Fear of treatment or tooth extraction is largely due to the fact that before anesthetic drugs good quality did not have. Today, clinics use new generation anesthetics. Painkillers in dentistry are completely excluded painful sensations both during the main actions and at the time of their introduction.
Indications for the use of painkillers in dentistry
Anesthesia is required when performing the following manipulations:
What painkillers are used in dental treatment?
The best means for local anesthesia are considered to be articaine anesthetics.. The main substance is much more effective than Novocaine and Lidocaine.
An important feature of Articaine is the possibility of its use in purulent inflammations when the effect of other drugs decreases. In addition to the main component, modern anesthetics contain vasoconstrictors.
Adrenaline or epinephrine constrict blood vessels, preventing the drug from being washed out from the injection site. Pain relief time increases.
The drug is an analogue of Ultracaine, their composition is the same. Produced in Germany in two forms depending on the epinephrine content.
Mepivastezin or Scandonest
Available in two forms, it contains adrenaline, as well as preservatives that can provoke an allergic reaction. The effect after administering the drug to the patient occurs within 1-3 minutes. Septanest is acceptable for use in children over 4 years of age.
Included in the group of second generation esters. It is used less and less, since its effectiveness in treating pain is 4-5 times worse than other drugs. Novocaine is most often administered for minor dental operations.
What is pain relief for wisdom tooth removal?
When removing a wisdom tooth, ester or amide anesthetics can be chosen. The action of the former is quick and short-term. These include Pyromecain and Novocain.
Amides include:
- trimecaine– injection, pain relief for 90 minutes;
- lidocaine– valid up to 5 hours;
- bupivacaine– relieves pain 6 times better than novocaine, but it is 7 times more toxic, lasts up to 13 hours;
- ultracaine D-S– the effect is 5 times higher than after the administration of Novocaine, lasts 75 minutes, can be used by pregnant women;
Names of modern anesthetics without adrenaline
Pain relievers without adrenaline include:
- Articaine hydrochloride. Leader among other anesthetics. Available with or without epinephrine and with increased vasoconstrictor content;
- Ubistezin. Patients with an allergic reaction, diabetes mellitus, hypertension, bronchial asthma, heart failure and thyroid disease, a drug labeled “D” is prescribed, without adrenaline;
- Prilocaine. It is used without vasoconstrictors or with a low content of them. The drug is not prescribed to pregnant women and patients with pathologies of the heart, lungs, or liver;
- Trimekain. It has a calming effect and is not used very often in dentistry;
- Bupivacaine. It is not used for heart pathologies and liver diseases;
- Pyromecaine. It has an antiarrhythmic effect, so it is recommended to be administered to people with arrhythmias.
Pain relief during pregnancy and breastfeeding
The best option for pregnant and nursing mothers is a carpule of Ultracaine and Ubisiesin in a ratio of 1:200000. The vasoconstrictor substance does not affect the fetus because it cannot penetrate the placenta.
Both carpule anesthetics are safe for breastfed children, since the components of the drug do not pass into milk. Scandonest and Mepivastezin without epinephrine are also often used by doctors. They are 2 times more toxic than Novocain and are absorbed into the blood faster.
What drugs are used in pediatric dentistry?
In children, pain relief occurs in two stages. First of all, the dentist performs topical anesthesia, that is, using an aerosol or gel with Lidocaine and Benzocaine, reduces the sensitivity of the mucous membrane, then injects an anesthetic.
In pediatric dentistry, preparations with Articaine are more often used. It is less toxic and is quickly eliminated from the body.
According to the instructions, these drugs can be administered to children from the age of 4 years. When molars are removed, an injection of Mepivacaine may be given.
Contraindications and side effects of local anesthesia
Before starting treatment, the dentist must ask the patient about possible somatic diseases or an allergic reaction to any drugs.
Contraindications to anesthesia may include:
- allergy to the administered drug;
- hormonal disorders due to pathologies of the thyroid gland;
- diabetes.
How much does dental anesthesia cost in the clinic?
The cost of anesthesia in dentistry is determined based on individual clinic prices, the equipment used and the experience of doctors. average price for an injection it costs 800-1200 rubles, an application costs from 100 to 1500, a conduction method costs from 250 to 4000.
List of the most powerful medications for toothache
There are 3 types of painkillers: opiates, analgesics and non-steroidal drugs. The latter are mainly used in dentistry. They cope well with pain, are not addictive, and can be bought without a doctor's prescription.
There are many medications to relieve toothache, but there are 5 most effective ones:
- Ketonal. Based on ketoprofen, prescribed after tooth extraction, as anti-inflammatory therapy after implantation and other interventions;
- Nurofen. Based on ibuprofen, also used in pediatric dentistry, has virtually no side effects;
- Voltaren. Used as anti-inflammatory therapy for TMJ;
- Nise. Based on nimesulide, relieves swelling and inflammation;
- Nolodotak. Based on flupirtine, relieves acute and chronic pain.
Video on the topic
About the use of pain-relieving injections during dental treatment in the video:
Anesthesia in dentistry – required procedure, relieving discomfort during dental treatment. The main thing is to choose the right drug and warn about possible diseases.
Types of anesthesia for dental treatment: what anesthetics and painkillers are used in dentistry?
Many people are afraid to visit the dentist. The doctor's actions are associated with pain and discomfort. Suffering from toothache, patients put off visiting the dentist until the critical moment and often, without time to spare, ask the doctor to perform several extensive procedures at once.
Today in dentistry, several methods of anesthesia are used to remove and treat teeth. An experienced specialist knows which drug will relieve pain best. The patient will not feel pain, and the dentist will have the opportunity to carry out dental treatment at the proper level.
