Local anesthetic for application anesthesia. Application anesthesia in dentistry: principle of action, application, contraindications. Indications and contraindications for use

Application anesthesia (from Latin appli-catio - application), consists in applying an anesthetic to the skin or mucous membrane. Sensory receptors are blocked, and touching them does not cause any sensations. used this species anesthesia in various medical fields: urology, gynecology, dentistry, pulmonology, otolaryngology, ophthalmology, etc.

The mechanism of action of application anesthesia

Otherwise, it is also called superficial, terminal or topical. The mechanism of action of application anesthesia is simple: a local anesthetic, which can be a gel, cream, aerosol, etc., penetrates into the deep layers of the mucous membrane or epidermis. This causes blockage of nerve receptors and disruption of their functions. Result: the patient loses sensitivity at the site of anesthetic application, and the doctor can perform manipulations without fear for reflex reactions to them.

Application anesthesia is often used in combination with (injection). If the injection needle is very thick, or the injection site is too sensitive, it may be necessary to pre-lubricate it with an anesthetic. This is done, for example, by dentists, applying an anesthetic gel to the oral mucosa before inserting a syringe.

During childbirth, it is also used in combination with superficial, because the catheter needle is inserted into the lumbar region. And in general, all sensations are exacerbated in pregnant women, so the application with an anesthetic is simply necessary for a woman in labor.

The average duration of application anesthesia: 10-20 minutes. If more is needed, the anesthetic is simply reapplied. The depth of anesthesia reaches 2-3 mm, and the effect occurs in about 2-3 minutes.

Where else is surface anesthesia used?

Most wide application superficial anesthesia found in dentistry. An anesthetic ointment is applied not only before injection, but also before trying on crowns or bridges to reduce discomfort patient. It is also good for the tartar removal procedure, when you need to quickly anesthetize a large area. Manipulations on the mucosa (incision or stitching) also require the use of a local anesthetic cream.

Patients who are terrified of injections are often asked by dentists whether it is possible to carry out treatment only with topical anesthesia. But due to the fact that the anesthetic penetrates only into the deep layers of the skin, and does not reach the nerves, the person will still be hurt. Therefore, sometimes injections are indispensable.

By the way! If the patient has strict contraindications for all types, superficial anesthesia is the only chance to reduce pain during dental procedures.

In other areas of medicine, the application method is often used when performing medical manipulations. They can cause not pain, but reflex reactions that interfere with the full examination. For example, before a gastroendoscopy of the stomach, which is popularly called "gut swallowing", a special aerosol is sprayed into the throat. It blocks the sensitivity of the mucosa, and the person does not open a gag reflex. In general, the procedure takes place without much discomfort.

Surface anesthesia is also used in cosmetology. Peeling, mesotherapy or hair removal is quite painful and unpleasant. A local anesthetic in the form of a cream or gel can reduce discomfort. The process of stuffing tattoos is also facilitated by application anesthesia.

Some drugs for surface anesthesia

Anesthesia by the application method can be carried out using various means. Their choice depends on the localization of application (skin or mucous membrane), as well as on the nature of anesthesia. So, in sports, bruises are often anesthetized with cold. But this special case, relating, rather, not to anesthesia, but to a method of temporary relief of pain in case of injury.

Of course, in cans there is not cold as such, but a chemical substance that performs its functions. More often it is chlorethyl (Ethyl chloride). It is applied only to skin previously treated with cream in order to avoid burns. Pain relief occurs almost instantly, because. cold blocks the nerve endings in the treatment area.

Consider a few more popular anesthetics for application anesthesia, many of which are sold in the public domain in pharmacies.

AT pure form comes in the form of a spray. Effective only on mucous membranes. Those. spraying it on the skin is useless. It is not recommended for use in pregnant women, as well as in people with pathologies of the heart and blood vessels. Lidocaine is found in most external anesthetics. Unlike the equally popular novocaine, less harmful.

