Anesthesia in dentistry, types of anesthesia, contraindications and features. Painkillers in dentistry Dental anesthetics

The fears associated with pain during the treatment and extraction of teeth are due to the fact that there were no high-quality anesthetic drugs before. But today, almost all dentistry clinics use local anesthetics of a new generation. Modern drugs allow you to completely eliminate pain, not only during the main operation, but even at the time of their introduction.

Anesthesiology in dentistry

Anesthesia is called the absolute disappearance or partial reduction of sensitivity in the whole body or its individual parts. This effect is achieved by introducing special preparations into the patient's body that block the transmission of a pain impulse from the area of ​​intervention to the brain.

Types of anesthesia in dentistry

According to the principle of impact on the psyche, there are two main types of anesthesia:

• Local anesthesia, in which the patient is awake, and the loss of sensitivity occurs exclusively in the area of ​​​​future medical manipulations.
• General anesthesia (narcosis). During the operation, the patient is unconscious, the whole body is anesthetized and the skeletal muscles are relaxed.

Depending on the method of supplying the anesthetic into the body in dentistry, injection and non-injection anesthesia are distinguished. With the injection method, the anesthetic drug is administered by injection. It can be administered intravenously, into the soft tissues of the oral cavity, into the bone or periosteum. With non-injection anesthesia, the anesthetic is supplied by inhalation or applied to the surface of the mucosa.

General anesthesia in dentistry

General anesthesia is the complete loss of sensitivity of nerve fibers, accompanied by impaired consciousness. In dentistry, anesthesia for dental treatment is used less often than local anesthesia. This is due not only to the small area of ​​the surgical field, but also to a large number of contraindications and possible complications.

General anesthesia can only be used in those dental clinics that have an anesthesiologist and resuscitation equipment that may be required in case of emergency resuscitation.

General anesthesia in dentistry is necessary only for long-term complex maxillofacial operations - correction of the "cleft palate", multiple implantation, surgery after injury. Other indications for the use of general anesthesia:

• allergic reactions to local anesthetics;
• mental illnesses;
• panic fear of manipulations in the oral cavity.

Contraindications:

• diseases of the respiratory system;
• pathology of the cardiovascular system;
• intolerance to anesthetic drugs.

The anesthetic may be given by injection or by inhalation. Nitrous oxide, commonly known as laughing gas, is the most commonly used general anesthesia drug among dentists. With the help of an intravenous injection, the patient is immersed in a medical sleep, for this, drugs that have a hypnotic, analgesic, muscle relaxant and sedative effect are used. The most common are:

• Ketamine.
• Propanidide.
• Hexenal.
• Sodium hydroxybutyrate.

Local anesthesia in dentistry

In dental treatment, local anesthesia is most in demand, aimed at blocking nerve impulses from the area of ​​the surgical field. Local anesthetics have an analgesic effect, due to which the patient does not experience pain, but retains sensitivity to touch and temperature.

The duration of anesthesia depends on how and what exactly dentists anesthetize the surgical field. The maximum effect lasts for two hours.

Local anesthesia is used for the following procedures:

• turning under the bridge or crown;
• pin tooth extension;
• implantation of implants;
• channel cleaning;
• surgical treatment of gums;
• removal of carious tissues;
• extraction of teeth;
• excision of the hood over the wisdom tooth.

Types and methods of local anesthesia in dentistry

Depending on what area and for how long it is necessary to desensitize, the dentist selects the optimal technology, medicine and its concentration. The main methods of administering an anesthetic are:

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

Infiltration method

It is used in dental practice and maxillofacial surgery. The advantage of the method is a quick action, a long analgesic effect, the possibility of repeated administration during a protracted operation, the rapid removal of the anesthetic from the body, and deep analgesia of a large area of ​​tissues. About eighty percent of dental interventions are performed under infiltration anesthesia.