Anesthesia methods used in dentistry
Anesthesia for tooth extraction and other dental procedures involves a decrease or complete loss of sensitivity in certain areas oral cavity. Numb the area surgical intervention is possible through the use of pharmaceuticals that interrupt the transmission of pain impulses coming from the sources of pain to the brain.
Thus, it is almost impossible to carry out high-quality treatment of wisdom teeth without anesthesia - therapeutic and surgical actions performed by the doctor will be accompanied by severe pain. That is why all modern dental clinics treat teeth using various types pain relief.
General anesthesia
Under general anesthesia, the patient falls into a deep sleep, his consciousness turns off. With this method, pain relief is administered intravenously or inhalation. narcotic drugs. During dental treatment, the patient’s condition is monitored by an anesthesiologist-resuscitator.
When a person is under general anesthesia, on the one hand, it is easier for the dentist to treat teeth, in particular wisdom teeth. But on the other hand, the doctor constantly needs to adapt to the patient, since he is immobilized and cannot fix his head in correct position and open your mouth wider. As a rule, with this type of anesthesia, after waking up, a person does not remember what happened to him during the operation.
This type of pain relief is advisable to use in the following cases:
- complex surgical operation;
- pathological fear of dental procedures;
- allergies to local anesthetics.
In many cases, general anesthesia is contraindicated for dental procedures. Before the patient is put under anesthesia, he needs to have his blood tested and undergo an ECG to rule out heart pathologies.
Shortly before dental surgery, the patient must give up smoking and alcohol. A few hours before going under anesthesia, the patient should not eat.
Local anesthesia
Local anesthesia is the safest. The person is conscious, the drug used affects only the peripheral nervous system.
With the introduction of carpule (strictly dosed) anesthesia, the patient begins to feel numbness in the gums, tongue and lips. There are often cases when, with an incorrectly calculated dose of the drug, patients complained that the anesthesia did not work. With the advent of carpules (ampoules with anesthetic), this problem disappeared. After the analgesic is broken down, its effect stops and sensitivity is restored.
Preparations for general anesthesia
Is anesthesia harmful when removing wisdom teeth? Under influence narcotic drugs a person does not feel pain, but at the same time his body is subjected to serious stress. The brain is primarily affected; anesthesia affects the conduction system of the heart; the components of the anesthetic can cause allergic reactions. That is why during the operation an anesthesiologist is present next to the patient, who has all the necessary resuscitation equipment at his disposal.
In dentistry, only intravenous general anesthesia is performed using drugs called Ketamine, Propofol, Sodium Thiopental, etc., which have a hypnotic, sedative and muscle relaxant effect. A person can be put into a state of deep sleep using nitrous oxide inhaled through a mask.
Types of anesthetics for local anesthesia
Today, the strongest anesthetics of the articaine series are considered the best anesthesia used in dentistry for local anesthesia. The main component of the painkiller is several times more effective than Lidocaine and Novocaine.
A distinctive feature of Articaine is the possibility of use for purulent inflammations, when the activity of other drugs is reduced. Many patients in such cases do not understand why the anesthetic does not work. In addition to the main component Articaine, modern drugs contain vasoconstrictors. Due to adrenaline or epinophrine, the blood vessels narrow, preventing the drug from being washed out from the injection site. The strength of anesthesia and the duration of action of the intraseptal anesthetic increase.
Ubistezin is an analogue of Ultracain; the composition of the two drugs is identical. The manufacturing company is registered in Germany. The anesthetic is available in two forms depending on the concentration of epinephrine: Ubistezin or Ubistezin forte.
Mepivastezin or Scandonest
It is not recommended for hypertensive patients to use anesthetics with vasoconstrictor components; for high blood pressure, it is worth selecting drugs without adrenaline and epinephrine in the composition. Mepivastezin (manufactured in Germany) and its complete analogue Scandonest (France) is prescribed to patients at risk.
These pharmaceuticals do not contain vasoconstrictors, so they are used to relieve pain in children, pregnant women and patients with bronchial asthma. Mepivastezin and Scandonest are also prescribed to patients with adrenaline intolerance.
Dentists have been successfully using Septanest anesthesia for several years. The anesthetic is presented in two forms, each of which differs in the content of adrenaline in the composition. Unlike Ultracaine and its analogues, Septanest contains preservatives, which, according to the instructions for use, can provoke allergic reactions.
After the drug is administered to the patient, the anesthetic effect occurs within 1-3 minutes. Anesthesia lasts for 45 minutes. Septanest can be used as a local anesthetic for children from 4 years of age.
Novocaine belongs to the group of second generation esters. A drug with moderate anesthetic activity is inferior in effectiveness to anesthetics of the articaine and mepivacaine series. It is used less and less, since modern painkillers are 4-5 times better at treating pain during tooth extraction. Novocaine is used for minor dental operations and in the treatment of pain syndromes.
Other types of anesthetics
When going to see a surgeon to have a tooth removed, many people wonder what types of anesthesia are used? By chemical properties Anesthetics are divided into two groups: substituted amides and esters. There are preparations for short, medium and long acting. Also, anesthesia in dentistry has its own classification:
- superficial;
- conductor;
- infiltration
Lidocaine has a deep analgesic effect, but it copes with toothache worse than other intraseptal anesthetics. If we compare it with Novocaine, which is widely used in government medical institutions, then the choice of dentists is more likely to focus on Lidocaine.
What medications are allowed during pregnancy?
The best option for pregnant women and nursing mothers is a carpule of Ultracaine or Ubistezin with epinephrine at a concentration of 1:200,000. The vasoconstrictor substance has no effect on the fetus, since it fails to penetrate the placenta. Studies have proven the safety of these carpule anesthetics in relation to breastfed children - their components in breast milk don't hit.
