Dental anesthesia

src: i.ytimg.com

Anesthetist (or dental anesthetics ) is an anesthetic field that includes not only local anesthetics but sedation and general anesthesia.

Video Dental anesthesia

Local anesthetic agents in dentistry

The most commonly used local anesthetics are lidocaine (also called xylocaine or lignocaine), a modern substitute for procaine (also known as novocaine). Its beak in the body is about 1.5-2 hours. Other local anesthetic agents in current use include articaine (also called septocaine or ubistesin), bupivacaine (long-acting anesthesia), Prilocaine (also called Citanest), and mepivacaine (also called Carbocaine or Polocaine). This combination can be used depending on the situation. Also, most agents come in two forms: with and without epinephrine (adrenaline) or other vasoconstrictors that allow the agent to last longer and also control bleeding in the tissues during the procedure. Usually this case is classified using ASA Physical Classification System before anesthesia is given.

Maps Dental anesthesia

Maxillary anesthesia

Local anesthetics are deposited on the buccal side of the maxillary alveolus that can diffuse through the thin cortical plates of the maxilla, then further into the dental pulp to achieve the effects of dental anesthesia.

Buccal Infiltration

Instruments

• 27 or 30 measuring needles
• Short needle, usually 20-25mm long needle
• Syringe
• Local anesthetic valve

Technique

1. Pull the lips/cheeks with a mirror or operator finger. This is easier when the patient's mouth is partly open because the cheeks are more relaxed, making it easier to stretch to gain access. A wide open mouth will result in excessive stretching of the cheeks throughout the teeth that restrict access.
2. Identify the point of needle insertion.
3. Use gauze to clean the injection site and allow to dry before applying topical anesthesia before the injection.
4. Make sure the lips/cheeks are pulled towards the superior and the needle is then pierced 45 'with the buccal cortical plate of bone through the toned tissue of the muccobuccal folds.
5. Point the needle toward the apex of the tooth.
6. If the needle is in contact with the bone, pull the needle slightly before depositing a local anesthetic.
7. Aspiration should be performed before injecting, this is to avoid intravascular injection. Injecting into the vascular tissue may result in anesthesia failing and increasing the risk of systemic side effects.
8. The solution should be stored slowly (1 ml/min)
9. Wait at least 2 minutes before checking the anesthesia site with dental checkup.

Limitations

1. The effectiveness of infiltration is determined by the permeability of the network in which the solution must be infiltrated and diffuse through. The thick cortical plates will reduce the distribution and diffusion of the solution through the bone.
   • E.g. The thick zigomatous process adjacent to the first upper molar is one of the most common causes of infiltration failure.
2. Local infection at the infiltration site.
3. Supply of nasopalatine nerve collateral/larger palatine nerves to the pulp will affect the effectiveness of buccal infiltration.

Advantages

1. Simple and simple techniques
2. Reduce the risk of intravascular injection
3. All the nerve endings in the local anesthetic area of ​​the deposition will be drugged independently of the origin of the nerve if successful.
4. It can sometimes be useful to achieve hemostasis if needed

Losses

1. Pulp anesthesia can only be achieved and is effective when local anesthetics are able to diffuse through the cortical bone.
2. Contagious to highly inflamed areas may increase the risk of spreading local infections.
3. The anesthetic effect of the tissue is limited to the injection area.

Palatal infiltration

This is only necessary before extraction or dental surgery. Buccal infiltration will be sufficient to perform most dental care.

Technique

1. The operator must insert the needle from the opposite side of the patient.
2. The injection point should be 90 'to the palate bone, in the most delicate part of the palate about 1-1.5 cm from the gingival margin.
3. Infiltration of 0.2-0.3 ml of solution slowly into the palatine mucosa only slightly distal tooth

Losses

• More painful/uncomfortable compared to buccal infiltration.

Regional blocking techniques

This anesthetic technique that can be useful in the jaw intra-orally when infiltration is ineffective or some large site or anesthetic area is needed at a time. There are various types of regional block techniques specifically used in dentistry to achieve dental anesthesia in the areas required in the maxilla.

