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

Anesthetics in dentistry are drugs that provide pain relief. All means for local anesthesia must have the following properties: low toxicity, rapid onset of effect, easy permeability through tissue, reversibility, easy permeability, long shelf life. Some products are more consistent with these standards ( modern drugs), others less so (usually outdated analogues).

clarifications: the groups that have the highest and lowest scores are highlighted in bold (so to speak, champion and underdog)

Classification

Classification of local anesthetics in dentistry involves division according to chemical structure and by generation. According to their chemical structure they are:

• Esters (Cocaine, Novocaine, Anestezin)
• Amides (Lidocaine, Articaine aka Ultracaine, Mepivacaine)

By generation (counting according to the time of discovery) there are: I - cocaine in 1860, II - novocaine in 1905, III - lidocaine in 1943, IV - mepivacaine in 1957, V - articaine in 1972. All substances will be considered according to this classification of local anesthetics in dentistry. For clarity, look at the table, which discusses toxicity, duration, and maximum dose.

Anesthetics in dentistry without adrenaline

As you know, ephedrine derivatives are added to painkillers to increase the duration of action. They are vasoconstrictors, that is, they narrow blood vessels. In some cases, such exposure is contraindicated (for pregnant women, people with heart and vascular diseases). The following are “safe” anesthetics in dentistry without adrenaline: Ultracaine D (do not confuse with prefixes D-S and D-S Forte), Mepivastezin 3%, Scandonest CVS 3%. They can be safely used.

Modern anesthetics in dentistry

As you may have guessed, these are V generation drugs. Modern anesthetics in dentistry include Articaine derivatives: Ultracaine, Ubistezin, Septanest. However, Mepivacaine and its analogues are not yet in a hurry to throw them into the dustbin of history, and they are ordered in dental clinics. And what kind the most powerful anesthetic in dentistry? The award goes to Ultracain. To make sure, go to the dentist and ask him to do mandibular anesthesia. They will have time to heal your tooth, you will get home and for another couple of hours you will not feel anything and all this “pleasure” is from 1 ampoule.

Mechanism

The mechanism of action of all drugs is the same. In short, they reduce the penetration of sodium ions into the membranes of nerve cells. In more detail, the scheme looks like this: the membranes of neurons are overcome by molecules of an anesthetic substance in an inactive form. There they become active, attaching (binding) hydrogen ions to themselves, and remain on sodium channels. The transmission of the pain impulse is blocked by stopping the rapid input of sodium ions, which is felt by the body as anesthesia.

Anesthesia or local anesthesia in dentistry, it allows you to treat teeth without pain, which provides comfort for the patient and ease of work for the dentist. Please note that in this article we will talk specifically about anesthesia, not anesthesia. Anesthesia is a complete shutdown of a person’s consciousness; in dentistry this is now commonly called “dental treatment in a dream.” This can only be carried out by anesthesiologists.

This article will focus specifically on anesthesia (sometimes also called local anesthesia). This type of anesthesia acts only on a limited area and is usually carried out by the dentist himself.

Many of us often delay visiting the dentist because... They have been afraid of them since childhood, but “advanced” caries can cause serious complications which may even require surgical intervention. The smaller the destruction and the earlier the patient consulted a doctor, the better, faster and less painful the treatment can be.

• pulpitis and periodontitis;
• diseases of cardio-vascular system and joints, because caries is a source of infection;
• chronic allergic reactions;
• if the tooth is completely destroyed, this will affect the quality of chewing food and, as a result, may lead to gastrointestinal diseases

In dentistry, the following types of local anesthesia are distinguished; below we will briefly consider each of them:

• Appliqué
• Infiltration
• Conductor
• Intraosseous
• Intraligamentary (intraligamentous)
• Stem
• Combined.
• Computer

All modern methods of pain relief in dentistry have their own characteristics, indications and contraindications.

In pediatric dentistry, the same types of local anesthesia are used, but for very young patients (2-3 years old), who simply will not allow the dentist to work, we give short-term anesthesia, for example, with propofol. This is a very modern and safe drug.

Application anesthesia

Allows superficial pain relief soft fabrics: skin and mucous membrane to a depth of approximately 1 – 3 mm. The drug quickly penetrates the tissue and temporarily disables the nerve endings located there. Used during the procedure high concentration local anesthetic in the form of a gel, aerosol or emulsion. The drug is applied to the dried mucous membrane or the solution is sprayed onto it using a spray bottle.

Local topical anesthesia in dentistry (in other words, anesthesia without an injection) is used:

• to numb the needle point before injecting;
• for removing baby teeth;
• when removing small soft tissue tumors.

Pain relief for stomatitis in children using special pastes and gels is also an application.

Infiltration of tissues with anesthetic solution

Infiltration used in dentistry much more often than other types. Tissue anesthesia occurs using a syringe or needleless injector. Sensitivity to pain is switched off after just a few minutes, and the duration of exposure depends on the type of anesthetic, its dose, and the presence of vasoconstrictor components in the composition.

The method, in addition, has some variations: intraosseous and intraligamentary anesthesia, they are also quite often used in dentistry. For them you need to use a special syringe.

Conductive anesthesia in dentistry

Conduction dental anesthesia is used much less frequently than infiltration anesthesia. An anesthetic solution is injected near the peripheral nerve trunk, and the entire area for which it is responsible is anesthetized. The desired effect occurs 10-15 minutes after the injection and lasts for 1-2 hours.

It is used when you need to numb a large area at once or if infiltration does not work. Unlike infiltration anesthesia, a smaller amount of anesthetic is used here, but in a higher concentration.

