In modern dentistry, there are several types of anesthesia. Recently, in addition to local anesthesia, dentists offer the use of general anesthesia. But how safe and objective is the choice of general anesthesia?

Alexander Evgenievich Potapov, Doctor of Medical Sciences of the Moscow State University of Medicine and Dentistry, will help us understand the features of treatment with the use of anesthesia.

What is general anesthesia and what is its main difference from local anesthesia?

Practicing dentist with 15 years of experience, Ph.D. MGMSU A.E. Potapov

Local anesthesia guarantees selective anesthesia of the required sector for a short period during which the person is awake. With general anesthesia, the effect of drugs occurs on the entire body.

A person for a long time is introduced into a state of sleep, in which he does not feel pain and tactile impact. This allows you to perform large dental work for one visit.

The drugs used for anesthesia tend to reduce salivation, which has a positive effect on the quality of work. Also a positive point is the absence of a defrost period in general anesthesia.

In what cases is the use of general anesthesia in dentistry indicated?

In dentistry, such anesthesia has a wide range of indications. It is prescribed for a large amount of work, for example, when it is necessary to remove a group of teeth, and in the treatment of children's teeth.

Anesthesia of a general type is indispensable if the patient has or has mental illnesses characterized by increased excitability. Also, general anesthesia is used in case of ineffectiveness of local anesthesia or the detection of allergic reactions to painkillers.

If the patient has a pathological manifestation of the gag reflex, then anesthesia is also used for anesthesia. The need for anesthesia is determined by the dentist and anesthesiologist.

Are there any contraindications for general anesthesia?

Since anesthesia affects the entire body as a whole, then, of course, there are contraindications for its appointment. Narcosis is contraindicated:

• at acute pathologies endocrine system, as well as diseases of the heart and blood vessels;
• with drug and alcohol intoxication;
• if there are deviations of blood parameters (low clotting, severe anemia) and its pathology;
• in the postoperative state;
• with confirmed dystrophy;
• in the post-vaccination period;
• with diseases of the lower and upper respiratory tract;
• at subfebrile temperature;
• children under 2 years of age;
• at low or high pressure;
• with neurological pathologies, for example, epilepsy.

What types of general anesthesia are used in dentistry?

In dentistry, two types of anesthesia are most often used: intravenous and inhalation or otherwise mask. With intravenous anesthesia, special drugs or their combinations are administered, which turn off the consciousness and pain reflexes of a person.

For this, drugs such as sombrevin, propofol, hexenal and others are used. This anesthesia begins to act a couple of minutes after the injection and lasts about an hour. In case of prolongation of the procedure, repeated administration of anesthetics is possible.

During inhalation anesthesia, a special anatomical mask is used to administer drugs, which is applied to part of the patient's face. Through the mask, the patient inhales a gaseous anesthetic mixture, which enters the bloodstream.

For administration, halothane, methoxyflurane, nitrous oxide, xenon are used. These drugs are used alone or in combination. With the inhalation method, the patient can be introduced into a state of superficial sleep, being aware of the entire treatment process, but at the same time, without feeling pain.

– What type of general anesthesia is preferable: intravenous or mask?

The use of this or that type of anesthesia is decided individually. Each case requires an objective approach to the choice of anesthesia, because they have their own characteristics.

Intravenous anesthesia quickly introduces a person into a state of sleep and is clearly controlled. Since the use of this type of anesthesia requires puncture of the vein, it is most often prescribed for adults or children from 10 years of age. Intravenous anesthesia begins to act quickly and guarantees full access to oral cavity.

Mask anesthesia does not require any physical impact and extension. That is, the patient sleeps while the mixture enters the lungs. This makes this method convenient for dental treatment in children. preschool age.

But there are some disadvantages of inhalation anesthesia: it is intended for short-term dental procedures and the mask limits the working space.

In dentistry, a combination of these methods is most often used. This allows you to achieve complete anesthesia and perform more dental operations. In any case, the anesthesiologist, not the patient, should choose the type of general anesthesia.

How safe is general anesthesia? Especially in children?

Modern drugs used for general anesthesia are no more dangerous than drugs for local anesthesia. After them, not a person comes to his senses a maximum of a quarter of an hour after treatment and does not experience drowsiness or any discomfort.

For anesthesia of children, the inhalation anesthetic "Sevoflurane" is most often used. This avoids injections, and hence the psychological discomfort of the child.

The main part of the inhalation anesthetic is quickly excreted from the body through the lungs. Even in combination with other drugs, anesthetics do not irritate Airways, do not affect the growth of hepatic and kidney failure and do not increase intracranial pressure.

The safety of using general anesthesia is affected by the correct organization of the procedure and the qualifications of doctors. General anesthesia can only be performed by dental clinics with a special license. For this, a separate equipped office should be allocated.

During treatment, standard monitoring of life-supporting organs should be used, which allows you to control pressure, body temperature, heart rate. In addition to the dentist, the presence of an anesthesiologist and resuscitator is mandatory.

Not always the safety of use depends only on specialists. The patient must strictly comply with all preparation requirements and report all information about his health. This is especially true for young patients.

Parents need to be careful and inform specialists about any changes in the child's condition. In any case, if anesthesia poses a danger to the patient, then the resuscitator will definitely report this and will not allow the procedure.

– What is the preparation for the treatment or extraction of teeth under anesthesia?

Like any other surgical procedure, dental treatment under anesthesia requires a complete examination of the patient and his careful preparation. Before the procedure, a complete clinical blood test is performed no more than 10 days before the procedure.

The time of blood clotting and the duration of bleeding are determined. If general anesthesia is indicated for a child, then a health certificate is additionally required.

In case of any pathologies, a certificate with a diagnosis and a list of prescribed drugs is required from a specialist who sees the patient. In addition, radiography, sugar analysis, ECG and some other examination methods may be prescribed. All methods are determined individually.

A few days before using general anesthesia, you should stop drinking alcohol and exclude heavy and fatty foods from the diet. Eating should be done at least 6 hours before the procedure, and fluid intake at least 4 hours before the procedure.

How is anesthesia treated?

Before using anesthesia, premedication is prescribed, which includes some sedative drugs. It aims to relieve fear and anxiety. Calming drugs are most often administered intramuscularly, but for children, tablets and mixtures may be used.

After the patient has calmed down, he takes the position lying on the dental chair. If anesthesia is used in a child of preschool age with increased level anxiety, you should place him on your knees, where he will be temporarily until the anesthesia works.

If anesthesia is performed by the inhalation method, then the doctor brings a special anatomical mask to the patient's face, smoothly repeating part of the face. Through this mask, the anesthetic drug in the gaseous state begins to be delivered.

A minute later, the person begins to fall asleep. During immersion in sleep, most often in children, there is a stage of excitation, in which there is disorientation and a violation of the rhythm of breathing.

These phenomena quickly pass, and the child comes into a state of deep sleep. There comes a full phase of anesthesia.

In the case of intravenous anesthesia, a catheter is inserted into the vein of the elbow or hand, through which the anesthetic drug is delivered. The catheter insertion site is pretreated with an anesthetic gel.

Unlike the inhalation method, intravenous anesthesia does not have an arousal stage, so deep sleep occurs within 1 minute.

