Anesthetics for application anesthesia in dentistry. Application anesthesia in dentistry: principle of action, application, contraindications. Application anesthesia technique

The most technically simple way local anesthesia tissues is superficial, or application (from lat. appli-catio - application), which, according to the mechanism of action, can be attributed to infiltration anesthesia. feature surface anesthesia is that the impregnation of tissues with a local anesthetic is carried out from the surface layers on which the local anesthetic is applied. For this, various dosage forms anesthetics (solutions, ointments, gels or aerosols) containing high concentrations of local anesthetics. Applied with a cotton or gauze swab, local anesthetics, due to their high concentration, quickly penetrate the surface of the mucosa or damaged (but not intact) skin tissue to a depth of several (2-3) millimeters and cause blockade of receptors and peripheral nerve fibers. The anesthetic effect develops within a few minutes and lasts up to several tens of minutes. The technique of surface anesthesia for anesthetizing the site of the proposed needle injection consists in the point application of an application anesthetic for 2-3 minutes, after which it should be carefully removed.

Application agents are also known, in which the analgesic effect is achieved not due to a local anesthetic, but with the help of coolants. These substances (for example, chloroethyl) quickly evaporate and cause deep tissue cooling. However, the use of such substances in the oral cavity is impractical because of the danger of their entry into the respiratory tract, as well as on intact teeth, a sharp cooling of which in itself can cause adverse effects and severe pain.
The main indication for surface anesthesia is to ensure the psychological comfort of the patient and the attending physician during injection anesthesia, since the injection is complicated by the fear of pain, fainting spells and other negative psychophysiological reactions of patients.

Surface anesthesia is indicated for various low-traumatic interventions, which include the removal of milk or permanent mobile teeth, opening of submucosal abscesses, painful manipulations at the edge of the gums, removal of tartar, fitting of crowns and bridges. In addition, it is used to reduce the gag reflex during the taking of impressions and to temporarily relieve pain in certain diseases of the oral mucosa (gingivitis, stomatitis).

However, along with the advantages, application methods of anesthesia also have significant disadvantages. The main one is expressed toxic effect local anesthetics. Due to the high concentration required to ensure their penetration into tissues, and their inherent vasodilating action they are absorbed into the bloodstream and create toxic concentrations there as quickly as when intravenous administration(Bennett, 1984). This is typical to a greater extent for water-soluble application agents (pyromecaine, tetracaine) and to a lesser extent for agents that are poorly soluble in water (benzocaine and lidocaine-based agents). According to M.D.W. Lipp (1998), two-thirds of patients rate injections as unpleasant and would like to avoid them.
Surface anesthesia is indicated for various low-traumatic interventions, which include the removal of milk or permanent mobile teeth, opening of submucosal abscesses, painful manipulations at the edge of the gums, removal of tartar, fitting of crowns and bridges. In addition, it is used to reduce the gag reflex during the taking of impressions and to temporarily relieve pain in certain diseases of the oral mucosa (gingivitis, stomatitis). A.Zh. Petrikas (1997) described the analgesia of the central upper incisors with intranasal application of an anesthetic application, in which blockade of the nasopalatine nerve is achieved.

As a result, when using application methods, both local and systemic toxic effects are often possible, therefore, strict control is necessary. total injected local anesthetics, including those used for surface anesthesia. In this regard, aerosol forms are less acceptable, since when using them, the assessment of the total dose is difficult. In addition, aerosol spraying allows the funds to get on the doctor and medical staff (not only in the respiratory tract, but also on open tissues of the hands, face, neck), which increases occupational hazard working conditions.

A certain contraindication to the use of application methods of anesthesia in the oral cavity is also the psychological discomfort of patients as a result of a prolonged violation of the sensitivity of the mucosa, as well as the likelihood of biting tissues, especially in children.
Our clinical experience indicates the need for a careful and balanced attitude to the use of application anesthesia in outpatient dental practice. For example, in a significant number of cases, overcoming pain when piercing a tissue with a needle can be achieved by the following methods:
- distraction of the patient's attention;
- compression of the soft tissues held by the fingers during the injection;
- asking the patient to deep breath before the injection of the needle;
- immediate administration a small amount local anesthetic solution.
In cases where pain cannot be eliminated by the above measures (for example, with palatal anesthesia), the smallest possible amount of anesthetic should be used and applied only at the site of the intended needle puncture.
For superficial anesthesia of the mucous membranes before injection, the recently developed domestic self-adhesive film "Diplen LH" seems to be very convenient. She has combined action: analgesic and antibacterial. It is based on the film coating "Diplen", which consists of two combined layers - hydrophilic and hydrophobic. The film has sorption capacity, protective properties (impermeable to microflora) and vapor permeability. The composition of the "Diplen LH" includes: antiseptic chlorhexidine, which has a wide range activity against the microflora of the oral cavity, anesthetic lidocaine hydrochloride and brilliant green located in the surface layer of the film.

The technique of using this tool is simple and convenient. Scissors cut off required size a piece of film and an adhesive side is applied to the mucous membrane in the area of the intended intervention. For anesthesia and at the same time antiseptic treatment of the needle injection site, a small piece is enough. After sticking the film, both effects develop after 60-90 seconds. Her bright green color makes it easier for the doctor to navigate in the oral cavity. The film is not removed - neither before the injection, by piercing it with a needle, nor after the injection, which protects the injection site of the needle from infection and contributes to its painless condition after the action of the injected local anesthetic solution ceases. After 10-12 hours, the film, as a rule, completely resolves itself. The sufficiency of a small concentration of drugs in the film has been scientifically and clinically substantiated: 10 µg/cm3 of chlorhexidine bigluconate and 30 µg/cm2 of lidocaine hydrochloride. Due to this, the film does not have a locally irritating, general toxic, sensitizing, mutagenic effect and actively affects the microflora of the oral cavity, including strict non-spore-forming anaerobic species. In addition, it does not have an unpleasant smell and taste, it does not cause discomfort and any negative sensations in patients. Due to its properties, the self-adhesive film "Diplen LH" has wide indications for use in dental practice (Ushakov et al., 1999) .