Torusal and mandibular anesthesia are performed on the lower jaw.

In this case, the lower alveolar and lingual nerves are switched off, so during the action of the anesthetic the patient feels numbness in the entire half of the lower jaw, lip, chin and tongue. Tuberal anesthesia in dentistry is often accompanied by the formation of a hematoma. It was this inconvenience, combined with the complexity of the technique and the high likelihood of complications, that forced dentists to abandon this type of anesthesia.

Intraosseous

To administer an anesthetic solution intraosseously, the physician perforates the dense outer cortex during injection. jaw bone and injects the solution into the spongy substance itself, where the terminal branches of the dental plexus are located. The effect appears within 1-2 minutes, the teeth and alveolar process are anesthetized. This manipulation is performed using a special syringe with a short, large-diameter needle and is a type of carpule anesthesia in dentistry.

Intraligamentary

Intraligamentary anesthesia involves the dentist injecting a solution into the periodontal ligament, which connects the tooth root to the bony alveoli. In this way, you can numb only one tooth and do it with a record small amount of anesthetic, which is why this type pain relief remains very popular. It should be noted that the injection into the periodontium is quite painful and minor discomfort remains in the tooth for 24 hours after it is performed.

Trunk anesthesia in dentistry

This type of anesthesia is rarely performed in dentistry. This technique is also called (according to the author) “according to Bershe-Dubov.” This technique is used when there is a strong pain syndrome in a patient, for the treatment of serious injuries and operations on the jaw and zygomatic bone, as well as for neuralgia and only in a hospital setting.

An anesthetic injection is given at the base of the skull (brain stem), and the painkiller spreads throughout both trigeminal nerves and their branches. This allows you to immediately disconnect the mandibular and maxillary nerves. The effect of stem anesthesia lasts quite a long time.

Combined anesthesia

Combined or sedative anesthesia in dentistry is used more and more often. In order for the treatment to be not only painless, but also completely comfortable, it is not enough to simply eliminate pain, it is necessary to cope with fear and emotional stress. It is this effect that potentiated analgesia can achieve. It is a combination of superficial sedation and local anesthesia, carried out with the participation of an anesthesiologist. This is one of the best types of anesthesia for children in dentistry at the moment.

Superficial sedation is a state of stunning, slight depression of consciousness. In this case, the patient does not experience fear or anxiety before the upcoming intervention, but remains conscious. Of course, the advantage of this pain relief is not only its comfort. Anxiety and fear, among other things, cause a significant decrease in pain threshold. That is, eliminating negative emotions allows you to achieve a good level of pain relief with smaller doses of anesthetic.

What is computer anesthesia?

Computer-controlled anesthesia is carried out by a special electronic system, which consists of a system unit and a tip. The needle has a special design that allows you to pierce soft tissue and perforate the cortical plate of the bone absolutely painlessly. Another advantage is the dosed administration of an anesthetic drug: the amount and speed of this process is controlled by a computer.

Carpule anesthesia

To perform carpule anesthesia in dentistry, special instruments are used - carpule syringes. They are a reusable metal device that has a body, a plunger and a needle that is much thinner than a regular injection needle. The drugs are supplied in special carpules and placed in the syringe body.

Local anesthetics in dentistry are divided into:

• Novocaine;
• Anestezin;
• Dicaine.

• Lidocaine;
• Pyromecaine;
• Trimecaine;
• Prilocaine;
• Mepivacaine;
• Articaine;
• Etidocaine;
• Bupivakakin.

In addition to the main analgesic component, most anesthetics contain vasoconstrictors, such as, for example, adrenaline or epinephrine. Due to the effect of vasoconstriction at the injection site, the washout of the anesthetic occurs more slowly. This allows you to increase the strength and duration of pain relief.

To carry out anesthesia in pediatric dentistry, drugs must be selected with the lowest level of toxicity, but at the same time effective. The choice in this case falls on drugs of the amide group: ultracaine and scandonest in children's dosages. The first of these is, in principle, considered the best anesthetic in dentistry. The analgesic effect of ultracaine occurs quickly and lasts a long time.

You should not endure pain and refuse anesthesia in dentistry when breastfeeding. Local anesthetics are excreted in small quantities in milk, which means they can enter the child’s body. IN in this case It is recommended to express several portions of milk before visiting the dentist and not to breastfeed your child for 24 hours after dental treatment.

If a woman decides not to treat or remove a diseased tooth, then sooner or later complications will arise that will require emergency treatment, which can affect the baby even more.

If you are planning a pregnancy, be sure to visit the dentist in advance, because... Doctors categorically do not recommend treating teeth during pregnancy using anesthesia, especially in the first trimester. Because It is in the first trimester that the main organs of the child are formed, and the use of anesthetics or anesthesia drugs can negatively affect further development baby.

Anesthesia without adrenaline

To enhance the effect, add to the anesthetic solution vasoconstrictors- this increases the duration of action and reduces the level of absorption of the drug into the blood. But accidental entry of the vasoconstrictor itself into the bloodstream is associated with serious side effects.

This is why anesthetics without adrenaline are used for pain relief in dentistry for pregnant women, in pediatric practice and in the treatment of patients with diseases of the cardiovascular system.

Contraindications to dental anesthesia are:

• Allergic reactions to substances included in anesthetics;
• History of cardiovascular diseases;
• Diabetes;
• Organ pathology endocrine system;
• Some types of severe injuries of the maxillofacial area.

