Anesthetic names for dental treatment. Local anesthetics in dentistry: composition, classification. Possible side effects

The most common type of anesthesia for dental treatment. It reliably relieves pain 100%, so that the patient only has tactile sensitivity. He continues to feel vibrations, touches and pressure, which are often perceived by the patient as unpleasant. These unpleasant sensations intensify if the patient experiences anxiety or nervous tension. Our task in this case is to completely protect the patient not only from pain, but also from discomfort, and stress.

There are four methods of local anesthesia in dentistry:

• Topical anesthesia: used as an initial agent for superficial anesthesia of the oral cavity. This is usually a gel or spray with an anesthetic: lidocaine or benzocaine.
• Infiltration anesthesia: the drug is injected into the gums using several injections next to the tooth. This is the most common type of pain relief in dentistry. Used in the treatment of caries, dental pulpitis, surgical operations in dentistry.
• Conduction anesthesia: the medicine is injected in close proximity to the nerve, after which it permeates the area around the nerve and the nerve itself. Typically used in dental surgery for major operations in the lower part of the mouth.
• Brainstem anesthesia: this method involves injecting a drug into the base of the skull to block all branches trigeminal nerve. It is used in a hospital setting for the patient’s increased pain sensitivity, neuralgia and some other rare cases.

Carpule anesthesia in dentistry

At the Doctor Dent clinic we use so-called carpule anesthetics. Carpules are disposable cartridges with a drug that are inserted into a special syringe injector. Then a needle is put on the syringe, which pierces the carpula with the opposite end. Advantages of carpule anesthetics:

• Thin needle - maximum comfort. We use carpule needles with a thickness of 0.3 mm, whereas the needle thickness of a regular disposable syringe is about 0.6 mm. Therefore, an injection into an area pre-treated with gel causes absolutely no pain.
• Complete sterility of treatment due to the tightness of the cartridges with the drug.
• Prolonged action. In addition to the anesthetic itself, the capsule may contain an additional vasoconstrictor (adrenaline), which significantly increases the duration of anesthesia.

Drugs used

In the past, traditional lidocaine and novocaine were used for pain relief in dentistry, which can still be found in budget clinics. Doctor Dent uses modern drugs based on much more effective anesthetics: mepivacaine and articaine.

• Ultracaine. A combined drug for local anesthesia, contains articaine and the vasoconstrictor adrenaline (epinephrine) to prolong anesthesia. Manufactured by Sanofi Aventis (France). As an anesthetic, ultracaine is 6 times more effective than procaine, and 2 times more effective than lidocaine. Exist various shapes release of the drug, both with and without epinephrine. It has a very limited range of contraindications and can be used in the treatment of children, elderly people, and pregnant women. The specific form of the drug is chosen by the doctor depending on the presence of contraindications in the patient (allergies, cardiovascular diseases, pregnancy in women, etc.)
• Scandonest. A local anesthetic based on mepivacaine, produced by the French company Septodont. Does not contain adrenaline and other vasoconstrictors, as well as preservatives. For this reason it is not used during pregnancy (see below). It is usually used in cases where the patient has serious contraindications to the use of anesthetics with adrenaline.
• Septanest. An analogue of ultracaine, produced by Septodont.

Anesthesia during pregnancy

Sedation

Since local anesthesia does not affect tactile sensitivity and the psycho-emotional state of the patient, if necessary, a method of pain relief such as sedation can be used. Sedation increases the pain threshold and calms the patient, but does not put him to sleep. During the treatment, the patient is in a pleasant relaxed state, but remains able to understand and respond to the doctor’s requests.

Sedation has virtually no contraindications or side effects. You just need to avoid alcohol the day before your visit to the dentist.

Questions and answers

Which painkillers, listed in the article, are most preferable as anesthesia for dental treatment if there is a risk of a stroke after using local anesthetics? I ask this question because my friends, unfortunately, had this kind of side complications(lethal, half an hour after treatment). Maybe the medicine was scorched, maybe the dose was too high, or maybe adrenaline should not be used for such people? This is why I'm afraid to go to the dentist

In our clinic we use the method of individual selection of anesthesia for each patient. To do this, we conduct a thorough survey of the patient about his state of health and, if necessary, involve general specialists and anesthesiologists. What list of drugs did you mean?