1. Superior posterior alveolar nerve block
2. Maximum molar nerve block
3. Superior superior alveolar nerve block
4. Superior alveolar nerve block
5. Infraorbital nerve block
6. The superior anterior palatal alveolar neural block
7. Integral superior anterior alveolar neural block
8. Maximum nerve block
9. Larger palatine nerve bridges:
   • Anaesthetises posterior 2/3 soft tissues and hard palate bone from one side of the midline (third molar of the maxilla to the canine area on the same side)
   • Technique
     1. Find a larger palate foramen between the 2nd and 3rd jaw junction.
     2. Apply topical anesthesia.
     3. The needle insertion point is adjacent to the larger palatine foramen, 90 'to the hard palate, only a few millimeters of the needle should be inserted.
     4. Aspiration before injecting a solution.
     5. A small amount of local anesthetic is required, about 0.2 mL sufficient for larger palatine nerve blocks.
10. Nasopalatina nerve block:
    • Anaesthetises the anterior hard palate and associated soft tissues in the bilateral incisors.
    • Technique
      1. Ask the patient to open his mouth wide.
      2. Find a sharp foramen. Sharper papillae are usually present as slightly raised soft tissue, 5 mm posterior to the center line of the upper central incisors, which cover the incisive foramen.
      3. Apple's topical anesthesia.
      4. Insert the 45 'needle into the palatal mucosa with the bevel facing the hard palate just laterally or one side to the peak of the sharp papillae. Penetrate 3-4 mm needles into sharp papillae or until the needle touches the bone.
      5. Aspiration before injecting a solution.
      6. Less than 0.2 mL local anesthetic should be injected.

src: i.ytimg.com

Mandible Anesthesia

Both regional blocs and infiltration techniques are considered the first injection option for anesthesia in mandibular teeth.

Different techniques are chosen based on different factors:

1. Pediatric age
   • Infiltration anesthesia is a better method for anesthesia of deciduous/eldest teeth in children. This method is similar to maxillary buccal infiltration. Make sure the lips/cheeks stretch laterally and inferiorly than the superior and the needle is then pierced 45 'with the buccal cortical plate of bone through the toned tissue of the muccobuccal folds.
2. Dental teeth
   • Infiltration anesthesia should be the first choice of method for pulp anesthesia and soft tissues of mandibular permanent incisors in adults. Regional block injections are sometimes ineffective because of the innervation of the cross from the opposite side of the inferior alveolar nerve. It is recommended to store at least 0.5 mL at each buccal and lingual site in the desired apical area of ​​the tooth. The use of infiltration anesthesia with 4% articaine with 1: 100,000 epinephrine in obtaining mandibular permanent mandibular first mandibular mandibular anesthesia increasingly common due to successful formulation.

Regional blocking techniques

Inferior alveolar and lingual blocks

Inferior alveolar nerve blocks may be one of the most commonly used methods of dentists to sedate mandibular teeth in adults. This technique aims to inject needles and deposit near local anesthetic nerve before entering the mandibular foramen, which locates on the medial aspect of ramus mandibula. This is to block the transmission of nerves in the inferior alveolar nerve before entering the bone through the foramen mandible.

Basic anatomy

Basic anatomy

• The inferior alveolar nerve has two terminal branches which are the mental and incisor nerves that innervate the mandibular tooth pulp and the anterior buccal tissue to the permanent first molars. It also provides anesthesia to the lower lip and chin skin at the same injection site.
• The lingual nerve provides innervation of the lingual soft tissues from the lower 3 molar to the midline.
• The location of the landmark and the point of needle insertion should be identified before depositing local anesthesia into the adjacent pterygomandibular space

1. Posterior: Parotid Gland
2. Lateral: Ramus mandibula
3. Medial and Inferior: Medial pterygoid muscle
4. Excellence: Pterygoid lateral muscle
5. Anterior: Buccinator

Instruments

• 27-gauge needle
• 30mm long needle: A longer needle is needed because the depth of needle penetration to reach the pterygomandibular space is about 25mm. This is also to reduce the risk of instrument fracture in the pterygomandibular spaces.
• Syringe
• Local anesthetic valve