Side effects of anesthesia in dentistry

If the doctor is a professional in his field, complications during local anesthesia in dentistry are very unlikely. There are some points that worry patients after and, in principle, are a variant of the norm: swelling of the lip or swelling of the cheek, pain in the gums or even headache during few hours.

However, all these symptoms should go away within 1-3 days after treatment. If you see that the situation is not improving or even worsening, contact the dentist who performed the procedure.

Rarely, more serious complications may occur, including:

• Allergic and toxic reactions. The body's increased sensitivity to medications is due to an allergic predisposition. May manifest as urticaria, Quincke's edema, anaphylactic shock etc.;
• Trauma to blood vessels from an injection needle, which may result in hematomas and bruises;
• Pain and burning at the injection site (quite common and considered normal);
• Lockjaw. Spasm of the masticatory muscles. Occurs when muscle fibers or nerves are damaged;
• Loss of sensation. Occurs when a nerve is damaged during injection;
• Damage to soft tissues. If sensitivity is lost, the patient may bite his tongue, lip, or cheek;
• Infection. If antiseptic rules are not followed.

Advice for patients

Pain during anesthetic injection and treatment will depend on several factors:

• from your sensitivity;
• professionalism of the dentist and equipment of the clinic;
• on the degree of tooth destruction and the depth of caries.

• do not drink alcohol the day before, this may worsen the effect of the anesthetic;
• if you have colds, cough, runny nose, it is better to postpone the visit until complete recovery;
• Women and girls are not recommended to visit the dentist during menstruation, because... during this period, blood clotting worsens (by the way, do not be surprised if the anesthesiologist asks you this question before surgery; operations are not performed during menstruation.
• choose your clinic carefully! Now their choice is very large, but very few comply with important requirements and all antiseptic requirements!

If you choose a clinic, pay attention to:

1. Legal name and registration documents, the same name must be in the contract for the provision of services.
2. Keep all receipts and receipts for payment, pay only through the cashier (also keep track of the legal name of the clinic on them).
3. Go to the clinic’s website (certificates, licenses and certificates of specialists should be presented there), read reviews on the Internet, talk with friends.
4. Visit the clinic itself and make an initial appointment.
5. If you plan to treat your teeth “in your sleep”, i.e. under anesthesia, be sure to check the availability of an anesthesiologist on the clinic staff!
6. Please note that the doctor must wear new gloves and print out all the disposable instruments with which he will carry out treatment and examination!!! In addition, the clinic must have air sterilizers.
7. Be wary of dental offices located on the ground floor of residential buildings; it is better to give preference to large clinics with good equipment, but remember that expensive does not mean quality.

“A patient well secured in a chair does not require anesthesia” - this well-known joke among dentists lost its relevance when dental practice began to use anesthesia in dental treatment. Today, going to the dentist no longer causes trembling knees, hysterics and tears. To remove a tooth, a nerve, to fill canals, to place crowns, to perform pulp surgery - any dental procedure can now be performed without pain and fear.

Types of pain relief in dental practice

Anesthesia is used when it is necessary to reduce or completely block the sensitivity of the body. Depending on the clinical situation and individual characteristics of the body, anesthesia can be performed in 3 options:

1. Local – specific areas are subject to pain relief oral cavity.
2. General (anesthesia) – complete blocking of the body’s sensitivity to pain.
3. Combined.

Dental procedures under local anesthesia: types, features, contraindications

Local anesthesia is divided into several categories:

Attention! In order for treatment of diseased teeth using a local anesthetic to take place without side effects, the patient must inform the specialist about hypersensitivity to painkillers, what sensations he experienced during his last visit to the dentist, whether local anesthesia was used then. Based on these criteria, as well as the person’s health characteristics and the severity of the problem, the specialist will determine the most harmless method of local anesthesia.

Video - Why use anesthesia during dental treatment?

Contraindications to local anesthesia

1. Increased sensitivity (allergy) to painkillers. If a person doubts a possible allergic reaction, then before undergoing anesthesia, the person must undergo an allergy test in a specialized center.
2. Recent heart disease (heart attack, stroke).
3. Diseases of the endocrine system.

The use of general anesthesia in dentistry

The feasibility of this type of pain relief is justified if:

1. The patient has a pronounced fear – dentophobia. A person experiences real horror and panic while sitting in a dental chair.
2. A person needs to undergo an extensive form of dental treatment.
3. The patient is allergic to local anesthetics.
4. The patient has neurological disorders, for example, cerebral palsy, autism, schizophrenia.

With this type of anesthesia, a person’s consciousness turns off. General anesthesia is not as safe as local anesthesia; it can disrupt the functioning of the body and lead to such side effects, How:

• nausea, vomiting;
• arrhythmia;
• bronchospasm;
• temporary increase or decrease in pressure;
• convulsions;
• stopping breathing.

Due to the possible occurrence of side effects, resorting to anesthesia is prohibited:

1. During pregnancy.
2. For sore throat, bronchitis and other diseases of the respiratory system.
3. For heart disease.
4. In old age.
5. When under the influence of alcohol or drugs.
6. With exacerbation of chronic diseases, diseases in the acute period.

Attention! General anesthesia complicates the specialist's work, because during it the doctor inserts a special tube that allows the patient to breathe normally, but makes the doctor's work more difficult.

Combined anesthesia as an alternative to general anesthesia

If general anesthesia is contraindicated for the patient and local anesthesia is not an option for the person suffering panic disorder, then he may be offered a combined type of anesthesia.

Its essence: a specialist gives the patient a sedative. The patient’s consciousness is preserved, however, the person quickly calms down. Then the doctor administers local anesthesia using the chosen method and only then begins dental procedures.