Infiltration technique

The infiltration technique of local anesthesia is the most common type of anesthesia in dentistry.
At surgical interventions ah on the soft tissues of the face, the alveolar process and other areas, direct infiltration anesthesia is used, and during the operation of tooth extraction and bone interventions on the alveolar process of the jaws - indirect, when the anesthetic solution from the created depot diffuses into the deep-lying tissues on which the operation is performed.
Thus, infiltration anesthesia can be performed by injection under the mucous membrane, under the periosteum, intraosseously (intraseptally), intraligamentally. In the clinic, during infiltration anesthesia, an anesthetic solution is injected into the transitional fold of the vestibule of the oral cavity, where there is a submucosal layer: upper jaw- slightly above the projection of the tops of the teeth, on the bottom - slightly below it. When injecting, the syringe is held in right hand three fingers (in the form of a "writing pen") so that the first finger freely reaches the end of the syringe plunger. The needle is inserted at a 45 degree angle to the bone alveolar process under the mucous membrane of the transitional fold with a bevel to the bone, and the first finger is located on the piston. Anesthetic in the amount of 1.5-2 ml is administered slowly to avoid strong pain from delamination of tissues with a solution; if necessary, move the needle deep into the tissues or along the alveolar process, an anesthetic should be released along the way of its advancement in order to reduce pain and prevent hematomas from damaged vessels.
On the palatine side, during infiltration anesthesia, the needle is injected at the border of the palatine process of the upper jaw with the alveolar process, where there is a small amount of loose fiber surrounding the nerve trunks passing here. The amount of anesthetic administered in this area should not exceed 0.5 ml.
On the lingual side of the alveolar process of the lower jaw, infiltration anesthesia is performed at the point of transition of the mucous membrane of the alveolar process to the sublingual region. The amount of injected anesthetic does not exceed 0.5-1 ml, while anesthesia of the peripheral branches of the lingual nerve is achieved.
During the operation of tooth extraction and operations on the bone of the alveolar process of the jaws, infiltration anesthesia along the transitional fold is carried out by introducing an anesthetic under the mucous membrane. The introduction of an anesthetic under the periosteum should not be carried out, as this leads to pain not only during anesthesia, but also in postoperative period. The anesthetic solution diffuses well through the periosteum into the bone tissue - anesthesia occurs in 5-7 minutes.
Subperiosteal administration of a local anesthetic can be performed with an intervention on the pulp.
When anesthetizing 2 teeth distant from each other, the needle should be changed between injections, since the tip of the needle becomes infected.
If conventional infiltration anesthesia is ineffective, when a depot of an anesthetic solution is created under the mucous membrane of the alveolar process or under the periosteum, intraosseous (intraseptal) anesthesia can be performed by injecting an anesthetic directly into the cancellous bone of the alveolar process between the roots of the teeth.

Intraseptal anesthesia

Intraseptal (intraseptal) anesthesia is a type of intraosseous anesthesia and consists in the introduction of a local anesthetic solution into the bone septum between the holes adjacent teeth. The mechanism of its action is based on the distribution of the solution in two main ways, as with other intraosseous methods of anesthesia.
These paths are:
- medullary spaces around the sockets of the teeth, including the periapical areas where the nerve fibers are located,
innervating periodontium and pulp;
- intravascular bed - the solution penetrates and spreads through the blood vessels of the periodontium and bone marrow
space.

Due to this, during intraseptal anesthesia, blockade of nerve fibers of bone and soft tissues and bleeding of periodontal tissues occur, which is clinically determined by whitening of the gums around the injection site and enhances the analgesic effect due to additional hypoxic blockade of myelinated fibers.
Thus, with intraseptal anesthesia, a deeper pain relief develops than with conventional methods of anesthesia. In addition, the occurrence of hemostasis creates additional convenience during curettage and other surgical operations on hard and soft periodontal tissues ( patchwork operations, implantation operations).
With intraseptal anesthesia, as with other methods of intraosseous anesthesia, a small volume of solution is injected - 0.2-0.4 ml. The analgesic effect develops quickly (within no more than one minute) and is characterized by a rare occurrence of local and systemic post-injection complications. Unlike intraligamentary anesthesia, this method can be used with a lower risk of tissue infection.

The disadvantages of the method include a rather limited anesthetic area, which captures only the tissues adjacent to the injection site, a short period of anesthesia of the dental pulp due to the resorption of a small amount of the injected solution, as well as an unpleasant taste that may occur in the patient if the local anesthetic solution accidentally leaks from the injection site. .
The technique of intraseptal anesthesia consists in inserting a needle into the bone tissue of the septum. To do this, use a short needle of size 27, which is used to pierce the gum at an angle of 90 degrees to the surface. After the introduction of a small amount of anesthetic, it is immersed until it comes into contact with the bone and then, overcoming resistance, is injected into the bone tissue of the interdental septum to a depth of 1-2 mm. Slowly, in order to minimize the area of distribution of the anesthetic, 0.2-0.4 ml of the solution is injected.

