Statistics show that more than half of the country's population are afraid to visit the dentist due to the presence of ideas about inadequate treatment, high risk of complications, etc. Anesthesia deserves special attention. Anesthesia in dentistry is a complex, independently functioning section. In the course of scientific research, many points and routes of administration of anesthetics have been identified, the composition of which also differs and is always selected strictly individually, taking into account somatic diseases, history data and degree of oral cavity lesions.
The list of conditions in which anesthesia is necessary:
- Complicated forms of caries;
- Extraction of teeth (single or group);
- Removal of dental debris;
- Change the location or zone of growth of the tooth;
- Any purulent-inflammatory processes of the bone skeleton or soft tissues of the jaws and the oral cavity;
- Contracture of the temporomandibular joint;
- Small plastic surgeries, these include: piercing, botuloplasty, etc .;
- Neuritis and other inflammatory and degenerative lesions of the peripheral nervous system;
- As a palliative therapy for severe lesions of the tissues of the oral cavity during radiation sickness or malignant neoplasms.
There are many different local anesthetics commonly used in dentistry. Each of them must meet criteria such as:
- Low ability to cause allergic reactions (including irritation of nerve trunks and fibers);
- Minor systemic toxicity (effects on the cardiovascular and central nervous systems are especially dangerous);
- The rapid development of analgesic effect.
- "Dikain." Applies only to application anesthesia. 10 times more toxic than Novocain.
- "Novocaine". Used for infiltration or conduction pain relief. About 1-2% of people on the planet are allergic to this substance.
- "Lidocaine". It acts stronger, faster and longer compared to Novocain. It has antiarrhythmic action. Recommended for any type of local anesthesia.
- “Mepivacaine” is a practically complete analogue of “Lidocaine” in terms of its strength and speed of onset of the analgesic effect, however, it has more significant neurotoxicity (with the slightest overdose, clonic convulsions).
- “Artikain” (“Ubuteszin”, “Ultracain”) is a practically non-toxic anesthetic that does not alter the blood pressure and heart rate in general. Quickly excreted from the body. Available under a variety of trade names: "Ubystezin Forte", "Ultrakain D-S", "Septanest", etc.
|Toxicity compared with Novocain (how many times higher)||1||4||4||5|
|The severity of the analgesic effect compared with Novocain (how many times higher)||1||2||1,9||1,5|
|The duration of the anesthetic (without vasoconstrictor substance), in hours||Up to 0.5||Up to 1||Up to 1.5||Up to 1|
|The rate of onset of analgesia||Slowly (3-5 minutes)||Fast (1-2 minutes)||Fast (1-2 minutes)||Very fast (15–30 seconds)|
Usually used drugs based on "Artikaina" ("Ultrakain", "Septanest", "Ubistezin"). Such medical products are more effective.
It is important! To reduce the absorption of toxic substances, all modern anesthetics are composed of a vasoconstrictor component - epinephrine or adrenaline.
However, vasoconstrictor components have a high allergenic activity, and therefore they are forbidden to be used among patients with bronchial asthma, atopic dermatitis and other allergic or autoimmune disorders. Alternatively, you can use Scandonest or Mepivacaine. The active ingredient has a moderate vasodilating effect, therefore, the addition of additional substances that cause a spasm of the smooth muscles of the vascular wall is not required.
Types of anesthesia in dentistry
Both in the therapeutic and in the surgical branches of dentistry, various types of anesthesia are used, differing in technique, list of indications and contraindications, as well as drugs used.
All methods of anesthesia are divided into two large groups:
- General anesthesia - oppression of the central nervous system, allowing to get rid of all types of sensitivity and briefly "turn off" the mind.
- Local anesthesia is a local effect of the drug on nerve fibers that blocks the conduction of an impulse. It is a priority due to the low number of complications and side effects.
Local administration of anesthetic solutions is a priority, as it allows:
- Achieve anesthesia in a short time;
- Quickly carry out surgery or treatment of teeth, gums, mucous membranes;
- Avoid systemic complications.