Attention! The advantage of combined anesthesia over general anesthesia is its safety and the absence of side effects.

Anesthesia in dentistry for pregnant women

It is imperative for pregnant women to treat bad teeth. You cannot endure pain and discomfort throughout pregnancy; expectant mothers should be attentive to their health and, if necessary, undergo dental treatment, and not put it off until later. Otherwise, a diseased tooth can cause infection in the woman’s body and fetus, leading to serious complications, including miscarriage.

Treatment of diseased teeth in pregnant women is carried out only with the use of anesthesia. A pregnant woman is prohibited from enduring pain, as this can lead to severe stress, the release of adrenaline, which can provoke an increase in uterine tone.

Attention! To relieve pain during dental procedures in pregnant women, only local anesthesia (injections) is used.

Most often, for local anesthesia of teeth in pregnant women, injections with a solution are used “ Lidocaine" Although this drug penetrates the placenta, it is eliminated very quickly and does not harm the fetus.

Also, for dental pain relief in pregnant women, the drug “ Novocaine", only in a smaller dosage than usual. Such drugs as “ Mepivastezin», « Ultracaine" They do not cause side effects, do not penetrate the placenta, and have an excellent anesthetic effect.

Carrying out pediatric anesthesia in dentistry

When treating sick teeth in children, specialists resort to the following anesthesia methods:

Dental treatment using anesthesia is an important process that allows the doctor to effectively carry out the manipulation and the patient not to experience painful sensations, fear and anxiety. Depending on the type of anesthesia and the characteristics of the patient’s body, the doctor chooses desired method pain relief. The patient’s task is to tune into a positive mood, notify the doctor about the characteristics of the body, the presence of allergies and diseases, and answer the specialist’s questions reliably and completely. Only then will the treatment outcome be positive, without side effects.

Why are we so afraid to visit the dentist? Many try to find all sorts of reasons to postpone a visit to this doctor. You will probably agree that people are afraid to visit the dentist precisely because dental treatment is associated with pain. But modern dentistry has reached such a level of anesthesia that almost any manipulation can be performed without pain. We will consider the main methods of anesthesia in dentistry, its types, as well as possible contraindications.

It is difficult to disagree with the fact that the suffering caused by toothache is one of the most severe. This type of pain is quite difficult to endure. Therefore, anesthesia in dentistry is used for many procedures. Unfortunately, it is pain that becomes the decisive factor that prompts us to go to the dentist. But it is much better to visit this doctor regularly. Going to the dentist just twice a year can help keep your teeth and gums healthy. And if there are any problems, the doctor will be able to detect them on initial stage development of the disease. For example, caries is much easier to treat when it has not yet destroyed most of the tooth. But, unfortunately, we often neglect it so much that the infection penetrates the pulp, destroys it and causes unbearable pain. At the same time, we, exhausted by pain, finally go to the dentist. And he, in turn, is faced with the fact that caries has destroyed tooth enamel and penetrated deep into the tooth tissue. Often in such cases it is necessary to remove the dental nerve. Such a tooth becomes dead, it changes color and ceases to function, as it simply does not receive any nutrition. Therefore, you should not delay your visit to the dentist. It is always better to prevent dental diseases than to treat them later. In addition, such treatment is quite expensive.

Did you know that a tooth is just a bone? Why does he hurt? The thing is that the pulp (in other words, the dental nerve) consists of a large number of tiny nerve endings. They are responsible for nutrition and preservation of teeth. As soon as an infection enters a tooth or its tissues are destroyed for some reason, the nerve endings immediately signal a problem with pain. The problem of toothache is rightly considered one of the most common. Almost every one of us has encountered it. Moreover, for many people they have known it since childhood. There are many reasons for this: poor nutrition, genetic predisposition, malocclusion, chronic diseases and much more. All these factors can worsen the condition of our teeth, destroying them every day.

Most of the dentist's actions are accompanied by severe pain for the patient. Even the most persistent of them are not ready to endure such intense pain. Anesthesia helps to cope with it. All types of anesthesia in dentistry are aimed at eliminating pain as effectively and safely as possible. Now anesthesia has reached such a level of development that at all stages of treatment the patient practically does not feel any discomfort.

How does anesthesia work, what types are there?

So what is anesthesia? How does it even work? How can you “turn off” pain? The fact is that pain relief in dentistry consists of temporarily removing sensitivity from tissues. This is required in order to efficiently perform the manipulations necessary for treatment. Very often they affect fairly deep layers, where many nerve endings are located, as well as the pulp itself. General anesthesia is also possible. It is performed to carry out various operations on teeth, for example, during dental implantation. Without anesthesia, it is almost impossible to perform deep fillings, remove a tooth or nerve, install crowns, carry out surgical or orthodontic treatment of the lower or upper jaw. All these manipulations would be accompanied by simply unbearable pain. But it is very important that the patient not only be given the opportunity to perform the necessary manipulations, but sit still.

What is the principle of anesthesia? It consists in the fact that when it is introduced, a block is performed nerve impulse. And it certainly occurs even with minimal impact on the tooth tissue. As soon as the tooth begins to be manipulated, the pulp immediately sends a signal to the brain. During anesthesia, such a signal does not reach the brain. With it, the patient has a feeling that the cheek and gums are numb. This is reminiscent of the effect of freezing. But anesthetic substances are very unstable. They break down quite quickly, so the effect of anesthesia most often wears off after 4-6 hours. Then sensitivity is restored very quickly.

