Compliance with the algorithm for choosing a local anesthetic in outpatient dentistry as a prevention of emergency conditions

Local anesthetics (local anesthetics) are medications that cause loss of sensitivity in nerve endings or block the transmission of nerve impulses along fibers.

It is important not to confuse local anesthesia with general anesthesia. With local anesthesia, there is a loss of pain, temperature and tactile (touch) sensitivity, while the effect is limited to a small area of ​​the body around the site of injection of the drug - the local anesthetic. In addition, with local anesthesia, the patient is conscious, unlike general anesthesia.

Advantages and disadvantages

For simple surgical interventions, local anesthesia is indispensable; it has advantages over other types of sensitivity suppression. The drug that is used, an anesthetic solution, acts strictly at the injection site, which helps to avoid severe complications and adverse reactions.

The blockade of pain sensitivity develops on average in 10-15 minutes. The effect lasts for an hour or more, so local anesthesia can reduce pain in the area of ​​the postoperative wound. The patient’s consciousness does not suffer from the action of the local anesthetic, so after the manipulation he can leave the clinic and not be in the ward.

But local anesthesia has its drawbacks. Just a few years ago, it was widely used for operations on superficial tissues and extremities; methods for intravenous administration of drugs with simultaneous application of a tourniquet were developed. Intraosseous anesthesia was widely used. But due to the large number of adverse reactions and complications, these methods began to be used less frequently. And after receiving high-quality drugs for anesthesia, dangerous methods of pain relief were practically abandoned.

The disadvantage of the local method is its limited scope of application. It is effective for anesthesia of mucous membranes, skin and superficial tissues, but is not used for operations on the abdominal and pelvic organs, neck and head.

The infiltration type of local anesthesia cannot be used when operating on malignant tumors due to the possibility of tumor cells entering beyond the wound into other tissues. This increases the risk of developing metastases.

ZAKS

The use of nitrous oxide (or laughing gas) is an ancient (used since 1844) and very effective method of pain relief, which has been adopted by the most modern clinics. Inhaling small amounts of nitrous oxide mixed with oxygen causes mild euphoria and has a relaxing and pain-relieving effect (called sedation). Nitrous oxide sedation is absolutely harmless, acts almost instantly, and recovery from it takes 10–15 minutes without any consequences.

Indications:

• fear and anxiety before treatment;
• young age of patients (most often ZAX is used for children);
• long-term treatment (for example, many teeth are removed at once);
• pronounced gag reflex, profuse salivation.

Contraindications:

• age under 3 years;
• severe intoxication, chronic alcoholism;
• mental disorders, severe neurological diseases;
• sensitivity to individual components of the mixture;
• very strong excitement before upcoming dental procedures, hyperexcitability or hysteria (in children);
• 1st trimester of pregnancy;
• use ZAX with extreme caution in case of high blood pressure, previous concussion and other head injuries;
• Serious respiratory tract infections (asthma, bronchitis) may be a contraindication to sedation.

ZAX does not exclude the use of conventional anesthetics. There is no need to prepare for ZAX in any specific way, but 2 hours before the procedure it is highly advisable to refuse any food (you can drink). On the day of sedation, it is better to take a day off from work and not drive. Children are advised to refrain from active games for 1-2 hours after sedation.

Types of local anesthesia

Several types of local anesthesia are used in surgical practice, but some of them already have historical significance. The main methods of pain relief are the following:

• superficial anesthesia - pain sensitivity is suppressed after the anesthetic comes into contact with the surface of the tissue, most often used to anesthetize the mucous membranes. The anesthetic solution is applied by lubrication or irrigation, the effect lasts for 10 minutes;
• infiltration anesthesia - anesthesia by impregnation, or infiltration of tissue layers with a local anesthetic. The technique allows you to control the depth and width of the drug injection, depending on the intended incision. The medicine is injected carefully first into the subcutaneous area until the lemon peel effect appears, then the needle is gradually moved inward and an additional dose of the drug is injected;
• anesthesia according to Vishnevsky is an improved version of the infiltration method. A weak anesthetic solution is injected layer by layer under high pressure. A tight creeping infiltrate forms in the tissues. It spreads through the interfascial spaces and disrupts the conduction of impulses along the nerves passing through them. After cutting the wound, the liquid gradually flows out of the wound, so there is no risk of its absorption into the systemic circulation and the development of toxic reactions;
• conduction anesthesia is the essence of the method in anesthetizing a specific area of ​​the body innervated by the nerve trunk. An anesthetic drug is injected into the tissue around the nerve; the technique is used for operations on the limbs;
• spinal anesthesia - the analgesic effect is achieved by injecting an anesthetic drug under the choroid of the spinal cord, the main place of drug administration is the lumbar region, and pain sensitivity in the pelvic organs and lower extremities disappears. But tactile sensitivity does not suffer;
• epidural anesthesia is a type of anesthesia in which a local anesthetic is injected into the space over the dura mater of the spinal cord, and a puncture is also performed in the lumbar region. Sensitivity is lost after 15-20 minutes, but the effect lasts for 3-4 hours. The use of this type of anesthesia allows you to resume activity early after surgery;
• bone anesthesia is a type of anesthesia in which an anesthetic solution is injected into spongy bone. Currently, it is practically not used; previously it was used for operations on the limbs.

