooth that needs treatment.

With infiltration anesthesia, sensitivity is very effectively removed. The whole secret is that the anesthetic acts directly on the branches of the dental nerve, and not on its trunk. It is best used in the treatment of teeth in the upper jaw. The upper dentition has thinner and more compact bone. Therefore, the anesthetic penetrates into its spongy structure very quickly. At the same time, the molars of the lower teeth are much stronger and more massive.

Conductive anesthesia

It is used very often in the procedure for removing teeth. Often in such cases, infiltration anesthesia may not work effectively enough or not work at all. It is also indicated in cases where several neighboring teeth are required to be anesthetized at once. One of the brightest examples of conduction anesthesia is mandibular anesthesia. It is important that the doctor perform the injection strictly in the region of the mandibular canal. This will provide a sufficiently strong and prolonged anesthesia of part of the dentition.

Anesthetics affect the following areas:

1. dentition of the lower jaw;
2. region lower lip;
3. adjacent side of the tongue and gums.

As you can see, with such anesthesia, anesthetization of a fairly large area occurs. Finding out that the anesthesia has worked is easy enough. You need to wait until you feel the numbness of the lower lip. After that, the doctor can begin his manipulations.

Anesthesia intraligamentous (intraligamentary)

This type of anesthesia is popular in pediatric dentistry. What is the reason? The fact is that children often cannot stand the feeling of numbness in the area of ​​​​the tongue, lips and part of the cheeks. This may scare them. But with other methods of anesthesia - this is an integral side effect. Also, children, due to the fact that they do not feel the numb part, can bite it quite hard. After the sensitivity returns, the resulting wound hurts and worries the child for quite a long time. After such a trip to the dentist, the child will not want to repeat it for a long time.

With intraligamentous anesthesia, the anesthetic must be injected into the area between the socket and the root of the tooth. It's called periodontal. Methods of administration may be different. The decisive role in their choice is played by the time for which it is necessary to anesthetize, as well as which particular area of ​​​​the dentition needs to be treated. In the event that it is required to treat several teeth nearby, then an anesthetic can be injected under enough strong pressure. This will ensure its deep penetration into the bone.

With this type of anesthesia, the sensitivity returns quite quickly - it will take about an hour. With the gradual introduction of the drug, only the gums and periosteum are anesthetized. This method is used in the treatment of caries, pulpitis. But it is also suitable for removing teeth.

Anesthesia intraosseous

Consider how intraosseous anesthesia is performed and what is its feature. The dentist injects a small amount of anesthetic into the gum where the injection will be made into the bone tissue. This guarantees complete painlessness of such an injection. Then the anesthetic drug is injected between the teeth into the bone.

With this method, sensitivity disappears only at the gums and teeth. Lips, tongue and cheeks remain fully sensitive. This method is often used specifically for the extraction of teeth. But the anesthetic acts with this method of administration for a short time, but extremely quickly.

stem anesthesia

Most often, this type of anesthesia is used in hospital treatment. It has the following indications:

1. neuralgia;
2. injuries of the teeth or jaws of various etiologies;
3. jaw surgery (orthodontic or removal of neoplasms);
4. severe pain syndrome.

In this case, anesthesia is not administered in the mouth area, but directly near the base of the skull itself. This allows you to securely block the stem nerves for the lower and upper jaw. With this type of anesthesia, the effect will be strong and long-lasting, but the indications for its implementation are associated with serious manipulations in the area of ​​​​the teeth and jaws.

Application anesthesia

This type of anesthesia has another name - superficial. It consists in removing sensitivity directly from the surface of the tissue. Most often used to anesthetize gum tissue. However, it can be applied to almost any type of oral tissue. The advantage of this type is that you do not need to use a needle. This is a good option for those who are afraid of injections. The doctor uses special anesthetics for application. They can be in the form of an ointment or spray. It is enough to apply them to the right place with a swab. There are the following indications for using this method:

1. it is necessary to remove tartar, which are located near the base of the tooth;
2. you need to anesthetize the surface before deeper anesthesia. After the desired surface is treated with such an anesthetic, the injection will be painless;
3. if necessary, open an abscess under the mucosa;
4. if you need to process the edges on the gum.