Local anesthesia in dentistry can be both medicinal and non-medicinal. Non-medicinal therapy has its own subtypes:

1. computer anesthesia;
2. electroanalgesia;
3. hypnotic and psychotherapeutic influence;
4. audio analgesia.

This type has other varieties. But they are used quite rarely due to the fact that quite serious additional training doctor In addition, they do not always bring a sufficiently strong and stable effect. Most often, non-pharmacological methods of anesthesia are only an addition to medicinal ones. They act as a kind of sedative for those patients who do not really trust drug anesthesia or consider it insufficient. The main task of non-drug methods of pain relief is to divert the patient’s attention from the manipulations performed by the doctor. This good way help the patient relax a little, get distracted, especially if he is quite suspicious. Often, the doctor needs to make considerable efforts even to get such patients to simply open their mouths for examination. Including it is quite difficult to provide dental care children. But sometimes it’s enough to turn on a children’s song or a fairy tale to distract the child a little and give the doctor the opportunity to work. But when performing direct treatment, songs and fairy tales will not be enough to help the child cope with pain. Then the usual drug anesthesia comes to the rescue.

How does drug anesthesia work? The doctor injects a substance into the patient’s gum area that acts on the nerve and relieves its sensitivity. Such substances are called anesthetics. There are quite a lot of them. The choice of a specific medicine will depend on a number of factors: the patient’s age, his state of health, allergies, type necessary manipulation etc. Anesthesia can be not only local, but also general. Local anesthesia is pain relief using an injection or application. The injection can be conductive, infiltration, etc. General anesthesia is general anesthesia, in which the patient is in unconscious.

Local anesthesia: types, advantages

Let's consider the types, as well as the advantages of local anesthesia. It is performed most often during the treatment and removal of teeth, as well as their prosthetics. Local anesthesia in dentistry is considered the safest and most convenient. And this is true. Indeed, local anesthesia in dentistry is the most effective and in a safe way eliminate pain. It causes minimal harm to the patient's body. The secret of its advantages is that the sensitivity of only those tissues that are involved in the direct treatment of the tooth or that are very close to it is removed. Most often, it is enough to give one injection so that the tooth almost completely loses its sensitivity for several hours. True, when treating some teeth you will need to give several injections. Most often, when treating wisdom teeth, it is necessary to perform anesthesia more thoroughly so that the sensitivity goes away completely.

How is the anesthetic administered? Most often, the injection method is used to administer the anesthetic, but an application can also be used. They are performed directly in the area of ​​the dentition in which the diseased tooth is located. In other tissues, their sensitivity is completely preserved. The undeniable advantage of local anesthesia is that the patient is fully conscious throughout the treatment and can help the doctor with his actions. For example, he can comply with the doctor's requests to open his mouth, spit, etc. During general anesthesia, the patient is naturally unconscious.

Infiltration anesthesia

This is a type of pain relief by injection. It is infiltration anesthesia that is used most often. For what events is it used? Infiltration anesthesia is indicated if necessary:

1. remove the nerve;
2. perform a certain operation on the pulp;
3. seal the canals.

But there are patients who are afraid of the injections themselves. It is a real problem for them to open their mouth for the doctor to give an injection. They think that an injection into the gum will certainly be very painful. This is actually a misconception. The injection of an anesthetic into the gum is practically not felt. Well, to be completely sure, the doctor can treat the gums special means. It causes temporary numbness, and the patient will not feel any discomfort during the injection. Very often, the gums are treated with an anesthetic drug before the injection is given to children. But they can also use it for pain relief in adults. After treating the injection site, an anesthetic is injected into the apex area at the root of the tooth that requires treatment.

With infiltration anesthesia, sensitivity is very effectively removed. The whole secret is that the anesthetic acts directly on the branches of the dental nerve, and not on its trunk. It is best used when treating teeth in the upper jaw. The upper dentition has thinner and more compact bone. Therefore, the anesthetic penetrates its spongy structure very quickly. At the same time, the lower molars are much stronger and more massive.

Conduction anesthesia

It is used very often during tooth extraction procedures. Often in such cases, infiltration anesthesia may not work effectively enough or may not work at all. It is also indicated in cases where several adjacent teeth need to be numbed at once. One of bright examples conduction anesthesia - mandibular anesthesia. It is important that the doctor injects strictly into the area of ​​the mandibular canal. This will provide sufficiently strong and long-lasting pain relief for part of the dentition.

Anesthetics affect the following areas:

1. dentition of the lower jaw;
2. region lower lip;
3. adjacent side of the tongue and gum.

As you can see, with such anesthesia, a fairly large area is numbed. Knowing that the anesthesia has worked is quite simple. You need to wait until you feel numbness in your lower lip. After this, the doctor can begin his manipulations.

Intraligamentous anesthesia (intraligamentary)

This type of anesthesia is popular in pediatric dentistry. What is the reason? The fact is that children often cannot tolerate the feeling of numbness in the tongue, lips and part of the cheeks. This may scare them. But with other methods of pain relief, this is an integral by-effect. Also, children, due to the fact that they do not feel the numb part, can bite it quite hard. After sensitivity returns, the resulting wound still hurts and bothers the child for quite a long time. After such a trip to the dentist, the child will not want to repeat it for a long time.

With intraligamentous anesthesia, the anesthetic must be injected into the area between the socket and the root of the tooth. It is called periodontium. Methods of administration may vary. The decisive role in their choice is played by the time for which it is necessary to numb the pain, as well as what specific area of ​​the dentition needs to be treated. In the event that it is necessary to treat several teeth nearby, an anesthetic can be injected under sufficient strong pressure. This will ensure its deep penetration into the bone.

