Anesthetics for application anesthesia in dentistry. Application anesthesia: areas of application, indications, conduct, preparations. How does anesthesia work?

Treatment dental diseases rarely resolves without injection into the affected area. Most of patients are afraid of the injection no less than the treatment procedure itself.

To make the process of administering the anesthetic more comfortable, application anesthesia is used before the injection.

What it is?

Application type anesthesia is a non-injection method of pain relief of oral tissues, which is achieved by applying a concentrated anesthetic to a limited area of the intended effect.

As an anesthetic application, not only medicines are used, but also methods of physical chemical exposure, at which the tissue oral cavity are cooled or cauterized, due to which they become less sensitive.

For dental intervention most often used drug application anesthesia in the form of an ointment, spray, gel. Many of these products have additional aromatization, which makes the process of use more comfortable.

Mechanisms of action

Application anesthesia is different quick action, which is achieved due to the instant penetration of the drug into periodontal tissues. The mechanism by which sensitivity blockage develops will depend on the type of application.

When applied to the mucosa of an anesthetic, it is absorbed into the mucosa and quickly distributed throughout its cells. In a few seconds, the tool reaches and blocks nerve endings leading to pain relief.

If fluoride or strontium paste was used as an application anesthesia, then the blockade pain It is carried out by blocking the micropores of the periodontium, thereby eliminating the effect on the nerve fibers.

When using silver nitrate or dehydration agents, pain relief occurs due to the narrowing of the vessels and pores of the mucosa.

Regardless of the mechanism of action surface anesthesia, the analgesic effect appears after a few seconds or minutes, and can last up to half an hour.

Kinds

Based on the mechanisms of development of the anesthetic effect, several types of application anesthesia have been identified.

Moxibustion

One of the first types of superficial anesthesia, in which potent aggressive drugs were used: nitric and carbolic acid, zinc chloride, silver nitrate. These funds were used not only for freezing the periodontium, but also for dental tissues.

At the time of application, there was blockage and narrowing of the pores that closed the nerve endings from any impact. Cauterization gave results for short period time, but never received distribution due to the aggressiveness of the substances used.

They are highly toxic and, when applied directly, damage tooth tissues, pulp, and the surrounding periodontium.

Dehydration

This type is relief of tooth sensitivity, due to the use of substances with dehydration properties. Basically, they use bicarbonate or carbonate: sodium, magnesium, potassium, as well as other trace elements with similar properties.

Means can slightly reduce sensitivity due to dehydration of enamel and dentin. This method is often used for professional cleaning teeth or with minor manipulations on them.

Means of physiological action

As a means of physiological action, sulfidine, aspirin, glycerophosphate, strontium paste are isolated. They differ specific impact on dentine receptors blocking the transmission of impulses to nerve endings.

In addition to the analgesic effect, these substances have a pronounced therapeutic effect, and therefore are often used in the treatment of teeth with pathological enamel or dentin. Regular use restores the structure of damaged dental tissue and strengthens healthy areas of the teeth.

Local painkillers

The most common type of surface anesthesia. They allow quickly stop sensitivity and accurately calculate the time of drug exposure.

For the procedure, concentrated anesthetics are used: benzocaine, lidocaine, tetracaine, which can quickly eliminate the conductivity of peripheral nerve fibers.

Indications and contraindications

The main indication for the use of topical anesthesia is increased anxiety patient before an injection with an anesthetic drug. Even in the absence excessive stress, preliminary treatment with an anesthetic reduces the psychological discomfort of the patient, which has a positive effect on the work of the dentist.

Especially often, this type of anesthesia finds its application in pediatric dental practice. According to the observations of doctors, the most terrible or unpleasant moment, children consider not treatment or tooth extraction, but an injection into the gum.

In addition to these factors, indications for the use of superficial anesthesia include:

professional cleaning;
removal of the neurovascular bundle of the pulp;
any effect on the periodontium;
opening of purulent capsules of gum tissue;
extraction of temporary or permanent mobile teeth;
fixation of orthodontic appliances, crowns, prostheses;
treatment of stomatitis, gingivitis;
expressed vomiting reflex when taking impressions.

A contraindication for superficial anesthesia is sensitivity or allergic reaction on the components of the tool used. For drugs that contain lidocaine, age up to 10 years is a contraindication.

Advantages and disadvantages

The advantages of this type of desensitization, first of all, include the speed of drugs. In addition, there are a number of positive sides applications:

safety. Since the substances are applied only to the surface of the periodontium, their general negative impact is excluded;
duration of exposure, which, depending on the concentration of the active substance, lasts from 10 to 30 minutes;
minimum side effects so that anesthetics can be used in young children.