EMLA

This is a cream that is a combination of lidocaine and prilocaine (has a less pronounced vasodilating effect and not as toxic as lidocaine). Often used to numb the skin before surgery cosmetic procedures(epilation). To achieve an anesthetic effect, it is required to apply EMLA cream under the bandage.

Perylene-ultra

This is an aerosol or solution based on tetracaine, a vasodilator used primarily in ophthalmology. It gives an anesthetic effect in just 3-5 minutes after instillation of the solution into the eyes. It is also suitable for anesthesia before simple dental procedures (fitting of crowns and prostheses, opening of abscesses on the gums, etc.).

Anestol

A combination of lidocaine, tetracaine, and benzocaine (another broad-spectrum local anesthetic). Unlike other external agents, Anestol provides a long-term analgesic effect (up to 2 hours) and does not require the use of a bandage.

Important! Before using any type of anesthetic drug, you need to make sure that you are not allergic to it. Otherwise, a reaction may follow in the form of Quincke's edema, severe cough or runny nose, or even anaphylactic shock.

Some drugs additionally contain antibiotics in order to have not only an analgesic, but also a bactericidal effect. Anesthetics used in pediatric dentistry can be sweetened to make the superficial anesthesia even easier for the child to tolerate.

Forms of release of anesthetic drugs

We have already familiarized ourselves with some of them. But for convenience, we list all forms of release of local anesthetics again:

Each type has its own advantages when applied to a particular area of ​​​​the skin or mucous membrane. For example, it is more convenient to spray a spray or aerosol into the throat, because touching the throat with a cotton swab with a solution can cause a gag reflex. In dentistry, the most popular form local anesthesia is the use of a gel: it is almost not washed off with saliva.

And the last. Any anesthetic (local or general) has a toxic effect on the body. But with application anesthesia, it is so small that it is simply pointless to refuse it and endure pain. If the patient had to give a large number of surface anesthetic, the doctor may recommend medication to protect the liver. But in most cases, everything goes well, and the effect of the drug does not affect human health in any way.

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 such drugs, then only local anesthesia is always used. 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 in general. 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 in oral cavity a full-fledged operation is performed, the application method may not be suitable enough. For local anesthesia, special preparations are used 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 a local anesthetic. 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 removing a large number of teeth or large-scale operations, general anesthesia is still used, 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 are not as severe as when using 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 for quite 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 slightly anesthetize the gums, 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.

Of folk remedies, the best anesthetic is considered 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. However, this method of anesthesia has some disadvantages and can cause complications. It all depends on the type of drug that is used as a local anesthesia.

Problems in use surface anesthesia may 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 from 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.

This article will tell you:

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

AT dental practice many anesthetics are used. 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 administered by injections deep into soft tissues, but there is also superficial anesthesia - application anesthesia, in which the integrity of the tissues is not disturbed.

Application anesthesia in dentistry 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.

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

Given these indications, we can say that application anesthesia is suitable for patients of any age. Most of 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:

1. Anesthetics. This includes gels, ointments, aerosols based on anesthetics. The principle of their work is to block nerve endings, and suitable anesthetics for any occasion requiring the application of an anesthetic application. The most popular anesthetics include lidocaine, benzocaine, and tatracaine.
2. 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.
3. Physiological. Pastes based chemical elements or minerals can block pain. They clog the dentinal tubules, reducing the sensitivity of dental tissues.
4. 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 strong and weak sides. The advantages of the applications are as follows:

1. performance. The drug begins to work within a minute after its application.
2. 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.
3. 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 the little patient.