In the stage of deep sleep, the dentist performs the necessary procedures, after which the anesthetic supply stops, and the patient returns to normal within 15 minutes. The allowable maximum anesthesia time is 1.5 hours, but anesthesia is most often used for no more than 30 minutes.

After general anesthesia, children may experience some excitement or lethargy, which disappear after an hour.

– What procedures can be performed in 30 minutes of anesthesia?

With highly qualified specialists and a favorable course of treatment in 30 minutes of general anesthesia, you can perform:

• turning from 1 to 5 teeth;
• removal of 1 to 10 teeth;
• formation of carious cavities on 5 crowns, without filling;
• formation of one affected cavity and its further filling with a light-cured composite;
• depulpation of a single-rooted tooth;
• osteotomy in the region of 5 teeth;
• opening and treatment of abscess;
• curettage of gingival sockets in alveolitis.

How often can teeth be treated under general anesthesia?

Since all drugs used for general anesthesia are precisely dosed and selected individually, their use does not have negative consequences. Therefore it is possible frequent treatment dental problems under general anesthesia.

To avoid side effects and consequences in the future, it is necessary to undergo a thorough examination before each procedure. Depending on the state of the body, the anesthesiologist each time prescribes the necessary treatment regimen.

– What are the negative consequences of treatment with general anesthesia?

During treatment using general anesthesia, such negative consequences as a sharp increase or decrease in pressure, short-term dizziness, agitation, and nausea can occur.

Negative consequences include poor-quality treatment, which leads to the absence of an X-ray machine in the office. Therefore, decide on a procedure with general anesthesia only in specialized clinics with properly equipped rooms.

And, if the dentist, without any reason, offers you only local anesthesia, you should consider visiting another dentist.

– Thank you for taking the time to give us detailed answers that helped to understand all the intricacies of the use of general anesthesia in dentistry.

Interviewed Angelina Tkacheva, interviewer for the online magazine Your Dentist.

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Toothache is a problem that almost everyone has experienced. It is a sign of a particular pathology of the organs of the dentoalveolar system. Such diseases require therapeutic, and in many cases - and surgical treatment. Often, patients put off a visit to the dentist for fear of pain during dental treatment.

Modern dental treatment without pain

Relatively recently, a number of therapeutic manipulations associated with unpleasant sensations for the patient could be carried out without prior anesthesia, so it is not surprising that many people are afraid of the dentist's office. Postponing a meeting with a specialist "until the last", a patient with a common carious lesion risks waiting for the development of complications of the disease, which may require surgical treatment.

Currently, in all clinics and dental offices, doctors treat teeth without pain, for which they use different kinds anesthesia.

Under anesthesia understand the reduction or complete disappearance of sensitivity throughout the body or in its individual areas. In most cases, this is achieved by introducing medications that disrupt the transmission of a pain impulse to the brain from the area of ​​intervention. Anesthesia in dentistry is necessary so that the patient does not experience pain during dental treatment. The calm behavior of the patient gives the doctor the opportunity to carry out therapeutic or surgical manipulations quickly enough, efficiently and in the required volume.

Indications for anesthesia

Anesthesia is indicated during the following manipulations:

• treatment of deep caries;
• extirpation or amputation of the pulp (depulpation);
• extirpation (removal) of the tooth;
• other surgical interventions;
• preparation of teeth for prosthetics;
• some types of orthodontic treatment.

note: medium caries can also be an indication for anesthesia, since the area of ​​\u200b\u200bthe border of the enamel and dentin layers is quite sensitive, and pain during dental treatment in this case is noted quite often.

Types of anesthesia in dentistry

Anesthesia is divided into local and general (narcosis). It is also customary to distinguish between drug and non-drug pain relief.

There are several types of non-drug anesthesia:

• audioanalgesia;
• electroanalgesia;
• anesthesia through hypnotic effects;
• computer anesthesia.

Drug anesthesia involves the injection of an anesthetic that blocks the conduction of an impulse for the time necessary for medical intervention. After a certain period of time, the drug breaks down, and the sensitivity is fully restored. Modern painkillers allow you to completely avoid discomfort during treatment.

General anesthesia in dental treatment is used relatively rarely and in the presence of special indications. Most often it is used in maxillofacial surgery.

Local anesthesia in dentistry

Most procedures are preceded by local anesthesia. For the body, it is much safer than anesthesia. Until recently, the most common anesthetics were Novocaine and Lidocaine, but more effective drugs are now being used.

There are several types of local anesthesia:

• application;
• infiltration;
• conductive;
• intraligamentary;
• intraosseous;
• stem.

Application anesthesia

It is an anesthesia that provides superficial anesthesia. It is carried out by spraying or applying the drug in the form of an ointment to the mucous membrane of the oral cavity. The most commonly used is 10% Lidocaine in aerosol cans.

Application anesthesia is indicated to reduce the sensitivity of soft tissues at the site where the injection will be made, as well as in the treatment of the mucous membrane (for stomatitis and gingivitis) and the opening of small suppurations. In therapeutic practice, it can be used before removing mineralized deposits in the cervical region, and in orthopedic practice, when preparing a tooth for prosthetics (turning).

Infiltration anesthesia

Infiltration anesthesia allows you to anesthetize one tooth or a small area of ​​the mucosa. It is practiced in the removal of the neurovascular bundle, as well as in the treatment of deep caries.

The injection is usually carried out in the projection of the root apex. In this case, the anesthetic drug blocks the conduction of the pain impulse at the level of the nerve branch. Most often, the upper teeth are anesthetized in this way, since the relatively small thickness of the bone upper jaw allows the anesthetic to penetrate relatively easily into the nerve endings.

Conduction anesthesia

It is needed when infiltration does not give the desired effect, or it is required to anesthetize several adjacent teeth. It is also used for extirpation of teeth, opening of abscesses with periostitis and exacerbation chronic periodontitis, as well as when draining a purulent focus. An anesthetic injection will allow you to temporarily “turn off” the entire nerve branch.

Most often, tuberal and palatal conduction anesthesia is performed before interventions on the upper jaw (if necessary, they are supplemented with incisive anesthesia), and for anesthesia mandible- torusal or mandibular.

Intraligamentary (intraligamentous) local anesthesia

Often practiced in pediatric dentistry in the treatment of deep caries and its complications, as well as in cases where the tooth is to be removed.

Injection of the drug is carried out in the periodontal ligament, which is located between the wall of the alveoli and the root of the tooth. At the same time, the mucous membranes do not lose their sensitivity, which excludes the child from accidentally biting the cheek, tongue or lip.

Intraosseous anesthesia

It is indicated during the operation for the extirpation of the tooth. First, an anesthetic is injected into the gums, and after the onset of local numbness, into the spongy layer of the jawbone in the interdental space. In this case, only the sensitivity of a certain tooth and a small area of ​​\u200b\u200bthe gum disappears. The effect develops almost instantly, but lasts a relatively short time.

Stem anesthesia

Carrying out stem anesthesia in dentistry is possible only in a hospital setting. Indications for its implementation can be pain of a high degree of intensity, neuralgia (in particular, of the facial nerve), as well as serious injuries of the jaws and zygomatic bone. This type of anesthesia is also practiced before the start of surgical interventions.

An anesthetic injection is carried out in the region of the base of the skull, which allows you to immediately turn off the maxillary and mandibular nerves. The effect of stem anesthesia is characterized by power and long duration.

