Dental anesthesia

Dental anesthesia
Intervention
MeSH D000766

Dental anesthesia (or dental anaesthesia) is a field of anesthesia that includes not only local anesthetics but sedation and general anesthesia.

Local anesthetic agents in dentistry

The most commonly used local anesthetic is lidocaine (also called xylocaine or lignocaine), a modern replacement for procaine (also known as novocaine). Its half-life in the body is about 1.5–2 hours. Other local anesthetic agents in current use include articaine (also called septocaine or ubistesin), marcaine (a long-acting anesthetic), and mepivacaine. A combination of these may be used depending on the situation. Also, most agents come in two forms: with and without epinephrine (adrenaline) or other vasoconstrictor that allow the agent to last longer and also controls bleeding in the tissue during procedures. Usually the case is classified using the ASA Physical Status Classification System before any anesthesia is given.

Types of local anesthesia in dentistry

Most common local anesthetic procedure

The Inferior alveolar nerve anaesthesia or block or IANB (sometimes termed "inferior dental block", or wrongly referred to as the "mandibular block") probably is anesthetized more often than any other nerve in the body. An injection blocks sensation in the inferior alveolar nerve, which runs from the angle of the mandible down the medial aspect of the mandible, innervating the mandibular teeth, lower lip, chin, and parts of the tongue, which is effective for dental work in the mandibular arch. To anesthetize this nerve, the needle is inserted somewhat posterior to the most distal mandibular molar on one side of the mouth. The lingual nerve is also anesthetized through diffusion of the agent to produce a numb tongue as well as anesthetizing the floor of the mouth tissue, including that around the tongue side or lingual of the teeth.[2]

Several nondental nerves are usually anesthetized during an inferior alveolar block. The mental nerve, which supplies cutaneous innervation to the anterior lip and chin, is a distal branch of the inferior alveolar nerve. When the inferior alveolar nerve is blocked, the mental nerve is blocked also, resulting in a numb lip and chin. Nerves lying near the point where the inferior alveolar nerve enters the mandible often are also anesthetized during inferior alveolar anesthesia, such as affecting hearing (auriculotemporal nerve).[2]

The facial nerve lies some distance from the inferior alveolar nerve within the parotid salivary gland, but in rare cases anesthetic can be injected far enough posteriorly to anesthetize that nerve. The result is a transient facial paralysis, with the injected side of the face having temporary loss of the use of the muscles of facial expression that include the inability to close the eyelid and the drooping of the labial commissure on the affected side for a few hours, which disappears when the anesthesia wears off.[1]

In contrast, the superior alveolar nerves are not usually anesthetized directly because they are difficult to approach with a needle. For this reason, the maxillary arch is usually anesthetized locally for dental work by inserting the needle beneath the oral mucosa surrounding the teeth so as to anesthetize the smaller branches.[3]

Dental syringe

A dental syringe is a syringe for the injection of a local anesthetic. It consists of a breech-loading syringe fitted with a sealed cartridge containing anesthetic solution.

Other anesthetics used in dentistry

Other drugs used in combination with general anesthesia in dentistry

See also

References

  1. 1 2 Illustrated Anatomy of the Head and Neck, Fehrenbach and Herring, Elsevier, 2012, page 216
  2. 1 2 Local Anesthesia for the Dental Hygienist, Logothetis, Elsevier, 2012
  3. Local Anesthesia for the Dental Hygienist, Logothetis, Elsevier, 2012

External links

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