I am about to have implants installed, how to prepare for dental implantation?

If implantation is performed under local anesthesia, no special preparation is required. The only recommendation is that you should eat an hour before the procedure. But if implantation is carried out under sedation, then the anesthesiologist will give you recommendations.

My gums are swollen, and my tooth hurts very much (or rather, there is a piece of it left there), what should I do? How will the treatment take place? What type of anesthesia will I be offered? Is it possible to use general anesthesia?

Good afternoon After a visual examination and x-ray, we will be able to determine treatment options for your tooth. Treatment in our clinic takes place under both local and general anesthesia. We ask you not to delay treatment of this tooth to avoid complications of the situation. We invite you to a consultation at our clinic. You can make an appointment by calling the clinic

I am very afraid of any pain during dental treatment. During previous treatments, I was given an injection, and it was terribly painful, and it seemed like the needle was so long. For a long time I did not visit the dentist because of this fear. And now there is a reason. The wisdom tooth began to grow, and because of this, the tooth that came before it began to crumble and collapsed to such an extent that half of it remained. The nerve was exposed. And in general, due to the fact that I have not been to the dentist for a long time, I need to treat many teeth with caries. Tell me, is it possible for you to cure everything under anesthesia? What will be needed for this? How much will it cost?

In our clinic, you can really get all your teeth treated efficiently and quickly, both under local anesthesia and general anesthesia. We guarantee absolutely painless and safe treatment. We use the latest medical equipment, the most modern medical supplies. Highly qualified medical staff will achieve high treatment results, both aesthetic and functional. In order to determine what treatment you will need and its cost, you need to make an appointment with us for a consultation and diagnosis. The cost of a consultation in our clinic is 500 rubles. We will be glad to see and help you in our clinic.

I've been terribly afraid of dental treatment since childhood. I haven't been to a doctor for about 10 years. Now there are a lot of teeth that need to be treated. Will any treatment with anesthesia or general anesthesia be absolutely painless? And even without the fact that it will be a little unpleasant?

Yes, indeed, in our clinic we carry out any treatment only with anesthesia. We use two types of anesthesia: general (anesthesia) and local. Before using local anesthesia, we numb the mucous membrane to ensure a comfortable feeling during local anesthesia. With any type of anesthesia, people treated in our clinic not only do not experience pain, but also do not feel any discomfort. We invite you to undergo consultation and treatment in our clinic.

What painkiller is indicated for children with toothache?

Most painkillers are approved for use by children from the age of 12, and before this age, only children's derivatives of ibuprofen can be used without a doctor's recommendation, and only in extreme cases.

I'm interested in how children's teeth are treated - under local or general anesthesia?

Mostly, children have their teeth treated under local anesthesia, but there are cases when sedation or anesthesia is used. But such procedures require significant evidence: the need to perform lengthy manipulations, the psychological state of the child, etc.

On the website I read about a way to relieve fear and pain: sedation in dentistry. I was given your site, but didn’t find a word about this method? Do you use it?

Yes, we use sedation for adults and children, but this requires consultation with our anesthesiologists and consultation with our dentists. We invite you for treatment at our clinic.

Painlessness is already a familiar principle modern dentistry. Treatment should not cause discomfort, much less be accompanied by feelings of stress or fear.

Most dental procedures are performed under anesthesia. Pain relief methods are selected depending on the individual characteristics of the body, age and health status, patient preferences and the complexity of treatment procedures.

Methods and types of pain relief

Local and general anesthesia

There are two main types of anesthesia - local and general. In the first case, pain sensitivity is “switched off” while the person’s consciousness and other types of sensitivity (to touch, exposure to cold) are preserved. In the second, there is a temporary and reversible loss of consciousness, accompanied by complete anesthesia of the entire body and relaxation of the skeletal muscles.

Local anesthesia is indicated for simple and short procedures - it is the most popular in dental practice, since it has practically no contraindications.