Contraindications

Before performing anesthesia, the dentist must definitely find out if the patient has serious somatic diseases or allergies to medications.

Contraindications to the use of painkillers can be:

• allergic reactions after the administration of anesthetics;
• sharp cardiovascular diseases in history (heart attacks or strokes less than six months ago);
• diabetes;
• some other hormonal disorders against the background of pathologies of the endocrine system (thyrotoxicosis, etc.).

Important: In decompensated forms of endocrine diseases, the patient should be treated exclusively in a hospital. Particular care must be taken when conducting anesthesia for children and pregnant women.

Modern painkillers

For local anesthesia, Lidocaine (2% for injections and 10% for applications) and Novocaine (nowadays less and less used) can be used. To enhance and prolong the effect, "traces" of adrenaline are usually added to the solutions of these drugs before administration.

Also used are such modern anesthetics as:

• Articain;
• mepivacaine;
• Ultracain;
• Ubistezin;
• Scandonest;
• Septonest.

These preparations are supplied in special cartridges, which are placed in the body of a metal cartridge syringe. Separately, a disposable needle is screwed onto the syringe, the thickness of which is several times less than that of conventional injection needles.

The undoubted advantage of carpool anesthesia is that the injections are practically painless. In addition, the composition of a number of solutions already includes adrenaline or norepinephrine for a stronger and more lasting effect.

Anesthesia in pediatric dentistry

There are no anesthetics that can be called absolutely safe for children. In childhood, the body is extremely sensitive to any medicines, as a result of which the risk of complications after injections is especially high.

Previously, Lidocaine and Novocaine were used for pain relief, and Aricaine and Mepivacaine are currently considered the safest drugs for children.

When treating children, dentists practice the following types of anesthesia:

• Application;
• infiltration;
• Intraligamentary;
• Conductor.

Note: in young patients, the risk of developing psychogenic complications is very high, since the baby's psyche is not completely formed. The most common complication is a short-term loss of consciousness due to strong emotions (fear).

The most common complications of local anesthesia

To the number possible complications anesthesia include:

• allergic reactions (with hypersensitivity to the drug);
• toxic reactions (with an overdose);
• prolonged violation of sensitivity due to injury to the nerve branch with a needle (in violation of the rules for the injection);
• pain and burning at the injection site (common and considered normal).

There is also the possibility of the following complications:

• the formation of hematomas (swelling and bruising) after an injection as a result of damage to a blood vessel;
• needle breakage during injection (extremely rare);
• infection of tissues (if the doctor does not follow the rules of asepsis and antiseptics when injected into the infected area of ​​​​the mucosa);
• transient spasm (trismus) of masticatory muscles (in case of damage to the nerve or muscle fibers):
• accidental biting of soft tissues (lips, cheeks, tongue) due to temporary loss of sensitivity.

The use of modern painkillers can minimize the likelihood of developing most complications.

On the eve of treatment and immediately before visiting the dentist, you should refrain from taking alcoholic beverages, since ethyl alcohol can reduce the analgesic effect of most drugs.

If you feel unwell, in particular against the background of SARS or influenza, a visit to the doctor should be postponed.

Patients during menstruation should also postpone dental treatment, if possible. During this period, nervous excitability and susceptibility to drugs increase. Extractions of teeth and other surgical interventions during menstruation can cause prolonged bleeding.

General anesthesia in dentistry

Under general anesthesia understand the complete loss of sensitivity, accompanied by varying degrees of impaired consciousness.

General anesthesia in dental treatment is used relatively rarely and according to strict indications, since this method of anesthesia is far from safe. It is used during major surgical interventions in maxillofacial region.

Please note: Currently, inhalation anesthesia with nitrous oxide (“laughing gas”) is used more and more often in the treatment of teeth (including in children).

Indications for general anesthesia in dentistry are:

• allergy to local anesthetics;
• mental illness;
• panic fear of dental procedures.

Contraindications include:

• respiratory diseases;
• serious pathologies of the cardiovascular system;
• intolerance to drugs for anesthesia.

Types of anesthesia in dental practice:

1. General:- with general anesthesia, a state of reversible inhibition of the central nervous system is achieved with the help of medicines. Consciousness is turned off, the perception of pain impulses is eliminated, some reflexes are suppressed, skeletal muscles relax. Adequate gas exchange and blood circulation, regulation of metabolic processes are maintained in the body.

Testimony to general anesthesia in an outpatient setting is the patient's psycho-emotional instability, intolerance to local anesthetics (the inability to choose drugs for another method of anesthesia), pain operations in children, CNS diseases with a decrease in intelligence (oligophrenia, Down's disease, epilepsy), which do not allow contact with the patient, children's cerebral paralysis, the patient's urgent desire to treat teeth only under anesthesia.

Anesthesia on an outpatient basis is carried out only by a qualified anesthesiologist.

The main method of anesthesia in outpatient dental practice is local anesthesia. But this method of anesthesia is not always adequate and effective. So, for example, with purulent-inflammatory processes, the analgesic effect is often insufficient. The possibilities of local anesthesia are limited in patients with emotionally labile mentality, allergic reactions to local anesthetics. With inadequate local anesthesia, it is difficult to qualitatively perform all stages of surgical intervention. Therefore, the necessity of introducing modern methods of general anesthesia into outpatient surgical practice is substantiated. The anesthesiologist should deal with the complex protection of the patient during dental procedures. However, this approach does not relieve the dentist from the need to know the indications and contraindications for the use of general anesthesia, the features of premedication, anesthesia, the post-anesthetic period when using various drugs, possible complications during dental interventions under general anesthesia, ways to prevent and eliminate them.

Only close cooperation between the dentist and the anesthesiologist with a deep understanding of the essence of each other's actions can provide optimal conditions for dental treatment with minimal risk to the patient.

Main requirements requirements for general anesthesia on an outpatient basis - the speed of action of the drug and the rapid awakening of the patient after the cessation of anesthesia, the minimum toxicity of the drugs used, the provision of sufficient relaxation of the masticatory muscles, the minimum effect on salivation. The optimal duration of anesthesia is considered to be 60 minutes, and in elderly people with several concomitant diseases, anesthesia should not exceed 45 minutes.

Depending on the method of administration of a general anesthetic, inhalation and non-inhalation anesthesia are distinguished.

In inhalation anesthesia, general anesthetics are administered as a vapor or gas through the respiratory tract, followed by diffusion from the alveoli into the blood. In this case, there is a faster flow of anesthetic into the blood compared to intravenous administration of the anesthetic. A mixture of nitrous oxide, halothane and oxygen is more commonly used, as well as methoxyflurane, enflurane, isoflurane, etc.

Non-inhalation general anesthesia includes all methods in which a local anesthetic enters the body not through the respiratory tract - intravenous anesthesia, intramuscular, oral, rectal, as well as non-drug electrical stimulation methods (regional electroneedling, central electrical stimulation anesthesia). Oral and rectal methods of general anesthesia are practically not used due to the complexity of dosage, the impossibility of taking into account individual conditions for the absorption of drugs by the mucous membrane of the stomach and rectum, the occurrence of dyspepsia, nausea, and vomiting. The method using submucosal administration of drugs - for premedication and (or) basic anesthesia was proposed in 2000 by Professor Grifin J.V. A local anesthetic is injected to painlessly administer the tranquilizer. Upon obtaining the desired effect (sedation without turning off consciousness or narcotic sleep), local anesthesia is performed in the intervention area or they switch to general anesthesia.

