Dental anesthesia
Types, advantages and disadvantages, contraindications
**Dental anesthesia** is a major advance in managing the pain that can occur during dental treatments, especially surgery. It temporarily blocks the propagation of electrical signals along nerves to eliminate the sensation of pain while the doctor performs various procedures. Here are the types of dental anesthesia, their advantages and disadvantages and contraindications.Types of dental anesthesia
In general, there are two main types of dental anesthesia: local and general. Choosing the right type of anesthesia depends on several factors: - The procedure the dentist will perform; - The degree of difficulty (treating a cavity, implant, etc.); - The amount of time the dentist needs to perform the procedures; - Patient's perception of injections; - The patient's medical history (medications taken, possible allergies, etc.). All these factors are important because, like any medical procedure, dental anesthesia can have side effects and contraindications. Below are the types of dental anesthesia. ###Local dental anesthesia **A local dental anesthesia **is commonly used when having fillings (dental fillings), treating gum disease or for dental crown treatments. This type of dental anesthetic temporarily and reversibly stops the excitability of nerve fibers, inhibiting pain. Products containing an anesthetic such as lidocaine, which may or may not be combined with adrenaline, are used for this. Adrenaline has a vasoconstrictive effect, i.e. it reduces bleeding and prevents the anesthetic substance from spreading to the surrounding regions. This type of anesthesia is relatively risk-free: [dentists]() are instructed to administer the anesthetic to specific parts of the mouth depending on the procedure they will perform. After 10-15 minutes, the doctor can start the targeted treatment. ###
Pre-anesthesia Many people - for example, patients suffering from anxiety or children - are afraid of the injection, and pre-anesthesia is used for these cases. This involves numbing the area beforehand with an anaesthetic spray, anaesthetic gel or cryogenic spray (which causes intense localized cold). ###
Osteocentral anesthesia Also called[ pain-free anesthesia](), this is an interesting alternative to the classic local injectable. With an electronic device the anesthetic is administered into the cancellous bone around the tooth. The procedure is quick, painless and without postoperative consequences. The doctor does not have to wait 10-15 minutes for the anesthetic to take effect as in the classic procedure, and the patient will not feel the numbness typical after the procedure.
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The Wand System Local (injection) anesthesia is one of the most anxiety-provoking procedures in dentistry for both children and adults. The devices used to make needle punctures less painful (slow injection, warmed local anesthetic, thin needle and pre-treatment with topical anesthetic gel) are not sufficient for some patients, especially for anxious, uncooperative children. A computerized system for the slow administration of local anesthetic, called Wand STA (Milestone Scientific, Livingston, NJ), has been developed as a possible solution to reduce the pain associated with this procedure, preventing patients from avoiding dental treatment. The Wand STA system consists of a computer-controlled unit and a hand-held component, allowing delivery of the anesthetic solution at a constant pressure and at a slow rate, potentially below the pain threshold. Dental anesthesia becomes much more comfortable for the patient, but also less threatening compared to the traditional dental syringe.
**What is the Wand STA system?** Using a slow flow, drops of solution can anesthetize the tissues just before the needle, resulting in an imperceptible injection. In addition, the lightweight, pen-like handpiece allows better control of needle insertion, improving patient comfort and decreasing the perception of pain and, consequently, the fear of injection. All local anesthesia techniques can be performed with this device (maxillary and mandibular infiltration, mandibular block, intraligamentary, anterior superior middle alveolar injection and even palatal approach injection, which is considered the most painful). The Wand STA system can be useful in several branches of dentistry, such as pediatric, restorative, endodontics, periodontics and oral surgery. Several studies have established that the use of the Wand anesthetic system in children and adolescents resulted in lower pain perception and was generally better accepted than conventional local anesthesia. In addition to being less painful, the Wand system could be considered more satisfying for patients, reducing soft tissue numbness and avoiding postoperative self-inflicted injuries (tongue or lip biting) by inducing a strictly local anesthesia. ### Dentapen Computer Controlled Local Anesthesia (C-CLAD) allows much more comfortable injections to be administered in any area of the oral cavity. The Dentapen is a small, hand-held C-CLAD system that allows the administration of any intraoral dental injection. The Dentapen system is easy to use and uses traditional local anesthetic needles and dental cartridges. The injections provide a steady flow of anesthetic at the right pace, allowing the dentist to focus more on needle insertion. This results in better control of the injection and less pain for the patient.