The disadvantages of the application method of anesthesia include:

1. 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.
2. limited effect. The scope of application of painkillers is small due to their weak action.
3. Difficulty in dosing. To ensure that the concentration of the anesthetic does not exceed the permissible norm, and the drug does not penetrate into the blood, the dentist must very accurately calculate the required dose, which is not easy to do, especially when working with aerosols.
4. 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 for home use topical anesthetics are not suitable because their misuse 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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Technically the most in a 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. A feature of surface anesthesia is that the impregnation of tissues with a local anesthetic is carried out from the surface layers, on which a local anesthetic is applied. For this, various dosage forms anesthetics (solutions, ointments, gels or aerosols) containing high concentrations of local anesthetics. applied with cotton or gauze swab, local anesthetics due to high concentration quickly penetrate the surface of the mucous membrane 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 surface anesthesia technique for anaesthetizing the site of the proposed needle injection consists in point application 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 getting into Airways, as well as on intact teeth, the 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 fear of pain, fainting 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 blood and create toxic concentrations there as quickly as when administered intravenously (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 injection of a small amount of 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 Diplen LH composition includes: the antiseptic chlorhexidine, which has a wide spectrum of activity against the microflora of the oral cavity, the anesthetic lidocaine hydrochloride and the brilliant green in the surface layer of the film.

The technique of using this tool is simple and convenient. A piece of film of the required size is cut with scissors and the 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 sufficient. 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. Besides, she doesn't have bad 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 on the soft tissues of the face, the alveolar process and other areas, direct infiltration anesthesia is used, and during tooth extraction and bone interventions on the alveolar process of the jaws, indirect anesthesia is used, 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. An anesthetic in the amount of 1.5-2 ml is injected slowly to avoid severe 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.

Just ten years ago, the need to visit the dentist in most people caused a feeling of fear and discomfort. Today the situation has changed, and even small patients are happy to go to a meeting with a dentist. Such a radical change is associated with the latest advances in medicine, which made it possible not to feel pain during dental procedures. The so-called application anesthesia is gaining more and more popularity among doctors and patients every year.

What is topical anesthesia

Application anesthesia- this is an anesthesia procedure in dentistry, performed by a doctor by applying special painkillers to the nerve endings of the tooth at a certain place in the oral cavity, while anesthesia is superficial. Anesthesia in dentistry can be achieved by the use of anesthetic drugs or by physical and chemical influences. The procedure does not involve the use of a syringe for anesthesia.

At use medications, the agent is applied with a swab or by direct application to the site of anesthesia. Painkillers may have the consistency of an ointment, gel, or spray. With the physico-chemical method of exposure, the method of cooling or cauterization can be used.

In most cases, anesthesia in dentistry is achieved by using special drugs. Application anesthesia today can be performed various means, which differ not only in appearance and method of application, but also in the strength of anesthesia. Often such products have additional aromatization, which makes the procedure more comfortable for the patient. The use of application anesthesia is not always allowed, therefore, the decision on the possibility of its use is made by the doctor, taking into account the complexity of future manipulations and the characteristics of the patient's body.

Existing methods of anesthesia

Today, in dentistry, application anesthesia involves several methods. anesthesia:

Methods of anesthesia that are not associated with the use of anesthetic drugs for local anesthesia, are used in dentistry much less frequently.

Moxibustion

The cauterization procedure involves superficial anesthesia through the use of aggressive drugs. To such funds relate:

• Nitric acid;
• carbolic acid;
• zinc chloride;
• silver nitrate.

When applying funds to the mucous membrane in place of the nerve endings of the tooth, the pores become blocked and their strong narrowing occurs, which contributes to the closure of the nerve endings from external influences. The cauterization procedure has been known since ancient times, but in modern medicine is used quite rarely, which is more associated with the high toxicity of drugs and severe tissue damage when it enters potent means on the mucosa.

Dehydration

Anesthesia by dehydration involves the use of anesthesia special means with a dehydrating effect. As such drugs carbonate or bicarbonate is used:

Often this type of anesthesia is used when brushing teeth or minor manipulations with them.

Physiological impact

With this method, anesthesia is achieved by applying special pastes, the components of which act on receptors and block the transmission nerve impulses. These pastes include: kinds:

• aspirin;
• glycerophosphate;
• strontium.

Such pastes are often used for therapeutic purposes in the treatment of teeth with problematic enamel, dentitis.