For non-inhalation anesthesia in dental practice, hexenal, sodium thiopental, sombrevin, sodium hydroxybutyrate, ketamine are more often used (for intravenous anesthesia)

2.Local:- such methods of influencing the tissues of a certain area of ​​the human body that do not turn off consciousness and cause a loss of pain sensitivity in the tissues of this area. The leading method of anesthesia in dentistry. It is indicated in all cases when performing dental interventions, accompanied by a pain reaction.

3.Combined anesthesia- a combination of local anesthesia and anesthesia, the simultaneous use of different general anesthetics for optimal use of their positive properties.

Local anesthesia.

Each method used to anesthetize the tissues of the maxillofacial region is characterized by the route and place of application of the local anesthetic solution, as well as the anesthetized nerves.

In accordance with the general classification, all methods of local anesthesia are divided into three types (Vishnevsky A.A., 1974; Bizyaev A.F. 1998):

application (from lat. Applicatio - application), terminal (from lat. Terminus - limit, end), or surface anesthesia, which is carried out by applying anesthetics to the surface of tissues. By impregnating the surface layers of tissues, anesthetics block the receptors located in these layers and the terminal parts of the peripheral nerve fibers;

infiltration (from lat.Infiltration- impregnated) anesthesia is carried out by impregnating the deep layers of tissues with an anesthetic solution injected through an injection needle. The area of ​​anesthesia in this case is also limited by the area of ​​diffusion of the solution that blocks receptors and peripheral nerve fibers in these tissue layers. Most often, infiltration anesthesia is carried out by introducing an anesthetic solution under the mucous membrane, over the periosteum, intraosseously or into periodontal tissues;

With application and infiltration anesthesia, they affect receptors perceiving pain stimuli.

regional (from lat.region- area) Anesthesia is achieved by the targeted administration of an anesthetic solution, in which the solution is concentrated around the nerve trunks, plexuses, or roots of the spinal cord. Due to this, their blockade occurs, and the effect of anesthesia occurs in the area of ​​the body that is innervated by the anesthetized nerve formations.

Regional anesthesia, in which the anesthetic solution is concentrated around a section of a nerve or nerve trunk, as a result of which the conduction of nerve impulses through it is disturbed, is called conductive anesthesia.

This anesthesia is carried out by the introduction of an anesthetic solution either inside the nerve trunk - endoneurally, or in the immediate vicinity of it - perineurally. The endoneural method of administration for anesthesia of dental interventions is currently not used due to its trauma and high risk of post-injection local complications.

In dentistry, all three types of local anesthesia are used: application, infiltration and conduction, with the last two being the main ones most commonly used.

injection methods local anesthesia: the anesthetic solution is injected into the tissues using a hollow needle or high pressure (needleless method - injector) - infiltration and conduction anesthesia

In the mid-1980s, domestic needle-free injectors were widely used in domestic dental practice. But at that time there were no modern anesthetics, and also due to the technical features of the injectors themselves, this technique did not stay in practice for a long time. In 2001, the German company "Rosh AG Medizintechnik" patented the INJEX TM system for dental practice. The injector works by activating a spring. After the trigger is pressed, the energy of the compressed spring causes the plunger inside the ampoule to move, and local anesthetic is released through a thin capillary hole.

Non-injection methods- provide superficial anesthesia of tissues without injection of anesthetics into them: application anesthesia ( chemical method), anesthesia with cold (physical method), electrophoresis of the anesthetic.

Application anesthesia (chemical method) -

anesthesia by lubrication, applying an anesthetic to the surface of tissues, while anesthetizing the terminal nerve endings. Application anesthesia is used for interventions on the oral mucosa, hard tissues and dental pulp, and is used for small-scale manipulations that do not require injection anesthesia.

Indications for application anesthesia:

1. Anesthesia of the injection site before injection anesthesia.

2. During interventions on the mucous membrane.

3. When puncturing the maxillary sinus

The technique of application anesthesia of the mucous membrane

We carry out antiseptic treatment (rinsing the mouth with an antiseptic solution).

The place to be anesthetized (operating field) must be isolated and dried from saliva.

Painkillers are used in the form of a liquid (solution, aerosol), gel, lubricant, paste.

The anesthetic, if used in the form of a solution, is applied to the surgical field with a roller soaked in the solution or with a cotton ball or gauze ball soaked in the anesthetic solution and slightly wrung out. An anesthetic liquid in the form of an aerosol is sprayed onto the surgical field. An anesthetic agent used in the form of a gel, lubricant, paste is applied to the mucous membrane with a thin layer.

Painkillers should be in the area of ​​the surgical field for 1-3 minutes and during this time not come into contact with saliva.

Before the intervention, the surgical field is freed from the remnants of the anesthetic (lubricant, paste) and the sensitivity is checked with a needle or probe. In case of insufficient anesthesia, application anesthesia is repeated with the implementation of all the rules.

Infiltration anesthesia is divided into direct and indirect.

Straight anesthesia - the anesthetic is injected directly into the tissues of the surgical field. Used for surgical interventions on soft tissues and organs of the oral cavity, face, alveolar process, and other areas.

indirect- the anesthetic solution from the created depot diffuses into the deeper located tissues, on which the surgical intervention is performed. It is used when removing teeth, performing bone operations on the alveolar process. In this case, the anesthetic from under the mucous membrane penetrates into the thickness of the cancellous bone and impregnates the nerve endings that go from the dental plexus to the teeth and other tissues.

Periodontal methods of local anesthesia

According to the indications, in any section of dentistry, periodontal (additional) [Malamed S., 1997] methods of anesthesia can be used, with the help of which anesthesia of the hard tissues of the teeth and periodontium is achieved. These methods include:

Intraligamentous, or intraligamentary, anesthesia;

Intraseptal or intraseptal anesthesia;

Intrapulpal and intracanal anesthesia.

The advantage of periodontal methods of anesthesia over other types of local anesthesia is to achieve an effect with the introduction of much smaller volumes of anesthetic - 0.2-0.5 ml, since its diffusion zone depends primarily on pressure and, to a lesser extent, on dose.

The use of these methods of anesthesia is indicated in the treatment of teeth, their preparation for crowns, during the extraction of teeth, during patchwork operations, implantation of dental supports, etc.

Their use reduces the risk of complications due to a significant reduction in the potential toxicity of the drug, which is especially important for patients with concomitant somatic diseases.

In essence, intraligamentous and intraseptal anesthesia refer to the intraosseous (spongy) method of anesthesia.

With intraligamentary anesthesia, the anesthetic is injected directly into the periodontium of the tooth under some pressure to overcome tissue resistance. An anesthetic solution injected under high pressure spreads into the spongy substance and the bone marrow space, into the dental pulp, and with slight pressure - towards the gums and periosteum. Before anesthesia, we perform antiseptic treatment of the tooth crown and gingival sulcus. The needle is driven into the gingival groove at an angle of 30 * to the central axis of the tooth. the bevel of the needle is facing the surface of the root. The needle is advanced into the periodontium to a depth of 1-3 mm. To anesthetize single-rooted teeth, 0.2 ml of anesthetic is sufficient, for multi-rooted teeth - 0.4-0.6 ml. Anesthesia occurs in 15-45 seconds, the action lasts up to 45 minutes when using an anesthetic with a vasoconstrictor.

