Anesthetics in dentistry are necessary measure in the treatment of teeth. With the help of them, it is possible to block the sensitivity and carry out the necessary manipulations.

Classification of anesthetics in dentistry

All pain medications are divided into groups according to their chemical properties- for amides and esters.

• Among the amides used are lidocaine, trimecaine, articaine.
• Among the esters are novocaine, anestezin.

Each of them has specific side properties.

They also differ in the method of injection: superficial and deep. The latter include infiltration (the injection is sequentially placed under the skin, under the fatty tissue, under the fascia, reducing sensitivity in the area where the solution has spread) and conduction (introduced into the nerve trunk or sheath, or into nearby tissues, so pain is not felt there, where this nerve passes) anesthesia.

• With superficial anesthesia, dikain, pyromecaine, anesthesin is taken.
• The second list includes lidocaine, novocaine, trimecaine.

Surface anesthetics are classified into a separate category. Their action is already provided by irrigation of the oral surface by means of a spray. The main component of these drugs is lidocaine. This application is often necessary before the procedure. infiltration anesthesia for painless insertion.
The last item in the classification is the duration of action of the local anesthetic.

• Weak effect - novocaine.
• Medium - lidocaine, mepivacaine, trimecaine, articaine.
• Long-term - etidacaine, bupivacaine.

Modern anesthetics in dentistry

The history of local anesthetics used in dentistry is divided into before and after, that is, other drugs and methods were previously used, which, with the advent of new technologies, became outdated and began to represent the least effective pain relief.

What local painkillers does modern medicine offer?

Present dental clinics use innovative carpool technology. Its essence lies in the fact that active substance contained not in a glass ampoule, but in a special cartridge (karpul), intended for single use. This device is inserted into a disposable syringe with a very thin needle.

This mechanism offers a number of advantages:

Modern local anesthetics, are represented by drugs based on articaine and mepivacaine.

Artikain - surpasses all drugs in its properties. It is available in the form of carpool capsules under such names as Ultracain, Ubistezin, Septanest.

In addition to articaine, the cartridge contains excipient- Adrenaline, which constricts blood vessels. Its content is due to the fact that with vasoconstriction, the action of the main substance is prolonged, and the possibility of its leakage into the general bloodstream is reduced. This contributes to the least harm to the body. The dosage is selected for each patient individually. Preparations based on it are 2 times more effective than lidocaine, and 5-6 times more effective than novocaine.

"Ultracain D" - recommended for patients with endocrine disorders such as diseases thyroid gland and diabetes, as well as with bronchial asthma or allergy sufferers. It contains no preservatives and stimulants (epinephrine, adrenaline).

Mepivastezin and Scandonest are also compatible with endocrine disorders.

"Ultracain DS" and "Ubestezin" are indicated for use in patients with cardiovascular problems. The concentration of epinephrine in it is 1:200,000. With a bright picture hypertension drugs that do not have vasoconstrictor components are shown.

With absolute health, you can put anesthetics with a ratio of epinephrine 1: 100,000. With a weight of 70 kg, it will not be dangerous for a person to deliver up to 7 doses. Examples: "Ultracain DS forte", "Ubistezin forte".

A special category includes pregnant and lactating women. To remove their sensitivity, "Ultracain DS" (1: 200000) or "Ubestezin" (1: 200000) is used, they are both in the same degree harmless. It is impossible to exclude adrenaline from an anesthetic for a pregnant woman, since it is he who prevents the further spread of active substances into the bloodstream. It is important that with increasing concentration increases the possibility of penetration into the bloodstream.

Mepivacaine is not as effective as articaine. It does not include adrenaline, because it already has a vasoconstrictor effect. The main advantage is that it is suitable for injection to children, pregnant women, people with heart disease, poor health or those who individual intolerance to adrenaline. Produced under the name "Scandonest".

Despite the availability of highly effective and safe local anesthetics, their use is usually limited to private dental offices. V public clinics use lidocaine and novocaine. Their distribution is decreasing due to low scores efficiency and frequent allergic reactions, but their risk of development is not reduced with the use of new generation drugs. Therefore, it is important to discuss everything with the doctor before the operation, to provide a complete history.