During pregnancy, there is no need to refuse injections with vasoconstrictors. However, in their practice, doctors use Scandonest and Mepivastezin without epinephrine in the composition for anesthesia for women during pregnancy. These drugs are twice as toxic as Novocaine and are absorbed into the blood faster.
Use of anesthesia in children
What anesthesia is used in pediatric dentistry? Dentists anaesthetize children in two stages. First, topical anesthesia is performed when the doctor uses an aerosol or special gel with Lidocaine or Benzocaine desensitizes the area of the mucous membrane where the anesthetic injection will subsequently be made. This type of anesthesia is also used for intraosseous anesthesia.
Children are administered drugs with Articaine as the main component. It is less toxic and is quickly eliminated from the body. According to the instructions for use, such drugs can be used for anesthesia in children over 4 years of age. Also, when molars are removed, an injection of Mepivacaine is often given. In pediatric dental practice, a table with weight and the maximum permissible dose of anesthetic administered is often used.
Types of modern methods of anesthesia in dentistry, drugs for pain relief
Fears associated with pain during treatment and tooth extraction are due to the fact that previously there were no high-quality anesthetic drugs. But today, almost all dental clinics use new generation local anesthetics. Modern drugs make it possible to completely eliminate pain not only during the main operation, but even at the time of their administration.
Anesthesiology in dentistry
Anesthesia is the absolute disappearance or partial decrease in sensitivity in the entire body or its individual parts. This effect is achieved by introducing special drugs into the patient’s body that block the transmission of pain impulses from the area of intervention to the brain.
Types of pain relief in dentistry
Based on the principle of impact on the psyche, there are two main types of anesthesia:
- Local anesthesia, in which the patient is awake, and loss of sensitivity occurs exclusively in the area of future medical procedures.
- General anesthesia(anesthesia). The patient is in a unconscious, pain relief occurs throughout the body and skeletal muscles relax.
Depending on the method of delivering the anesthetic into the body, dentistry distinguishes between injection and non-injection anesthesia. With the injection method, the anesthetic drug is administered through an injection. It can be administered intravenously, in soft fabrics oral cavity, bone or periosteum. In non-injection anesthesia, the anesthetic is administered by inhalation or applied to the surface of the mucosa.
General anesthesia in dentistry
General anesthesia is the complete loss of sensitivity of nerve fibers, accompanied by impaired consciousness. In dentistry, anesthesia is used less frequently for dental treatment. local anesthesia. This is due not only to the small area surgical field, but also a large number of contraindications and possible complications.
General anesthesia can only be used in dental clinics that have an anesthesiologist and resuscitation equipment that may be required in case of emergency resuscitation.
General anesthesia in dentistry is only necessary for long-term complex maxillofacial operations - correction of cleft palate, multiple implantations, surgery after injury. Other indications for the use of general anesthesia:
- allergic reactions to local anesthetics;
- mental illnesses;
- panic fear of manipulation in the oral cavity.
Contraindications:
- diseases of the respiratory system;
- pathology of cardio-vascular system;
- intolerance to anesthetic drugs.
The anesthetic can be delivered by injection or inhalation. The drug most commonly used by dentists for inhalational general anesthesia is nitrous oxide, known as laughing gas. By using intravenous injection The patient is immersed in medicated sleep, for this purpose drugs are used that have a hypnotic, analgesic, muscle relaxant and sedative effect. The most common are:
- Ketamine.
- Propanidid.
- Hexenal.
- Sodium hydroxybutyrate.
Local anesthesia in dentistry
In dental treatment, local anesthesia is most in demand, aimed at blocking nerve impulses from the surgical field. Local anesthetics have an analgesic effect, due to which the patient does not experience pain, but retains sensitivity to touch and temperature.
The duration of anesthesia depends on how and with what exactly dentists numb the surgical field. The maximum effect lasts for two hours.
Local anesthesia is used for the following procedures:
- turning for a bridge or crown;
- pin tooth extension;
- implantation;
- channel cleaning;
- surgical treatment of gums;
- removal of carious tissues;
- tooth extraction;
- excision of the hood over the wisdom tooth.
Types and methods of local anesthesia in dentistry
Depending on what area and for how long the sensitivity needs to be deprived, the dentist selects the optimal technology, medicine and its concentration. The main methods of administering anesthetic are:
- infiltration;
- intraligamentary;
- stem;
- intraosseous;
- applique.
Infiltration method
Used in dental practice and maxillofacial surgery. The advantage of the method is fast action, long-lasting analgesic effect, the possibility of repeated administration during a protracted operation, rapid removal of the anesthetic from the body, deep analgesia of a large area of tissue. About eighty percent of dental interventions are performed under infiltration anesthesia.
The method is used for the following manipulations:
The anesthetic medicine is injected in layers, first under the mucous membrane at the apex of the tooth root, and then into the deeper layers. The patient feels discomfort only with the first injection; the rest are completely painless.
There are two types of infiltration dental anesthesia - direct and diffuse. In the first case, the immediate site of injection of the anesthetic is anesthetized, in the second, the analgesic effect extends to nearby tissue areas.
The following drugs are used for local infiltration anesthesia in dentistry:
Intraligamentous (intraligamentous) method
It is a modern type of infiltration anesthesia. The dose of the administered anesthetic is minimal (does not exceed 0.06 ml), which makes possible treatment and tooth extraction in pregnant and lactating women.
The anesthetic is injected into the periodontal space using a special syringe and under high pressure. The number of injections depends on the number of roots of the tooth. Sensitivity to pain disappears instantly without causing a feeling of numbness, so the patient can speak freely and does not experience discomfort after the operation.
Restrictions on the use of the method are:
- The duration of the manipulation is more than 30 minutes.
- Fang manipulations. By virtue of anatomical features it is not always possible to anesthetize them intraligamentously.
- Inflammatory processes in the periodontium, periodontal pocket, gumboil.