Possible complications after tooth extraction

After simple extraction of any tooth, complications occur quite rarely, provided that the doctor’s recommendations are followed.

The main thing is that the patient needs to remember that if the blood clot remains in the socket until healing, then infection and suppuration of the wound will not occur, and within two weeks a healthy gum mucosa will appear at the site of the clot. In case of loss of a blood clot, the unprotected wound surface of the socket is exposed to pathogenic microflora of the oral cavity; the accumulation of pathogenic bacteria provokes the development of an inflammatory process - alveolitis.

Infection of the alveolar socket is the most common complication after tooth extraction. In this case, the infection penetrates and affects the soft tissues surrounding the tooth. If an infectious infection of the hole is accompanied by the presence of throbbing pain and suppuration, this signals the development of an abscess. When alveolitis is advanced, there is a danger of the inflammatory process spreading to the jaw bone - the development of osteomyelitis.

Complex (traumatic) tooth extraction has more prerequisites for the development of inflammatory complications. If after removal there remains a piece of tooth infected with caries, curettage of the hole and extraction of the tooth fragment will be required.

Also, after a complex removal, there is a possibility of delayed bleeding, several hours after the operation. The causes of such bleeding can be high blood pressure, severe stress, the body's reaction to certain medications, excessive rinsing and irritation of the wound with hot food.

In rare cases, the nerve trunks of the lower jaw may be damaged during surgery. Simple or complex tooth extraction is an unpleasant operation, but there is no point in postponing a visit to the doctor if the tooth causes discomfort and pain, most likely its removal is only a matter of time. Modern ultrasonic removal of teeth on the upper or lower jaw will save you from unwanted consequences and many troubles associated with the onset of complications after surgery.

Incorrect position of the wisdom tooth in the row

When a wisdom tooth takes an incorrect position during growth or is partially erupted, pericoronitis (inflammation of the tissues around the tooth) often develops, this is due to the fact that part of the tooth remains in the gum, and the formed periodontal pocket covering the tooth is difficult to clean from food debris , which accumulate and create an environment favorable for the development of pathogenic microflora.

A common disease of wisdom teeth is caries, since food particles remain in the interdental space with the adjacent tooth due to difficult access for cleaning, and plaque forms on the teeth. In this case, carious destruction spreads to the adjacent second molar.

Doctors recommend removing wisdom teeth if they have partially erupted or are incorrectly positioned in the dentition as early as possible, before complications occur and before their roots are fully formed.

Removal of impacted wisdom tooth

Defects in the development of third molars are caused by injury and destruction of the wisdom tooth itself and, if it puts pressure on the adjacent tooth, it damages the roots and surrounding tissues. This situation is observed due to improper growth, damage by caries, often inaccessible to treatment, surfaces of the wisdom tooth with the formation of a focus of infectious inflammation. These complications diagnosed by a doctor are absolute indications for tooth extraction.

This includes the removal of an impacted (unerupted) figure eight, when the tooth failed to erupt and remained embedded in the gum or bone.

Immersion may be tissue if the tooth has passed through the bone but is unable to penetrate the gum tissue, or bone if the tooth remains completely in the jawbone.

Follicular cyst of wisdom tooth

The formation of a follicular cyst can be asymptomatic, but the appearance of pain and high temperature already signals its active development and the presence of an inflammatory process. An increase in the size of a follicular cyst is dangerous due to the thinning of the jawbone tissue due to its replacement with a new growth.

Also, impacted and semi-impacted (partially erupted) figure eights are indicated for removal, since remaining covered by a large layer of dense mucous membrane, they put pressure on the surrounding soft tissues.