Technique

1. Ask the patient to open his mouth widely and hold the mandibular ramus with the operator's thumb and forefinger.
2. The thumb is placed in the depth or deepest part of the coronoid notch, located in the anterior part of the ramus from the lower jaw to the molars to determine the vertical height of the injection. Stretch your cheek with your thumb while painting your thumb position to get better access for injection.
3. Rapica pterygomandibular provides a reliable reference for palpation of the mandibular internal oblique bulge. This can be easily identified and the internal slashes lie with lateral palpation of the pterygomandibular raphe.
4. The index or middle finger is placed on the posterior aspect of the ramus outside the mouth to support the thumb.
5. Dry the needle insertion point and apply topical anesthesia.
6. The soft tissue is pulled laterally to facilitate the penetration of the needle and expose the injection point.
7. The elevation of the injection site coincides with the height of the fingernail tip or about half of the thumbnail.
8. The bevel of the syringe position of the contralateral premolar region, the needle is penetrated into the pterygomandibular depression, the needle rests laterally and slightly inferior to the raphe, midway between the internal oblique cavity and the pterygomandibular rapheus.
9. Reinforce the needle until the correct bone contact position is made with the mandibular ramus gently. The penetration depth is usually 15-25mm in adults.
10. Drag a little needle and aspiration.
11. Substitute 1.5 mL of local anesthetic solution slowly at a rate of 1 ml/min.
12. Dazed anesthesia
    • Pull the needle into the middle of the mucosa following the original place of the inferior alveolar nerve block, aspirate and store the local anesthetic solution.

Limitations

1. Abnormal position of the mandibular foramen
2. Bending needle during injection
3. Teeth and surrounding tissue may not be fully anesthetized because of the accessory nerve supply
   • The lingual nerve
   • Long buccal nerves
   • Mylohyoid Nerve
   • Auriculotemporal nerve
   • Cervical upper nerves

Complications

1. Bell's palsy
2. Needle Damage
3. Hematoma

Long buccal nerve block

Basic anatomy

Basic anatomy

• The long buccal nerves are the sensory nerves that provide the innervation of the soft tissues of the buccal and cheek mucosa of the lower 3 molar to the first molar
• Walks between the lateral ptereygoid muscles and exits below the anterior border of the master muscle. Then it crosses the anterior border of the ramus at the occlusal plane level of the permanent lower molars.

Technique

1. Ask the patient to open his mouth wide
2. Feel the coronoid notch as described previously for the inferior alveolar nerve block technique.
3. The site of distal and buccal injection into permanent lower molars in the arch.
4. Insert the parallel needle into the distal occlusal plane to the permanent mandibular second molars until bone contact is made.
5. Drag a little needle and aspiration before injecting the solution.
6. 0.5 mL local anesthetic solution is recommended to be deposited slowly anteriorly into the mandibular ramus to achieve the correct buccal nerve block

Mental nerve block

Basic anatomy

Basic anatomy

• The mental nerves and sharp nerves are the terminal branches of the inferior alveolar nerve of the mental foramen.
• The sensory nerve area in the mandible arch
  1. Premolar
  2. Canine
  3. Incisors
  4. Soft and buccal soft tissue
• Sharp and mental nerve blocks anesthetize the anterior buccal mucosa to the mental foramen, premolars pulp fibers of the premolars, canines and incisors, lower lip and chin skin.

Technique

1. Pull the lower lip/cheek laterally with the mirror radius or operator. This is easier when the patient's mouth is partly open because the lips/cheeks are more relaxed, making it easier to stretch to gain access.
2. Seek mukobukal folds and palmarisation of mental foramen between bottom and 1 pramolar apices
3. Use gauze to clean the injection site and allow to dry before applying topical anesthesia before the injection.
4. Identify the point of needle insertion.
5. Insert the needle parallel to the long axis of the premolar, into the mucobukal fold network slightly anterior or directly adjacent to the mental foramen.
6. After bone contact is established, deposit 1.5 mL of local anesthesia slowly.
7. Do not try to insert a needle into the mental foramen because it can damage the nerves.
8. Extra-oral massage around the injection site to encourage local anesthetic diffusion into the mental foramen.

Limitations

1. The position of the mental foramen may not be constant because it may differ among ethical groups.
2. It is more difficult to identify the mental foramen if both premolar teeth are lost or the premolar position changes due to orthodontic treatment.

src: cdn1.medicalnewstoday.com

Additional Techniques

Intraosseous

This is an alternative anesthetic injection technique first published in 1910. Intraosseous anesthetic injection involves deposition of anesthetic solution directly into the cancellous alveolar bone adjacent to the root apex of the tooth to be anesthetized through a small opening. Can also use more involved dental procedures such as surgery or endodontic therapy (root canal).

Instruments

• Stabident system
• X-tip dental anesthesia system

Technique

1. Perforation of cortical plates to create small boreholes between tooth roots with specific rotary instruments.
2. Perforation should be about 2mm apical to buccal papilla
3. The constant pressure on the cortical bone increases heat and can cause permanent damage to the tissues.
4. The strength of light pecking with a rotary instrument is recommended instead
5. Insert the small needle into a small drilled hole and deposit approximately 1.0 mL of local anesthesia slowly into the cancellus/porous bone.