Despite serious advantages, surface application of anesthetics has certain disadvantages. The main ones include:

the impossibility of accurate dosing of the drug. As a result of the application high concentration an anesthetic, it enters the bloodstream, where it exerts toxic effect. Particularly inconvenient in this regard are aerosols;
lack of deep analgesic effect, due to which the scope of the application method is reduced;
expressed vasodilating action which can lead to bleeding gums.

The listed shortcomings are easily eliminated by substituting one agent for another, and by strictly observing the methodology for conducting the procedure of superficial anesthesia.

What drugs are used?

To relieve the sensitivity of dental and periodontal tissue, agents are used that contain the following substances as an anesthetic:

lidocaine;
dikain (tetracaine);
bumecaine (pyromecaine);
benzocaine (anesthesia).

The preparations are presented for use in dental purposes in a wide range in different forms: gels, ointments, aerosols, films, oil-based or water-based emulsions.

Often, in addition to the main active ingredient, the composition may include flavors, antiseptics, anti-inflammatory components.

The most popular means include:

Diplen LH

It is a film with analgesic and antibacterial properties, intended for sticking to the affected area.. The film consists of a hydrophobic and hydrophilic layer, with sorption capacity.

They are impregnated with chlorhexidine and lidocaine. After sticking the film, the effect appears within 1 minute. The injection is made directly through the film.

It can be left after the intervention, as the layers dissolve after 12 hours.

Topex - benzocaine-based gel

It is applied to the problem area for at least 1-2 minutes. The consistency of the gel allows you to accurately treat the mucosa without affecting the healthy area.

Disilan

This drug is in the form of a spray, the main active substance which is also benzocaine. The drug relieves sensitivity for no more than 15 minutes.

A small concentration of the main substance makes it possible to use the product in children from 5 years.

Desensetin

belongs to the most fast-acting drugs. It contains lidocaine, which has an effect within 10 minutes after application.

Methodology

A high effect of anesthetic application will be ensured only if it is proper conduct, with the observance of certain technology . Before applying the anesthetic, the mucous membrane and the surface of the tooth are treated with an anesthetic and dried.

Then the drug is rubbed into the mucous membrane or the necessary area is irrigated with it. If the dosage is observed, the depth of anesthesia will reach up to 3 mm. The continuation of the action of the agent will depend on the main substance and its concentration.

The acceptable pain relief range is 10-30 minutes. For a longer relief of sensitivity, the substance is applied repeatedly.

Side effects

As side effects speaks long recovery full sensitivity of the mucosa. In children, this can lead to injury due to biting.

For adults given state associated with psychological discomfort, which in the future may be the cause of development.

In conclusion, we suggest watching a video about another type of anesthesia used in modern dentistry:

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Many dental procedures are painful, uncomfortable and causing discomfort. In the course of their implementation, involuntary defensive reflexes, arising as a reaction to pain, which, in turn, is fraught with damage to healthy tissues, because usually such manipulations are carried out using sharp instruments.

To minimize pain during the elimination of dental defects, the use of local anesthesia. It provides comfort during dental procedures and their high-quality full implementation. One option is application anesthesia, which is used to anaesthetize superficial skin and mucous membranes.

What is application anesthesia and the method of its implementation

Application anesthesia is a type of superficial anesthesia, which is carried out by applying special concentrated agents to the required limited area of the skin and mucous membranes, without the use of injections. The applied drugs instantly spread their action to a depth of up to 3 millimeters, blocking the impulses of nerve fibers located on the surface from the first seconds or minutes after application.

The drugs that are used are available in the form of gels, ointments, solutions and sprays. It is possible that the dentist rubs the product manually in order to accelerate and enhance the effect of the drug. When spraying an aerosol, the drug also enters other parts of the oral cavity, which is not always desirable.

Medicines are not the only way implementation of anesthetic application. Anesthesia can be carried out by physical or chemical effects, for example, cooling or cauterization.

The doctor should select the type of anesthesia and the remedy for it, taking into account the direction of the future manipulation and the characteristics of the patient's body.

It is possible to ensure the effectiveness of the application as a result of its correct implementation:

Before proceeding with the anesthesia procedure using an anesthetic application, you should check whether the selected agent causes allergies.
The mucous membrane and tooth surface are preliminarily dried.
An anesthetic is applied cotton swab or rubbed into the oral mucosa.
In the absence of effect or to prolong the analgesic effect, the procedure is repeated. Depending on the treated tooth, the dosage varies, since each tooth has its own sensitivity threshold.