Prolonged injury to the mucous membrane from the inside contributes to the formation of pathogenic microflora. The appearance of redness, pain, and swelling indicates the occurrence of an inflammatory process, pericoronitis.

Simple tooth extraction

Simple tooth extraction, including wisdom teeth, is in most cases permissible in the upper jaw, which has a looser and softer structure and allows the tooth to be successfully grasped with forceps. If the tooth has fused roots and can be rocked, then its removal will not be difficult.

Simple removal of a wisdom tooth in the upper jaw can be done with little resistance.

Complex tooth extraction

The anatomy of the lower jaw itself prevents not only the eruption of third molars without complications, but also complicates the process of wisdom tooth extraction.

Difficult tooth extraction from below is due to the fact that the mandibular bone has a denser and stronger structure, and the roots of such teeth in the lower jaw are often curved and may have several processes, which complicates their smooth removal.

Bent or damaged roots of the eighth tooth below or above and its incorrect location, including complete or partial immersion in bone tissue, create a serious obstacle to its extraction. This situation is non-standard and requires labor-intensive efforts to remove wisdom teeth in difficult conditions. To provide quick access to the area where the tooth is located, the surgeon cuts the gum and periosteum.

During such an operation, it is possible to drill out a certain amount of bone covering the tooth or extract the problematic tooth in parts.

Ultrasound removal of wisdom teeth

At the Apex-D Dental Implantation Clinic, wisdom teeth are removed using an ultrasonic instrument.

Ultrasound surgery allows the removal of wisdom teeth, especially in complex cases, in the most atraumatic way.

The use of ultrasound in dental surgery makes it possible to perform surgery in extremely hard-to-reach places, minimize trauma to the soft and bone tissues surrounding the tooth, reduce the likelihood of complications after surgery and speed up the healing of the wound surface of the socket after tooth extraction.

Questions and answers on this topic: Tooth extraction, wisdom teeth removal

You can make an appointment at Apex-D Dentistry by calling the administrator at +7 and +7, or filling out an electronic form (the administrator will contact you at the specified phone number and agree on the date and time of the appointment).

Preparations for local anesthesia

Local anesthetics are drugs from the group of neurotropic drugs that completely or partially block the flow of signals along nerve fibers from the site of painful manipulation or surgery to the central parts of the nervous system.

The peculiarity of the action of drugs is related to their spectrum of action. They suppress the transmission of signals along myelinated type A nerve fibers, which transmit feelings of pain, smell, and temperature. Tactile sensations are carried out through type B fibers, and anesthetics do not affect them. Therefore, when using local anesthesia, the patient does not feel pain, but feels the touch of the doctor and the surgical instrument.

Local anesthetic drugs are divided into 3 groups depending on the duration of action:

• short-acting - the effect lasts 30-50 minutes, these include Novocain;
• average duration - up to 90 minutes, these are drugs Lidocaine, Trimecaine, Ultracaine;
• long-acting – the effect lasts more than 90 minutes, typical for Bupivacaine.

Local anesthetic drugs affect the electrochemical processes of ion exchange in nerve endings. Medicines work effectively in an alkaline environment and tissues rich in lipids, which include nerves. But the analgesic effect decreases with severe tissue inflammation, which is associated with a transition of pH to the acidic side.

The effect of local anesthetics is enhanced by drugs that affect vascular tone. Therefore, they are often combined with adrenaline to prolong the effect. This allows you to reduce the dose of pain medication and avoid toxic reactions.

Basics of local anesthetic treatment

Preparations for conduction and infiltration anesthesia are produced exclusively in the form of solutions for injection; they are classified as prescription drugs. The administration of these drugs is carried out strictly by medical personnel in a clinical setting and under the mandatory supervision of a doctor.

From the moment of administration of the local anesthetic to the development of local anesthesia, it takes from several minutes to half an hour - it all depends on the specific drug. Therefore, you need to wait for the effect of the drug and not re-introduce it - this is dangerous due to the development of the toxic effect of the local anesthetic.

The duration of the effect of local anesthetics is different and depends on the chemical structure of the drug: esters of para-aminobenzoic acid are quickly destroyed by special esterase enzymes in human tissues, while substituted acetanilide amides are insensitive to the action of these enzymes, and therefore have a much longer local anesthetic effect.

What is operated under local anesthesia in mammology?