The method is applied with the following manipulations:

The anesthetic medicine is injected in layers, first under the mucous membrane at the top of the tooth root, and then into the deeper layers. The patient feels discomfort only at the first injection, the rest are completely painless.

There are two types of infiltration dental anesthesia - direct and diffuse. In the first case, the injection site of the anesthetic is anesthetized directly, in the second case, the analgesic effect extends to the nearest tissue areas.

For local infiltration anesthesia in dentistry, the following drugs are used:

• Procaine.
• Lidocaine.
• Mepivacaine.
• Ultracain
• Trimecain.

Intraligamentary (intraligamentous) method

It is a modern type of infiltration anesthesia. The dose of the administered anesthetic is minimal (does not exceed 0.06 ml), which makes it possible to treat and remove teeth in pregnant and lactating women.

The anesthetic is injected into the periodontal space with a special syringe and under high pressure. The number of injections depends on the number of roots of the tooth. Sensitivity to pain disappears instantly, without causing a feeling of numbness, so the patient can speak freely and does not feel discomfort after the operation.

Restrictions to the use of the method are:

• The duration of the manipulation is more than 30 minutes.
• Fang manipulations. Due to anatomical features, it is not always possible to anesthetize them intraligamentally.
• Inflammatory processes in the periodontium, periodontal pocket, flux.
• Radical cyst of the tooth.

The intraligamentous method of anesthesia is the most painless and safest in dentistry, so it is often used in pediatric practice. Ease of implementation, painlessness, safety and high efficiency makes the method popular among dentists. The cost of such a procedure is higher than infiltration due to the high prices for injectors.

For intraligamentous anesthesia in dental treatment, the following drugs are used:

• Ultracain.
• Trimecain.
• Lidocaine.

Stem (conductor) method

Distinctive features of the stem method of anesthesia are the power and long duration of the effect. It is used during long-term surgical operations and in situations where it is necessary to block sensitivity in the tissue area of ​​the entire lower or upper jaw.

Indications for conductive anesthesia are:

• pain syndrome of high intensity;
• neuralgia;
• removal of cystic formations;
• endodontic treatment;
• severe injuries of the jaw and zygomatic bone;
• curettage;
• complex tooth extraction.

The injection is injected into the region of the base of the skull, due to which it is possible to block two jaw nerves at once - both upper and lower. An injection is performed by an anesthesiologist and exclusively in a hospital.

Unlike all other methods of local anesthesia, the stem one does not affect the nerve endings, but completely on the nerve or group of nerves. The anesthetic action takes one and a half to two hours. Novocain and Lidocaine are considered to be the basic preparations; more effective agents are used in modern anesthesiology.

Application method (surface, terminal)

It is used mainly in pediatric dental practice to desensitize the place where the anesthetic will be injected, which ensures the absolute absence of pain. As an independent method, it is used in cases where it is necessary:

For application anesthesia in dentistry, painkillers are used in the form of a spray, ointment, paste and gel. Most often, dentists use ten percent lidocaine in an aerosol as an analgesic. The drug penetrates deep into the tissues by 1-3 mm and blocks the nerve endings. The effect lasts from several minutes to half an hour.

Intraosseous (spongy) method

It is used to anesthetize the lower molars, during the extirpation of which infiltration and conduction anesthesia are ineffective. Instantly eliminates the sensitivity of one tooth and the adjacent gum area. The advantage of the method in the field of dentistry is a strong pain relief at low doses of the drug.

Classical intraosseous anesthesia in anesthesiology has not received wide application, due to the complexity of implementation and trauma.

The essence of the method is the introduction of an anesthetic into the spongy layer of the jawbone between the roots of the teeth. Preliminary infiltration anesthesia is performed. After numbness of the gums, the mucosa is dissected and the cortical bone plate is trepanated with the help of a drill. The drill is deepened into the spongy tissue of the interdental septum by 2 mm, after which a needle with an anesthetic is inserted into the formed channel.