Types of application anesthesia

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In such a method of superficial anesthesia as application anesthesia, there is a certain classification, which is based on the methods of exposure. In total, four types of it are distinguished - cauterization, dehydration, physiological and local effects:

Moxibustion. With this method, due to the narrowing and blockage of the pores, the nerve endings are closed from any impact. Cauterization is carried out using aggressive substances, including nitric and carbolic acids, zinc chloride, silver nitrate solution. Since they are toxic and their use is often accompanied by damage to the dental and pulp tissue, the method is not widely used.
Dehydration. A decrease in the sensitivity of tissues to pain is due to the use of agents that reduce the amount of fluid in the enamel and dentin. These include bicarbonate or carbonate of sodium, magnesium, potassium and other elements with similar qualities.
Physiological impact. When applied special paste, for example, aspirin, strontium, glycerophosphate or sulfidine, the transmission of pain impulses to the nerve endings is blocked. In addition to anesthesia, it is used for therapeutic purposes, as it helps to restore damaged tissues and strengthen teeth.
The effect of local anesthesia. As a result, the conduction of nerve fibers in the periphery is blocked. It is carried out with the help of anesthetics.

Drugs that are used for topical anesthesia

All drugs that are used for surface anesthesia in dentistry are divided into three large groups:

anesthetics;
dehydration agents, which are alcohol solutions;
combined funds.

Among the most commonly used anesthetics for anesthesia are:

When using alcohol solutions, a decrease in sensitivity occurs due to tissue dehydration. The most popular is a solution of propolis, which effectively eliminates pain.

Concerning combined funds, then in addition to anesthetics, they contain extracts medicinal herbs. Examples of such drugs are Lidoxor and Calgel. The pleasant taste and the absence of mucosal tingling after application make these preparations convenient and popular in pediatric dentistry.

When is topical anesthesia used?

Widespread use of topical anesthesia as pre-treatment before anesthetic injection. The procedure reduces the degree of anxiety and psychological discomfort. This is especially true for children who are afraid of injections.

There are a number of situations in which this kind of anesthesia is indispensable. Application anesthesia is used when they want:

Contraindications and side effects

The main contraindication to the use of application anesthesia is individual sensitivity to the components of the drug, which is used as an anesthetic. If the preparation contains lidocaine, then the application has age restrictions, and allowed only from 10 years. Among other contraindications can be identified.

Application anesthesia in dentistry in Latin means attachment. Many people don't like syringes that have sharp needles, especially when pointed at them. Therefore, scientists have developed a non-injection method of local anesthesia.

The emergence of topical anesthesia in dentistry means that it innovative way elimination of pain during dental operations. An anesthetic in the form of an ointment or gel is applied by the orthodontist to the mucous membranes of the oral cavity, the pulp and nearby hard tissues tooth.

Thanks to high percentage diffusion, the gel penetrates into the tissues by more than 2 mm, reaching its goal - the terminal fibers of the nerve endings. The downside is that the effect does not last long - about half an hour. Consequently, this method anesthesia is not suitable for long-term surgical procedures.

Application anesthesia is widely used in pediatric dentistry. Little patients are not afraid of injections and allow anesthesia to be carried out calmly. Plus, it is worth noting that milk teeth pass the drug much more efficiently, as they have a developed network of tubules in the dent. However, the anesthetic is used only for manipulations that leave a living pulp.

To increase the bioavailability of medicines, suction of accumulated saliva is carried out to isolate the required area.

The price of the drug is even lower than that of some injectable anesthetics, and fluctuates around two hundred rubles. That's why medical preparation available to people with different financial backgrounds.

The basis of the anesthetic is made up of three basic ingredients: benzocaine, lidocaine and tetracaine. All three chemicals dull pain by stopping the function of nerve endings.

Indications for use may be:

- simple caries that has not reached the pulp;

- hypersensitivity of dental nerve endings;

- grinding of the tooth surface before a longer operation or crown setting;

- pulpitis. A swab soaked in an ointment is placed at the bottom of carious corrosion, which removes the sensitivity of the nerve tangle;

- removal of dairy and permanent damaged teeth;

- removal of tartar.

However, like all drugs, application anesthesia has side effects that occur extremely rarely, manifesting themselves in the form of allergic reactions and inflammation. With the latter, hoarseness of voice, difficulty in breathing, due to inflammatory processes mucous membranes. Allergic reactions consist in the aggressive perception of antibodies to the molecules of the drug, which are allergens. There is itching, swelling and redness of the mucous tissues.