It is necessary to dwell in more detail on two features of the technique for performing intraseptal anesthesia.
1. The needle injection point should be on a line mentally drawn in the middle between the two adjacent teeth; twirl
its calic size corresponds to the place where the inserted needle enters the top of the septum. This is due to the fact that in the lower jaw, where the use of intraseptal anesthesia is most indicated, the cortical layer has the smallest thickness at the top of the septum. Therefore, the mechanical resistance and the required depth of immersion in the bone will be less in this particular place, contributing to the successful implementation of the method. As a rule, the bony tissue of the septum is located 2-4 mm below the gingival prominence, but due to periodontal disease, this distance can vary greatly. To more accurately determine the location of the septum, x-rays should be used.
2. With the introduction of a local anesthetic solution, a distinct resistance to the movement of the piston should be felt, which is better expressed when using conventional syringes. The presence of resistance is a sign that the solution is being injected not into soft, but into bone tissues.
In addition, during administration, the solution should not enter the patient's oral cavity. If this occurs, then the needle should be redirected and it should be repeated to a greater depth.
This method of anesthesia is effective, simple, less traumatic and is not accompanied by post-injection pain.

Intraligamentous (intraligamentary) anesthesia

Intraligamentous (intraligamentary) anesthesia has become more widely used in all areas of dentistry. Its principle is to introduce an anesthetic solution into the periodontium under pressure necessary to overcome tissue resistance.
Intraligamentous anesthesia, like intraseptal, refers to periodontal methods of local anesthesia (Rabinovich, 2000). The designation "Intraligamentous anesthesia" is not entirely correct, since the injector is not directly injected into the ligament, but most authors still use this term.
A feature of intraligamentary anesthesia is the fact that the anesthetic is administered at a higher pressure than with conventional anesthesia. If it is sufficient, then only a small part of the solution will be distributed along the slit-like periodontal space, while the main part of the liquid through the openings of Lamina cribriformis will pass into the intraosseous space of the alveolar bone, spreading from here to the periapical region, which proves the intraosseous nature of this anesthesia.

According to many properties, intraligamentary anesthesia stands out from the group of infiltration methods of local anesthesia: 1) minimal latency period: anesthesia occurs in the 1st minute from the moment of injection;
2) the maximum effect develops immediately and lasts up to the 20th minute;
3) the technique of anesthesia is quite simple and easy to master;
4) intraligamentary anesthesia is practically painless;
5) absence of soft tissue numbness during and after injection.
The latter property is very important not only for adult patients, professional activity which is associated with speech load. We consider this method to be especially useful in children's practice, since:
- prevented the formation of a hematoma and possible postoperative chewing of a numb lip, tongue or cheek;
- it is easier to carry out bite correction after therapeutic interventions;
- Potential drug toxicity is unlikely due to minimum quantity solution used.
Intraligamentary anesthesia is safer and easier to perform with special injectors. The requirements for them are:
- creating and maintaining a sufficiently high pressure during the injection;
- the presence of a system of dosed removal of the solution;
- the presence of an angular nozzle or a swivel head to change the angle of the needle in relation to the tooth;
- must be made of material that can withstand various ways sterilization;
- small weight, simplicity and convenience in work.
The applied injectors due to the reducer increase muscle strength doctor's hands and allow you to develop strong pressure.
Since the effectiveness of anesthesia in to a large extent depends on the technical capabilities of the instruments, we will give a brief description of the new generation syringes that are currently used for intraligamentary anesthesia.
The needle recommended for injection should have an outer diameter of not more than 0.3 mm, while the inner diameter of the cannula is 0.03 mm; needle length can be 10.12 or 16 mm. Its feature is the ability to bend without breaking. Since the width of the periodontal gap is 0.05-0.36 mm in the middle part of the root, the needle is not inserted deeply, and the solution is pushed under pressure.
The carpulated local anesthetic solution used for intraligamentary anesthesia must contain an amide series anesthetic and a vasoconstrictor.

Technique of intraligamentary anesthesia.

After removal of plaque and antiseptic treatment (for example, 0.06% solution of chlorhexidine bigluconate) of the entire surface of the tooth and the gingival groove around it, the anesthetic solution is injected under pressure into the periodontal space. The needle slides over the surface of the tooth at an angle of 30 degrees to the central axis of the tooth, pierces the gingival groove and penetrates to a depth of 1-3 mm until the doctor feels tissue resistance. Then the maximum pressure is developed by pressing the syringe handle for 7 seconds, as a result of which the solution is injected. Proper placement of the needle is indicated by strong tissue resistance.
Sometimes, with the correct insertion of the needle, there may be no flow of fluid. This is possible when the needle is pressed very tightly against the surface of the root or the wall of the alveolus, or when the needle itself is blocked. In the first case, you should change the position of the needle, in the second, check whether the solution passes through the needle. It is very important to monitor the flow of anesthetic: if a drop of anesthetic appears in the area where the needle was inserted, this indicates that the needle is incorrectly positioned and the solution comes out. In this case, it is necessary to change its position. The clinical sign of properly administered anesthesia is gingival ischemia around the anesthetized tooth.
The number of injections depends on the number of tooth roots. Anesthesia of a single-rooted tooth requires 0.12-0.18 ml of solution. The main requirement is its slow introduction. When working with an injector with a dispenser of 0.06 ml, this amount of solution is injected within 7 seconds. For a single-rooted tooth, the introduction is repeated 2-3 times with an interval of 7 seconds. At the end of the injection, the needle is not recommended to be removed immediately: you should wait another 10-15 seconds so that the solution does not come back.
Anesthesia is carried out from the proximal surfaces of the tooth (medial and distal), that is, at each root. Thus, 0.12-0.18 ml of anesthetic is enough to anesthetize a single-rooted tooth, 0.24-0.36 ml for two-rooted teeth, and 0.24-0.36 ml for three-rooted ones (for upper molars an anesthetic of the training root is additionally injected) - 0.36-0.54 ml.