Contraindications for local anesthesia

Before prescribing local anesthesia to a patient, the dentist must find out if there are any contraindications to its implementation. The doctor should take special precautions when prescribing anesthesia to children and expectant mothers.

Contraindications to local anesthesia are:

• allergic reactions to drugs in history;
• diseases of the cardiovascular system;
• had a stroke or heart attack less than six months ago;
• diabetes;
• hormonal disorders and pathologies of the endocrine system.

Modern anesthetics (painkillers) in dentistry

With the advent of local anesthetics and new generation technologies, the usual Novocain is almost never used in the field of dentistry, especially in Moscow and other large cities. Despite possible complications and a high percentage of allergic reactions, lidocaine remains the main local anesthetic in regional clinics.

When visiting the clinic, you need to provide the attending physician with a complete and reliable history so that he can eliminate all risks and choose the right drug. Most dental clinics use carpool technology to administer anesthetics, which means that the active substance is contained in a special disposable carpule, which is inserted into a syringe without opening manually. The dose of the drug in the carpule is designed for one injection.

Articaine and Mepivacaine formed the basis of modern local anesthesia drugs. In the form of carpool capsules, Articaine is produced under the names Ultracaine, Septanest and Ubistezin. The effectiveness of drugs based on it exceeds the effectiveness of lidocaine by 2, and novocaine by 5-6 times.

In addition to Articaine itself, the carpule contains adrenaline (epinephrine) and an auxiliary substance that promotes vasoconstriction. Due to vasoconstriction, the period of action of the anesthetic is prolonged, and the rate of its distribution into the general circulation decreases.

Patients with endocrine disorders, bronchial asthma and a tendency to allergic reactions in dentistry are usually prescribed anesthetics without adrenaline. If powerful pain relief is required, the use of Ultracaine D with a minimum concentration of epinephrine is acceptable.

Anesthesia without adrenaline in dentistry

Mepivacaine is used to treat patients with contraindications to adrenaline in dentistry. The drug with this active ingredient, produced under the name Scandonest, is less effective than Articaine. But it does not include epinephrine, so Scandonest is suitable for administration to children, women in position, people with heart disease, individual intolerance to adrenaline.

In diseases of the endocrine system, Scandonest and drugs without adrenaline are more often used. It is unacceptable to use drugs with vasoconstrictor components for hypertension.

The type of anesthesia used by dentists determines not only the degree of painlessness of the medical intervention, but also the list of consequences that will be encountered after the operation. Modern means minimize the risks associated with incorrect administration of the drug, incorrect dosage and the occurrence of allergic reactions to the anesthetic.

Painlessness is already a familiar principle of modern dentistry. Treatment should not cause discomfort, and even more so - be accompanied by stressful sensations, fear.

Most dental procedures are performed under anesthesia. Anesthesia methods are selected depending on the individual characteristics of the body, age and health status, patient preferences and the complexity of treatment procedures.

Methods and types of anesthesia

Local and general anesthesia

There are two main types of anesthesia - local and general. In the first case, pain sensitivity is "turned off" with the preservation of human consciousness and other types of sensitivity (to touch, exposure to cold). In the second - a temporary and reversible loss of consciousness, accompanied by complete anesthesia of the whole body and relaxation of the skeletal muscles.

Local anesthesia is indicated for simple and short procedures - it is the most popular in dental practice, since it has practically no contraindications.

The general one is recommended for complex and time-consuming maxillofacial operations, as well as in cases where the patient does not adequately respond to treatment, experiences a panic fear of the dentist, etc. It has many contraindications and sometimes causes a number of complications, therefore it is practiced only in exceptional cases.

Anesthesia methods

Both types of anesthesia are carried out in the following ways: injection and non-injection.

Injection anesthesia is given by injection - the drug is injected into the tissues of the mucous membrane of the oral cavity, into the periosteum or bone, intravenously. With non-injection anesthesia, the drug is applied to the surface of the mucosa, delivered through inhalation - that is, it is inhaled through the lungs.