Thus, it is possible to sum up the question what is topical anesthesia in dentistry. This is a painless method of anesthesia that does not involve long-term manipulations. Therefore, they are eligible to be used by experienced qualified orthodontists for short operations. The use of such anesthetics is excellent for the treatment and extraction of milk teeth. This is very useful and effective drug, on the action of which specialists work in the laboratory.

Dentistry became humane only after scientists invented painkillers. Until that moment, the only reliable painkiller for doctors was a blow to the head with a wooden mallet. The patient lost consciousness, the doctor got the opportunity to treat. Fortunately, today there are many less traumatic methods of anesthesia.

What does it represent?

Anesthesia helps the patient to painlessly endure all medical manipulations. In dentistry, pain relief is most often done by injection. This method has a significant drawback: many patients, especially children, are terrified of needles and syringes and therefore experience severe psychological discomfort in the dentist's office. Then application anesthesia comes to the rescue.

Application anesthesia is a non-injection pain relief. The defining word in this type of anesthesia is the word "application". It means the application and impact of a drug blocking the nerve endings to a specific area of the body. In dentistry, it is a tooth, a section of the gum or oral mucosa.

Indications

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Most often, application anesthesia is used in pediatric dentistry for simple surgical intervention. However, it is also indicated for adult patients before the following procedures:

fitting of crowns;
removal of calculus and plaque;
hygienic cleaning of the oral cavity;
fixation of crowns and bridges.

Application anesthesia is able to cope with more serious problems, including surgical interventions on occasions:

pulp removal;
opening of purulent formations;
removal of postoperative sutures;
treatment of teeth affected by caries.

There are cases when a tooth with deep-seated roots is to be extracted. Then those who are terribly afraid of an anesthetic injection are offered the following scheme: on the site where the injection will be injected, an agent for application anesthesia is applied, an injection is made and surgery follows.

Pros and cons

Dentists choose topical anesthesia because it:

does not damage the oral cavity;
has an effect immediately after application;
safer for the body than injectables;
psychologically tolerated easier than an anesthetic injection.

There are application anesthesia and cons, these are:

Contraindications

The list of patients with contraindications to the application method of anesthesia should include those who:

has mental illness;
sick with diabetes;
prone to allergies to individual components in the composition of the drug.

Pregnant and lactating mothers should consult a doctor before using topical anesthesia. The same applies to children under 2 years of age.

Kinds

Preparations for application anesthesia are available in the following forms:

ointments;
liquid solutions;
chewing plates;
powder mixtures;
aerosol spray cans;
films adhered to the oral mucosa.

All of the above forms allow the content of aromatic flavors in the composition, which make the use of the drug not only an anesthetic, but also quite pleasant. Manufacturers make sure that dental procedures was the most comfortable.

For painful manipulations, application anesthesia in dentistry is often used, since not every patient tolerates anesthesia normally. Anesthetics always greatly affect the state of the human body. If he has a tendency to allergic reactions, then with anesthesia you need to be extremely careful.

However, there are certain types of dental procedures that cannot be performed without pain relief and are often difficult. In such situations, the doctor should use anesthesia as carefully as possible. If the patient has previously had negative reactions on the similar drugs always use only local anesthesia. One of the varieties of this method of anesthesia is the application system. This is the surface application of drugs that are classified as anesthetics.

Advantages of surface anesthesia

This method is very popular in medical practice generally. But it is in dentistry that application anesthesia is used most often. This is the best option for those cases when the gum needs to be pierced repeatedly or make small incisions. In order not to load the body with full-fledged anesthesia, an application is used.

With a low-traumatic intervention, this type of anesthesia will the best option. But when a full-fledged operation is performed in the oral cavity, the application method may not be suitable enough. For local anesthesia use special preparations that are applied to the mucous membrane and are quickly absorbed.

Often, when working with young patients, it is the method of application anesthesia that is used. Children are often very afraid of dentists, and this method makes it possible to get rid of phobias.

Anesthetics, which are used for local application anesthesia, have a fairly powerful effect on nerve receptors. Thanks to this, unpleasant sensations completely disappear on the treated area.

Active ingredients do not penetrate too deeply into the body, so they do not affect internal organs. A huge advantage of this technology is that it is always noted high efficiency with maximum safety for the patient. Therefore, application anesthesia can be used even in the treatment of children.

In pediatric dentistry, this method is very common. The anesthetic is produced in the form of a gel, which often has a very pleasant taste. For adults, not only gel forms can be used, but also aerosols, solutions and ointments. In any case, this method of pain relief is very effective and well suited for all patients.

In dentistry, this method is often used. When we are talking about the treatment of children's teeth, special gels can be used in each oral therapy. But there are also special indications when the application system will be especially useful.