With the ineffectiveness of conventional infiltration anesthesia, when an anesthetic depot is created under the mucous membrane of the alveolar process or under the periosteum, it is possible to perform intraosseous anesthesia, when the anesthetic is injected directly into the spongy bone of the alveolar process between the roots of the teeth. To do this, under application or infiltration anesthesia, a special trephine or a thin spherical bur is pierced soft tissues interdental papilla at its base to the bone. The trephine is placed at an angle of 40-60 degrees to the horizontal plane. Then, at low speeds, the drill trepans the outer compact plate. Through the formed channel, an injection needle is inserted into the spongy substance of the alveolar process and 1-2 ml of anesthetic is injected. Immediately within the two teeth, between the roots of which anesthesia was performed, deep anesthesia occurs due to the shutdown of the nerve trunks going to the pulp and periodontal teeth. The duration of anesthesia is about 1 hour. The technique is time-consuming; when forming a channel in the bone, injury to the vessel is possible; in the bone tissue, the vessel does not collapse, then when injected, the anesthetic can easily enter the bloodstream, which will cause general complications. Rarely used in the outpatient setting

Intraligamentous (intraligamentary) anesthesia - the introduction of an anesthetic into the periodontal space of the tooth using a special injector and a needle under high pressure.

The injected solution spreads along the periodontal fissure and further through the lamina cribriformis into the alveolus surrounding the tooth root, including its apical part.

Anesthesia is performed by first removing plaque from the tooth and after its antiseptic treatment and the periodontal groove. The needle is inserted at an angle of 30° to the central axis of the tooth, puncturing the gingival groove to a depth of 1-3 mm until a feeling of resistance appears. Then, under high pressure, the anesthetic is slowly removed over 7-8 seconds. This technique is repeated 2-3 times with an interval of 5-7 s, after which the needle is held at the achieved depth of 10-15 s to avoid the outflow of anesthetic. It should be borne in mind that the forced introduction of the solution can lead to tooth subluxation, which does not matter only in the event of its forthcoming removal.

Anesthesia occurs within 30-40 seconds and lasts 20-30 minutes. It is quite effective in the area of ​​all groups of teeth, with the exception of the canines of the upper and lower jaws and the central incisors of the upper jaw, which is explained by the length of their roots.

Intraseptal (intraseptal) anesthesia is achieved by introducing an anesthetic into the bony septum between the sockets of the teeth. The injected solution spreads through the bone marrow spaces to the region of adjacent teeth to the level of periapical tissues and through intravascular periodontal formations, providing the effect of anesthesia of the dental pulp and periodontal.

Anesthesia occurs within 1 minute and is achieved by introducing through a special needle at a right angle to the surface into the bone tissue of the top of the interdental septum 0.2-0.4 ml of the solution to a depth of 1-2 mm.

The achieved effective anesthesia and pronounced hemostasis provides the possibility of surgical interventions on soft and hard periodontal tissues in the amount of curettage, patchwork operations, implantation of dental supports, etc.

Intrapulpal and intracanal anesthesia can be performed in cases where a sufficient analgesic effect has not been achieved using other methods. Anesthesia is provided by the introduction of 0.2-0.3 ml of the solution intrapulpally or by moving the needle deep, intracanal, under pressure.

The effect of anesthesia comes immediately.

Premedication - drug preparation for anesthesia and surgical intervention to prevent the development of general complications (fainting, collapse, hypertensive crisis, etc.), to relieve psycho-emotional stress before intervention.

Premedication leads to stabilization of the CNS function, increases the threshold of pain sensitivity, enhances the effect of anesthetics.

The most common form of premedication on an outpatient basis is the appointment of tranquilizers 30-40 minutes before dental intervention. Tranquilizers remove the patient's feeling of fear, excessive emotional excitability, irritability, aggressiveness. Tranquilizers enhance the effect of anesthetics, analgesics, sleeping pills and narcotic drugs. They cannot be assigned to drivers of machines before and during work. Their unreasonable and uncontrolled prescription can lead to side effects (drug dependence)

Diazepam - a group of benzodiazepines, causes a decrease in the patient's anxiety, has a sedative effect, the ability to cause amnesia.

Any medical preparation does not exclude the need for local anesthesia.

For anesthesia in dentistry, drugs of the following groups are used:

tranquilizers

Analgesics

Local anesthetics

Preparations for general anesthesia

Analgesics, analgesics, are called drugs that have the ability to eliminate or relieve pain. Pain relief with the use of analgesics is not accompanied by loss of consciousness and impairment of motor functions.

According to the chemical nature, nature and mechanism of action, analgesics are divided into two main groups: a) narcotic analgesics; b) non-narcotic analgesics

Narcotic analgesics. The main property of narcotic analgesics is their high analgesic activity. Narcotic analgesics, acting on the thalamic centers of pain sensitivity, reduce the perception of pain impulses by the central nervous system. Enhance the action of local anesthetics, reduce the excitability of the respiratory center, inhibit cough and gag reflexes.

In dental practice, narcotic analgesics are used in the pre- and postoperative periods for fractures and other operations in the maxillofacial region. With repeated use of narcotic analgesics, addiction usually develops. Outpatient use of opioids should be strictly limited.

Non-narcotic analgesics. The effectiveness of the analgesic action of non-narcotic analgesics is much lower than that of narcotic ones. However, in the conditions of outpatient treatment, the use of potent substances is impractical. To narcotic analgesics, patients develop addiction and addiction, so it is impossible to give them into the hands of patients. Preparations of the group of non-narcotic analgesics are used in outpatient clinics. They relieve pain of various origins (neuralgia, myositis, arthritis, headache and toothache, etc.). They do not have a depressing effect on the respiratory and cough centers, do not cause euphoria and drug dependence phenomena. In febrile conditions, they have antipyretic and anti-inflammatory effects. In the mechanism of action of these drugs, their influence on the thalamic centers of the brain plays a certain role, which leads to inhibition of the conduction of pain impulses to the cerebral cortex.

Non-narcotic analgesics such as paracetamol; non-steroidal anti-inflammatory drugs - aspirin, ketoprofen, ketorolac, lornoxicam, etc.

Local anesthetics.

The arsenal of drugs for local anesthesia is very diverse. The mechanism of action of local anesthetics is associated with the blocking action of the plasma membrane of the nerve fiber, which is responsible for the generation and transmission of nerve impulses. As a result of the blockade, nerve impulses from the operation area do not enter the central nervous system.

There is a shutdown of pain, temperature, tactile sensitivity.

Preparations used for local anesthesia should be highly soluble in water, should quickly penetrate into the nervous tissue, have low toxicity, and not cause an irritant effect. It is desirable that they have a vasoconstrictive effect or be compatible with vasoconstrictor drugs. Local anesthetics latest generation meet all these requirements.

Anesthesia on the tubercle of the upper jaw. The purpose of anesthesia is to block the posterior alveolar branches located in the pterygopalatine fossa and on the posterior surface of the jaw tubercle. This type of anesthesia can be performed intraorally and extraorally.

