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Anesthesia during tooth extraction: basic methods and preparations
Last reviewed: 23.04.2024
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In the history of medicine, dentists did not use anesthesia for tooth extraction: the Aztecs used the extract of mandrake root, the Egyptians applied the fat of the sacred crocodile inhabiting the waters of the Nile to the skin. In the 19th century, ether began to be sprayed, then - nitrous oxide and chloroform ... Today, dentists around the world use modern anesthetic drugs that allow for tooth extraction and other manipulations to be absolutely painless.
Anesthesia during tooth extraction: methods
Local anesthesia with tooth extraction has two main methods: non-injection (external) and injective (with the help of an injection).
Non-injection method gives a superficial anesthesia of tissues with the help of medicines, with which the necessary site is lubricated or irrigated. This is the method of application. There are other non-injecting methods (the effect of low temperatures, electromagnetic waves, the introduction of anesthetic with the help of electrophoresis), but in domestic dentistry they are practically not used.
The method of application is used, as a rule, when removing milk teeth in children or as a means for anesthetizing the place of needle insertion during injection anesthesia - to completely relieve the patient of unpleasant sensations during a visit to the dentist.
Injection methods of anesthesia during tooth extraction, in turn, are subdivided into conductive, infiltration, intraligamentary and intraosseous anesthesia.
Conductive anesthesia can anesthetize several teeth at once, since the injection is done in the area of the last tooth (where the branch of the nerve passes), and thereby blocking the entire nerve.
Infiltration anesthesia is carried out by injecting an anesthetic drug into the area of the projection of the apex of the tooth root. For anesthesia, when removing the teeth of the upper jaw, an injection is made into the area of the root tip into the gum (from the lips and from the side of the palate). For anesthesia with the removal of teeth located in the center of the lower jaw, the prick is made into the region of the root of the tooth in the gum just from the side of the lip.
Intraligamentary (intramuscular) anesthesia anesthetizes the tooth and the adjacent gum due to the fact that the injection is made through the gum in the periodontal circular ligament of the tooth (these are fibers and tissues supporting the tooth in the alveolus). For this method, there is a special syringe with a dispenser, which allows the use of a minimum amount of anesthetic preparation.
Intraosseous anesthesia is recognized as the best anesthetic for tooth extraction, as the injection is made directly into the spongy bone, which is surrounded by dental alveoli.
Anesthesia with tooth extraction: the main analgesics
Not all pain medications are suitable for anesthetics when the tooth is removed. Therefore, in dentistry there is a list of the most used drugs, which begins with all known novocaine.
However, now novocaine is not used as often as before. Some people do not tolerate it at all, many cause it to be allergic, and its side effect is manifested by dizziness, weakness, and lowering of blood pressure. In addition, it is by far not the most powerful anesthetic, and for this reason it is often administered together with small doses of epinephrine - for a better analgesic effect. The mixture of novocaine and epinephrine is contraindicated in people with high blood pressure.
For infiltration anesthesia, when a tooth is removed from adults, a 0.5% solution of lidocaine is widely used, and a 1-2% solution is used for conductive anesthesia. Its maximum total dose is 300-400 mg. Side effects of lidocaine rarely, however, headaches, fatigue, temporary loss of sensitivity of the lips and tongue, violation of heart rhythm, lowering blood pressure, urticaria.
To date, the most modern anesthetics are preparations based on the active ingredient articaine: Articaine and its analogues - Ultrakain DS, Ubistezin, Septanest. These anesthetics operate long enough and reliably, so most dental surgeons believe that this is the best anesthesia for tooth extraction. The anesthetic effect of Articaine manifests itself in a maximum of 10 minutes and lasts 1-3.5 hours from the time of administration. Side effects of the drug can be expressed in the form of headaches, tremors and muscle twitches, nausea, vomiting and diarrhea. In rare cases, it is possible to lower blood pressure, cardiac arrhythmia, skin rash, angioedema. In the list of contraindications of Articaine: meningitis, tumors, poliomyelitis, osteochondrosis, spondylitis, tuberculosis or metastatic spine lesions, heart failure, tumors in the abdominal cavity, severe arterial hypotension, hemostasis violation. Application during pregnancy can lead to a decrease in the frequency of fetal heart.