- Root cyst of the tooth.
The intraligamentous anesthesia method is the most painless and safe in dentistry, therefore it is often used in pediatric practice. Ease of implementation, painlessness, safety and high efficiency make the method popular among dentists. The cost of this procedure is higher than infiltration due to high prices for injectors.
The following drugs are used for intraligamentous anesthesia during dental treatment:
Stem (conductor) method
Distinctive features of the stem method of pain relief are the power and long duration of the effect. It is used during long-term surgical operations and in situations where it is necessary to block sensitivity in the tissue area of the entire lower or upper jaw.
Indications for conduction anesthesia are:
- high intensity pain syndrome;
- neuralgia;
- removal of cystic formations;
- endodontic treatment;
- severe injuries to the jaw and zygomatic bone;
- curettage;
- complex tooth extraction.
The injection is injected into the area of the base of the skull, thanks to which two jaw nerves can be blocked at once - both the upper and the lower. The injection is performed by an anesthesiologist and exclusively in a hospital.
Unlike all other methods of local anesthesia, stem anesthesia does not act on nerve endings, but completely on a nerve or group of nerves. The anesthetic effect time is one and a half to two hours. Novocaine and Lidocaine are considered the basic drugs; in modern anesthesiology, more effective agents are used.
Application method (surface, terminal)
It is used primarily in pediatric dental practice to desensitize the place where the anesthetic injection will be given, which ensures an absolute absence of pain. It is used as an independent method in cases where it is necessary:
For topical anesthesia in dentistry, painkillers are used in the form of spray, ointment, paste and gel. Most often, dentists use ten percent Lidocaine in an aerosol as an analgesic. The drug penetrates 1–3 mm deep into the tissue and blocks nerve endings. The effect lasts from several minutes to half an hour.
Intraosseous (spongy) method
It is used for anesthesia of lower molars, during the extirpation of which infiltration and conduction anesthesia are ineffective. Instantly eliminates the sensitivity of one tooth and the adjacent gum area. The advantage of this method in dentistry is strong pain relief with small doses of the drug.
Classical intraosseous anesthesia has not received widespread use in anesthesiology due to the complexity of its implementation and the traumatic nature.
The essence of the method is to inject an anesthetic into the spongy layer jaw bone between the roots of the teeth. Infiltration anesthesia is preliminarily performed. After numbness of the gums, the mucous membrane is dissected and the cortical plate of the bone is trepanned using a drill. The bur is buried 2 mm into the spongy tissue of the interdental septum, after which a needle with an anesthetic is inserted into the formed canal.
Contraindications to local anesthesia
Before prescribing local anesthesia to a patient, the dentist must find out whether there are any contraindications to its administration. Special measures The doctor must take precautions when prescribing anesthesia for children and expectant mothers.
Contraindications to local anesthesia are:
- history of allergic reactions to drugs;
- diseases of the cardiovascular system;
- suffered a stroke or heart attack less than six months ago;
- diabetes;
- hormonal disorders and pathologies endocrine system.
Modern anesthetics (painkillers) in dentistry
With the advent of local anesthetics and new generation technologies, the usual Novocaine is almost never used in dentistry, especially in Moscow and other major cities. Despite possible complications and a high percentage of allergic reactions, lidocaine remains the main local anesthetic in regional clinics.
When visiting the clinic, you need to provide the attending physician with a complete and reliable history so that he can eliminate all risks and choose the right drug. Most dental clinics use carpule technology to administer anesthetics, which consists in the fact that the active substance is contained in a special disposable carpule, which, without opening manually, is inserted into a syringe. The dose of the drug in the capsule is designed for one administration.
Modern drugs for local anesthesia are based on the drugs Articaine and Mepivacaine. In the form of carpule capsules, Articaine is produced under the names Ultracaine, Septanest and Ubistezin. The effectiveness of drugs based on it exceeds the effectiveness of lidocaine by 2, and novocaine by 5–6 times.
In addition to Articaine itself, the carpul contains adrenaline (epinephrine) and an auxiliary substance that promotes vasoconstriction. Due to vasoconstriction, the period of action of the anesthetic is prolonged, and the speed of its spread into the general bloodstream is reduced.
Patients with endocrine disorders, bronchial asthma and a tendency to allergic reactions in dentistry, anesthetics without adrenaline are usually prescribed. If powerful anesthesia is required, it is permissible to use Ultracaine D with minimum concentration epinephrine.
Anesthesia without adrenaline in dentistry
Mepivacaine is used to treat patients with contraindications to adrenaline in dentistry. drug with this active substance, marketed under the name Scandonest, is less effective than Articaine. But it does not contain epinephrine, so Scandonest is suitable for administration to children, pregnant women, people with heart disease, and individual intolerance to adrenaline.
For diseases of the endocrine system, Scandonest and drugs without adrenaline are more often used. It is unacceptable to use products with vasoconstrictor components for hypertension.
The type of anesthesia dentists use determines not only the degree of painlessness of the medical intervention, but also the list of consequences that will have to be encountered after the operation. Modern means minimize the risks associated with incorrect administration of the drug, incorrect dosage and the occurrence of allergic reactions to the anesthetic.
“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 for 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, individual characteristics body, anesthesia can be performed in 3 options:
- Local – specific areas of the oral cavity are subject to pain relief.
- General (anesthesia) – complete blocking of the body’s sensitivity to pain.
- Combined.