With this method, anesthesia of the surface layers of the mucous membrane and submucosa is made (depth - about 3 mm). Recommended for performing simple surgical or therapeutic operations (closure of the gap, removal of tartar, temporary anesthesia during the inflammatory process). The duration of action, as a rule, does not exceed 10–20 minutes. Used drugs such as:
It is important! To increase the local effect, reduce the rate of absorption into the systemic circulation and prevent the occurrence of undesirable toxic effects, a vasoconstrictor is added to the solution.
The technique is extremely simple:
- An anesthetic is used to wet the bandage, gauze, or cotton swab. You should squeeze the excess medication to avoid getting the solution to unwanted places.
- Putting a tampon on the lesion for 2–3 minutes.
Variation is the most common in dental practice. Used when performing any dental procedures. There are 2 main ways:
- Straight. The solution of the medicinal substance is injected under the mucous membrane in the area of the affected area.
- Indirect. The drug is applied on a remote proximal segment (more than 2 cm from the primary lesion) and causes a nerve impulse transmission unit.
The main advantages of the technique:
- Ease of execution and quick staff training;
- Low incidence of complications after the intervention (less than 0.02%);
- Zero probability of breaking the needle (as it sinks superficially and is not in contact with bone tissue and muscle fibers);
- There is no possibility of the solution entering the large vessels (in the peripheral tissues, the diameter of the lumen of the arteries and veins is insignificant).
Anesthesia is not difficult:
- The choice of the location of the needle (depending on the affected tooth or the mucous membrane).
- Promotion of the needle to a depth of 2 to 5 mm.
- The introduction of the drug component. You can use up to 5 ml of anesthetic.
|Region||Needle insertion site||Depth||Name of medicinal solutions permitted for use|
|Upper jaw: 13, 12, 11, 21, 22, 23 tooth.||Transitional fold in the area of the projection of the middle part of the crown of the affected tooth.||2-3 mm.||"Ultracain", "Lidocaine".|
|Upper jaw: 17, 16, 15, 14, 24, 25, 26, 27 tooth.||The region of the transitional folds of the previous tooth. The needle is inserted parallel to the fold to the zone of projection of the middle of the crown of the next chewing element.||3–6 mm.||"Lidocaine", "Trimecain", "Artikain".|
|Upper jaw: 35, 34, 33, 32, 31, 41, 42, 43, 44, 45 tooth.||Transitional fold in the area of the projection of the middle part of the crown of the affected tooth.||3-5 mm.||"Lidocaine", "Trimecain".|
Separate types of infiltrative anesthesia are also distinguished. For example, the subperiosteal method of anesthesia allows you to deposit anesthetic in the area of the periosteum, which increases the efficiency and duration of anesthesia several times.
Subperiosteal anesthesia is indicated for severe dental operations and for those with a low pain threshold. Staging can be represented as follows:
- Vcol needle in the mucous membrane of the alveolar process in the area of the projection of the middle of the crown of the tooth, which requires anesthesia. It is necessary to retreat from the transition fold by 1-3 mm.
- Create a minor anesthetic depot.
- Piercing the periosteum, the location of a thin needle at an angle of 40–45 degrees relative to the long axis of the tooth.
- Advance the needle towards the top of the root until it stops.
- The introduction of the drug.
This type has only earned the attention of dentists in the last 10 years. The anesthetic is injected into the soft tissues of the dental ligaments under high pressure, with the result that medicinal substances quickly enter the bone tissues of the alveolar process, through which the medicament spreads to the top of the tooth.
To conduct anesthesia should:
- Treat antiseptic solutions of the teeth and periodontal pocket.
- Make a needle puncture in the area of the gingival sulcus, while the needle must be in contact with the side surface of the tooth and form an angle of 30 degrees with its root.
- Introduce the needle to the sensation of obstruction, rotate it 180 degrees, inject the drug (from 0.2 to 1 ml) in 30–40 seconds.