More about methods of administration

Among anesthetics, there are three routes of administration.

infiltration

It happens direct and indirect. Direct affects the place where the injection was placed, indirect - freezes the surrounding tissue. By methods it is divided into intraoral and extraoral. It acts more actively in the region of the upper jaw, due to the spongy contents located there.

How is intraoral anesthesia administered?

A needle is inserted into the transitional fold at an angle of 45 degrees to the vertical dental axis. The cut end should rest against the bone. The introduction is also used in the periosteum, for this the syringe piston is squeezed out with greater force.

Pros: due to the use of low concentrations, it is safer and more controllable (re-injection if necessary), fast onset time, rapid excretion from the internal environment, the area of ​​action is slightly larger than the problematic nerve.

Conductor

Popular for mandibular injections. It has a finger and fingerless method.

How is the process going?

With the finger method, the needle is guided index finger on the left hand, focusing on upper edge terminal phalanx. The ampoule is emptied upon reaching bone tissue.

Fingerless technology involves the introduction of a needle in the gap lower canine and the second molar on the opposite side, it plunges 1.5 - 2 cm deep until hard tissues are found. In this case, the patient's mouth opens very wide.

The extraoral method is successful in that the manipulation area becomes more accessible. Easier to plan where to stab . But such activity is possible only with a high knowledge of the location of the necessary tissues. Wrong actions lead to such consequences as impaired speech, inconsistency in breathing, eating.

mental

Blocks the nerve of the chin coming out of the mandibular canal. It is localized between the roots of the first and second small molar. Produced both inside the mouth and outside.

• External method: determine the location of the hole, the injection is placed relative to it laterally or above the projection. Having reached the bone, 0.5 ml is injected, moving the remaining 1 ml into the canal.
• intraoral method: underlip is pulled, a needle is inserted into the transitional fold near the first molar and directed down, forward and inward, 2 ml is injected.

At the same time, incisor, canine and premolar teeth, the mucous membrane of this area, and the muscles of the chin are anesthetized.

“A well-supported patient does not require anesthesia” - this well-known ridicule of dentists has lost its relevance when dental practice began to use anesthesia in the treatment of teeth. Today, going to the dentist no longer causes tremors in the knees, tantrums and tears. Remove a tooth, a nerve, fill the canals, put crowns, perform an operation on the pulp - perform any dental procedure now you can do it without pain and fear.

Types of anesthesia in dental practice

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

1. Local - specific areas of the oral cavity are subject to anesthesia.
2. General (anesthesia) - a complete blockage of the body's susceptibility to pain.
3. Combined.

Dental procedures under local anesthesia: types, features, contraindications

Local anesthesia is divided into several categories:

№	Types of local anesthesia in dental practice	Category Description
1		The gel (or spray) is applied to the surface of the oral mucosa. This method is used before next injection(for painless needle insertion): when opening an abscess, removing tartar. The effect of this type of anesthesia is short-term
2		An anesthetic is injected into the area that needs treatment. The effect of the anesthetic is 1 hour. A method is used to remove the nerve, clean the canals
3		A more extensive method of anesthesia than the previous one. An injection is made into the nerve trunk, the anesthetic acts not only on 1 area, but also on the entire jaw; may go numb tongue, cheeks. This method is used if you need to cure several teeth at a time
4		The injection is made into the periodontal space of the jaw. The injection does not cause numbness, as in the previous case, more often this method is used in the treatment of teeth in small patients
5		It is rarely used and only if a person is being treated in a hospital. Anesthesia is injected near the base of the skull. The method is used during serious operations on the jaw, with injuries, neuralgia

Attention! So that the therapy of diseased teeth using a local anesthetic goes without side effects, the patient should inform the specialist about hypersensitivity to painkillers, what sensations he experienced during the last visit to the dentist, whether local anesthesia was used then. According to these criteria, as well as the characteristics of human health and the severity of the problem, the specialist will determine the most harmless method of local anesthesia.

Video - Why do anesthesia for dental treatment?

Contraindications to local anesthesia

1. Hypersensitivity (allergy) to pain medication. If a person doubts a possible allergic reaction, then before doing anesthesia, the person must undergo an allergic test in a specialized center.
2. Recently past illnesses heart (heart attack, stroke).
3. Diseases of the endocrine system.