With this type of anesthesia, sensitivity returns quite quickly - it will take about an hour. With gradual introduction of the drug, only the gums and periosteum are anesthetized. This method is used in the treatment of caries and pulpitis. But it is also suitable for tooth extraction.

Intraosseous anesthesia

Let's consider how intraosseous anesthesia is performed and what is its peculiarity. The dentist injects a little anesthetic into the gum in the place where the injection will be made into the bone tissue. This guarantees complete painlessness of such an injection. The anesthetic drug is then injected between the teeth into the bone.

With this method, only the gums and teeth lose sensitivity. Lips, tongue and cheeks remain fully sensitive. This method is often used for tooth extraction. But the anesthetic does not act for long with this method of administration, but extremely quickly.

Anesthesia stem

Most often, this type of anesthesia is used for treatment in a hospital. There are the following indications for it:

1. neuralgia;
2. injuries of teeth or jaws of various etiologies;
3. jaw surgery (orthodontic or tumor removal);
4. severe pain syndrome.

In this case, anesthesia is not administered in the mouth area, but directly near the base of the skull itself. This allows you to reliably block the trunk nerves for the lower and upper jaw. With this type of anesthesia, the effect will be strong and long-lasting, but the indications for its implementation are associated with serious manipulations in the area of ​​​​the teeth and jaws.

Application anesthesia

This type of pain relief has another name – superficial. It consists of removing sensitivity directly from the surface of the tissue. Most often used to numb gum tissue. However, it can be used for almost any type of oral tissue. The advantage of this type is that you do not need to use a needle. This a good option for those who are afraid of injections. The doctor uses special anesthetics for the application. They can be in the form of an ointment or a spray. They just need to be applied to the desired location using a tampon. For use similar method The following indications exist:

1. it is necessary to remove tartar that is located near the base of the tooth;
2. it is necessary to numb the surface before deeper anesthesia. After the desired surface has been treated with such an anesthetic, the injection will be painless;
3. if it is necessary to open an abscess under the mucous membrane;
4. if you need to process the edges on the gum.

We must pay tribute to topical anesthesia. She made many manipulations much more comfortable. Previously, such procedures were performed without anesthesia and caused considerable discomfort to patients. After all, a lot of manipulations are performed on the mucous membrane, and it is quite sensitive and tender. At the same time, it is quite difficult to anesthetize it using other methods. But after topical anesthesia became widely used, patients can receive quality treatment without pain.

Are there any contraindications for local anesthesia?

When you visit a doctor, he should first of all ask if you have allergies. If it exists, it is important to determine what exactly it is for. Often a contraindication for local anesthesia is an allergy to one of the anesthetics. Be sure to tell your dentist about possible allergies, if available. In general, an experienced dentist will try to ask the patient leading questions that will help determine whether there are contraindications for local anesthesia. Be sure to tell your doctor about previous diseases or about the diseases you are currently suffering from, about allergies to medications. If you have undergone any operations in your life, they should also be mentioned. Of course, local anesthesia is justifiably considered one of the safest, but even it has some contraindications. Local anesthesia should not be performed if:

1. The patient has recently suffered a heart attack or stroke. At least six months must pass;
2. the patient suffers from diseases of the endocrine system (thyrotoxicosis, diabetes mellitus, etc.);
3. The patient suffers from an allergy to some local anesthetic.

Pay due attention to the safety of your health and give the most truthful and complete answer to each question from the dentist. There are times when dental treatment is required and the patient becomes ill. Then urgent treatment performed in a hospital. But for this there must be an urgent need. Well, if there is a suspicion of an allergy, then before administering anesthesia, the patient must undergo an allergy test in special center allergology. There they will accurately and safely determine which anesthetic the patient is allergic to.

General anesthesia

We have given great attention local anesthesia, reviewed its types, indications and contraindications. But general anesthesia can also be used in dentistry. To be fair, let us clarify that this happens very rarely. There must be a very good reason for putting a patient under general anesthesia for dental procedures. The most common is odontophobia (dentophobia). There is a category of patients who are not just afraid of dentists and everything related to their activities, but experience real horror and panic as soon as they sit in the dental chair. Most often, such fear appears in childhood. That is why it is so important that treatment of children in the dental office does not bring them any discomfort, much less pain. Failed treatment may leave an imprint on his attitude towards doctors for the rest of his adult life.

Such patients put off visiting the dentist until the very last moment, when it is simply impossible to do without his help. The disease is already in an advanced form. In such cases, the doctor may resort to general anesthesia.

During general anesthesia, the patient is completely unconscious. Because of this, there are quite a lot of contraindications for its implementation:

1. respiratory system diseases;
2. cardiovascular diseases;
3. age limit;
4. individual intolerance.

During general anesthesia, adverse reactions occur quite often:

1. bronchospasm;
2. muscle cramps;
3. heart rhythm disturbance;
4. respiratory distress and depression;
5. decrease or increase in pressure;
6. spasm of the larynx;
7. vomit;
8. psychomotor and motor activity;
9. amnesia is rarely observed.

That is why it is necessary to resort to general anesthesia in the most severe cases. Even if a minimum of drugs are administered for general anesthesia, this does not guarantee that they will not have a negative effect on the body. Even the most modern drugs can cause unwanted reaction. In addition, the clinic must have a license and technological criteria to administer general anesthesia.