At conservative interventions(dental treatment for caries and pulpitis), as well as the preparation of teeth for crowns during anesthesia, it is necessary to carefully insert the needle into the periodontium to a depth of no more than 2-3 mm and release the solution very slowly, strictly observing the pauses between the introduction of each dose of the solution.
When removing teeth, intraligamentary anesthesia does not require sparing measures. In this case, both a deeper immersion of the needle and a more rapid introduction of the solution are acceptable.
In case of insufficient effectiveness of intraligamentary anesthesia in the treatment of acute and chronic forms pulpitis, an anesthetic solution can be administered intrapulpally using the same injector with a needle. The pre-opened area of the pulp is anesthetized by application.
The effectiveness of intraligamentary anesthesia is very high: 89% for therapeutic, 94% for orthopedic and 99% for surgical interventions. It should be noted that intraligamentary anesthesia is not effective for all groups of teeth: in 46% of cases, anesthesia of the canines on the upper and mandibles, slightly higher efficiency of anesthesia of the upper central incisors. Probably, the length of the root of these groups of teeth affects the success of anesthesia (Fedoseeva, 1992; Rabinovich, Fedoseeva, 1999).

Advantages of intraligamentary anesthesia:

1. High percentage of successful anesthesia - from 89% in therapeutic to 99% in surgical practice. Exception with
puts anesthesia of the canines and sometimes the central incisors of the upper jaw 46%.
2. Mostly painless administration of anesthesia.
3. The anesthetic effect appears almost immediately (after 15-45 seconds), which saves the time of the doctor and the patient.
4. The duration of intraligamentary anesthesia is sufficient for basic outpatient dental interventions (20 to 30 minutes).
5. Minimal use of an anesthetic (0.12-0.54 ml for anesthesia of one tooth) and a vasoconstrictor, which is especially important for streets with comorbidities.
6. Absence of shortcomings of conduction anesthesia - such as a long-term violation of nerve conduction, a long latent period, contracture, etc.
7. The possibility of replacing bilateral conduction anesthesia during interventions on the anterior teeth of the lower jaw.
8. The possibility of treatment in one visit to the teeth in the four quadrants of the jaws using the minimum
the volume of the anesthetic solution, the absence of discomfort in the patient during the injection.

Contraindications for intraligamentary anesthesia.

1. The presence of a periodontal pocket, unless tooth extraction is required.
2. The presence of acute inflammatory diseases periodontal tissues.
3. Treatment and extraction of teeth for acute and exacerbation of chronic periodontitis.
4. The presence of a history of endocarditis.
Intraligamentary anesthesia is a promising, highly effective, safe and simple method of anesthesia, providing adequate anesthesia for almost all outpatient dental interventions. For the patient, anesthesia is acceptable, since at the end of the intervention, not only the functions dental system not violated, but the injection itself does not cause negative emotions. Intraligamentary anesthesia can serve as both the main and additional method of pain relief, the development and use of which will improve the efficiency and quality of dental interventions.

Source rusmg.ru

This article will tell you:

what is application anesthesia;
why is it needed;
what are the contraindications for this method of anesthesia.

A variety of anesthetics are used in dental practice. The use of each pain medication is determined by the clinical situation and age category patient. Modern anesthetics effectively eliminate the pain that occurs during dental interventions. Analgesics can be given by injection deep into the soft tissues, but there is also superficial anesthesia - application anesthesia, in which the integrity of tissues is not violated.

Application anesthesia in dentistry, it is implemented by applying an anesthetic drug to the mucous membrane or tooth tissue. The drug penetrates to a depth of up to three millimeters, blocking nerve impulses in the area of application. The effect of such anesthesia is not very strong, and applications cannot be dispensed with for operations with dental nerves. However, they are quite effective if it is necessary to perform soft tissue surgery or provide preliminary anesthesia when it is planned to treat a child's teeth. Deep injection of anesthesia involves an injection, which can be painful for the baby. And if you anesthetize the injection site before the injection, the child will not feel pain.

Pediatric dentists most often resort to the application method of anesthesia, since superficial preparations are less harmful and do not cause either pain or fear, unlike other painkillers, for which syringes are used. Surface pain relievers come in the form of gels, sprays, solutions, etc. The doctor applies the drug to the desired area with a cotton swab or other improvised means. To enhance action medicinal substances the dentist can mechanically rub the anesthetic into the area to be treated.

Cleaning of tartar in contact with gum tissue.
Extraction of mobile milk teeth and pathologically mobile permanent teeth.
Treatment of sensitive teeth.
Removal of casts from the dentition in a patient with increased gag reflexes.
Anesthetize the injection area before the injection.
Treatment of the mucous membranes of the oral cavity.
Intervention in periodontal tissues.

Given these indications, we can say that application anesthesia is suitable for patients of any age. Most of the application preparations are non-toxic, and are safely used in the treatment of children (from two years old) and even pregnant women. Concerning general contraindications to the imposition of anesthetic applications, then only intolerance to the components of the treating substance is distinguished among them. But individual preparations may have particular contraindications and be harmful to children, diabetics, people with heart and vascular problems, as well as people with diseases of the endocrine system. The possible existence of contraindications before the introduction of any anesthetic drug should be evaluated by the dentist.

Types of drugs for application anesthesia

If application anesthesia is planned, the preparations for the procedure may differ according to the principle of action:

Anesthetics. This includes gels, ointments, aerosols based on anesthetics. The principle of their work is to block the nerve endings, and anesthetics are suitable for any case requiring the imposition of an anesthetic application. The most popular anesthetics include lidocaine, benzocaine, and tatracaine.
Dehydration. Carbonates (salts of carbonic acid) are removed from the dentinal tubules of fluid, thereby eliminating the symptoms of pathological sensitivity of hard dental tissues.
Physiological. Pastes based chemical elements or minerals can block pain. They clog the dentinal tubules, reducing the sensitivity of dental tissues.
Cauterizing. This category includes chemical substances strong action, eliminating the sensitivity of the teeth. Now they are trying not to use due to high toxicity.