Local anesthesia is convenient to use when removing teeth, including in difficult cases. Application anesthetic will be appropriate in the treatment of caries, removal of tartar, opening of abscesses, removal of pulp and even fixation of prostheses, which is not always painless.

There are several types of drugs that can be used in dentistry as topical anesthesia. For each case, one or the other option is more suitable.

Anesthetics can be cauterizing, dehydrating, have a physiological effect, or work as local anesthesia. Often, specialists use dehydration or physiological preparations. The former have a dehydrating effect on tissues. As a result, the nerve endings become less sensitive, which relieves pain. In the second case, we are talking about the use of pastes with fluorine or strontium.

Application anesthesia is the best option when minor or moderate surgical intervention is required.

When removed a large number teeth or large-scale operations still use general anesthesia, since local anesthesia will not be enough. An indication for complete immersion in artificial sleep may be a strong gag reflex.

When choosing drugs for application anesthesia, only those medicines, which are suitable for a particular patient, taking into account the sensitivity of his teeth and other indications. Therefore, the choice of anesthetic is an individual process for each patient.

Before using this or that remedy, the doctor must check the patient for contraindications. This is very important condition which concerns every patient, and especially a child. Allergic reactions to local anesthetics not as strong as when used general anesthesia, but they can be quite noticeable and even life-threatening. Therefore, the specialist is obliged to eliminate all risks before starting treatment.

If the freezing method is chosen, it is likely that the dentist will use chloroethyl. It is released in a jet to the place where the incision or puncture will be made. The action of chloroethyl is quite powerful, so the mucous immediately becomes insensitive. The main thing is that this method allows you to process only that part of the tissue that is to be processed. Everything else will not be in any way connected with the action of the anesthetic.

The cauterization and freezing method is considered very common, but it has some significant drawbacks. The thing is that tissue necrosis often becomes a side effect of such anesthesia. This is very dangerous, so many specialists are trying to move away from such anesthesia and opt for other means. Freezing is well suited for gum abscesses and when superficial roots need to be removed.

Application anesthesia can be applied not only in a jet, as when using chloroethyl. In addition, gel and ointment can be used. After a short period of time, a strong analgesic effect appears, which lasts long enough for a long time. If you need to enhance the effect of anesthesia, then the specialist can add Dimexide or Lidase to the agent used. When choosing drugs of this type, the condition of the tooth and tissues around it is always taken into account. Each area may have different sensitivities. Therefore, the amount of anesthetic can vary significantly.

One of the commonly used means of application anesthesia is Emla gel. It can be called the most popular tool of its kind. feature this drug is its absolute safety for the human body. Operate active ingredients Emla for about 20 minutes, but at the end of their action, they simply apply a new portion of the product. This way you can ensure good pain relief for 1 hour. Longer use of the product will not best solution as it may cause an overdose.

Application anesthesia can also be used in powder form. Sometimes they are simply sprinkled on a certain area of tissue, but in some cases, when you need to numb the gums a little, they dilute the dry ingredients and prepare a solution.

Some time ago, Tetracaine, which was used as a powder, was quite popular. Now it is little used, as it has a very high level toxicity.

From folk remedies considered the best anesthetic alcohol solution propolis. But it must be borne in mind that such a remedy should in no case be used for those patients who have allergic reactions to bee products. Before using any anesthetic, you should definitely make sure that the patient has no contraindications to its use.

Application anesthesia is widely used primarily for the reason a small amount side effects, as well as because of the relative safety for patients different categories. Nonetheless this method anesthesia has some drawbacks and can cause complications. It all depends on the type of drug that is used as a local anesthesia.

Problems with the use of surface anesthesia can be systemic or local. In the first case, pathologies occur on the skin or mucous membrane, namely where the agent was applied. Allergy is the main systemic complication that is possible when using topical anesthesia. AT this case not excluded severe itching and tissue swelling. expressiveness unpleasant symptoms depends on the amount of substance used.

If a specialist has used freezing or cauterization, this can cause permanent tissue damage. Sometimes even necrosis appears, which requires special attention by the doctor.

It is necessary to choose drugs for application anesthesia as carefully as possible. Some products can be quite toxic. This primarily applies to water-soluble products. They are used very carefully to avoid overdose, which can lead to bad consequences.

Contraindications for use

The main indicator that the patient cannot use one or another pain reliever is an allergic reaction that has already taken place. These drugs will be banned for him forever.

Otherwise, there are no special contraindications to the use of most substances used for topical anesthesia. The main thing is to monitor the reaction of the body and avoid overdose. Each drug has age restrictions. This must be taken into account when treating the oral cavity of a child.