**Advantages of the Dentapen system** The**Dentapen** is an ergonomic, lightweight, self-contained, wireless, intuitive device that requires no bracket, footrests, tubes or disposables. It can be held in two different ways - by the wings, as a manual syringe, or as a pen, for precise injection during special procedures. The Dentapen uses standard 2.2 ml cartridges, which means dentists can use their choice of local anesthetic and their preferred dental needle. It also allows for challenging injections, such as intraligamentary injections, and performs aspirations for a safe procedure. Patients find the small, modern look less threatening and reassuring, helping them to relax. ###
Sedation techniques
These allow the anxious patient to relax and also have an amnesic effect. Although sedation produces a state of relaxation, it does not have the same effect as traditional dental anesthesia. The patient will still need a local anesthetic injection to eliminate the pain caused by the procedure. Sedation simply relieves the nervousness and anxiety that often accompany a visit to the dentist. Sedation can be conscious and allow patients to feel relaxed, yet remain awake and able to respond. With this sedation, the patient will not remember most of the procedure. Deep sedation places the patient in a state somewhere between conscious and unconscious. The patient cannot respond to commands and may need breathing support.
**Nitrous oxide inhalation sedation** Inhaled nitrous oxide (nitrous oxide gas) sedation can be used for anxious patients or children, as it has analgesic, sedative and anesthetic properties. It is effective in low pain and has the advantage of speed of action, as the doctor can intervene 2-3 minutes after the patient has started inhaling the gas. It also wears off after a few minutes and the patient can even drive away if necessary.
**Intravenous sedation** This consists of the intravenous administration of one or more anesthetics aimed at reducing the patient's level of consciousness, but the patient may still be able to respond to stimuli and questions asked by the dentist. Intravenous sedation is effective and safe, the amnesia induced in the patient is real and the recovery time is shorter. However, the patient must be accompanied after the procedure. The disadvantages of intravenous sedation are the need for an infusion catheter, which may be difficult for some patients to accept, and the need for closer monitoring. Intravenous sedation is not recommended for patients who are claustrophobic, have blocked nasal passages, obesity or sleep apnea. ###
General anesthesia
In the case of major surgery, which may last several hours, patients with disabilities or certain illnesses, or young children, general anesthesia may be considered. It may also be indicated in rare cases of proven allergy to local anesthesia. General anaesthesia is performed by a specialist anaesthetist in a clinic or hospital, but the patient does not necessarily need to be admitted overnight. After general anesthesia, the patient recovers in about an hour, but will need an attendant.
Dental anesthesia in pregnancy
Contrary to some popular beliefs, pregnancy or breastfeeding is not incompatible with a local dental anesthetic administered during treatments, if necessary. Lack of dental care during pregnancy can have repercussions on the mother-to-be and the fetus and can be a risk factor for complications.
For example, periodontal disease can mean an increased risk of premature birth, pre-eclampsia, growth retardation in utero and low birth weight.
For example, periodontal disease can mean an increased risk of premature birth, pre-eclampsia, growth retardation in utero and low birth weight.
Anesthetic without adrenaline - dental anesthesia for heart patients
Adrenaline, a hormone that is usually combined with anesthetics and used during treatments to increase their effectiveness and limit bleeding, has side effects such as tremor, low blood sugar, tachycardia and high blood pressure. For these reasons, dental anesthesia without adrenaline is recommended for patients suffering from diabetes, hypertension or coronary insufficiency.How to prepare for dental anesthesia
**Dental anesthesia** is not a complicated procedure, but there are a few things to keep in mind before going to the doctor: - Avoid consuming caffeinated products at least 12 hours before you arrive at the office; - Eat before you have anesthesia, because you won't be able to eat anything for a few hours afterward; - Take your regular medications, if needed; - Don't forget to mention your medical conditions to your doctor; - Relax and trust your doctor.
### Preparing for sedation The patient should be in good health before sedation. For inhalosedation, no food or drink one hour before the procedure; for deep sedation, no food or drink three hours before. Otherwise nausea or vomiting may occur after the dentist's intervention.
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