Intraoral access: with a half-open mouth, the cheek is taken aside with a dental mirror, providing a sufficient view of the arch of the vestibule of the mouth and tension of the mucous membrane of the transitional fold in the molars. The needle is injected into the mucous membrane above the projection of the tops of the teeth at the level of the second or third molars, and in their absence - behind the zygomatic-alveolar crest, introducing it at an angle of 45 ° and moving it up, back and inward. In this case, it is necessary to ensure that the needle slides the beveled surface of the point over the bone all the time. As the needle advances, the anesthetic solution should be slowly released, thereby preventing damage to the blood vessels of the pterygoid plexus. By advancing the needle to a depth of 2-2.5 cm, an anesthetic solution is deposited, which achieves anesthesia of the area of ​​the molars adjacent to them from the vestibule of the mouth of the mucous membrane and periosteum, as well as the posteroexternal bone wall of the maxillary sinus.

Extraoral access: puncture the skin at the anteroinferior angle of the zygomatic bone, direct the needle at an angle of 45 ° up and inward to the tubercle of the upper jaw, bringing it to the bone; after which the anesthetic solution is deposited. The time of onset of anesthesia in the area of ​​anesthesia is the same as with intraoral anesthesia. At the same time, it must be borne in mind that in the process of anesthesia during anesthesia on the tubercle of the upper jaw, as a result of damage to the pterygopalatine plexus veins by the injection needle, a hematoma invariably occurs.

Conducted computed tomography studies of the distribution pathways of the injectable anesthetic during "tuberal" anesthesia confirmed the high probability of such a complication.

Anesthesia of the infraorbital nerve. The purpose of anesthesia is to block the branching of the branch of the infraorbital nerve, which forms the small crow's foot after exiting the bone canal, as well as the anterior and middle upper alveolar branches.

As a result of anesthesia at the infraorbital foramen, the incisors, canine, premolars, adjacent gums from the vestibule of the mouth, bone tissue of the alveolar process and nasal septum, mucous membrane and bone structures of the anterior, partially posterior external, lower and upper walls of the maxillary sinus, skin of the infraorbital area, lower eyelid, wing of the nose, skin and mucous membrane of the upper lip.

The infraorbital foramen, which is a guide during anesthesia, is projected onto the skin of the face 0.5 cm below the edge of the orbit and corresponds to a line drawn through the center of the pupil of the eye looking forward. This type of anesthesia can be performed by extraoral and intraoral accesses.

Extraoral access: the lower edge of the orbit is determined by palpation, a groove is found corresponding to the junction of the zygomatic bone with the zygomatic process of the jaw, and, stretching the skin between the 1st and 2nd fingers of the left hand, a needle is injected, retreating 0.7 cm down from the edge of the orbit. The needle is advanced upward and outward towards the bone. Having reached its surface, without penetrating the canal with a needle, an anesthetic solution is released. Anesthesia comes in 2-3 minutes.

Intraoral access: I and II fingers of the left hand take the upper lip up and outward, and with the middle finger they fix the projection of the infraorbital foramen, which during intraoral access is located at the intersection of two lines - horizontal, passing 0.5-0.75 cm below the infraorbital margin, and vertical, passing along the axis of the second upper premolar of the corresponding side, the Needle is injected 0.5 cm upward from the edge of the attachment of the transitional fold between the middle and lateral incisors and is advanced upward, forward and outward towards the infraorbital foramen until it stops at the bone surface, where the anesthetic is injected

Anesthesia at the foramen magnum. This method of anesthesia provides blocking of innervation by branches of the greater palatine nerve, resulting in anesthesia of the mucous membrane of the corresponding side of the hard palate, the alveolar process on the palatal side from the third molar to the middle of the coronal part of the canine. The area of ​​anesthesia can extend to the lateral incisor and to the vestibular surface in the region of the third molar. In some patients, the border of anesthesia reaches the second premolar.

The large palatine opening is located in the horizontal plate of the palatine bone and its pyramidal process at the base of the alveolar process, 0.5 cm anterior to the border of the hard and soft palate. On the mucous membrane above the hole there is a small depression.

The projection of the hole on the mucous membrane of the hard palate is at the intersection of two mutually perpendicular lines: the horizontal one passes through the middle of the crown part of the third molar, and the vertical one - through the middle of the line connecting the crest of the alveolar process with the middle of the upper jaw.

Anesthesia technique: with a wide open mouth, a syringe with a needle is directed from its opposite corner and the needle is injected 1 cm anteriorly and medially from the projection of the palatine opening onto the mucous membrane. The needle is advanced posteriorly and outwards until it comes into contact with the bone. Enter 0.5 ml of anesthetic solution. After 2-3 minutes, anesthesia occurs. If the anesthetic is injected directly at the large palatine opening, and even more so into the lumen of the pterygopalatine canal, then anesthesia extends to the posterior palatine nerves emerging from the small palatine opening, resulting in anesthesia of the soft palate, which can cause nausea and urge to vomit. Another complication of anesthesia associated with excessive injection of a solution under pressure may be the development of soft tissue necrosis of the hard palate, which is most likely in patients with vascular atherosclerosis.

Anesthesia at the incisal foramen. This type of anesthesia provides anesthesia of the anterior part of the mucous membrane of the hard palate in the region of the anterior teeth by turning off the nasopalatine nerve.

The incisive opening is located between the anterior incisors 7-8 mm posterior to the gingival margin at the intersection of lines connecting the distal edges of the canine necks and the median palatine suture (behind the incisive papilla). The needle is parallel to the axis of the central incisors.

Anesthesia technique: the patient sits in a chair with his head thrown back and his mouth wide open. The needle is injected into the mucous membrane near the incisal hole to a depth of 3-4 mm and the anesthetic solution is slowly released. The injection of a needle into the papilla is very painful, therefore, thin needles are used for injection, after having previously applied anesthesia. Anesthesia occurs after 2-3 minutes.

Intranasal method - the anesthetic is injected at the base of the nasal septum on both sides or by applying 2% solution of dicaine with adrenaline to the mucous membrane of the bottom of the nasal cavity and its septum on both sides.

Anesthesia of the mandibular nerve at the mandibular foramen (mandibular anesthesia)

The purpose of anesthesia is to block the inferior alveolar and lingual nerves in the region of the mandibular foramen.

Target point: The inferior alveolar foramen is located on the inner surface of the mandibular ramus at the level of the masticatory surface of the lower molars, and in children and the elderly - somewhat lower. (from the front edge of the inner surface of the lower jaw branch at a distance of 15 mm, from the posterior edge - by 13 mm, from the notch of the lower jaw - by 22 mm, from the base of the lower jaw - by 27 mm). From the front and from the inside, the opening of the lower jaw is covered with a bone protrusion - the uvula of the lower jaw, so the anesthetic solution must be injected 0.75-1 cm above the level of the hole - above the upper pole of the bone protrusion, where the nerve lies in the bone groove before entering the canal and is located loose fiber.

Anesthesia zone: anesthesia of the teeth of the corresponding half of the lower jaw and its alveolar part, gums, mucous membrane of the sublingual region, skin and mucous membrane of the lower lip, skin of the corresponding half of the chin, and 2/3 of the tongue.