The use of general anesthesia in dentistry

The expediency of this type of anesthesia is justified if:

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

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

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

In connection with possible appearance side effects, resorting to anesthesia is prohibited:

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

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

Combined anesthesia as an alternative to general anesthesia

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

Its essence: the specialist gives the patient a sedative. The consciousness of the patient is preserved, however, the person quickly calms down. Then the doctor performs local anesthesia in the chosen way and only then proceeds to dental manipulations.

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

Anesthesia in dentistry for pregnant women

Treating bad teeth for a woman in position is a must. It is impossible to endure pain and discomfort throughout pregnancy, expectant mothers should be attentive to their health and, if necessary, carry out dental treatment rather than postponing it for later. Otherwise, a bad tooth can cause infection of the body of a woman and the fetus, lead to serious complications, including miscarriage.

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

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

Most often, with local anesthesia of teeth in women in position, injections with a solution of " Lidocaine". Although this drug penetrates the placenta, it is excreted very quickly and does not harm the fetus.

Also, for anesthesia of teeth in pregnant women, the drug " Novocaine”, only in a smaller dosage than usual. Well-established and drugs such as " Mepivastezin», « Ultracain". They do not cause side effects, do not cross the placenta, and have an excellent anesthetic effect.

Conducting pediatric anesthesia in dentistry

In the treatment of diseased teeth in children, specialists resort to the following methods of anesthesia:

Dental treatment with anesthesia important process, which allows the doctor to effectively carry out the manipulation, and the patient does not experience pain, fear and anxiety. Depending on the type of anesthesia, the characteristics of the patient's body, the doctor chooses desired method anesthesia. The patient's task is to tune in a positive way, inform the doctor about the characteristics of the body, the presence of allergies and diseases, and reliably and fully answer the specialist's questions. Only then the outcome of treatment will be positive, without side effects.

More recently, the procedures for the treatment and extraction of teeth were accompanied by painful sensations, but today dentistry has every opportunity to ensure that the patient does not feel the slightest discomfort even with complex interventions. Anesthesia in dentistry is designed to guarantee the painlessness of any procedure.

Anesthesia is a decrease in the sensitivity of a certain area of ​​\u200b\u200btissues to pain. Various Methods make it possible to achieve total loss sensitivity for a certain period of time. It is widely used during most manipulations in therapeutic, surgical dentistry, during implantation and prosthetics, and even during ordinary brushing of teeth.

Indications for the use of anesthesia

Regardless of the types of anesthesia in dentistry , they are used for the following reasons:

• the need for surface anesthesia before the introduction of the main injection,
• treatment of dental diseases - of any degree, pulpitis, periodontitis and many others,
• treatment of gum and periodontal diseases,
• removal of teeth and their roots,
• , i.e. installation of a large number of artificial metal roots,
• performing surgical operations,
• treatment of acute purulent inflammation of the bone tissue of the jaws,
• neuritis, neuralgia facial nerve.

In addition, pain relief is indicated even for minor interventions, for example, during ultrasonic cleaning teeth when the patient has hypersensitivity or nervousness.

The main types of anesthesia in dentistry

There are three types of anesthesia: local, general and sedation. Local is to anesthetize a certain area of ​​tissue for comfortable performance of procedures, while the patient is conscious. General anesthesia or anesthesia is performed with the use of analgesics, which are introduced into the body by inhalation or intravenously, while the patient is unconscious. In sedation, gas is administered by inhalation, this variety involves being conscious.

Types of local anesthesia in dentistry

Modern local anesthesia is called carpool anesthesia - the composition is supplied in disposable containers (carpules or ampoules), where the necessary components are already mixed in the right dosage. The doctor inserts the cartridge into a special syringe - compared to disposable syringes, his needle is thinner, so the process of administering the drug is less painful.

1. Application anesthesia

Application is widely used when performing simple operations not taking much time. The drug is applied with a cotton swab or fingers on desired area, impregnates soft tissues which reduces their sensitivity. It penetrates to a depth of no more than 3 mm. Action time - from 10 to 25 minutes. Very often it precedes another type of anesthesia.