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Advantages and disadvantages of applications

Application anesthesia, like any medical technique, has strengths and weaknesses. The advantages of the applications are as follows:

performance. The drug begins to work within a minute after its application.
Safety. The application of the drug to the surface of the periodontium eliminates the spread of the active substance outside the required area, as a result of which it minimizes Negative influence painkiller to the body.
Convenient form. Application preparations are very easy to apply to the required surface, and for children they even produce painkillers in the form of sweets to facilitate the work of the doctor and cheer up. little patient.

The disadvantages of the application method of anesthesia include:

Short duration. Depending on the strength of the drug, pain relief can last from ten minutes to half an hour, while anesthetic injections relieve sensitivity for an hour.
limited effect. The scope of application of painkillers is small due to their weak action.
Difficulty in dosing. so that the concentration of the anesthetic does not exceed allowable rate, and the drug has not penetrated into the bloodstream, the dentist must very accurately calculate the required dose, which is not easy to do, especially when working with aerosols.
Vasodilating action. This effect can cause bleeding gums.

Application anesthesia: price

What will be the cost of application anesthesia depends on the drug used. Please note that topical anesthetics are not suitable for home use, because their incorrect use can cause side effects. If a tooth hurts at home, you need to take an analgesic tablet (Paracetamol, Analgin, Aspirin). And in dental office You will have to pay about fifty hryvnias for application anesthesia.

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Local or topical anesthesia for dental purposes is used to relieve or reduce pain threshold gingival and mucosal areas. In this case, a drug is used that is absorbed by the oral mucosa and enters the tissues. This method is the ideal solution for minor surgical interventions. Below is information on how topical anesthesia is used in dentistry.

The actions of anesthetics are aimed at temporarily stopping the nerve endings, as a result, the person does not feel pain. The main advantages include the effectiveness and absolute safety of the drug, if the correct dosage is administered. Local anesthesia acts on a specific place and does not affect the state of the body as a whole, as with general anesthesia.

In children's dental clinics most often, such preparations are found in the form of a gel, supplemented with a pleasant fruit or berry aroma. In addition, anesthetics are available in the form of aerosols or ointments.

In dental procedures, anesthetic is used in such cases:

At .

With caries or.

Pulpe and.

Such drugs have two spectrums of action: the first belong to cauterizing agents, the other dehydration drugs belong to the group of anesthetics with a physiological effect. In the second case, their action is aimed at removing fluid from the tissues, which subsequently leads to the removal of pain. In this case, strontium or fluoride paste is usually used.

Superficial anesthesia is a freezing or lubrication of a certain area with anesthetic drugs. General anesthesia used in dentistry only in some cases, such as severe vomiting, during procedures on oral cavity, if you are allergic to local preparations and when many teeth are removed at once.

Painkillers are prescribed based on the patient's pain defect and general indications.

Operating principle

This method of anesthesia has fast action, which occurs due to the instant absorption of the drug into the tissues and mucous membranes. The principle of operation of application anesthesia depends on the agent used.

If the drug is applied to the mucous membrane, it is quickly absorbed from it and is also rapidly distributed throughout the tissues. Within a few seconds, the anesthetic reaches the nerve endings, blocks their action, and subsequently the patient's sensitivity decreases.

When compositions with strontium or fluoride paste are used as an anesthetic, their active components are directed to the micropores of the periodontium, while pain sensations are blocked.

In the case of using drugs with silver nitrate, pain is relieved by reducing the pores and vessels of the mucous membrane.

It does not matter how anesthesia will act, the effect is achieved in a period of several seconds, ending with minutes. The duration of the result obtained is stored for thirty minutes.

Varieties

Anesthesia can be classified according to the principle of action:

Moxibustion

This is the first method of pain relief in which strong drugs are used, such as: silver nitrate; zinc chloride, etc. With their help, not only the periodontium, but also dental tissues are subject to freezing.

When such drugs penetrate the tissues, they narrow the pores and thereby prevent any effect on the nerve cells. This method gave nice results, but did not become too common due to the substances used. Since they belong to the toxic group, when they enter the mucous membranes and tissues, they have a destructive effect on tooth enamel.

Dehydration

In this case, the drugs have dehydration properties that are aimed at reducing pain. In most cases, these are bicarbonates or carbonates, for example: potassium, sodium, etc. with a similar effect.

They reduce the sensitivity of tissues and teeth, as they remove moisture from enamel and dentin. This method is often used for minimal manipulations on the teeth and also for high-quality brushing of the teeth.

Compounds with a physiological effect

Such preparations include strontium, aspirin and sulfidine paste. Their action is directed to dentinal receptors, thereby stopping the transmission of impulses to nerve cells.

In addition, such pastes, or rather the substances contained in them, have therapeutic effect, as a result, they are used in the treatment of teeth with damaged enamel, etc. Periodic use of such compounds restores destroyed tissues and helps strengthen teeth.

Most well-known drugs surface anesthesia. With their help, you can quickly anesthetize the area on certain period time. For this specialists use anesthetics with a concentrated composition: lidocaine, tetracanine, etc. Substances quickly block the sensitivity of nerve endings.

Contraindications and side effects

Before choosing this method of anesthesia, you first need to consider all possible contraindications, if any, there are limitations in the application of such a method.

Main:

Allergic reaction to at least one of the components.
Diabetes.
Various heart diseases, such as a previous heart attack or stroke.
Improper functioning of the endocrine system.

A common contraindication to the use of local anesthetics is an allergic reaction. If application preparations are used in correct dosage, you can protect yourself from side effects as much as possible. An important point is that such anesthesia cannot be used alone at home.