Anesthesia can be performed by extraoral and intraoral access. Intraoral access: anesthesia can be performed apodactyly or after preliminary palpation of bone anatomical landmarks. Anesthesia after preliminary palpation begins with a palpatory determination of the retromolar fossa and the temporal crest, which is the guideline for the injection of the needle. With a wide open mouth, the injector is placed at the level of the premolars of the opposite side and the needle is injected medially from the temporal crest, 0.7-1.0 cm above the occlusion surface of the adjacent tooth, moving it outwards and backwards until it comes into contact with the bone. Part of the anesthetic solution is withdrawn, which results in blocking the lingual nerve. After advancing the needle deeper by another 2 cm and reaching the bone groove, the remainder of the anesthetic solution is injected, blocking the inferior alveolar nerve

When performing anesthesia using the apodactyl method, the pterygo-mandibular fold, which is located medially from the temporal crest, is used as a guide. With the mouth wide open and the position of the injector similar to that described above, the needle is injected into the outer slope of the pterygo-jaw fold at the middle of the distance between the surfaces of the closure of the upper and lower molars, advancing it outward and backward until it comes into contact with the bone. An anesthetic solution is injected, blocking the inferior alveolar and lingual nerves. When using both methods of anesthesia by intraoral access, the effect of anesthesia occurs after 3-5 minutes and lasts at least 1.5 hours.

Anesthesia in the area of ​​the mandibular ridge according to M. Weisbrem (torusal anesthesia)

With this anesthesia, an anesthetic solution is injected into the region of the mandibular roller (torus mandibulae). It is located at the junction of the bone scallops coming from the coronoid and condylar processes - above and anterior to the bony uvula of the lower jaw. Below and medially from the roller are the lower alveolar, lingual and buccal nerves, surrounded by loose fiber. With the introduction of an anesthetic in this area, these nerves can be turned off at the same time.

During anesthesia, the patient's mouth should be opened as wide as possible. The needle is injected perpendicular to the buccal mucosa, directing the syringe from the opposite side, where it is located at the level of the large molars. The injection site is a point formed by the intersection of a horizontal line drawn 0.5 cm below the chewing surface of the upper third large molar and a groove formed by the lateral slope of the pterygo-mandibular fold and cheek. The needle is advanced to the bone (to a depth of 0.25 to 2 cm). Enter 1.5-2 ml of anesthetic, blocking the lower alveolar and buccal nerves. Pulling the needle a few millimeters in the opposite direction, 0.5-1 ml of anesthetic is injected to turn off the lingual nerve. Anesthesia occurs after 5 minutes.

Area of ​​anesthesia: the same tissues as during anesthesia at the opening of the lower jaw, as well as tissues innervated by the buccal nerve - the mucous membrane and skin of the cheek, the mucous membrane of the alveolar process of the lower jaw from the middle of the second small molar to the middle of the second large molar. However, due to the peculiarities of the relationship of the buccal nerve with the lower alveolar and lingual nerves, anesthesia in the zone of innervation of the buccal nerve does not always occur. In this case, infiltration anesthesia should be additionally performed in the area of ​​the surgical field to turn off the peripheral endings of the buccal nerve.

Extraoral methods used when it is impossible to carry out the blockade by intraoral access. Apply access from the submandibular region or subzygomatic method (according to Bershe - Dubov)

Extraoral method. When performing anesthesia submandibular access the needle is injected into the skin under the inner surface of the lower edge of the jaw, retreating 1.5 cm from the angle, and it is advanced along the bone parallel to the posterior edge of the branch by 3.5-4 cm. Here, a depot of an anesthetic solution is created in an amount of 1 ml, which ensures blocking of the lower alveolar nerve. Then, advancing the needle by another 1 cm, 1 ml of anesthetic is injected, turning off the buccal and lingual nerves. When the needle is advanced 4 cm from the lower edge of the jaw and the anesthetic solution is injected into the tissue, there is usually no need to additionally move the needle to the lingual and buccal nerves, since the diffusion of the solution provides anesthesia in the area of ​​​​innervation of all three nerves. When conducting anesthesia according to the described method in patients with a short neck, a needle should be injected without a syringe, since it interferes with the advancement of the needle to the bone. The syringe is attached to the needle, reaching the level of the mandibular foramen.

When performing anesthesia subzygomatic access (according to Bershe-Dubov) the needle is injected into the skin perpendicular to its surface under the lower edge of the zygomatic arch 2 cm anterior to the base of the tragus auricle. Having advanced it to a depth of 3-3.5 cm and thereby reaching the inner surface of the external pterygoid muscle, 2 ml of an anesthetic solution is injected. As a result, after 8-10 minutes, a blockade of the lower alveolar, buccal and lingual nerves occurs. Somewhat earlier, the contracture of the lower jaw is partially or completely eliminated.

Painkillers are divided into 3 groups: analgesics, opiates and nonsteroidal drugs. The latter are most often used in dentistry. They effectively relieve pain, are not addictive, and are often sold without a doctor's prescription.

There are many medicines for relieving toothache. However, you can review the 5 most powerful painkillers in dentistry.

A drug based on ketoprofen. The strongest and most effective pain reliever in domestic dentistry. It is prescribed for anti-inflammatory therapy after implantation, complex extraction of teeth and other surgical interventions.

Important!"Ketonal" is often confused with "Ketanov". But they are two different drugs. The second is produced by an Indian companyRanbaxy is cheaper and has many side effects. Although due to an aggressive marketing campaign, it is mistakenly considered the best pain reliever.

Do not confuse Ketonal with Ketanov.

"Nurofen"

The drug is a British company based on ibuprofen. Available in the form of tablets (regular and soluble), capsules, suspensions for children.

Additional Information! There is also an improved drug - Nurofen Plus. It contains 200 mg ibuprofen and 10 mg codeine.

The most favorite and effective pain reliever for pediatric dentists. Almost no side effects. In exceptional cases, it can be used for children from 3 months.

pros	Minuses	Reception	Analogues	Price (rubles)
Good anti-edematous and anti-inflammatory action; penetrates into the joint bone tissue therefore it is recommended for pulpitis, periostitis,; convenient forms of release - from 4 tablets per pack.	In dentistry, it is not recommended to prescribe to children under 3 years of age; relieves pain worse than Ketonal; long-term use is undesirable; should not be taken in the 3rd trimester of pregnancy and undesirable - in the first two.	Children: 3 to 10 ml of suspension. Adults: 200-400 mg three times a day. The maximum dose is 1.2 g.	"Ibusan", "Motrin", "", "Brufen", "Seclodin", "Profinal".	Blister of tablets for 10 pieces - 80 - 120, suspension - 130 - 180.

Nurofen is often prescribed by dentists.

"Voltaren"

The review of the 5 most powerful painkillers in dentistry continues with the Voltaren drug. It is used as an anti-inflammatory therapy for pathologies of the temporomandibular joint (TMJ).

Pain reliever "Voltaren" is available in the form of tablets for adults (25 mg) and children (15 mg), prolonged-release capsules (100 mg), gel (1%) and solution (2.5%).

It is widely used as anti-inflammatory therapy for pathologies of the temporomandibular joint.

"Nise"

Another of the most powerful painkillers are Nise tablets and suspensions. Preparation based on nimesulide. The main effect is achieved by eliminating inflammation and relieving edema.