Dental procedures under local anesthesia: types, features, contraindications
Local anesthesia is divided into several categories:
| № | Types of local anesthesia in dental practice | Category description |
|---|---|---|
| 1 | The gel (or spray) is applied to the surface of the oral mucosa. This method is used before the next injection (for painless needle insertion): when opening an abscess, removing tartar. The effect of this type of pain relief is short-term |
|
| 2 | An anesthetic injection is given into the area requiring treatment. The effect of the anesthetic is 1 hour. A method is used to remove the nerve, clean the canals |
|
| 3 | A more extensive method of anesthesia than the previous one. The injection is made into the nerve trunk, the anesthetic acts not only on 1 area, but also on the entire jaw; The tongue and cheeks may become numb. This method is used if several teeth need to be treated at one time. |
|
| 4 | The injection is made into the periodontal space of the jaw. The injection does not cause numbness, as in the previous case; this method is more often used in dental treatment in young patients |
|
| 5 | It is used rarely and only if a person is being treated in a hospital. Anesthesia is injected near the base of the skull. The method is used when performing serious operations on the jaw, for injuries, neuralgia |
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 increased sensitivity to painkillers, what sensations he experienced during the last visit to the dentist, and 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
- 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.
- Recent heart disease (heart attack, stroke).
- Diseases of the endocrine system.
The use of general anesthesia in dentistry
The feasibility of this type of pain relief is justified if:
- The patient has a pronounced fear - dental phobia. A person experiences real horror and panic while sitting in a dental chair.
- A person needs to undergo an extensive form of dental treatment.
- The patient is allergic to local anesthetics.
- 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 possible appearance side effects, resorting to anesthesia is prohibited:
- During pregnancy.
- For sore throat, bronchitis and other diseases of the respiratory system.
- For heart disease.
- In old age.
- When under the influence of alcohol or drugs.
- During exacerbation 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 woman in the position is prohibited from enduring pain, as this can lead to severe stress and the release of adrenaline, which can provoke an increase in the tone of the uterus.
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 perform the procedure and the patient not to experience pain, fear and anxiety. Depending on the type of anesthesia and the characteristics of the patient’s body, the doctor chooses the desired method of 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.
In dentistry, pain is a major concern in dental office visits around the world. It is because of the fear of painful sensations that many patients avoid visiting a dentist, mistakenly assuming that the treatment will be extremely and unbearably painful.
Anesthesia, anesthetics, anesthesia, premedication in dentistry
Pain relief methods:
- injection anesthesia,
- topical anesthesia,
- general anesthesia.
At the Imperial clinic in St. Petersburg, when preparing our patients for dental procedures, we try to provide psychological guidance and, if necessary, use premedication.
Features of local anesthesia.
For the so-called “Risk Group (GR)”, some components of local anesthesia may be especially dangerous.
- experiencing increased fear (fear) of treatment, doctors;
- with drug intolerance;
- with some hereditary diseases;
- women during pregnancy (in extreme cases, anesthesia is used, only in the second trimester);
- women during lactation.
When using local anesthesia, the doctor faces several tasks:
Firstly, the selection of local anesthesia should be such as to completely eliminate sensitivity to pain in the area of intervention and obtain maximum effectiveness during and after the operation.
Secondly, choose a drug that will minimize the impact of individual substances contained in the drug.
Please note that if, after anesthesia, you still feel PAIN, then most likely there was an insufficient dose of anesthesia or the anesthesia was administered incorrectly!
An experienced dentist must be well versed not only in the actions of anesthetic drugs from various companies, but also in their chemical composition.
The doctor must know:
- duration of action of the local anesthetic drug,
- time of its elimination from the body,
- toxicological properties,
- the use of an anesthetic with other dental drugs in different combinations and different concentrations.
Contrary to people's expectations, modern medicine has stepped so far forward that it makes any treatment very easy and comfortable even for the most pampered patients.
The Imperial Clinic invites you to experience the latest developments in anesthesiology and feel comfort instead of fear and pain.
Compositions of components of modern local anesthesia drugs
The components of a local anesthetic (or local anesthetic) are substances such as:
- Local anesthetic (articaine, bupivacaine, lidocaine, mepivacaine, novocaine, prilocaine, trimecaine, etidocaine);
- Parahydroxybenzoates ( nutritional supplements);
- Substance for narrowing blood vessels- Vasoconstrictor (adrenaline or epinephrine, mesaton, norepinephrine or norepinephrine, felypressin or octapressin);
- Stabilizers (sodium sulfite, potassium sulfite).
Drugs used for local anesthesia do not always contain all of the above components.
To block impulses along the nerve endings, only one local anesthetic is enough, but for a longer action and to enhance the effect of anesthesia, vasoconstrictors are used.
Almost all new, local, anesthetic drugs, although to varying degrees, are vasodilators, so vasoconstrictors, being a vasoconstrictor, help concentrate the anesthetic, just in the area of dental intervention.
If you have contraindications to substances such as adrenaline, mesaton, norepinephrine or felypressin, then a local anesthetic can be used without a vasoconstrictor, but this reduces the useful time of the analgesic effect.
The presence of stabilizers and preservatives in modern drugs suggests that these anesthetics have a long shelf life.
Indications for the use of local anesthesia
Anesthesia of the surface of the mucous membrane at the injection site, for the removal of permanent mobile and baby teeth and tartar, during simple operations on the gums (eg abscess), as well as in the treatment of diseases of the oral mucosa (eg gingivostomatitis).
Contraindications for the use of local anesthesia
All contraindications to the use of a local anesthetic can be combined into 3 points:
- Hypersensitivity immune system body to local anesthetic:
- At the same time, the attending physician selects the painkiller that is most suitable for the planned dental intervention (depth, duration, nature). - Insufficiency of the patient's metabolic regulation system (cleaning and elimination):
- This takes into account the peculiarities of the pathology of the patient’s body, his general somatic condition, as well as the presence of contraindications. - Age limit:
- This point takes into account the dosage of local anesthetic drugs, taking into account the age of the patient (child or old man) Criteria for choosing a local anesthetic drug (anesthetic).