2. Infiltration anesthesia

Infiltration is provided by an injection that is injected around its non-medical name - "freeze". It is more often used in the treatment of teeth of the upper jaw, since the alveolar process has a more porous structure, which means that anesthesia will be more effective. The action time is about 60 minutes, enough to perform rather complex manipulations - endodontic treatment, pulp removal, deep caries therapy.

3. Conduction anesthesia

Conduction anesthesia in dentistry is focused on blocking the nerve that transmits the pain signal. This allows you to "turn off" not only one tooth, but also a certain part of the jaw that is associated with this nerve. Most often, this type is used when it is necessary to cure or remove several teeth located nearby at once, especially in the lower jaw. Action time - 90-120 minutes. The most common option is conductive mandibular. It makes it possible to effectively anesthetize the lower jaw and perform complex interventions in the area of ​​molars.

4. Intraligmentary (intraligamentous) anesthesia

Intraligmentary is also called intraperiodontal. The specificity of this type is to exert more pressure during the introduction. This allows the agent to be evenly distributed in the periodontal space and penetrate into the intraosseous. Begins to act immediately - after 15-45 seconds. Action time - from 20 minutes to half an hour.

5. Intraosseous anesthesia

Indications - the impossibility or inefficiency of other types. As a rule, it is used in the treatment and removal of lower molars, operations on the alveolar process. Its implementation involves the dissection of the mucous membrane, the creation of a hole in the bone using boron, after which a needle is inserted into the hole and the drug is fed to the spongy substance under great pressure. The advantage of this type is efficiency even with small volumes. weak remedy. Action time - from 60 minutes.

6. Stem anesthesia

Stem means blocking branches trigeminal nerve at the base of the skull. This is useful when performing extensive surgical interventions v maxillofacial surgery. The action of this type of anesthesia covers both jaws.

Types of drugs for local anesthesia

Modern anesthesia in dentistry is carried out using ready-made anesthetic formulations. The most common are drugs based on articaine - this is the main active ingredient of many anesthetics. They are 1.5-2 times more effective than lidocaine, and 6 times more effective than novocaine. The big advantage is that such drugs are very safe today.

1. "Ultracain"

The result of the development of the French pharmaceutical company Sanofi Aventis. This drug based on articaine is available in three versions, differing in the concentration of the component and the presence / absence of a vasoconstrictor component:

• "Ultracain DS forte" - the concentration of epinephrine 1: 100.000,
• "Ultracain DS" - the concentration of epinephrine is 1: 200.000, can be used during pregnancy, feeding the baby, as well as the presence of cardiovascular diseases,
• "Ultracain D" - without epinephrine, can be used in patients prone to allergic reactions, since it does not contain preservatives necessary to stabilize drugs with a vasoconstrictor component.

2. "Ubistezin"

A German-made anesthetic, the composition is similar to Ultracain, or rather, its two forms containing epinephrine.

3. Mepivastezin or Scandonest

Scandonest is an anesthetic produced by the French company Septodont, the main component of which is mepivacaine 3%. It does not contain vasoconstrictor components and preservatives. This explains its demand for dental procedures in patients at risk. Mepivastezin is a hollow analogue of Scandonest, but already of German production (3M).

4. "Septanest"

It is produced in two forms by the Septodont company:

• articaine + epinephrine 1:100.000,
• articaine + epinephrine 1:200.000.

The difference between this drug and others lies in the relatively more preservatives in the composition, which increases the likelihood of allergic reactions.

5. "Novocaine"

"Novocaine" in combination with a vasoconstrictor component is much weaker than articaine preparations. In addition, its effectiveness is reduced if it is necessary to anesthetize the area of ​​​​inflamed tissues. "Novocaine" has vasodilating action, and therefore very "dependent" on vasoconstrictors. It is difficult to call such a manipulation safe, especially if it is necessary to anesthetize a part of the oral cavity for a patient at risk, a pregnant or lactating patient, a child.

Complications due to the use of local anesthesia

Complications are quite rare, but it is impossible to completely exclude them from practice. They are divided into two groups:

1. local: damage to soft tissues with a needle, breakage of a needle, infection of tissues with poorly disinfected instruments, damage to the vessel (as a result - a hematoma), tissue necrosis, paresis of the facial nerve, contracture of the temporomandibular joint,
2. general: allergic reactions, toxic reactions, alteration blood pressure, dizziness.