Intravasive anesthesia is rarely used and is indicated when it is impossible to perform other types of anesthesia:
- Anesthesia in children in the presence of intolerance to other species;
- Treatment of diseases of tooth hard tissues, including complications;
- The presence of individual drug intolerance (with this type of anesthesia, several times less anesthetic solution is required).
Conductive anesthesia in dentistry - the introduction of anesthetic far from the lesion. As a result, a nerve impulse transmission block occurs on a separate nerve fiber segment. It has several undeniable advantages:
- Anesthesia of large areas, the innervation of which is carried out by a single nerve trunk, with a total of 1 injection;
- The use of small volumes of anesthetic solution;
- Low invasiveness and, as a result, low risk of complications after the intervention;
- The ability to administer the drug away from the source of an infectious-inflammatory lesion, where the efficiency is several times lower;
- The possibility of using high concentrations of the drug to prolong the action;
- The absence of mechanical damage to the tissues in the place where surgery will be performed;
- Safety use among patients of older age groups (60 years and over);
- Facilitating the work of the dentist: with this type of anesthesia, vegetative nerve fibers are also blocked, as a result salivation decreases to zero.
The technique of the following:
- The location of the syringe at the level of the premolar of the opposite side and the implementation of vcol in the outer slope of the fold, which is located on the border between n / 3 and c / 3 of its parts (each part is 1/3 of the fold).
- Promotion of the needle until it stops in the bone tissue.
- Rotate the needle towards the premolars and dive to a depth of 1.5 to 2 cm.
- The introduction of the anesthetic solution.
As a drug can be used: "Trimekain", "Novocain", "Lidocaine", "Artikain".
A type of mandibular anesthesia is torusal, in which the main orientation is on the mandibular cushion. Both options allow anesthesia of all branches of the trigeminal nerve.
Innervation zone of both types of anesthesia:
- Alveolar bone, mucous membrane or teeth of the mandibular half on the side of the injection;
- 1/2 of the tongue and sublingual area from the side of the introduction of the medicinal solution;
- The skin and mucous membrane of the cheek on the side of the injection, half of the lower lip;
- Chin area: all - on the side of the introduction, in part - from the opposite area.
This option provides for the introduction of anesthetic between the bumps of the upper jaw. In this area are luvial nerve fibers that provide the innervation of the alveolar ridge from 1 to 3 molars. Tuberal analgesia is the most dangerous and is characterized by a high incidence of complications (up to 10%) associated with the anatomical structure of the jaw (the location of large-caliber vessels and nerve fibers).
Currently the method is not used.
Shown for extensive operations that require a one-time anesthesia of the entire jaw. The introduction of anesthetic leads to the block of the entire maxillary nerve. This intervention can be implemented in 2 areas:
- Oval hole in the mandibular fossa;
- Round hole in the pterygo-palatine.
The technician suggested more than 10. As an example, you can bring the sub-stalk path of anesthesia:
- The introduction of the needle in the area of intersection of the lower surface of the zygomatic bone with a vertical axis, which is held at the lateral edge of the orbit.
- The needle is directed upwards and inwards until it touches the upper jaw bone.
- Moving the needle in and out 4–6 cm, sliding along the bone.
- The needle gets into the pterygopal fossa (feeling of failure).
- Introduction from 1 to 3 ml of the drug solution. Apply: "Novocain", "Trimekain", "Lidocaine", "Artikain".
General anesthesia is a reversible depression of consciousness, accompanied by complete analgesia, amnesia and relaxation of all muscles. The route of administration may be:
- Non inhalation
Through the first method, gaseous and vaporous preparations are introduced. Now widely used "Ftorotan", "Methoxyflurane", "Xenon", "Enflurane."
Sodium oxybutyrate, propofol, ketamine, calypsol and others are used as intravenous anesthetics.
Less commonly, oral, rectal, intramuscular routes of administration are realized (however, they are not common in dentistry).