Types of drugs for topical anesthesia
Application anesthesia is used by doctors at the Imperial Clinic for complete patient comfort in the form of ointments, solutions and aerosols. Using this product makes the penetration of the needle completely imperceptible.
Local anesthetics used in dentistry "Imperial"
Anesthesia of the desired area, when using topical anesthesia, occurs in one to two minutes, to a depth of 1-3 mm and lasts from 10 to 20 minutes.
Premedication - preparation for anesthesia
Premedication is the use of one or more medications immediately before surgery to facilitate anesthesia and reduce the risk of possible complications.
The most common premedication is sedation.
Sedatives used for premedication:
- Herbal preparations (tincture of motherwort, valerian, valocordin, corvalol, valoserdin, etc.)
- Benzodiazepine tranquilizers (phenazepam, diazepam, midazolam, etc.)
- Chemicals(eg trioxazine).
Indications for the use of sedative anesthesia for premedication
- Fear, horror, before dental treatment,
- disturbance of blood supply to the myocardium ( ischemic disease hearts),
- high blood pressure (hypertension),
- attacks of suffocation due to bronchial spasms and swelling of the mucous membrane (bronchial asthma),
- endocrine diseases(eg diabetes mellitus),
- intoxication with thyroid hormones,
- Parkinson's disease,
- chronic neurological stereotypical seizures (epilepsy),
- finally, simply the desire of the patient himself.
Carrying out general anesthesia (general anesthesia) in dentistry
Anesthesia is one of the methods of pain relief, based on blocking the patient’s consciousness due to deep inhibition of sensitivity, synapses of the cerebral cortex, using various drugs.
Due to new developments in anesthesiology, our dental clinic stopped using anesthesia with inhalation of a specialized gas and began to use a new licensed method called SEDATION(introduction of drugs into the body that put the patient into short-term controlled drug sleep). Cost of a new sedative method anesthesia for 20 minutes - 3700 rubles.
From how they are introduced into the body medications, there are several types of sedation:
- Inhalational sedation
- Oral sedation
- Intravenous sedation
In dentistry, intravenous superficial sedation is most often used. So, as with shallow sedation, all body functions continue their normal activities, and the person is as if in a dream.
Sedation is a modern approach to dental treatment while you sleep and at rest. Video
Indications for the use of sedation in outpatient dentistry
- allergy to local anesthetic drugs,
- strong fear of any pain and dental procedures by dentists (in particular).
Considering innovations in practical dentistry, to this we can also add the great desire of many patients to undergo treatment under general anesthesia.
When making an informed decision about the use of anesthesia, in our clinic, each patient is necessarily informed about all possible dangers and complications of any anesthesia.
IN dental clinic"Imperial" St. Petersburg, operations for the treatment, removal, prosthetics and implantation of teeth under general anesthesia are carried out by a licensed anesthesiologist-resuscitator with more than 10 years of experience in various clinics St. Petersburg!
Our anesthesiologist-resuscitator is always present during all dental procedures that happen to you.
Prices for the use of general anesthesia can be viewed.
At least once in their life, every person has experienced toothache. This symptom is a sign inflammatory processes or jaw pathologies. Patients often put off visiting the dentist due to fear of discomfort during treatment. In our review, we will tell you in detail what anesthesia is like in dentistry.
Anesthesia in dentistry - important element full treatment
What is anesthesia
To prevent the patient from experiencing discomfort, many clinics and professional offices use pain relief. Thanks to anesthesia, sensitivity decreases or completely disappears in certain places or throughout the body. The drugs disrupt the transmission of pain impulses to the brain during operations. The person does not get nervous or twitch, which allows the dentist to quickly and efficiently carry out therapy.
The drug is administered when:
- tooth extraction;
- treatment of deep caries;
- depulpation;
- preparatory work for prosthetics;
- orthodontic intervention;
- low pain threshold.
If the patient has increased sensitivity and any touch causes pain, the dentist decides to administer anesthesia.
In this case, you can calmly perform all the necessary manipulations, and the person will not twitch and interfere with the treatment.
After the injection, the patient experiences numbness in the lips, cheeks or tongue, but after a while the effect disappears. The drug is broken down inside the body and gradually eliminated.
Types of anesthesia
There are several types of pain relief. Depending on the treatment or the patient’s pain threshold, the doctor chooses the best option to help avoid discomfort. Let's look at the most common tools used in modern dentistry.
Local anesthesia
Before almost all manipulations, the doctor uses this type of pain blocking. The drugs are quickly eliminated from the human body and do not have as many contraindications as with anesthesia. Depending on the direction of treatment, funds are divided into several types.
Applying the drug before the injection - for those who are afraid
Local anesthesia helps relieve discomfort during treatment. Modern medicines have virtually no complications, therefore they are used in all clinics and dental offices. Professional introduction will avoid negative consequences.
General anesthesia
This type of anesthesia leads to complete loss of sensitivity, which is accompanied by different degrees blackouts. Such anesthesia is rarely performed and only after indications permitting anesthesia. Major surgeries maxillofacial area cannot do without these procedures.
The most commonly used laughing gas for children is nitrous oxide. inhalation method served to the patient.
Anesthesia is prohibited:
- for diseases of the cardiovascular system;
- due to intolerance to anesthesia;
- for diseases of the respiratory organs.
To identify these problems, specialists must take ECG readings for a real assessment of heart activity. And also needed general analysis blood and urine (for hepatitis, HIV). If there are contraindications, then the operation is postponed until the course of the disease subsides.
General anesthesia through a mask
Why is such anesthesia prescribed, since there are many safe local methods? An allergy to drugs or panic fear before dental procedures forces the doctor to look for another, more accessible method. For some mental illnesses, general anesthesia is also chosen. Treatment of advanced forms of diseases or removal of teeth with deep roots is difficult without such anesthesia. A strong gag reflex will not allow the therapy to be carried out normally.