General anesthesia (narcosis)

Anesthesia is performed only by an anesthesiologist. By way of submission medicinal product it is divided into inhalation (preparations "Prichlorethylene", "Sevoran") and intravenous ("Geksenal", "Propanidide", "Propofol", "Ketamine", etc.). The drugs are put to sleep and the patient does not feel pain. How long a particular anesthesia lasts is determined by the doctor, taking into account how much time the dentist will need.

Anesthesia requires certain indications:

• pronounced dental phobia and mental disorders,
• pronounced gag reflex
• complex surgical procedures,
• a large number of teeth to be removed or complex treatment,
• failure of local anesthetics.

Such anesthesia is quite justified in the event that a child needs to be cured of a lot of milk teeth - it is very difficult for babies to “force” to be in the doctor’s chair, especially during long period time.

Contraindications to anesthesia are as follows:

• relative - exacerbation of chronic diseases, viral infections, pregnancy and lactation, respiratory infections and etc.,
• absolute - cardiac, kidney failure, some types of heart defects, decompensated diabetes mellitus and other severe endocrine diseases, respiratory dysfunction.

In order to decide on the possibility of using anesthesia, the doctor will prescribe an extensive diagnosis of the state of health.

Side effects of anesthesia can be reversible and severe, requiring immediate intervention doctors. The first group includes nausea, vomiting, confusion, fainting, behavioral disorders, coordination of movements. As a rule, they pass with little intervention from specialists and with peace of mind. Serious complications are cardiac disorders and respiratory function: They require immediate medical attention.

On a note! Lack of attention to the advice of an anesthesiologist regarding preparation for anesthesia can cause severe complication– aspiration respiratory tract. The doctor must explain the day before, during what time it is forbidden to eat and drink - it is important to strictly follow the recommendation.

Sedation in dentistry

Sedation is an immersion in a state similar to drowsiness or intoxication - the patient is conscious, but feels calm and relaxed. There are three types of sedation: inhalation, intravenous, oral. Sedation is effectively used for both children and adults. It is effectively combined with local anesthesia.

Unlike general anesthesia, sedation is safer and does not entail unpleasant consequences treatment.

Features of anesthesia in pediatric dentistry

Effective anesthesia in pediatric dentistry must necessarily take into account a number of features:

• most local anesthetic drugs are approved for use from the age of 4,
• dosage calculation is carried out taking into account the weight,
• children often suffer from allergic reactions to anesthetics.

The correct selection of the method of anesthesia is very important - the child's attitude to dental procedures in the future, trust in the dentist depends on this.

Features of the use of anesthesia during pregnancy

Today, there are ample opportunities to ensure maximum comfort for a pregnant woman. Local anesthetics with a minimum content of vasoconstrictor components are approved for use in expectant mothers. Restrictions apply to general anesthesia and drugs with maximum content adrenaline or epinephrine.

Related videos

Pain that occurs during dental treatment is a factor that often becomes decisive for a person making a decision about whether to make a visit to the dentist. That is why the issue of anesthesia in dentistry is constantly studied by doctors and is very important. Modern doctors have a lot of means and methods in order to provide high-quality and effective pain relief. Pain-free dentistry is the ideal that doctors aspire to.

Features of anesthesia

Pain relief in dentistry is always carried out taking into account the individual characteristics of the patient, the problem that needs to be eliminated, the degree of severity pain etc. It is important to know that all practiced methods of anesthesia in dentistry involve fast recovery patient after. After a while (about half an hour), he can even drive a car.

Both in surgical dentistry and therapeutic dentistry such anesthesia is practiced that can reduce pain to the desired minimum. Initially, the doctor analyzes all the problems of the patient and chooses exactly those types of anesthesia that are optimal in this case.

Adequate anesthesia in dentistry involves eliminating pain to a minimum. However, most dentists are of the opinion that there is no need to anesthetize to such an extent that the patient is unconscious during treatment. Moreover, it is very important that during the provision dental services the doctor could communicate with the patient.