The mammary glands are located superficially, they do not have muscles and large nerve trunks. Breast tissue is loosely located; in young women, glandular tissue predominates, which is replaced by fatty tissue with age. Therefore, for numerous manipulations and operations, local anesthesia can be used.

In mammology, anesthesia is used to perform invasive diagnostics, which include breast tissue biopsy. To do this, a local anesthetic is injected with a thin needle into the area of ​​the intended puncture. After 10-15 minutes, the doctor can take breast tissue for examination without fear of causing pain to the patient.

Local infiltration anesthesia in mammology is used for small, minimally invasive operations. A woman can undergo puncture of a breast cyst after preliminary infiltration anesthesia. A similar approach can be used when removing small benign breast tumors.

In men, anesthesia is used during surgery for type 1 gynecomastia, when the size of the gland is still small. Infiltration of tissues increases hydrostatic pressure in them, thanks to which the doctor can easily separate pathological tissues from healthy ones.

Other applications

Local anesthesia may also be used to diagnose some chronic conditions and to relieve pain after surgery.

Research has shown that local anesthesia may be more useful than opioids such as morphine for treating pain after total knee replacement surgery.

In 2010, results from a rodent study in Turkey showed that local anesthetics may reduce some symptoms of inflammatory bowel disease (IBD).

Anyone administering any type of anesthetic should be appropriately trained and qualified.

Is it painful to do local infiltration anesthesia?

When performing anesthesia, a standard disposable syringe with a thin needle is used. Whether local anesthesia is painful depends on your general pain threshold. The patient feels the moment of the first puncture of the skin and a slight feeling of fullness when the drug is administered. After the medication begins to act, sensitivity disappears. The doctor checks how effective the injection is by tapping the skin. In response, there is a feeling that the injection site has become woody.

After the end of anesthesia, sensitivity gradually increases, and a slight tingling sensation may appear. If anesthesia was performed for surgery, pain in the wound area begins to bother you, which can be reduced with the help of non-steroidal anti-inflammatory drugs.

Benefit

Local anesthesia provides pain relief for dental surgery and other outpatient procedures.

Local anesthesia is used when:

• the operation is minor and does not require general or regional anesthesia
• the procedure can be performed quickly and the patient does not have to stay overnight
• the operation does not require muscle relaxation or loss of consciousness of the patient

Examples include dental surgery, removal of warts, moles or cataracts, and biopsy.

Contraindications for local anesthesia

Local infiltration anesthesia is a relatively safe method of pain relief. But to reduce risks during and after surgery, it is necessary to take into account contraindications to the use of the method. The main ones are the following:

• allergy to anesthetic - if earlier during dental treatment under local anesthesia an allergy to an anesthetic appeared, then during breast surgery the effect will repeat, and may be more pronounced, up to anaphylactic shock;
• psychomotor agitation and mental illness, reaction to the administration of an anesthetic and the surgical procedure itself can cause unpredictable behavior of the patient;
• during operations on malignant tumors - when infiltration anesthesia does not allow compliance with the ablastic rule;
• during long operations that require the use of microsurgical equipment;
• during interventions on areas of the body with a pronounced vascular network, for example, on the neck.

If local anesthesia is contraindicated, general anesthesia is preferred.

Prices for tooth extraction at Apex-D dentistry

Modern dental practice makes it possible in most cases to prevent tooth extraction. The doctor’s rule is to prescribe tooth extraction surgery only as a last resort, when all available treatment methods have been tried and it is no longer possible to save the tooth, or in the event that the problematic tooth is the cause of the development of more serious complications.

How to increase the effectiveness of anesthesia

Following a few very simple rules will significantly increase the effectiveness of anesthesia and help make dental treatment as painless as possible:

1. If you are very nervous, 3-4 days before your visit to the doctor, you can drink mild sedatives: persen, valerian, motherwort. Severe anxiety impairs the quality of anesthesia, since people under stress often have a lower pain threshold. As an alternative, you can ask for a sedative injection directly at the dental clinic - the doctors will definitely accommodate you.
2. At least a day before visiting the dentist, you should completely avoid drinking alcohol, as alcohol seriously reduces the effectiveness of anesthesia.
3. If you feel unwell, have a cold or runny nose, you should reschedule your visit. It is worth postponing a visit to the dentist and women in the midst of pronounced PMS or during the menstrual period.

The doctor selects a dental anesthetic individually, taking into account the health status and even the mood of each patient. Therefore, it is so important to tell your doctor frankly and in detail about your ailments and possible concerns.