Local anesthesia

It is aimed at blocking nerve impulses in the area of ​​the surgical field. On average, the effect of it lasts 1-2 hours. Patients do not feel pain, but they feel touch, cold.

In dentistry, it is most often used for:

• preparation of carious tooth tissues;
• canal treatment;
• removal of a cyst;
• turning under the crown or bridge;
• excision of the hood over the "eight";
• implantation of the implant;
• operations on the gums;
• removal of teeth.

There are several types of local anesthesia depending on the technology, the method of influencing the tissues and the duration of the effect.

Let's consider them in more detail:

General anesthesia

General anesthesia is rarely used in dental practice. And only in those clinics where there is a full-time position of an anesthesiologist and the equipment necessary for the "supply" of anesthesia to the patient and in case of emergency resuscitation, which may be required in case of complications.

Most often, general anesthesia is indicated for people who experience a panic fear of dentists, as well as for complex long-term operations - multiple implantation, correction of the so-called cleft palate, etc.

General anesthesia according to the method of "feed"

• inhalation - a vaporous anesthetic or narcotic gas is inhaled through the nose using a special mask;
• non-inhalation - intravenous administration of the drug.

Sometimes these two types are combined. For example, with extensive operations on the face.

The main disadvantages of general anesthesia are a large number of contraindications and a high likelihood of complications.

Inhalation anesthesia: 1. Inhale, the valve is open. 2. Exhale, valve closed

Preparations

For local anesthesia

Are used:

• ultracaine - in pure form or with epinephrine, which constricts blood vessels and provides a prolonging effect;
• ubistezin - similar in action to epinephrine-containing ultracaine;
• septanest - an alternative to ubistezin and ultracaine, contains preservatives;
• scandonest - for patients who are contraindicated in drugs with epinephrine and adrenaline in the composition (including suitable for asthmatics, hypertensive patients, diabetics).

The first three names are preparations based on articaine, a potent anesthetic that has received the widest use in dentistry.

The injections are performed with special cartridge syringes with the finest needles - only 0.3 mm in diameter. They are twice thinner than ordinary medical needles and are practically not felt by patients.

To ensure the longest possible anesthetic effect, bupivacaine is also used - it “works” up to 13 hours, but it is highly toxic.

But for injections in modern clinics, lidocaine is no longer used - as well as novocaine, trimecaine - they are too toxic and have low efficiency.

For general anesthesia

For inhalation anesthesia, doctors most often use nitrous oxide, trichlorethylene. For intravenous use - ketamine, hexenal, propanidide, sodium hydroxybutyrate and other drugs that have hypnotic, sedative, muscle-relaxant properties.

Complications

The most common complications after local anesthesia:

• soft tissue injury - while the anesthetic is still acting, you need to be careful not to accidentally bite your lip, cheek, tongue;
• bruise - hematomas occur if during the injection the needle touched the vessel.

Other complications include spasms of the masticatory muscles (in case of injury with a needle), an allergy to an anesthetic drug, and a temporary loss of sensation in the facial muscles. Even more rarely, the needle breaks off, in isolated cases - infection.

It should be noted that complications from local anesthesia are extremely rare. This is the safest and easiest form of anesthesia.

But from general anesthesia, complications occur more often:

• nausea;
• vomit;
• fainting, collapse;
• inappropriate behaviour.

The most dangerous consequences are a violation of respiratory and cardiac activity, in which death can occur without resuscitation.

Application in pediatric dentistry

The two most commonly used types of anesthesia used by pediatric dentists are topical and intraligamentous. The combination of these two types allows for a completely painless medical intervention.

Before starting the treatment of caries or pulpitis, removing a tooth or opening a flux, a pediatric dentist treats the area around the problem area with an anesthetic in the form of a gel, ointment or spray with lidocaine (lidocaine is contained in preparations for application anesthesia in low concentrations that are not dangerous for the child's body) .