Combined anesthesia

U general anesthesia There is an excellent alternative - combined anesthesia. If the patient is unable to cope with his fear of dental procedures, then they can use combined anesthesia. It can also be indicated during pregnancy, Down syndrome, and cerebral palsy.

It consists of calming the patient down with the help of special medications. At the same time, his consciousness is preserved. In medicine there is a term for this condition - pre-medication. After this, the dentist will still need to administer local anesthesia, and only then begin treatment. This method is much safer than general anesthesia. At the same time, it is quite effective.

Summarize. Since manipulations in the dental office are associated with quite severe pain, then anesthesia in dentistry is mandatory. But preference should be given to local anesthesia. The doctor will select exactly the method of local anesthesia that will be most effective in a particular case. After performing anesthesia, it will be easier for the doctor to work, and it will be easier for the patient to endure all manipulations. We hope that now you will go to your next dentist appointment without fear or fear.

More

Toothache is an ailment that almost every person experiences during his life. Such painful sensations are a sign of the presence of one or another disease of the dental organs. Such pathologies require not only therapeutic, but in many situations, surgical intervention. It often happens that patients postpone their visit to the dentist due to fear of pain during dental treatment.

Let's consider the most known species anesthesia in dentistry.

Painless dental treatment

Relatively recently a number therapeutic actions, which are associated with unpleasant sensations for a person, could be carried out without a preliminary anesthesia procedure, so, of course, it is not surprising that many people are very afraid of visiting dentists. When a person postpones an appointment with the dentist until the last minute, having a common carious lesion, he risks waiting for more serious complications of his disease to arise, which will subsequently force him to seek surgical treatment.

Today, in absolutely all clinics, as well as dental offices, doctors carry out dental treatment without pain, for which purpose they use Various types anesthesia in dentistry.

This is a decrease or complete elimination of sensitivity in the patient’s entire body or in its individual parts. In most situations this can be achieved by introducing medications, which contribute to disruption of the transmission of pain impulses to the brain from the site of the intervention. In dentistry, anesthesia is required so that the patient does not experience pain during dental treatment. The calm state of the patient gives the doctor the opportunity to carry out therapeutic or surgical actions quickly enough, and most importantly - with high quality and in the required volume.

What types of anesthesia in dentistry exist?

Indications for anesthesia

• Carrying out treatment deep caries.
• The process of depulping, that is, performing extirpation or amputation of the pulp.
• Teeth extraction procedure.
• Other surgery.
• Preparation for dental prosthetics.
• Various types of orthodontic therapy.

It should be noted that caries medium degree is also an indication for anesthesia, since the boundaries of the enamel, as well as the dentinal layers, are very sensitive, so pain in this situation is noted quite often.

Types of anesthesia in dentistry

Anesthesia is divided into local and general anesthesia. In addition, in medicine it is customary to distinguish between medicinal and non-medicinal pain relief.

Thus, there are several types of non-drug anesthesia, which include audio analgesia along with electroanalgesia, as well as pain relief through hypnotic and computer effects. We will consider the types of local anesthesia in dentistry below.

The procedure for drug anesthesia involves the injection of an anesthetic, which blocks the conduction of the impulse for some time required for medical intervention. After a certain period of time, the product breaks down, and sensitivity is fully restored. Modern painkillers make it possible to completely avoid the appearance of discomfort against the background of treatment.

General anesthesia is used relatively rarely for dental treatment. It is most often used in the field of maxillofacial surgery.

Types of local anesthesia in dentistry

Before most medical procedures, local anesthesia is performed. This type of anesthesia is much safer for the body compared to anesthesia. More recently, the most common anesthetics were Novocaine along with Lidocaine, but now even more are used effective means. Thus, there are such types of local anesthesia as application type, infiltration, conduction, intraligamentary, as well as intraosseous and stem.

All types of local anesthesia are most often used in dentistry.

Performing topical anesthesia

This type of anesthesia provides superficial anesthesia, which is performed by spraying a spray or applying an ointment to the mucous membrane of the oral cavity. Most often, ten percent “Lidocaine” is used in the form of aerosol cans.

Application anesthesia is recommended to eliminate the sensitivity of soft tissues in the area where the injection is planned, as well as as part of the treatment of the mucous membrane against the background of stomatitis, gingivitis, and during the procedure for opening minor suppurations. IN medical practice such anesthesia can be used before getting rid of mineralized deposits that are located in the cervical region. In orthopedic medicine, this anesthesia is used to prepare teeth for prosthetics.

What other types of anesthesia are there in dentistry?

Infiltration type of anesthesia

The infiltration option allows you to anesthetize one tooth or a small area of ​​the mucous membrane. It is usually practiced as part of eliminating neurovascular bundle, and, in addition, for the treatment of deep caries.

Types of infiltration anesthesia in dentistry are also very popular.

Usually the injection is given into the projection of the root apex. In this situation, the anesthetic agent blocks pain impulses at the level of nerve branches. Often this is how the anesthesia procedure is performed. upper teeth. This is explained by the fact that the small thickness of the jaw bone allows the anesthetic to easily penetrate the nerve endings.

Performing conduction anesthesia

Conduction anesthesia is needed when infiltration anesthesia does not have the necessary effect, or pain relief for several nearby is required. standing teeth. In addition, it is used for tooth extraction. In addition, conduction anesthesia is used to open abscesses against the background of periostitis, as well as exacerbation of chronic periodontitis. Sometimes it is performed during the process of draining a purulent focus. Thus, an injection of an anesthetic makes it possible to temporarily turn off the entire nerve branch.