Visit to a modern dental clinic in 21st century causes no more worries than visiting a beauty salon.

Certainly, such manipulations are carried out, which cause a very uncomfortable feeling.: removal of a nerve or tooth, the establishment of crowns, orthodontic procedures.

For these cases, various methods of anesthesia are provided.

Anesthesia for dental treatment is selected individually for a specific patient. A variety of options allows you to effectively and safely relieve pain even in children and pregnant women. And since everyone has to visit a doctor's office from time to time, it is important to figure out how and with what they are anesthetized during dental treatment.

How do dentists anesthetize during the treatment and extraction of teeth?

Many people avoid going to the dentist because they have already encountered a specialist who did not perform high-quality anesthesia. But medicine has come a long way. New technologies and methods of anesthesia can convince you that you do not need to be afraid of pain during medical intervention. The process of extraction and treatment of teeth has become as comfortable as possible for both the patient and the physician.

More common local anesthesia, it is with its help that the dentist anesthetizes a specific tooth or a whole area next to it. It is divided into injection and non-injection.

To non-injection methods anesthesia include application anesthesia. Its essence lies in the application of an anesthetic to the selected area of ​​​​the mucosa. This method is used when you need to pull out a baby tooth from a child, as well as before an injection.

Prior to this, the sensitivity was reduced using low temperatures, but this technique is no longer used in practice.

Injection anesthesia includes the following types:

• conductive(by injecting into a certain tooth, you can anesthetize the area adjacent to it, to facilitate work);
• infiltration(the effect is achieved quickly, the injection is injected into the upper part of the tooth);
• intraosseous(injected directly into the bone);
• intraligamentary(injection of anesthetic into the area of ​​the periodontal ligament)

Reference. Occasionally used and anesthesia, but the method has a lot of contraindications, accompanied by complaints, not every clinic is granted permission for its use.

Application anesthesia in pediatric dentistry

Application means "attaching", such anesthesia is used for people who find it difficult to tolerate injections with an anesthetic drug. It works this way: the doctor applies a gel or ointment to the mucous tissues in the oral cavity, the anesthetic is absorbed and reaches the nerve endings.

Weak side of such a method lies in the short duration of the action - only half an hour. For long-term manipulations, this technique is not suitable, but very often it is used in pediatric dentistry, as milk teeth pass the drug more easily. The basis of the gel includes three basic drugs: benzocaine, lidocaine and tetracaine.

Indications for use:

• hypersensitivity nerve endings;
• mild form caries;
• removal tartar;
• pulpitis;
• removal milk teeth;
• damage to permanent teeth.

Infiltration anesthesia

The positive side of this type is that the effect occurs almost instantly. Patients call this method "freeze", it is most often used by doctors. The principle of operation is as follows: the anesthetic penetrates into the tissues near the diseased tooth and blocks the conduction of nerve impulses directly in the injection area or in the surrounding tissues.

Indications:

• treatment caries;
• removal teeth;
• removal cysts and neoplasms soft tissues;
• periostitis;
• treatment root canals teeth.

Conduction anesthesia

Conductor anesthesia works by blocking nerve transmission in the area where the operation is planned. This leads to total absence sensitivity and immobility. The effect is achieved by nerve blocks along which the pain impulse comes from the source of pain. It is considered a plus fast action and long-term effect, as well as the ability to use for pregnant women.

Photo 1. The drug Lidocaine in the form of a solution for injection from the company MicroGen, in a package of 10 ampoules of 2 ml.

With such anesthesia, apply: mepivacaine, lidocaine, articaine anesthetics.

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Stem: the most powerful tool

This type of anesthesia is indicated for extensive operations on the upper and lower jaw. The strongest and longest lasting pain reliever. Accepted as it should be only in hospital.

Indications for carrying out can serve as pain of a high degree of intensity, neuralgia(in particular, the facial nerve), as well as serious injury jaw and zygoma. This type of anesthesia is also practiced before the start of surgical interventions.

An anesthetic injection is carried out at the base of the skull, which helps to immediately disable the maxillary and mandibular nerves.

What anesthetics are used to anesthetize a tooth?

In clinics, as a rule, they use: lidocaine(Lidocaine, Xylocaine), procaine(Novocaine), trimekain(Trimekain), mepivacaine(Scandonest) articaine + epinephrine(Ultracain D-S, Ultracain D-S forte, Septanest with adrenaline, Alfakain SP, Ubistezin, Ubistezin forte).

The most popular anesthetic today is Ultracain D-S. It starts working quickly 1 to 3 minutes) and long-acting ( up to 45 minutes), inexpensive, and sold in any pharmacy.

The drug Ultracain D-S forte is distinguished by a higher content of adrenaline and a longer ( up to 75 minutes) action.

Lidocaine is a good and effective remedy

Among other drugs for the treatment of teeth, it stands out especially Lidocaine, as it is used more often than others by dentists, especially in public institutions.

In percentage terms, it is effective on 70—90% , the maximum concentration of the drug is reached within 10 minutes. The medicine expands the vessels well and is evenly distributed over them.

It is used:

• when removed teeth;
• stomatitis;
• with painful eruption teeth;
• suturing, prostheses;
• removal cyst;
• at crown fixation.

Issued in the form ampoules, spray and gel.

Painkiller Novocain

Novocaine- a legendary drug, as it has an almost fifty-year history of use. At one time it was quite popular and effective, but in 21st century became much inferior to modern anesthetics and became a thing of the past.

As a rule, it is used in local infiltration anesthesia. Novocaine is also prescribed and for therapeutic blockades in the treatment of chronic inflammatory diseases and purulent processes, neuralgia, poorly healing ulcers.

Important! The effectiveness of its use in dental treatment - up to 50%, this was one of the main reasons why it has become less common replaced by lidocaine.

Ultracain - the best to date

Ultracaine (otherwise it is called articaine) has been unanimously recognized by dentists from all over the world as the most effective anesthetic for teeth. Was put into practice at the end 70s 20th century. It is used in infiltration and conduction anesthesia. Twice stronger than lidocaine.

The drug is used in everyday dentistry, and during operations in the oral cavity.

How to anesthetize a tooth with Articaine

Artikain- one of the most preferred painkillers by doctors, it can be taken pregnant women and women during lactation. The tool is used for conduction anesthesia, as it shows a quick and good effect. The dosage and method of use of this drug depend on the planned procedure.

When removing teeth, Artracaine is injected into the submucosa. When suturing - locally, when preparing, an infiltration technique is used. The maximum dosage for an adult is 7 mg per 1 kg body weight.

Ubistezin

A local anesthetic that begins to work within two or three minutes after administration, and the effect lasts for at least forty minutes.

Used for simple removal one or more teeth, when filling caries, preparation.

Has a lot of contraindications and is prohibited for pregnant women. For one appointment, the doctor uses 1.7 mg per tooth, the maximum dosage is 7 mg per 1 kg adult body weight.

Contraindications to the use of anesthetics

Despite the wide distribution, there are a number of contraindications:

• individual intolerance components of painkillers;
• previous heart attack or stroke within 6 months before a doctor's appointment;
• bronchial asthma , respiratory disorders;
• mental illness;
• diseases of the endocrine system;
• liver failure;
• antidepressant use;
• early childhood ;
• elderly age ;
• psychomotor agitation.