Indication

• Previously failed inferior alveolar blocks
• Previously failed maxillary infiltration
• As an additional technique for irreversible pulpitis

Contraindications

• Heavy cortical plates
• Active periodontal disease
• Formation of fistulas in perforated spaces
• Root proximity with adjacent teeth
• Limitations of cancellous bone in certain areas of the lower jaw

Intraligamentary

Intramiginal or periodontal ligament anesthesia is a technique used primarily for endodontic treatment and to complement inferior gear blocks where they may have failed. This technique involves 'deposition of at least 0.2 ml of local anesthetic solution for each tooth root' spreading to the marrow spaces around the tooth. Doctors may adopt this technique because of several benefits such as: no soft tissue anesthesia, the use of anesthesia anesthesia and single anesthesia in smaller amounts but use can be contraindicated due to claims that patients report sharp pain on the interligamentary aesthetic administration. However, the use of high-pressure syringes and ultra fine needles provides chemical anesthesia (with the action of an anesthetic agent) and mechanical anesthesia (by pressure from deposition). Interligament anesthesia can be complicated by poor operator techniques in which rapid injections and excessive volume are used; this can cause sensitivity to biting and percussion.

Studies have shown that the rate of onset of anesthesia in patients is between 15-20 seconds; this provides benefits compared to inferior alveolar tooth blocks. Other benefits include decreasing overall trauma compared to conventional blocks making it an ideal procedure for the extraction and treatment of endodontics in children.

Intrapulpal

Interphase interphase involves placing an anesthetic agent directly with a small needle (from 25 or 27 gauge) into the pulp chamber; it is injected under pressure that leads to brief but intense discomfort. This particular technique provides effective pulp anesthesia because the pulp tissue is subject to chemical action by anesthesia agents and mechanical stimuli due to applied pressure. This method is usually adopted when all other techniques are unsuccessful and should include a sharp preoperative pain warning. However it may prove useful for pulp extirpation or endodontic treatment in teeth where anesthesia is difficult to achieve. However, because patient discomfort associated with this technique should not be the primary anesthetic technique used.

Intra-papillary

Intra-papillary anesthesia is used as an additional technique for infiltration to improve patient comfort and is primarily used to replace palatal or lingual infiltration. It is very successful in pediatric patients and works to replace or increase comfort for very uncomfortable infiltration such as palatal or lingual infiltration. This technique involves deposition of an anesthetic agent directly into the papilla with tissue-related blanching at the site of the injection. The penetration point should be located in the 2mm apical papilla gingiva

Pressure anesthesia

Pressure with cotton in the area to divert the sensation of nerve pain when the needle enters a certain area such as the palatal tissue.

Akinoski's Approach

Technique

This approach is an additional method for conventional regional conventional inferior alveolar nerve blocks, to achieve lower posterior anesthesia. Anatomical landmarks are slightly different in individuals such as shape & amp; the size of their mandible, making it difficult to determine the location of the mandibular foramen to accurately manage anesthesia in the correct location in the regional bloc. Additional neural supervation from other sources may not be anesthetized, resulting in anesthesia failure.

The use of materials in this technique is the same as that used in conventional blocks - standard anesthetic cartridges (2% Lidocaine, 1: 80,000 adrenaline), long gauge (27 gauge), appropriate forceps of extraction. When this technique is practiced in children, a short needle is recommended.

Anatomy

The patient will be in a semi-supine position, and the operator stands in front of the patient. With open mouth, identify the pterygo-mandibular crease in which it joins the posterior tissue to the upper third molar. With the patient's cheeks pulled back, topical anesthesia can be placed on the buccal and distal mucosa to the upper third molar.

When anesthesia is given, the patient has their teeth together, so that the cheek muscles are relaxed and well drawn to ensure maximum field of view. With the needle parallel to the maxillary occlusal plane, the forward syringe and the needle entry point will be in the indentation between the vertical ramus and the maxillary tuberosity, through the buccinator, into the pterygo-mandibular chamber. 2.5 - 3 cm needles will be inside the tissue and 1.5 - 2ml of anesthesia given, and then carefully withdrawn and securely closed.

In close proximity to the pterygo-mandibular chamber lies the main branches of the mandibular nerve where anesthesia can easily be through diffusion.