Indications for general anesthesia are a severe general condition (massive jaw injuries, multiple fractures, etc.) or individual intolerance to local anesthetics.
Any drug has a list of diseases in which its use is strictly prohibited. Stand out:
- Genetically determined individual intolerance of individual components of the anesthetic solution;
- Pathology of the musculo-articular apparatus (myasthenia, hypotension);
- Severe disruption of vital organs, especially of the kidneys and liver (amyloidosis, cirrhosis, etc.).
- Pathological processes in the area of the injection, this group includes infiltrates, any abdominal formations with accumulation of pus, ulcers, erosion, and other defects.
Anesthetics, having in its composition a vasoconstrictor component, are additionally contraindicated in:
- Pregnancy (at any time);
- During the period of breastfeeding;
- Arrhythmias (sinus bradycardia, paroxysmal type tachycardia, atrial fibrillation);
- Angle-closure glaucoma;
- Heart failure;
- Acceptance of certain drugs (beta-blockers, TAG, MAO inhibitors).
Side effects and complications
Among the undesirable effects of emit:
- Local allergic reactions (itching, burning, hyperemia, the appearance of vesicles). Common allergopathologies (anaphylactic shock, urticaria) are extremely rare.
- Reactions of irritation to the introduction of anesthetics (manifestations are similar to allergies, but take place within 1-2 hours).
- Erroneous introduction of aggressive liquids (hydrogen peroxide, formalin) due to violation of storage conditions. The consequences are any: from allergic reactions to necrosis of massive areas of the maxillofacial region.
- Intravascular anesthetic administration. Causes vessel spasm, sharp pain and ischemia of tissues located distal.
- Wound of the vessel with a needle (hematoma or bleeding is formed).
- Nerve damage with a needle. Consequences: paresis or paralysis.
- Any violation of the integrity of the facial muscles.
- Perforation of the nasal cavity and paranasal sinuses.
- Eyeball injured by needle.
- Dislocation of the temporomandibular joint. Due to the wide opening of the mouth during anesthesia against the background of weakness of the articular, muscular and tendon apparatus.
- The development of infectious and inflammatory pathologies in the place of injection of the needle.
- Cicatricial contractures in the foci of primary inflammation.
Anesthesia for children
For children under the age of 3, the only way to solve dental problems is general anesthesia. The use of local anesthetics is inappropriate because of the aggressive behavior of the child towards the doctor.
General anesthesia is also indicated for children with severe defects and developmental abnormalities, autism, epilepsy, chromosomal abnormalities (Down syndrome, Kleinfelter syndrome).
It is important! From 3 to 14 years, it is possible to use infiltrative anesthesia, however, before the procedure, it is necessary to impose applications with analgesics that additionally contain pleasant flavoring substances.
From the age of 14, the use of any method of pain relief is allowed.
Maternity and breastfeeding
During the period of childbirth, it is prohibited to use anesthetic solutions that contain vasoconstrictor substances (adrenaline). Systemic vasocontractive effect can lead to violations from the complex system “mother - placenta - fetus” and cause fetal hypoxia, premature detachment of a normally located placenta and other disorders.
The only safe medication can be considered "Mepivacaine", which does not dilate the vessels of the microvasculature, and also has a low list of side effects.
The price of various types of pain relief varies depending on the region and the profile of the clinic (private or public).
|Procedure name||average price|
|Application||From 100 to 1 500 rubles|
|Infiltration||From 250 to 3 000 rubles|
|Conductor||From 350 to 4 000 rubles|
|Intraligamentary||500–2 500 rubles|
|Stem||From 5 000 rubles|
|General anesthesia||From 2 500 to 50 000 rubles|
Video: anesthesia in dentistry
Thus, in the modern market of dental services, there are many different types and methods of local anesthesia or general anesthesia. Each method is endowed with a separate list of indications and contraindications. When choosing an anesthetic, it is necessary to take into account the patient's allergic history to avoid unwanted complications.