On the other side, strong pain can cause shock human body. Therefore, severe pain during dental treatment undoubtedly harms a person. Thus, the main task of a doctor who performs anesthesia before dental treatment is to make it so that pain relief is as effective as possible and does not pose a danger to a person.

Local anesthesia

Modern doctors practice different types in dentistry. Anesthesia is divided into general , local and combined . Local anesthesia involves anesthesia of only a specific place in which manipulations will be carried out. A small area is determined in which, with the help of the introduction of medications, the sensitivity of the nerve endings is removed. Local anesthesia, in turn, is divided into several types. Application anesthesia (another name is superficial anesthesia) is used if superficial anesthesia is needed. It is carried out without using a syringe. The doctor applies an anesthetic drug to the area that requires anesthesia using an applicator. Sometimes an aerosol is also used in this case. In this case, only a few millimeters of tissue are anesthetized. Such anesthesia in dentistry is used only for minor interventions, it is often practiced in pediatric dentistry.

Infiltration anesthesia - this is pain relief, in which the appropriate drugs are administered using a syringe. At the same time, soft tissues are impregnated. This type of anesthesia is practiced by modern dentists very often, as the procedure is well tolerated by patients and at the same time allows you to effectively relieve a person of pain.

Conduction anesthesia in dentistry allows the doctor to save the patient from pain in a relatively large area. For example, in this way you can anesthetize half of the jaw. This method is best suited for major operations, and is also practiced if after treatment there are complications that require urgent intervention. This procedure is distinguished by a more complex technique of execution.

All the described methods are practiced by doctors taking into account the individual characteristics of the patient, the disease, etc. So, during pregnancy in a woman, the dentist always uses the most gentle method of local anesthesia.

At the same time, the disadvantage of local anesthesia is, first of all, that the sensitivity of nerve endings disappears only for a relatively short period of time. Consequently, this method can be used if the doctor treats one tooth. But with the defeat of several teeth and, accordingly, the need to treat them, you immediately have to practice other methods.

As a side effect of this method, sometimes manifested cardiopalmus or there are fluctuations. This occurs under the influence of anesthetics, which are part of anesthetics with the aim of vasoconstriction.

General anesthesia

If you need to completely get rid of pain sensitivity of the whole body, then general anesthesia is practiced. Anesthesia in dentistry is used much less often than local anesthesia. The fact is that dentistry under general anesthesia has a lot of contraindications. In addition, a person treated with general anesthesia may later experience side effects that last several days after the procedure. Reviews indicate that after anesthesia, the patient can notice very rapid breathing, disturbed respiratory rhythm, bronchospasm, changes motor activity, muscle twitching. In addition, as side effects, which provokes dentistry under anesthesia, can develop psychomotor agitation, increase blood pressure, and in especially severe cases, there is a partial loss of memory. That is why general anesthesia in pediatric dentistry is rarely used.

The advantages of general anesthesia are the provision of complete rest and the absence of shocks for the patient, the ability for the doctor to perform a large number of tasks in one session. different procedures. When using general anesthesia, the patient has much less salivation, so the quality of treatment during dental filling increases. With general anesthesia, there is more low risk development inflammatory processes after tooth extraction.

Anesthesia for the teeth the doctor must select taking into account not only the physical, but also emotional state patient. It is sometimes advisable to treat teeth under general anesthesia if a person demonstrates pronounced emotional stress and severe anxiety before starting the procedure. Therefore, dental treatment under general anesthesia is prescribed for those people who show signs of panic fear in relation to everything related to dentistry. Especially often in this case it is practiced under general anesthesia. In addition, the use of general anesthesia is advisable during prosthetics, with very complex dental lesions, and with some chronic concomitant diseases.

In other cases, as a rule, the doctor does not see the need to treat teeth under anesthesia of this type.

If a person has serious diseases of the cardiovascular system, before starting treatment under general anesthesia, he must initially undergo all the necessary examinations, and in the process of dental treatment, only an experienced anesthesiologist should monitor the condition of such a patient. When used in the treatment of general anesthesia, next to the doctor should be all the necessary equipment, the use of which may be needed in an emergency.