The division of the sensory nerve of the mandible will be anesthetized, except for the auriculotemporal nerves.

Complications

So far no significant local or systemic complications have been reported with this technique.

Benefits

This technique does not require the patient to open his mouth completely, then indicated for use in patients with trismus. This induces much less pain, because soft tissue is not tight, after penetrating the needle. It is much easier to manage because 1 injection allows the main nerve (lingual nerve, IDN, long buccal nerve) to be drugged compared to at least 2 separate needle entries in the conventional block, and has a faster onset of anesthesia & amp. ; high success rate. Fewer aspiration incidents were also reported with this technique compared to conventional blocks.

Disadvantages

This technique may be challenging when there are abnormalities or tumors in the maxillary tuberosity region, or when there are no posterior teeth in the area. However, identifying and targeting alveolar ridges in the area should address this problem.

Lower success results are noted for children as compared to adults, due to the struggle in assessing the depth of needle penetration in a child. Achieving anesthesia is also reported slightly slower than conventional blocks.

Electric nerve block

Technologies involving the use of electric current to block reception or generation of pain signals; pain control can be temporary.

Acupuncture

Acupuncture or acupressure is an alternative to chemical or electrical blocks, but is rarely used.

src: thumbs.dreamstime.com

Transcutaneous Electronic Nerve Stimulation (TENS)

Applications in Dentistry

TENS can be an additional form of treatment that is useful in treating head and facial pain, eg. temporomandibular joint pain and extraction. It produces analgesia and has secondary beneficial effects, such as sedation and increased tissue temperature. According to Wall and Street experiments, 2 minute stimulation can relieve severe chronic pain for half an hour. It is a safe and reliable technique for pain relief. However, be aware that some drugs, such as diazepam, codeine, and narcotics, can reduce TENS effectiveness.

Action Mechanism

The effects of TENS can be explained by two theories, the theory of gate control and endogenous opioid theory.

TENS stimulates the spinal cord to release endogenous opioids resulting from activation of local circuits within the spinal cord or from underlying triggers of pain inhibition pathways.

TENS Classification

1. High frequency TENS, & gt; 50 Hz. It works on the theory of gate control, producing short-term analgesia.

2. Low frequency, & lt; 10 Hz. It works on endogenous opioid theory and produces systemic long-term analgesia.

TENS equipment

1. TENS Unit, '' Clinical Model ''. This device generates electrical pulses.

2. Tin wire, used to connect TENS units and electrodes.

3. Electrode. They convert the electric current from the TENS unit into an ion current. Intraoral electrodes such as cotton wool electrodes, clamp electrodes, and adhesive electrodes are used in dentistry.

TENS Techniques

1. Conventional TENS - This is the most common technique used in practice. High frequency (10-200 pps) and low intensity pulsed current (10-30 mA) are used. It stimulates the large diameter of A? fiber without activating small diameter A? and fiber C. It has a fast onset and offset (within 30 minutes when TENS 'is turned on/off).

2. TENS acupuncture like - low frequency (2-4 pps) and high pulsed current intensity used to stimulate small diameter A? fibers in muscles. Phasic muscle twitches are induced. It can only be used for half an hour each time as it can cause muscle fatigue. It has a delayed onset and offset. This method may be more effective than conventional methods, however, the patient may not be able to tolerate because it is quite uncomfortable.

3. TENS Intens - High frequency (200 pps) and high intensity pulsed current are used to produce stimulation that can only be tolerated by the patient. Small diameter A? afferent skin is activated and extracegmental analgesia effects are generated. It has a fast onset and a delayed offset. It can be used for approximately 15 minutes because the stimulus can cause discomfort.

Contraindications

Patients with...

• Heart problems
• Pacemakers
• Epilepsy
• Pregnant
• Handicap communication or mental disability
• Pain due to unknown aetiology

TENS should not be placed in the anterior portion of the neck, carotid sinus, temple, mouth or eye, irritated skin, sensory damage area and chest and upper back at the same time.

When performing techniques in patients with spinal cord stimulators or intrathecal pumps, practitioners should be more careful.

src: pediatricsedation.com

Jet injection

Jet injection aims to create a sufficiently strong pressure release to push the dosage of the liquid drug through a small opening. This is usually done with the help of a mechanical energy source. With this, a thin column of liquid is made which has the power to penetrate soft tissues, so needles are not needed.