We must pay tribute to the application of anesthesia. She made many manipulations much more comfortable. Previously, such procedures were performed without anesthesia and caused considerable discomfort to patients. After all, many manipulations are performed on the mucous membrane, and it is quite sensitive and tender. At the same time, it is quite difficult to anesthetize it in other ways. But after the application of anesthesia has become widely used, patients can get quality treatment without pain.

Are there any contraindications for local anesthesia?

When you come to the doctor, he should first of all ask if you have allergies. In the event that it is, it is important to determine what exactly. Often a contraindication for local anesthesia is precisely an allergy to one of the anesthetics. Be sure to tell your dentist about possible allergies if it exists. Generally, experienced dentist will try to ask the patient leading questions that will help to establish whether there are contraindications for local anesthesia. Be sure to tell your doctor about past illnesses or illnesses that you currently suffer from, about allergies to medications. If you have undergone any operations in your life, they also need to be mentioned. Of course, local anesthesia is justifiably considered one of the safest, but even it has some contraindications. Do not perform local anesthesia if:

1. The patient has recently had a heart attack or stroke. At least six months must pass;
2. the patient is ill endocrine system(thyrotoxicosis, diabetes mellitus, etc.);
3. the patient is allergic to some local anesthetic.

Pay due attention to the safety of your health and give the most truthful and complete answer to each question of the dentist. There are times when it is required dental treatment and the patient is sick. Then urgent treatment is performed in a hospital. But for this there must be an urgent need. Well, if there is a suspicion of an allergy, then before injecting anesthesia, the patient must pass allergic test in a special allergology center. They will accurately and safely determine which anesthetic the patient is allergic to.

General anesthesia

We have given great attention local anesthesia, considered its types, indications and contraindications. But in dentistry, general anesthesia can also be used. In fairness, let's clarify that this happens very rarely. There must be a very good reason for administering general anesthesia to a patient for dental procedures. The most common is odontophobia (dentophobia). There is a category of patients who are not just afraid of dentists and everything related to their activities, but experience real horror and panic as soon as they sit in the dental chair. Most often, such fear appears in childhood. That is why it is so important that the treatment of children in dental office did not bring them any discomfort, let alone pain. Unsuccessful treatment can leave an imprint on his attitude towards doctors for the rest of his adult life.

Such patients delay the visit to the dentist until the very last moment, when it is simply impossible to do without his help. The disease is already in advanced form. In such cases, the doctor may resort to general anesthesia.

Under general anesthesia, the patient is completely unconscious. Because of this, there are quite a few contraindications for its implementation:

1. diseases of the respiratory system;
2. cardiovascular diseases;
3. age limit;
4. individual intolerance.

During general anesthesia, adverse reactions often occur:

1. bronchospasm;
2. muscle cramps;
3. violation of the heart rhythm;
4. respiratory failure and depression;
5. decrease or increase in pressure;
6. spasm of the larynx;
7. vomit;
8. psychomotor and motor activity;
9. amnesia is rarely observed.

That is why you need to resort to general anesthesia in the most severe cases. Even if a minimum of drugs is introduced for general anesthesia, this does not guarantee the absence of their negative effect on the body. Even the most modern drugs may cause unwanted reaction. In addition, the clinic must have a license and technological criteria for the introduction of general anesthesia.

Combined anesthesia

General anesthesia has an excellent alternative - combined anesthesia. If the patient is unable to cope with their fear of dental procedures, then they can use combined anesthesia. It can also be indicated in pregnancy, Down syndrome, cerebral palsy.

It consists in the fact that the patient calms down with the help of special medicines. At the same time, his consciousness is preserved. In medicine, there is a term for this condition - preliminary premedication. After it, the dentist will still need to introduce local anesthesia, and only then begin treatment. This method is much safer than general anesthesia. At the same time, it is quite effective.

Summarize. Since manipulations in the dental office are associated with quite severe pain, anesthesia in dentistry is necessarily used. However, local anesthesia should be preferred. The doctor will select exactly the method of local anesthesia that will be most effective in a particular case. After anesthesia is performed, it will be easier for the doctor to work, and it will be easier for the patient to endure all manipulations. We hope that now you will go to the next appointment with the dentist without fear and fear.

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