In this case, you can choose another, more safe way. Namely, infiltration or application anesthesia is also a type of local anesthetic. But at the same time, it is necessary to understand that the first method is used only when the second one is not suitable for some reason. The main difference between these methods of anesthesia is that infiltration is administered by injection.

What drugs can be used? In the case of application anesthesia, such funds should be prescribed by a specialist. Because their range is quite wide.

List of drugs:

. One of the common drugs used for local anesthesia- both for adults and children in the treatment or extraction of teeth. It is found in pharmacies in the form of gels and ointments. It is also sold in liquid form.

"Tetrikain" ("Dikain"). Available in the form of a powder, ointment or liquid solution. because of toxic substances, included in its composition, is used extremely rarely. Not suitable for use on children.
. It can be purchased at pharmacies in the form of a glycerin or oil solution. It also refers to a local anesthetic, mainly used in dentistry by adult patients.

"Pyromecaine". Has good application performance. Available in the form of an ointment, and also administered with anesthesia.
Propolis solution, infused with alcohol, reduces pain.

The cost of drugs

In Moscow and the Moscow region, the price of local painkillers ranges from 80 to 200 rubles, slightly lower than the price of drugs administered by injection. In other regions of Russia, the cost may be lower.

This price is indicated for one dosage and, accordingly, for one procedure related to the oral cavity.

Possible Complications

Side effects after using these drugs are extremely rare. It could be: itching, allergic reactions, swelling, irritation of mucous membranes.

On the infants and pregnant women bad influence on the body of such anesthesia has not been fully studied. Therefore, it is not recommended for such patients.

The main guarantee of successful performance of dental operations using local anesthesia is a high qualification of the attending physician.

Application anesthesia is a method of pain relief applied without the use of injections. Here, the anesthetic is applied directly to the area that needs to be anesthetized. It can be both the mucous membrane and the surface of the skin, depending on which area it will be applied. this technique. If you are offered to use, for example, topical or, but you don’t know what it is, don’t worry, all these names are synonymous with application anesthesia and refer to the same type of anesthesia.

As we have already said, the technique of application anesthesia is successfully used in various branches of medicine. Let's take a closer look at where you can encounter it.

Application anesthesia in cosmetology

In cosmetology, there are a number of enough unpleasant procedures that require anesthesia in order to create the patient the most comfortable conditions. But at the same time, the use of injections in this case is not at all necessary, and application anesthesia comes to the rescue. If you do hair removal, artistic tattooing, Botox injections, piercings and other painful cosmetic manipulations, most likely the vulnerable spot will be treated with an anesthetic, which will significantly reduce the discomfort from the procedures.

In otorhinolaryngology

Here, the technique is used for minor surgical interventions, as well as for various manipulations in the nasal cavity.

In ophthalmology

Here, this technique is used to measure intraocular pressure, if it is necessary to remove a foreign object, with gonioscopy, with various, more or less simple surgical interventions on the cornea of the eye, and with a disease such as conjunctivitis.

In urology

Here, such anesthesia is successfully used when installing a urinary catheter, the urethral mucosa is processed. It is also possible to use this technique for other unpleasant procedures that accompany the treatment of diseases of the genitourinary tract.

In gynecology

Here, most often, a local anesthetic is treated with a portion of the cervix in the treatment of its erosion.

Application anesthesia in dentistry

We will talk about the use of local application anesthesia in dentistry in more detail, since this technique is used most often in this area.

Mainly, application anesthesia is common in pediatric dentistry, since this method is the most painless and causes the least fear in children. Application anesthesia preparations for children during dental treatment are available in the form of gels with a variety of pleasant tastes (for example, fruit, berry), which makes the anesthesia procedure not only painless, but also pleasant.

Indications for the use of such anesthesia in dentistry, except for childhood:

The so-called "pain before anesthesia", that is, a local anesthetic is applied to the place where, subsequently, an injection with a more serious medicine will be given
Suturing
Opening of abscesses located on the surface
Removal of mobile teeth in periodontal disease
Dressings
Punctures
Removing tires
For ulcers and erosions

Methodology

The mucous membrane must be dry before applying the anesthetic, so it is usually blotted with a cotton swab or dried in other ways.
The anesthetic is applied to a bandage swab and applied to the desired place for about 30-40 seconds (the time during which anesthesia occurs)
If the medication is released in the form of an aerosol, it is sprayed to the right place at a distance of 2-3 cm.
Typically, application anesthesia lasts about 15-20 minutes.

Preparations for application anesthesia

Anesthetics that are used to carry out this particular technique are available in various forms. It can be either a gel, or a liquid, or an aerosol. According to the technology of impact on the body, drugs are divided into cauterizing, dehydration, local and physiological effects.

Most often this method is used:

Very often in dentistry, a gel called Empla is used. It can be applied every ten minutes for an hour.

Possible complications and side effects

Even such a seemingly simple and safe method There are a number of side effects to be aware of.

First of all, it is worth noting that if you are allergic to any of the drugs used, this is an absolute and most important contraindication to the use of this technique.

It is allergy that is the most important side effect after such anesthesia. It can manifest itself in the form of a rash, redness, as well as swelling of the skin and mucous membranes. AT rare cases it is possible to develop a more severe reaction - anaphylaxis.

As a side effect, damage to the skin and soft tissues is also possible, especially if the dosage of the drug is incorrectly calculated. That is why the use of topical anesthesia at home is highly discouraged.

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All materials on the site are prepared by specialists in the field of surgery, anatomy and related disciplines.
All recommendations are indicative and are not applicable without consulting the attending physician.