Advantages:

Ã, Â · Rapid drug absorption at the injection site

Ã, Â · Easy to use

Ã, Â · Few/painless

Ã, Â · Less network damage

However, in dentistry, the effectiveness of this technique has been reported to be limited.

Examples of jet injections include: Syrijet and MED-JET H III

src: thumbs.dreamstime.com

Dose

src: cdn.shopify.com

Contraindications

When considering the use of local anesthesia, there are many factors to consider. In terms of contraindications associated with LA there are "absolute" and "relative" contraindications. When something is said to have an "absolute" contraindication, it underscores that under no circumstances will LA be elected to be given to a particular patient because it has the potential to pose a life-threatening risk, eg. allergy. When LA has a "relative" contraindication, LA administration is not favored and should be avoided, but it does not pose a life-threatening risk.

Type

As stated earlier, Local Anesthesia used in dentistry can vary significantly because there are various preparations with many qualities. Each preparation has little difference in how the anesthetic effect on the body. This is because the use of different constituents. Local anesthetics containing adrenaline such as Lidocaine (using 1: 80,000 adrenaline) or Articaine (using 1: 100,000 adrenaline) have a direct effect on cardiac output by increasing the rate and contraction of the heart itself. Because of this effect, if the patient is suffering from unstable angina or severe cardiac dysrhythmias, this preparation is often not recommended as it may affect undesirable side effects.

Alternatively, other preparations such as Mepivicaine Hydrochloride or Prilocaine (containing Felypressin) may be used. Prilocaine is perfect for patients who want to avoid adrenaline or may have latex allergy/preservatives. The main contraindication of Prilocaine is that it has a short half-life and has mild cytotoxic effects, therefore it should be avoided in pregnancy. These cytotoxic effects can affect uterine tone and disrupt circulation, which can have a detrimental effect on pregnancy. Mepivicaine Hydrochloride is then considered if Prilocaine is contraindicated. Mepivicaine is the lowest vasodilation anesthetic because it has no vasoconstrictors and no preservatives.

Dosage related

The dose of local anesthesia is often reduced when the patient has systemic health implications or habits that can cause the disorder. From time to time the local anesthetic itself should be reduced (thereby reducing the maximum dose). This is especially true when alcoholism, anemia (if using Prilocaine), anorexia, bradycardia or GORD are concerned. On other occasions the vasoconstrictor used (often adrenaline) should be reduced when an individual suffers from angina, bradycardia, chronic bronchitis, cardiacarrymia, COPD or glaucoma. These include drug abuse, calcium channel blockers containing drugs, beta blocker drugs or liver diseases as this destroys metabolism.

In Relation with Technique

The various techniques involved when administering local anesthesia can affect success and if done wrong leads to possible needle fracture. Very rare needles are broken when giving intra-oral injections unless inadequate techniques are adopted. To prevent such occurrence, especially when conducting inferior alveolar nerve blocks, it is advisable not to bend the needle, use the right needle and not insert the needle into the center.

src: previews.123rf.com

The most common local anesthetic procedure

Anesthesia or inferior alveolar nerve blocks or IANB (sometimes called "inferior gear blocks", or incorrectly referred to as "mandible blocks") may be more frequently anesthetized than other nerves in the body. Inferior alveolar nerve blocking sensations, which travel from the mandibular angle to the medial aspect of the mandible, inhibit mandibular teeth, lower lip, chin, and tongue, which are effective for dental care in the mandible arch. To anesthetize this nerve, the needle is inserted posteriorly to the most distal mandibular molar on one side of the mouth. The lingual nerve is also anesthetized by the diffusion of the agent to produce a numb tongue and anesthetize the tissues of the mouth, including around the side of the tongue or lingual tooth.

Some nondental nerves are usually anesthetized during the inferior alveolar block. The mental nerve, which supplies the skin innervation to the anterior lip and chin, is the distal branch of the inferior alveolar nerve. When the inferior alveolar nerve is blocked, the mental nerve is also blocked, resulting in dead lips and chin. The nerve is located near the point where the inferior alveolar nerve enters the mandible is often also anesthezed during the inferior alveolar anesthetic, such as affecting hearing (the auriculotemporal nerve).

The facial nerve is located some distance from the inferior alveolar nerve in the parotid salivary glands, but in rare cases anesthesia can be injected far enough into the posterior to nerve the nerve. The result is a temporary facial paralysis, with the injected facial side experiencing a loss while the use of facial expression muscles includes the inability to close the eyelids and the commencement of the labial commissures on the affected side for several hours. , which disappears when anesthesia is exhausted.