Advantages and disadvantages

Anesthesia aims to minimize pain during dental procedures. To virtues procedures include the following:

• speed of action of anesthesia;
• uniform distribution over the cells of the mucosa;
• effectiveness and efficiency of action;
• high degree of security for the client;
• the minimum level of discomfort during anesthesia.

The disadvantage of anesthesia by the method of application anesthesia is considered to be an insignificant duration of the effect. The maximum anesthesia time is 30 minutes. This time is very often not enough for the doctor to carry out all the manipulations. Drugs used in machine anesthesia are considered safe compared to traditional anesthesia. Despite the high degree of safety for humans, the drugs still penetrate the human bloodstream and can cause side effects.

Another of the significant disadvantages of anesthesia is the impossibility of controlling the required dosage of the drug.

In what cases is topical anesthesia used?

Application anesthesia is used when performing the following procedures:

What are the contraindications

There are a number of specific contraindications in which the use of topical anesthesia prohibited. This list includes the following contraindications:

• individual intolerance to the components of the anesthetic drug;
• propensity to develop allergic reactions;
• recent heart attack or stroke;
• acute diseases hearts or blood vessels;
• Availability diabetes;
• disturbances in the work of the endocrine system.

The most common side effect of application anesthesia is the occurrence of an allergic reaction to the action of the drug. In order to exclude similar situation correct dosage is required. It is forbidden to use painkillers for application anesthesia at home on your own.

What are the drugs for local anesthesia

Today, there is a huge offer of concentrated anesthetics used in application anesthesia on the medical drug market. Although independent application such drugs are prohibited, it is worth having information about the painkillers used by the doctor.

Most often in dentistry, drugs are used that contain the following: Components:

Often the composition of the medical preparation includes an antiseptic, flavors, various anti-inflammatory components. Today there is a fairly large number of anesthetic drugs.

"Diplan LH"

The drug for application anesthesia is film, which contains antibacterial and analgesic components. The film is glued to the immediate place of anesthesia.

The film consists of two layers impregnated with lidocaine and chlorhexidine. The analgesic effect after applying the film can be observed after 1 minute. After surgical manipulations, the film can be left at the site of application, since after 12 hours the layers of the film will resolve themselves.

"Topex"

The drug is available in the form of a gel, which allows you to apply it directly to the site. anesthesia. To obtain an analgesic effect, it is enough to wait a period of time of 1-2 minutes.

"Disilan"

The drug is available in the form spray, the main active ingredient of which is benzocaine. Anesthesia when using an anesthetic is observed for a short time, which is no more than 15 minutes. The advantage of the drug is considered to be a small concentration of benzocaine, which allows the use of the drug in children from 5 years of age.

"Desensetin"

The drug belongs to the category of fast-acting anesthetics. The main active ingredient is lidocaine. After application, the effect of anesthesia appears within 10 minutes.

How does pain relief work

Application anesthesia shows good effect anesthesia only if all the requirements of the technology are met. Before direct application of the drug, the doctor dries the mucous membrane and the surface of the tooth.

medicinal product, depending on the type, rubbed to the place of anesthesia, or it is irrigated. At correct application anesthetic and dosage, the total depth of anesthesia should reach 3 mm. The duration of anesthesia depends on the concentration of the main active substance.

As a rule, the duration of action of the anesthetic is from 10 to 30 minutes. It is allowed to reapply the substance for more lasting effect anesthesia.

With application anesthesia, a number of side effects effects. The use of an anesthetic for some time leads to a loss of sensitivity of the mucous membrane, so people very often injure it as a result of biting.

Despite the more comfortable conditions with application anesthesia, compared with traditional anesthesia, some patients experience a psychological imbalance, as a result of which dental phobia may develop.

• on the eve of a visit to the doctor is not allowed to use alcoholic beverages;
• the procedure should not be carried out in the presence of inflammatory or infectious diseases;
• women are not recommended to do anesthesia in the first days menstrual cycle;
• the doctor before anesthesia should make sure that the patient has no allergic reactions to the drug.