Among the many methods of pain relief special place occupies application anesthesia, which is a non-injection application of an anesthetic drug to the surface of the mucous membrane. It has found wide application in dental practice, since many dental procedures do not require long-term anesthesia and may well be carried out through the use of special gels, solutions, aerosols.

Pain is one of the reasons that causes fear of dentists; not only kids, but also adults who are still clearly aware that they will have to treat teeth or other diseases of the oral cavity are afraid of it. Many people know that the moment of puncturing the gums for the introduction of an anesthetic is also quite unpleasant, it is also quite possible to be afraid of it. It is completely impossible to refuse anesthesia, because strong and unbearable pain in the process of manipulations on the teeth is provided.

Superficial, or application, anesthesia came to the aid of specialists and patients, which all more often chosen in the treatment of pathology of the oral cavity, teeth in both adults and young children. The absence of tissue puncture is not the only advantage of this type of anesthesia, there are others, but there are also side effects, as well as contraindications to the method.

Application anesthesia is called superficial not because it does not provide the proper level of loss of sensitivity, but because there is no need to pierce the tissues with a needle to inject anesthetics into them. Anesthesia is achieved by applying the drug directly to the gums or mucous membrane of the oral cavity, nasopharynx, to the skin.

Non-injection anesthesia in dentistry is possible because the mucous membrane of the gums is well supplied with blood, which ensures rapid absorption of the drug and a local anesthetic effect without a general toxic effect on the body. The relative safety of the method is especially relevant when working with children, who can be harmed by an excessive dose of an anesthetic injected with a syringe.

A very important advantage of surface anesthesia is its ease of implementation, because the application of an anesthetic does not require special equipment and special training of the doctor. At the same time, the procedure is completely painless.

In some cases, superficial anesthesia is used as an auxiliary step before deeper anesthesia. The use of a special gel makes the injection and subsequent infiltration of the tissue with an anesthetic painless, which is extremely comfortable for the patient and relieves discomfort even before the doctor starts treatment.

In addition to the dentist, this type of anesthesia can also be offered by a cosmetologist for a variety of cosmetic procedures. It does not lose its relevance in general surgery during some unpleasant procedures during general anesthesia.

Indications and contraindications for topical anesthesia in dentistry

Indications for application anesthesia are a variety of dental procedures in adults and children:

In children, milk teeth respond well to the application of anesthetics due to their structure, therefore, in pediatric dentistry terminal anesthesia is used for almost all types of treatment, as well as for tooth extraction. It does not scare the baby and allows you to feel comfortable not only for a small patient, but also for the treating specialist. The method is used in children after two years.

In addition to dentistry, application anesthesia is used in general anesthesiology when installing an endotracheal tube, a nasogastric tube, changing a tracheostomy, while lidocaine remains the most popular agent.

Contraindication cases of increased individual sensitivity to the components of drugs, allergic reactions in the past to the active substance, age up to 2 years are considered to be superficial (terminal) anesthesia. Dicain is not used in children under the age of 10 due to soy toxicity. These obstacles to the method are usually limited, since the drugs do not have a general adverse effect at the correct dosage used.

The safety of the method is high, but it is not recommended to use it on your own, at home. Treatment of oral pathology with local anesthetics is possible only as directed by a doctor, under his control and in compliance with the exact dose of the agent used.

If there are contraindications to superficial anesthesia, specialists resort to infiltration or conduction techniques, injecting drugs directly into the tissue or into the nerve trunks during major interventions.

Preparations for terminal anesthesia

For application anesthesia, the same substances are used as for other types of anesthesia, but they are enclosed in the form of a gel, ointment, spray and are contained in higher doses than in ampoules for injection.

Gel-based lidocaine, dicaine and promecaine, pyromecaine ointment are considered common., anestezin in the form of a solution or ointment, which are widely available and do not differ high cost. The drug of choice is lidocaine in the form of a spray, which can be used in both adults and children. In some cases, the drug with an anesthetic also contains antiseptic additives, flavorings, dye. The latter are often added to anesthetics for children.

Drugs, when placed on the surface of the mucosa, quickly penetrate to nerve endings deep by 3-5 mm and block the passage of nerve impulses through them, due to which the sensitivity disappears after a few minutes. Pain relief lasts about half an hour and affects both the nerve trunks with blood vessels and dense bone tissue.

The means used for application anesthesia may differ in the mechanism of action:

Anesthetic ointment, gel, spray eliminate the nerve impulse at local application(liquid of Platonov, Shinkarevsky, Hartmann);

Dehydration drugs remove water from the dentinal canals and thus eliminate sensitivity (salts of carbonic acid);

have a physiological effect mineral-based products(fluorine, strontium, calcium glycerophosphate in the form of pastes, sulfidine paste), which eliminate the feeling of pain, fill the dentinal tubules and retain water in them, preventing its leakage (shown with hypersensitivity teeth and pain)

Cauterizing preparations- these are chemical compounds with acids that "glue" the dentinal tubules, but they are not used because of the strong damaging and toxic effect.

Cooling anesthetics, such as chloroethyl, are not currently used in dentistry due to the risk of their penetration into respiratory system, as well as possible contact with unnecessarily sensitive teeth which will cause severe pain.

Aerosols not found wide application due to the large spray area and the difficulty with accurate dosing. High doses of these drugs can cause intoxication if they are rapidly absorbed into the blood. Children with a prolonged freezing effect can bite the tissues of the cheek or tongue, and adults most often feel subjective discomfort from prolonged anesthesia.

Anesthetics used by application include lidocaine, tetracaine, benzocaine and other substances, but they can be produced with different names - perylene ultra, xylonor, camistad and others. Spray with lidocaine for children has a fruity (banana, pineapple) taste.

Among the local anesthetics is propolis, which is a beekeeping product, but its strong allergenic effect does not allow its widespread use.