In contrast, superior alveolar nerves are usually not directly anesthezed because they are difficult to approach with needles. For this reason, the maxillary arch is usually anesthetized locally for dental work by inserting a needle under the oral mucosa around the teeth to sedate a smaller branch.

Syringe gear

A syringe of a tooth is an injection for local anesthetic injection. It consists of a breech syringe equipped with a closed cartridge containing an anesthetic solution.

In England and Ireland, hand syringes are operated manually to inject Lidocaine into gum patients.

src: i.ytimg.com

Other anesthetics used in dentistry

• Topical anesthetics benzocaine, eugenol, and xylocaine forms are used topically to turn off various areas prior to injection or other minor procedures.
• Nitrous oxide (N ₂ O), also known as "laughing gas", easily crosses the lung alveoli and dissolves into the passing blood, where it moves to the brain, leaving feeling dedicated and euphoric in many cases. Nitrous oxide is used in combination with oxygen. Often (especially with children) the aroma of a fragrant fruit similar to the automatic scent is used with gas to inspire deep breathing.
• Common anesthetic drugs such as midazolam, ketamine, propofol and fentanyl are used to put a person in a dusk or make them completely unaware and unaware of the pain. Dentists who have completed a training program in anesthesiology can also manage general IV and inhalation anesthesia agents.
• Nebotamine, a drug with an effect similar to ketamine, is injected into the anterior lingual gland that blocks the action potential of sending signals to the myelin nerve. Anesthesia potential is directly related to lipid solubility, since 90% of nerve cell membranes are composed of lipids.
• Midazolam (Versed), a drug that suppresses the memory of the procedure, is usually given two hours before the procedure is combined with Tylenol in general anesthesia so that the person will go home with no memory in operation.
• Sevoflurane gas in combination with nitrous oxide and oxygen is often used during general anesthesia followed by the use of isoflurane gas to maintain anesthesia during the procedure. In children the aroma of sweet fruit is often used with gas to inspire deep inhation. The scent comes in cherries, apples, chewing gum, watermelons, etc...
• Propofol, a drug with an effect similar to Sodium Pentathol, is often used by intravenous infusion through an infusion during general anesthesia after the gas is started.
• Morphine is often used to control pain during dental surgery under general anesthesia. Morphine is usually given through IV.
• Ketorolak is often given through IV to suppress pain and inflammation when under general anesthesia.

src: thedoctorweighsin.com

Other drugs used in combination with general anesthesia in dentistry

• Decadron steroids are often given through IV to suppress inflammation and swelling produced during surgery while under general anesthesia.
• An Ondansetron brand named Zofran is often given to prevent nausea during surgery that may be caused by blood flowing into the stomach when under general anesthesia, or given after the procedure for postoperative nausea that may result from the anesthesia itself. given.

src: previews.123rf.com

Local anesthesia and pregnant patient

Provided that the dentist does the right aspiration to avoid intravenous injection, a local anesthetic containing epinephrine (adrenaline) is safe to use during pregnancy. lignocaine and prilocaine are rated Category B by the FDA and are therefore safe to use during pregnancy. Lignocaine and prilocaine were sold as 2% and 4% formulations, respectively. It is therefore safer to use lignocaine so as to provide lower drug concentrations to pregnant patients.

Mepivicaine, articaine, bupivicaine are rated FDA Category C and should be avoided. Benzocaine, a topical anesthetic formulation material, is also classified as Category C and should be avoided. Lignocaine should be used as a topical anesthetic.

Epinephrine in high doses is harmful to pregnant women because it affects the blood flow of the uterus. However, its use in low doses with local anesthetic administration is justified. Epinephrine causes vasoconstriction which in turn reduces the distribution of systemic anesthesia and prolongs its action as well as reduces bleeding at the site of surgery. Lidocaine 2% with 1: 100.000 adrenaline is a local anesthetic of choice in the care of pregnant women.

src: centrodenticija.lt

Allergy to local anesthesia

Allergic reactions from local anesthesia have been reported in some patients. However, this incidence is rare even in patients with a history of adverse reactions to LA.

There are mainly 2 classes of local anesthetic agents: Amide or Esther linkages, based on their chemical structure.