Combined anesthesia

Combined anesthesia involves a combination of incomplete general anesthesia and very effective local anesthesia. In this case, local anesthesia is performed after the patient has previously received pharmacological preparations for relaxation and tranquility. In this case, the patient remains fully conscious. This dental anesthesia is much safer than general anesthesia, and in severe cases can be used even during pregnancy or serious illnesses. Respectively, severe consequences described above are absent with combined anesthesia.

Anesthesia during pregnancy

V modern dentistry anesthesia for the teeth may not be used at all only if practiced laser treatment. In this case, when processing the tooth, the patient does not feel any particular discomfort, so anesthesia is not needed for dental treatment by this method. That is why doctors advise practicing this method of treatment during pregnancy.

However, dentists strongly recommend that pregnant women visit a dentist even if only possible traditional treatment. Local anesthetics, which are used in modern dentistry, do not negative impact on the future mother and for the unborn child. Most importantly, the doctor must know about the woman’s pregnancy before starting treatment and select the drug for pain relief taking this into account. important point. Most often, it is used as such a drug, which is completely safe and at the same time produces a pronounced effect. The drug is relatively quickly excreted from the human body and practically does not get to the fetus through the placenta. Therefore, it is used both for filling and for tooth extraction in pregnant women. The use of other drugs is also practiced on an individual basis, but only under the strict supervision of a doctor and taking into account the individual characteristics of the woman's body.

The most important thing is that a pregnant woman should visit a dentist as soon as necessary and be sure to tell the doctor in detail before treatment about all the features of her condition.

A visit to the dentist for any person is accompanied by a feeling of fear. From one memory of the drill, his head starts to spin and a lump rolls up in his throat. But modern medicine does not stand still, new types of anesthesia in dentistry appear, and adequate anesthesia will allow you to leave the dentist with a smile on your face and pleasant memories. We continue the conversation about freezing teeth that we started.

Used in dentistry the following types anesthesia: application, infiltration, conduction, intraligamentary (intraligamentous), stem and general anesthesia. Let's consider them in order.

Application

A special gel or spray is applied to the necessary gum area with a gauze swab. The anesthetic effect occurs almost instantly, which allows you to anesthetize the gum area before the injection. It is used to open abscesses under the mucous membranes, during manipulations at the level of the gum margin, as well as to remove tartar.

infiltration

Infiltration anesthesia involves the introduction of an anesthetic drug directly into the area of ​​​​the tooth on which medical manipulations will be performed.

The most popular and beloved anesthesia in dentistry. The doctor will give an injection of anesthetic, which in a couple of minutes will freeze the area of ​​​​surgical intervention. The effect of the drug lasts about an hour, while the patient does not experience any pain. Such anesthesia is optimal for both the doctor and the patient: the patient is comfortable and does not hurt, and no one bothers the dentist to work and does not jump in the chair. It is used mainly in the extraction of teeth, manipulations on the pulp, for the treatment of tooth canals.

Conductor

It is used for anesthesia when the area of ​​surgical intervention is much wider than for the use of infiltration anesthesia. Basically, the branches of the trigeminal nerve are blocked, so several teeth and the soft tissues adjacent to them can be blocked at once. The effect of this type of anesthesia lasts from one and a half to two hours. Most often, conduction mandibular anesthesia is performed - blockade of the trigeminal nerve, which allows you to anesthetize all organs and tissues in the lower jaw. It is used for large-scale surgical interventions, in the area of ​​large molars and gums.

Intraligamentary (intraligamentous)

The mandibular anesthesia discussed above can cause discomfort in some patients due to numbness of the tongue and lips, so intraligamentary anesthesia is an alternative. The direction of the needle goes through the gingival groove into the periodontal ligament from the medial and distal sides of the diseased tooth. This anesthesia is most often used in children, since there is no numbness of the tongue, lips and cheeks, which eliminates the inadvertent trauma to these areas. In adult patients, it may not be effective, and is also contraindicated in the presence of a purulent periodontal pocket. Under this anesthesia, you can prepare and remove teeth.

stem

With this type of anesthesia, all branches of the trigeminal nerve at the base of the skull are blocked. This anesthesia is used for extensive surgical interventions in maxillofacial surgery. To potentiate the effect of local anesthetics, a vasoconstrictor is added to them, due to which the duration of anesthesia increases. After such anesthesia, the patient is monitored, and, given the nature and extent of the operation, all manipulations are carried out only in a hospital. The effect of stem anesthesia extends to both the upper and lower jaw. This anesthesia is used not only for operations, but also for injuries.

anesthesia

This type of anesthesia is used much less often than local anesthesia. It is resorted to when the patient has a history of allergy to local anesthetics, the patient is not adequate or there is a psychiatric diagnosis, as well as when manipulations in children are too painful. requirement for this species anesthesia is the presence of an anesthesiologist, who must prepare the patient for surgery and conduct anesthesia.