The drug Ubistesin for anesthesia when removing a tooth except articaine contains adrenaline (epinephrine hydrochloride), which causes vasoconstriction at the injection site, hampers its absorption and prolongs the analgesic effect. The time of the onset of the effect does not exceed three minutes, the duration of the action is about 45 minutes. To all of the above-listed side effects of Articaine, the probability of occurrence of ischemic zones at the site of administration is added, with accidental entry into a blood vessel or nerve damage if the technique of injection is not observed.
Local anesthetics Ultracaine D-C and Septanest also contain adrenaline, therefore they are contraindicated in paroxysmal tachycardia, arrhythmias with high heart rate and some forms of glaucoma.
Anesthesia with the removal of wisdom tooth
For anesthesia with the removal of the wisdom tooth, the same analgesics are used as with the removal of other teeth. And the method of their introduction (infiltration, intraligamentary or intraosseous) the doctor chooses in view of a concrete pathology and a condition of the patient.
Removal of wisdom teeth is most often caused not by their defeat, but by an abnormal position in the dentition. The most complex pathologies are dystopia and retention.
The wisdom tooth's dystopy is expressed by the fact that the tooth has shifted towards the cheek, towards the tongue or even turned around its own axis in the process of eruption.
And with the retention of the wisdom tooth in the jaw bone, there are its rudiments, and the tooth itself does not develop further and does not erupt. With such a pathology, the dentist has to cut the gum, remove the inconspicuous tooth, and then superimpose the stitches on the gum. Such operations to remove the wisdom tooth are carried out under local anesthesia.
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Anesthesia in the removal of milk teeth
Baby teeth that are not treatable or have caused various acute inflammations (bones or periosteum) require removal. The choice of the method and method of anesthesia in the removal of infant teeth is dictated by specific situations.
For example, the milk tooth is so mobile that the doctor concludes: the root of the tooth has almost completely resolved. In this case, it will be sufficient to apply anesthesia for application - gel or aerosol. For example, an aerosol Lidocaine (the maximum recommended dose for children is 3 mg per 1 kg of body weight), children are recommended to apply with a cotton swab.
Most often, dentists are used to anesthetize the removal of infant teeth in children infiltration anesthesia: an anesthetic is given (Lidocaine, Ubistizin Forte and their analogs) with two injections - from the gum and the tongue. If applied Ubistezin, then its dosage is determined by the mass of the child's body. Children with a body weight of 20-30 kg have enough 0.25-1 ml, with a body weight of 30-45 kg - 0.5-2 ml.
In most cases, these anesthetics are well tolerated by children. Nevertheless, the dentist must necessarily know about the child's allergy to any medication or about having problems with the cardiovascular system.
PS For information, in Europe, the first anesthesia for tooth extraction in the form of ethereal anesthesia was officially registered on December 19, 1846, but even in the first quarter of the 20th century, in most cases, "extraction of teeth" was carried out without any anesthesia, although all known novocaine was synthesized in 1904 year.
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Anesthesia after tooth extraction
After the anesthesia begins, as is often said, to "retreat" when the tooth is removed, the wound begins to hurt - the place of the dental extraction operation. Sometimes the pain is so strong that it requires anesthesia after tooth extraction. In such cases, you need to take painkillers, and most often doctors recommend Ketanov.
An anesthetic drug Ketanov quickly suppresses severe pain, including postoperative It is taken one tablet every 6 hours. But this drug can take no more than 7 days. There may be side effects, which are manifested by drowsiness, dyspeptic phenomena, increased dryness in the mouth and palpitations. If the patient has such diseases as bronchial asthma, stomach or duodenal ulcer, as well as kidney problems, the use of this analgesic is contraindicated, As well as pregnant and lactating women.
By the way, in the first day after tooth extraction you can not rinse your mouth, take alcohol and drink hot - too. And if, three days after tooth extraction, suddenly there was swelling and pain again, then you should quickly go to your dentist.