Anesthesia is a serious matter
The indications are general or local anesthesia. General anesthesia, or anesthesia, is a method of general anesthesia, in which the patient has no sense of pain and consciousness. In dentistry use inhalation and non-inhaling types of anesthesia. With inhalation anesthetics in the gaseous state are introduced into the respiratory system and enter the blood in the same way as oxygen. With non-anional anesthesia, anesthetics are injected into the body intravenously or intramuscularly. In both cases, the operation proceeds painlessly.
However, when it is necessary to remove a tooth, general anesthesia is rarely used and, as a rule, in a hospital. The main indications are intolerance of local anesthetics and increased psychoemotional excitability. Local anesthesia is the main way to anesthetize in dentistry. It is shown in all cases when performing dental interventions accompanied by pain reaction. Contraindication is one: intolerance of a local anesthetic patient.
In dental practice, non-injectable (application) and injectable types of local anesthesia are used. With application anesthesia, an anesthetic is applied to the surface of tissues, which blocks receptors and terminal parts of peripheral nerve fibers located in the tissues. This method is used for small volume manipulations: the removal of a mobile milk tooth, hard dental deposits, minor benign lesions on the oral mucosa, and the like. If the patient is "scared" afraid of pricking in the gum, he is also previously given an anesthetic anesthesia before injecting anesthesia.
Injection anesthesia is aimed at excluding the pain sensitivity of the relevant site by introducing an anesthetic solution - a) near the peripheral nerve fibers and their endings (infiltration anesthesia); b) near the nerve trunk (conductive anesthesia).
To this method of anesthesia resort at:
• removal of dairy and permanent teeth;
• dissection of subgingival and submucous abscesses;
• Removal of small benign tumors and tumor-like formations (papilloma, fibroma, retention cyst, etc.);
• surgical treatment of wounds (suturing);
• during the plastics of the bridle lips and tongue;
• When treating teeth.
Why does anesthesia "not work"?
Sometimes injection anesthesia does not provide complete anesthesia. This happens when the dental surgeon is forced to perform surgery for a patient with an inflammatory disease of the teeth and / or jaws. The fact is that in the acidic environment of inflamed tissues, the effect of such anesthetics is weak. In addition, because of the increased blood supply in the inflamed tissues, rapid absorption of the anesthetic occurs, which reduces the duration of action and increases its toxicity.
It was noted that a decrease in anesthetic effect in patients with inflammatory diseases is observed to a greater extent with infiltration anesthesia.
Choosing a drug for pain relief
Local anesthetics are divided into two main groups: esters - anesthesin, cocaine, novocaine, dicaine, etc .; amides - articaine, lidocaine, tri-mecaine, mepivacaine, bupivacaine idr. Differences between groups consist, first of all, in the peculiarities of biotransformation of local anesthetics and possible side effects. At present, in Russia, esters for injection anesthesia in dentistry are not used because of their high toxicity. Recently, dentists have been attracted to the attention of dentists from UI-tracain DS, Septanest 4% N, Ubiste-sin, Ultracain DS forte, Septanest 4% SP, Ubistesin forte. They are based on articaine - a local anesthetic group of amides with a quick action: anesthesia occurs in 0.5-3 minutes. Articaine is better tolerated than lidocaine. Allergic reactions to it are very rare. In addition, articaine does not penetrate the hematoplacental barrier and is therefore the most safe for pregnant women.
At present, the reaction of destruction of mast cells (RDTK) is widely used to determine individual sensitivity to anesthetic. Carrying out of RDTC is indicated to patients who have allergic reactions of unknown etiology, intolerance of medicinal substances. With injectable anesthesia, local complications are possible:
Pain and burning when injected. These sensations are always short-lived and can be prevented. Slow introduction of a local anesthetic increases both safety and comfort of injection.
Paresthesia (residual anesthesia). It is manifested by a small change and a decrease in sensitivity in the field of surgical intervention. Help is not required, it spontaneously passes for several weeks or months.
- Post-injection traumatic contracture. These are restrictions on the opening of the mouth to varying degrees. It occurs because of a muscle needle injury during conductive anesthesia on the lower jaw. The problem is solved after a course of physiotherapy procedures.
- Education with hematomas. As a rule, they are removed using a pressure bandage and cold.
As you can see, anesthesia in dental practice is used today quite widely. Methods of anesthesia are constantly being improved, new, more effective and safer drugs are being created. And now the doctors answer the question "Is it possible to carry out the extraction of teeth painlessly to any patient" - "yes". And, nevertheless, impeccable, as well as in general all anesthesia, anesthesia in dentistry can not yet be called. Therefore, a doctor who is going to treat a patient "neglected" teeth, perform removal or other painful manipulations, when deciding on the use of anesthesia, is forced to think. Think about how best to protect the patient from discomfort and at the same time minimize the risk of complications and negative side effects from anesthesia.
IMPORTANT! Absolutely contraindicated local anesthesia with increased individual sensitivity to anesthetic. The use of local anesthesia in this case can lead to the most formidable complication - anaphylactic shock, which can occur at any age. Most often it happens with repeated administration of anesthetic, but there are cases of such a reaction at the first injection of the drug.