A very popular means of local anesthesia in dentistry is considered diplen-LH- a special film with analgesic and antiseptic properties for gluing to the mucous membrane. Contains chlorhexidine and lidocaine. The resorption of the film lasts up to 12 hours, so it can be left in the mouth after treatment.

Topex- a gel containing the anesthetic benzocaine. It is applied to the desired area for 1-2 minutes, after which anesthesia is achieved. Disilan is a benzocaine spray that relieves pain for no longer than a quarter of an hour. It can be used in children under 5 years of age.

The listed drugs can be used not only in dentistry or for anesthesia of mucous membranes. More than a decade ago, the drug began to be used ESMA, capable of penetrating the skin and combining water solubility with fat solubility. As part of the product - lidocaine and prilocaine, mixed in equal proportions in a water-oil emulsion.

ESMA can be used in surgery, cosmetology and anesthesiology. The cream is applied to the skin under the paper for compresses, left for 45-60 minutes, after which anesthesia occurs to a depth of half a centimeter. The duration of such application anesthesia is 1-2 hours.

ESMA cream can be used for puncture and catheterization of blood vessels, circumcision, sampling skin flaps for transplantation and other operations. For pain relief, use up to 2 grams of cream for every 10 square centimeters skin.

This drug can not be applied to mucous membranes, damaged skin, as well as children up to a month of life, and as side effects possible swelling, redness or blanching of the skin, itching.

In addition to the dentist, this type of anesthesia can also be offered by a cosmetologist for a variety of cosmetic procedures. It does not lose its relevance in general surgery during some unpleasant procedures during general anesthesia.

Application anesthesia in cosmetology

Cosmetology in last years is actively developing, and some methods of fighting for beauty, health and youth are being replaced by others that are possible only under conditions of anesthesia, so the application of an anesthetic is often a great way out for both clients and specialists in beauty salons.

The anesthetic must penetrate intact skin, so it is important to create the correct concentration at the site of manipulation. by the most popular drug local action considered EMLA (ESMA), containing lidocaine and prilocaine.

An hour before the cosmetic procedure, a cream is applied to the skin, during which time up to 3 mm of the depth of the skin is anesthetized. If you need a deeper anesthesia (maximum - half a centimeter), the effect of the cream can be increased. Required condition applications EMLA - an occlusive dressing that prevents the evaporation of liquid from the preparation.

The specified cream is usually well tolerated and gives a minimum adverse reactions. It is indicated for injection mesotherapy, correction age-related changes face and body skin, contouring, the introduction of drugs based on botulinum toxin, epilation.

In addition to ESMA, Anestol, containing lidocaine, tetracaine and benzocaine, is also used in cosmetology. The anesthetic is rapidly absorbed and gives lasting effect anesthesia (up to 2 hours). It must be applied a quarter of an hour before the manipulation, a bandage is not required. Anestol is indicated for tattooing, permanent makeup, mesotherapy, epilation, etc.

The most powerful application of anesthetics in cosmetology, Ane stop is considered a drug containing amecon, lidocaine, prilocaine, benzyl alcohol and other components. The gel is applied for 15-20 minutes, after which it is removed, but acts up to 1 hour, penetrates to a depth of 5 mm. The indications for its use are injection plastic faces.

In cases where a very rapid onset of anesthesia is required, xylocaine aerosol can be used, applied to the skin and giving an anesthetic effect after just a few minutes.

Application anesthesia technique, its advantages and disadvantages

The technique of surface anesthesia is extremely simple: the agent is applied to the surface of the mucous membrane or skin (ointment, gel, paste) or the tissue is treated with a spray. If it is necessary to anesthetize the soft tissues of the tooth (pulp) or dentin during caries, a cotton or cotton pad is applied to the desired area. gauze swab with the drug after drilling out a pathologically altered bone tissue tooth.

Before application, the anesthesia area is dried as much as possible with a swab or cotton swab. To provide highest efficiency anesthesia, places of saliva excretion are closed cotton swabs, and the tooth is covered with a latex sheet, fixed with a metal clip.

The effect of application anesthesia of large molars is lower than after injection infiltration of soft tissues, however, the depth of anesthesia allows for comfortable treatment. In addition, one should take into account the different sensitivity of different teeth to the drug, which requires the use different quantity anesthetics.

Benefits application anesthesia can be considered:

Rapid onset of analgesic effect;

Safety;

No general toxic effect;

The minimum number of adverse reactions and the possibility of application in pediatric dentistry.

To shortcomings method include difficulties with dosing the drug, especially if it is in the form of a spray or solution, as well as the potential toxic effect when excess is absorbed through the mucous membrane. Insufficient depth of anesthesia does not allow the use of anesthetics for prolonged and too painful manipulations.

What is the danger of topical anesthesia?

Although local application anesthesia is considered safe, yet it carries some risks. Complications rare but possible:

Allergy to the active substance and components of the drug - itching, swelling, redness of the mucosa at the site of application;

Severe allergic reaction up to Quincke's edema (very rare);

Upper irritation respiratory tract when using sprays and aerosols - breathing becomes difficult, hoarseness appears;

General toxic effect when the recommended dose is exceeded.

Sufficient data on the safety of topical use terminal anesthesia pregnant women and babies under 2 years old do not, so it is better for such patients to refrain from this kind of anesthesia.

Application anesthesia is a great alternative injection techniques anesthesia in cases where the planned intervention is not too long or too painful. It helps the patient not to feel pain while being conscious, and the specialist to calmly carry out manipulations.

The most important circumstance that ensures the safety, quality and effect of pain relief is the experience of a specialist who must correctly calculate the safe dose of drugs, so it is important to decide in advance where the treatment will take place, and it is worth discussing pain relief options and possible risks with the doctor in detail.