• E.g. amida LA: lidocaine, prilocaine, articaine, mepivacaine
• E.g. of the LA esters: benzocaine, procaine

The original allergic reaction of LA amide is very uncommon. An LA ester is more likely to produce an allergic reaction because the compound will be split into para-aminobenzoic acid (PABA) which is a trigger for allergic reactions. In general dentistry, only topical LA applications contain ester (benzocaine) when applied to the area before LA is given.

If a person is allergic to an LA ester, then the use of another type of LA ester should be avoided because the breakdown of all esters will result in PABA. However, patients who are allergic to LA esters are usually unaffected by the LA amida because PABA is not produced at the time of the breakdown of the LA amide. Unlike LA ester, allergic to LA amides will not eliminate the use of other LA amide types.

Some reactions are caused by excessive administration of drugs, usually due to drug intravenous or rapid drug into the system, or vasoconstrictor side effects. Unfavorable reactions to LA can be classified into 3 distinct groups: psychogenic, allergic, toxic.

Differential Diagnosis & amp; management

• Psychogenic reactions

A poor reaction to LA is usually caused by a hyperemosional response to the perceived danger in one's mind, and it can be demonstrated in several ways. Examples include temporary loss of consciousness, sweating, flush, changes in heart rate or blood pressure, panic attacks, hyperventilation, which may be mistaken as an allergic reaction.

When caring for such patients, treat them carefully and consider their anxiety. During treatment if the patient feels faint or has decreased blood pressure, place them flat and keep their legs elevated in an attempt to restore their blood pressure. Loosen tight clothing and keep the patient's food/drink sweet after they are conscious. Reassure the patient.

• Toxic reaction

This can occur when there is a large amount of anesthesia in their vascular system, which may be because they receive recurrent LA, intravenous drug entry, or have a fundamental systemic condition that does not metabolize or utilize the drug efficiently. Signs and symptoms primarily involve the nervous system eg aggressive behavior, drowsiness, speech changes, disorientation etc.

Their symptoms will usually disappear within a few hours, up to 12 hours, as the body will gradually get rid of the bloodstream of the drug. Reassure patients that their symptoms will improve after several hours and that such reactions should not recur, and no need to abstain from the drug in the afterlife.

Such reactions can be minimized by practicing a safe injection method by using a syringe to prevent injection in blood vessels, slow drug administration, and avoid excessive LA administration, keeping in mind the patient's weight, age and medical history.

Alerts & amp; symptoms of an allergic reaction to LA

The original LA allergy will manifest as type 1 or type 4 hypersensitivity. The signs and symptoms will vary depending on the type of allergy. Type 1 reactions have rapid onset of symptoms that include swelling, redness, rash, hives, chest tightness, respiratory problems. Type 4 reactions have delayed onset of symptoms and are usually localized to the site of injection.

Management

If an original allergic reaction to LA should occur, the patient should be treated as an emergency for anaphylaxis, in accordance with the guidelines in each region. For the UK, the section on medical emergencies in dentist practice in the "Prescribing in Practice Dental" section of the BNF should be referred. Patients should be sent to the hospital immediately if the condition worsens.

Individuals should undergo further tests to certify their allergies to LA or for other possible causes of adverse reactions.

src: st3.depositphotos.com

Gate Control Theory in Painless Anesthesia

The gate control theory explains that pain can be reduced if the touch nerve fibers are stimulated because the stimuli are harmless.

Advances in techniques used to provide local anesthesia are essential. There is a type of local anesthetic that applies vibration to the skin when the injection is being placed onto the skin. It uses gate control theory to minimize pain in patients. High frequency vibrations originating from the device attached to the syringe inhibit the pain that comes from the needle. They can interfere with pain signals by closing the gates in the brain. The stimulated nerve fibers are Ab fibers using pressure or vibration. Other receptors called meissner body cells in deeper tissues and bones also contribute. It closes the 'nerve gate' This reduces the patient's pain.

The methods used by dentists to reduce pain during anesthesia by using gate control theory are: Heating local anesthetic cartridges, Stretching oral mucosa, Gentle scrubbing of extra-oral skin.

src: thumbs.dreamstime.com

See also

• Dental operation
• American Society of Dentist Anesthesiologists
• American Dental Board of Anesthesiology
• National Dental Anesthesia Board.
• American Dental Society of Anesthesiology

References

External links

• Endo T, Gabka J, Taubenheim L (January 2008). "Intraligamentary anesthesia: benefits and limitations". Quintessence International . 39 (1): e15-25. PMID 18551207. < span>

Source of the article : Wikipedia