After the drug is administered, the patient goes through three stages.
- Analgesia. Begins two minutes after injection. This stage is characterized by complete loss of sensation of pain. Speech becomes slurred and the patient soon passes out. Body reflexes are preserved, so it is allowed to perform light, non-traumatic operations (drilling with a drill).
- Excitation. Breathing becomes irregular, pupils are dilated. Transitional stage into deep sleep. Now the dentist is taking no action.
- Surgical stage. The patient breathes deeply and evenly, and the doctor can calmly remove the wisdom tooth or fill the canals. This condition of the patient allows the most complex operations to be performed.
General anesthesia is given to children only in the presence of an anesthesiologist.
Being unconscious, a person does not feel pain or worry, so his blood pressure does not rise. The amount of saliva that interferes with treatment is reduced. In one session, the dentist will carry out the entire scope of work, which is impossible under local anesthesia.
While under general anesthesia, the patient does not move, and this forces the specialist to independently adjust or look for a comfortable position. Due to the fact that a person lacks reactions, there is a possibility of medical errors.
Drugs
For anesthesia, carpule syringes are now used, the needle of which is much thinner than the usual ones. Injection with such a device will become as painless as possible than it was five years ago.
Lidocaine, gel and spray - a popular anesthetic
Patients with an increased sensitive threshold are preliminarily treated with a spray containing Lidocaine. The substance is sprayed onto the gums, and only then anesthesia is carried out.
If a person regularly experiences stress before going to the dentist, then we recommend taking a course a few days before the session. sedatives(“Afabazole”, tincture or tablets of valerian, motherwort). Be sure to tell your doctor what medications you took.
Novocaine and Lidocaine were previously used for local anesthesia, but in Lately Doctors are moving away from these drugs and using modern means:
- "Ubistezin";
- "Artikain";
- "Ultracaine";
- "Septanest";
- "Scandonest". To enhance the effect of drugs and speed up local anesthesia, adrenaline is often added to the solutions. The substance quickly activates the medicine and slows down absorption into the blood, which is used for therapy in pregnant women. Mepivacaine and Articaine are considered the safest for children.
Ultracaine is the most effective anesthetic
For diseases of the heart, thyroid gland and diabetes mellitus Drugs containing adrenaline are not recommended. Severe hypertension will respond negatively to thoughtless use medicines. Before manipulation, be sure to warn your dentist about the presence of diseases. After all, local anesthesia does not provide full examination body and performing the operation in the presence of an anesthesiologist.
Things to remember
Dental treatment under anesthesia is always stressful for the body. No matter what the modern drug is, complications may occur. The most common exacerbations during general anesthesia became cardiac arrest and respiratory depression. Such problems are associated with drug overdose or diseases of the cardiovascular system. To eliminate danger, the operation is performed in a specially equipped clinic room and in the presence of an anesthesiologist.
After recovery from anesthesia, patients often feel discomfort, which
The drug Desensil for topical anesthesia
accompanied by:
- hallucinations;
- vomiting;
- nausea;
- decrease in pressure;
- dizziness;
- neuromuscular excitation.
You should not eat or drink for several hours before the procedure. Under the influence of anesthesia, a person has no control over his body, so gastric juice will enter the lungs, causing burns or inflammation.
“General anesthesia for dental treatment is contraindicated - in patients with pneumonia, with catarrh of the upper respiratory tract, difficult nasal breathing, acute liver diseases, in all cases when the duration of medical intervention exceeds acceptable standards.”
The most common complications with local anesthesia are allergies and toxic reactions to the drug. Most often this is the result of an overdose of the drug or natural rejection of the components of the drug. Due to needle injury to the nerve, long-term sensory loss occurs. Burning and pain at the injection site is normal.
Due to doctor errors after the injection (damage to a vessel, breaking off the game), bruises and tumors are observed. If you do not follow the rules of antiseptics, then an infection gets into the injection site. A patient under anesthesia does not control his movements, so he often bites the soft tissues of his tongue, cheeks or lips. In this case, there is a temporary loss of sensitivity. Spasm masticatory muscles goes away in a few days.
“Infection from a needle is almost impossible, since all syringes are disposable. But this is quite possible if the injection is carried out into an infected area of the mucosa. In this case, under pressure, the anesthetic will push the infection into healthy area fabrics."
Local anesthesia causes complications in children, so doctors often warn parents.
- Overdose. Given the small weight of the child, you need to carefully calculate the amount of the drug. When the norm is exceeded, a toxic reaction of the body occurs.
- Allergy. Modern anesthetics are as safe as possible, but sometimes the body rejects the antioxidants included in the composition.
- Mental complications. Children do not know how to independently control their emotions and feelings, so under the influence of fear, a short-term loss of consciousness occurs. Often the very sight of a syringe causes horror in a child. The doctor’s task will be to distract the patient as much as possible before the injection to another object.
Alcoholic drinks reduce the effect of the drug, so a few days before your visit to a specialist, you need to abstain from alcohol. We also do not recommend visiting the clinic during a cold season.
Women should not have dental treatment before or during menstruation. These days, all sensations are heightened and nervous system unstable, which will negatively affect susceptibility to anesthesia. Additionally, under the influence of the drug, bleeding may increase.
The use of anesthesia drugs in dentistry is a necessary procedure that will relieve the patient of discomfort during dental treatment. A properly selected drug will relieve pain and will not cause concern to the person. Tell your specialist about any illnesses.
Fear of dentists is such a common phenomenon that this phobia has several names: dental phobia, odontophobia and dentophobia. Most of the procedures that dentists perform actually cause discomfort. This is not surprising; the sensitivity of oral tissues is on average six times higher than the sensitivity of the skin. That is why visits to this specialist are rarely done without anesthesia.