Indications for anesthesia in dentistry:

• extensive and traumatic operations;
• psychiatric and psychosomatic disorders (schizophrenia, autism,).

Contraindications for general anesthesia in dentistry:

• transferred or if 6 months have not passed since treatment;
• cardiopulmonary diseases in the stage of decompensation;
• heavy;
• endocrine diseases in the stage of decompensation;
• acute infectious diseases;
• diseases and.

Probably, any patient would like to come to the dentist, get a “magic injection”, fall asleep and wake up with Hollywood smile! I don’t want to see a doctor with a bunch of terrible instruments in his hands, reminiscent of instruments of medieval torture, fidgeting nervously in his chair and looking at the clock when the torment ends. General anesthesia is able to fulfill all the wishes of the patient. But this is far from safe. It may entail serious complications: cessation of breathing and cardiac activity, lowering blood pressure and slowing of the pulse, hallucinations, nausea, vomiting, anaphylactic shock and etc.

Local anesthesia

Anesthesia is simply necessary for people who experience panic fear before dental treatment.

In modern dentistry, local anesthetics of a new generation are used, the effect of which occurs instantly, they are better tolerated, less toxic and many times stronger than the well-known novocaine. By the way, novocaine does not act in the focus of inflammation, and ultracaine provides excellent anesthesia. Mainly applied the following drugs: Ultracain, Ubistezin, Septanest, Scandonest. Ultracaine is available in three types:

• "Ultracain DS forte" (concentration of epinephrine 1: 100.000);
• “Ultracaine DS (concentration of epinephrine 1:200.000);
• "Ultracain D" (without epinephrine and preservatives).

Ultracaine is most often used in dental practice. Additive in the form of epinephrine helps to increase the duration of anesthesia and reduce the toxicity of the anesthetic. Scandonest is produced in pure form and does not contain epinephrine and preservatives. "Ultracain D" and Scandonest are used mainly in allergy sufferers, with bronchial asthma.

For dentistry, special carpules (an ampoule with a finished medicine) have been developed that allow you to accurately dose the substance, contain an additive in the form of epinephrine, and when using them, all the rules of asepsis and antisepsis are perfectly observed.

The needle, which is put on the carpula, is very thin, the injection after it is practically not felt. Even for those patients who are afraid of the injection itself, the injection site is anesthetized with a spray or gel with lidocaine, and then the drug is only injected. Anesthesia lasts an average of about an hour and does not give side effects in the form of dizziness. So immediately after visiting the dentist, you can safely drive a car and go to work.

Another advantage of this type of anesthesia is that it can be used repeatedly. adult healthy person with a weight of 70 kg, you can put up to 7 ampoules of Ultracaine without any harm to health, but usually one is enough. Under Ultracaine, you can treat teeth without fear and risk for both pregnant women and nursing mothers.

Indications for the use of local anesthesia:

• minor surgical interventions;
• removal of one or more teeth;
• acute purulent inflammation jaws;
• removal of the roots of the teeth;
• treatment of periodontal diseases and complicated forms of caries;
• removal of dystopic or impacted teeth;
• contraindications to general anesthesia;
• neuritis and neuralgia of the facial nerve.

Contraindications to the use of local anesthesia:

• allergy to local anesthetics;
• injuries of the maxillofacial skeleton, which led to a change in the topography of this area;
• extensive surgical interventions.

More commonly used in children general anesthesia as mask anesthesia. Not every child can be persuaded to a "magic injection". This type of anesthesia allows the child to overcome all fears before visiting the dentist. However, if the child is contact and you can “negotiate” with him, then the advantage is given to local anesthesia.