Quite often, immediately before surgery on the upper jaw, palatal conduction anesthesia is performed, which, if necessary, is supplemented with incisal anesthesia. To numb the lower jaw, torus or mandibular anesthesia is used.

Intraligamentous anesthesia

This anesthesia technique in dentistry is often used in children to treat deep caries, as well as its complications. In addition, it is used when a tooth is to be removed.

Injection of the product is performed in the area of ​​the periodontal ligament, located between the root of the tooth and the wall of the alveolus. As a result, the mucous membranes do not lose their sensitivity, which prevents the child from accidentally biting his tongue and lips.

Carrying out intraosseous anesthesia

This anesthesia is recommended for tooth extraction operations. First, an anesthetic is injected into the gums, and after achieving local numbness, the injection is performed in the area of ​​the jaw bone in its spongy layer, which is located in the interdental space. In this case, only the sensitivity of a specific tooth and a small area of ​​​​the gum disappears. This effect occurs almost instantly, but lasts for a short time.

Trunk type of anesthesia

Stem anesthesia in the field of dentistry is performed exclusively in a hospital. Indications for its implementation are pain of high intensity along with neuralgia of the facial nerve, as well as serious injuries to the zygomatic bone and jaw. This type of anesthesia is also practiced in preparation for surgery.

An anesthetic injection is performed at the base of the skull, which makes it possible to disconnect the maxillary and mandibular nerves simultaneously. The effect of such anesthesia differs from other options in power, as well as in its significant duration.

When is anesthesia technique prohibited in dentistry?

Contraindications

Before performing an anesthesia procedure, the dentist must find out whether the patient has any serious somatic diseases or allergic reactions for medications. Thus, the main contraindications to the use of painkillers may be:

• The occurrence of allergies after the administration of an anesthetic.
• Availability diabetes mellitus and a history of acute heart disease, for example, heart attacks or strokes six months ago.
• A number of others hormonal disorders against the background of ailments of the endocrine system, for example, thyrotoxicosis and so on.

It is important to note that against the background of decompensated forms of endocrine diseases, treatment of the patient should be carried out only in a hospital. Extra caution It is recommended to observe when performing anesthesia in children and pregnant women.

Anesthesia in pediatric dentistry

Unfortunately, today there are no anesthetics that can be called completely safe for children. IN childhood The body is extremely sensitive to any medications, so the risk of complications after injections is very high.

Previously, Lidocaine and Novocaine were used for pain relief, but now Aricaine and Mepivacaine are considered to be the safest for children. In dental treatment of children, such types of anesthesia as application, infiltration, intraligamentary and conduction are practiced.

It is important to consider that among young patients there is a very high risk of psychogenic complications, since the child’s psyche is not fully formed. Especially a common complication There is a short-term loss of consciousness, which is associated with strong emotions and fear.

Complications associated with the use of local anesthesia

To the number probable complications during the anesthesia procedure include:

• The appearance of allergic reactions with special hypersensitivity to these drugs.
• Possibility of toxic reactions as a result of overdose.
• Prolonged loss of sensitivity due to nerve injury from a needle, which sometimes occurs due to violation of the injection rules.
• Burning and pain at the injection site. This phenomenon occurs quite often and is considered normal for all types of anesthesia in dentistry. The technique must be strictly followed.

In addition, there is a possibility of the following complications:

• The occurrence of swelling and bruising after the injection due to damage to the blood vessels.
• The needle breaks during the injection, which happens extremely rarely.
• If the dentist does not follow the rules of asepsis when injecting into the affected area of ​​the mucosa, tissue infection may occur.
• The appearance of transient spasms of the masticatory muscles as a result of damage to the nerve or muscle fibers
• Accidental biting of the tongue, lips or cheeks due to temporary loss of sensation.

The use of modern painkillers makes it possible to minimize the likelihood of most complications.

On the eve of treatment, before visiting the dentist, you must refrain from consuming alcoholic drinks, because ethanol reduces the analgesic effect of most medicines. In case of emotional stress, it is advisable to take a sedative at night, for example, Afobazol, motherwort or valerian extract. If you feel unwell, especially with otolaryngological diseases or flu, it is best to postpone a visit to the dentist.

Women during menstruation would also be better off holding off on dental treatment, if possible. During this period, nervous excitability increases greatly, as well as susceptibility to medicines. Therefore, tooth extraction along with other surgical interventions during menstruation can cause prolonged bleeding.

General anesthesia

Under general anesthesia In dentistry, we mean a complete loss of sensitivity, which is accompanied by various disturbances of consciousness. General anesthesia during dental treatment is used quite rarely and only for strict indications, since this method of pain relief is extremely dangerous. It is used when carrying out serious surgical manipulations in the maxillofacial area.

It should be noted that nowadays, inhalation anesthesia, that is, nitrous oxide, is increasingly used during dental treatment. Thus, the indications for performing general anesthesia in dental practice are:

• Allergic reactions of the body to local anesthetics.
• Mental illnesses.
• Panic fear of dental procedures. Anesthesia in dentistry during pregnancy is used, but mostly local and in the most extreme cases. It is better if it is not in the first trimester.

Contraindications in this case include:

• Respiratory diseases.
• The presence of serious pathologies of the cardiac system
• General intolerance to anesthetic drugs.

Immediately before a planned intervention, which involves putting the patient under anesthesia, the patient is recommended to undergo an examination, which will include:

• An electrocardiogram for an objective assessment of the condition of the heart.
• Change general analysis blood, as well as for hepatitis and HIV.

We looked at anesthesia methods in dentistry.