To prick or not to prick?
There are two types of anesthesia: general and local. Most often, dentists prefer the latter.
“General anesthesia is essentially anesthesia. Dentists mainly work with local anesthesia, that is, they numb only a certain area,” said head dental department Anna Gudkova, one of the private clinics in Moscow.
There are several types of local anesthesia: application, infiltration, conduction, mandibular, torus and trunk. At the same time, application is the only method of pain relief that does not require the use of a needle.
“With topical anesthesia, a gel or ointment is applied directly to the mucous membrane and only freezes it,” the expert noted, adding that this method of pain relief is suitable, for example, for removing tartar.
Other types of anesthesia differ from each other only in the technique of administration.
“They differ only in the insertion technique. For example, experts know that conduction anesthesia cannot be given to the upper row of teeth; the injection is given precisely in the corner lower jaw", explained Gudkova.
To reduce pain, dentists give injections using special carpule syringes, which have a thinner needle. In addition, the device is designed in such a way that no foreign substances enter the anesthetic.
Substitute for cocaine
The safety of anesthesia largely depends on which drug the doctor chooses. Local anesthetics are divided into amide and ether. One of the oldest painkillers is novocaine. It was first synthesized back in 1898 by the German chemist Alfred Einhorn and replaced cocaine used at that time for local anesthesia.
“Today, novocaine is used extremely rarely as an anesthetic drug. It has a very long latent period, that is, it acts after 10, 15, or even 20 minutes. Now there is too little time allocated to see a patient, so it is not possible to wait 20 minutes for the anesthesia to take effect,” said Elena Zorian, Candidate of Medical Sciences, Associate Professor of the Department of Pain Management in Dentistry at Moscow State Medical and Dental University (MGMSU).
According to the specialist, novocaine is usually contained in ampoules, which means it is almost impossible to maintain the sterility of the anesthetic. The drug has other disadvantages.
“Novocaine dilates blood vessels, so before the anesthesia was very weak and did not last long. To increase the duration of action, adrenaline was added. However, it was, of course, impossible to confirm the accuracy of the dosage in this case,” explained the dentist with 50 years of experience.
Amide instead of ether
Modern doctors prefer to use drugs from the amide group. According to the expert, they act faster and their effect lasts longer. Most often, dentists use lidocaine, articaine and mepivacaine for pain relief. Each of these drugs has its own advantages and disadvantages, the doctor noted.
"IN public clinics Lidocaine is mainly used because it is cheaper. This is the first drug from the group of amides that was introduced into practice. It begins to act within 2-5 minutes after application. And this is the only drug that provides all types of pain relief. That is, it can not only be injected inside, but also applied to the mucous membrane,” Zoryan said.
However, like novocaine, lidocaine is available in ampoules and is sold in various concentrations.
“Dentists can only use it in a 2% concentration, but there are ampoules of lidocaine with a 10% concentration,” the doctor explained.
In addition, the drug penetrates tissues and is quickly absorbed into the blood, which can negatively affect patients with disorders of the cardiac and nervous systems.
“Lidocaine, like other local anesthetics, dilates blood vessels, so it should be used together with drugs that narrow them - vasoconstrictors. Therefore, the doctor can only use a 2% solution for injection. Higher concentrations are sometimes used for superficial anesthesia. However, even in this case, it is important to remove excess anesthetic,” the expert warned.
Lidocaine should not be used by people with severe liver and kidney dysfunction, and should also be used with caution during pregnancy, lactation and diseases of the hematopoietic organs.
Choosing a Dentist
According to Candidate of Medical Sciences Zoryan, doctors use articaine much more often. It is also known as ultracaine.
“It breaks down faster and is eliminated from the body faster. In addition, it is less absorbed into the blood and almost does not pass into breast milk. That is, there are significantly fewer contraindications for use. The drug is used only for injection types of local anesthesia,” the expert said.
It is also often used in conjunction with vasoconstrictors. According to the dentist, due to the latter, a person’s heart rate may increase and blood pressure may increase.
“This alone should alert the doctor when he is dealing with patients with cardiovascular insufficiency,” the doctor warned.
Vasoconstrictors, which are essentially adrenaline, can have a negative effect on people with severe thyroid disease, hypersensitivity to adrenaline, as well as for patients with open-angle glaucoma.
“That is, an anesthetic containing a vasoconstrictor has a number of contraindications. In addition, these drugs are not combined with all medications and can provoke allergic reactions, especially in patients with hypersensitivity to sulfur. These, for example, include people with bronchial asthma,” the dentist warned.
If a person does not tolerate an anesthetic with a vasoconstrictor, doctors use mepivacaine.
The main thing is not to be silent
It is worth noting that before proceeding directly to the procedure, the dentist must ask the person what he is allergic to, whether there is any drug intolerance and whether he has had any diseases of the cardiovascular system. In order to choose the right anesthetic, it is also important for the specialist to know the condition of the patient’s liver and kidneys.
“In case of allergies to medications, we refer the patient for allergy tests. The results of this test are usually ready within three days. In some clinics, the analysis is ready within 24 hours,” said Anna Gudkova.
However, according to her, most often people feel ill during a visit to the dentist not because of the anesthetic, but because many patients are afraid of the upcoming procedure or do not have time to eat before the appointment.
The success of the procedure depends not only on the doctor, but also on the patient himself, Elena Zoryan is sure. The candidate of medical sciences advises to approach the dentist responsibly and always inform the specialist in advance about your diseases and allergies.
“The patient must inform the doctor about the presence of complications from the cardiovascular system, gastrointestinal tract and the immune system. In addition, it is worth talking about allergic reactions to drugs and food. Because very often food products Sulfites are used as an antioxidant, which are also added to local anesthetics,” the doctor warned.