When the mucosa "goes numb", the doctor, using the thinnest carpule needle, performs intraligamentous anesthesia - at this moment the child does not feel any discomfort. The first injection is administered a small amount of medication - 0.1-0.2 ml. After a minute or a minute and a half, the doctor injects the rest of the dose - so the child does not feel the process of passing the game inside the soft tissues.

The safest injectable drug for babies under five years old is Scandonest or Septanest without adrenaline in the composition. For children over five years old, ultracaine with a low concentration of adrenaline (1:200,000) is suitable.

In no case are such drugs toxic for a fragile organism as dikain, amethocaine, tetracaine used in pediatric dentistry!

During pregnancy and breastfeeding

Breastfeeding is not a contraindication to anesthesia. Modern anesthetics are used in small doses and are excreted from the body quickly - from 20 minutes to 2 hours. Given this time, it is better for mothers to feed the child immediately before going to the doctor or express milk in advance.

But during the bearing of a child, it is better to refuse the use of anesthetics. If you still cannot do without them, it is recommended to plan a trip to the dentist during the second trimester. At this time, the likelihood of complications is the lowest.

Preference should be given to gentle agents that are administered in low concentrations and have the shortest effect. Mepivacaine and bupivacaine are contraindicated for pregnant women! These drugs can cause a slowing of the fetal heart rate. And filipressin and octapressin can cause uterine contractions!

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

To prick or not to prick?

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

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

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

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

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

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

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

Replacement for cocaine

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

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

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

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

Amide instead of ether

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

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

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

“Dentists can only use it at 2% concentration, but there are ampoules of lidocaine at 10% concentration,” 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 together with drugs that narrow them - vasoconstrictors. Therefore, for injection, the doctor can only use a 2% solution. A higher concentration is sometimes used for superficial anesthesia. However, in this case, it is also important to remove excess anesthetic, ”the expert warned.

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

Choosing a dentist

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

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

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

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

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

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

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

The main thing is not to be silent

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

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

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

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

“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.

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

In dentistry, there are four methods of local anesthesia:

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

Carpool anesthesia in dentistry

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

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

Used drugs

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

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

Anesthesia during pregnancy

Sedation

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

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

FAQ

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

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

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

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

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

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

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

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

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

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

What pain reliever is indicated for children with toothache?

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

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

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

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

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

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

The history of the discovery of local anesthetics is quite interesting, check out the classification of local anesthetics by generation below.

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

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

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

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

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

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

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

Requirements for local anesthetics

An anesthetic for effective use must present certain functional properties:

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

Classification of local anesthetics

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

Chemical classification of local anesthetics

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

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

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

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

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

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

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

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

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

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

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

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

Diluent acts as a preservative for vasoconstrictor agents. Vasoconstrictors are unstable in solution and can oxidize, especially with prolonged exposure to sunlight.

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

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

The composition of the local anesthetic Lidocaine-Adrenaline

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

Contraindications to the use of local anesthetics

Complications from local anesthetic

Local anesthetics can cause various side effects, among which are and. As a rule, these side effects develop after the administration of the drug without prior collection of an allergic history. It is for this reason that you should always monitor the main parameters of life, take special care and take into account the patient's history. The general condition may manifest as disorders of the central nervous system (CNS) or cardiovascular system (CVS).

Neurotoxicity

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

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

These are the so-called warning symptoms that can occur with the introduction of minimal doses of local anesthetic. If these symptoms occur, you should:

• immediately stop the injection of the drug
• give 100% oxygen
• advise the patient to "deep breath" (to create hyperventilation)
• prevent the development of hypoxia and acidosis, which increase the toxicity of the local anesthetic (an “ion trap” develops)
• in case of seizures, propofol or benzodiazepines can be used
• to prevent the development of hypoxia and acidosis, the possibility of providing muscle relaxants, intubation and the start of mechanical ventilation should be considered.

Cardiotoxicity

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