General is recommended for complex and time-consuming maxillofacial operations, as well as in cases where the patient responds inadequately to treatment, experiences panic fear of the dentist, etc. It has many contraindications and sometimes causes a number of complications, so it is practiced only in exceptional cases.

Anesthesia methods

Both types of anesthesia are carried out in the following ways: injection and non-injection.

Injection anesthesia is given through an injection - the drug is injected into the tissue of the oral mucosa, into the periosteum or bone, intravenously. With non-injection anesthesia, the medicine is applied to the surface of the mucous membrane, delivered through inhalation - that is, inhaled through the lungs.

Local anesthesia

Aimed at blocking nerve impulses in the area of ​​the surgical field. On average, its effect lasts 1-2 hours. Patients do not feel pain, but feel touch and cold.

In dentistry it is most often used for:

• preparation of carious tooth tissues;
• canal treatment;
• cyst removal;
• turning for a crown or bridge;
• excision of the hood above the figure eight;
• implantation;
• gum surgeries;
• tooth extraction.

Depending on the technology, the method of exposure to tissue and the duration of the effect, several types of local anesthesia are distinguished.

Let's look at them in more detail:

General anesthesia

General anesthesia is rarely used in dental practice. And only in those clinics where there is a full-time position of an anesthesiologist and the equipment necessary to “give” anesthesia to the patient and in case of emergency resuscitation, which may be required in case of complications.

Most often, general anesthesia is indicated for people who have a panic fear of dentists, as well as for complex long-term operations - multiple implantations, correction of the so-called cleft palate, etc.

General anesthesia according to the “delivery” method

• inhalation - a vaporous anesthetic or narcotic gas is inhaled through the nose using a special mask;
• non-inhalation - intravenous administration of the drug.

Sometimes these two types are combined. For example, with extensive facial surgery.

Main disadvantages general anesthesia- a large number of contraindications and a high probability of complications.

Inhalation anesthesia: 1. Inhale, the valve is open. 2. Exhale, valve closed

Drugs

For local anesthesia

Are used:

• ultracaine - in pure form or with epinephrine, which constricts blood vessels and provides a prolonging effect;
• ubistezin - similar in action to epinephrine-containing ultracaine;
• Septanest - an alternative to ubistezin and ultracaine, contains preservatives;
• scandonest - for patients for whom medications containing epinephrine and adrenaline are contraindicated (including suitable for asthmatics, hypertension, diabetics).

The first three names are drugs based on articaine, a potent anesthetic that has received widest application in dentistry.

Injections are performed with special carpule syringes with the thinnest needles - only 0.3 mm in diameter. They are two times thinner than conventional medical needles and are practically not felt by patients.

To ensure the longest possible anesthetic effect, bupivacaine is also used - it “works” for up to 13 hours, but is highly toxic.

But lidocaine is no longer used for injections in modern clinics - just like novocaine, trimecaine - they are too toxic and have low effectiveness.

For general anesthesia

For inhalation anesthesia, doctors most often use nitrous oxide and trichlorethylene. For intravenous use - ketamine, hexenal, propanidide, sodium hydroxybutyrate and other drugs that have hypnotic, sedative, muscle relaxant properties.

Complications

The most common complications after local anesthesia:

• soft tissue injury - while the anesthetic is still in effect, you need to be careful not to accidentally bite your lip, cheek, or tongue;
• bruise - hematomas occur if the needle touches a vessel during an injection.

Other complications include spasms of the masticatory muscles (when injured by a needle), allergies to painkillers, and temporary loss of sensitivity in the facial muscles. Even less often, the needle breaks off, and in isolated cases, infection occurs.

It is worth noting that complications from local anesthesia are extremely rare. This is the safest and simplest type of pain relief.

But complications from general anesthesia occur more often:

• nausea;
• vomit;
• fainting, collapse;
• inappropriate behavior.

The most dangerous consequences- violation of respiratory and cardiac activity, in which without resuscitation measures death may occur.

Application in pediatric dentistry

The two most commonly used types of anesthesia used by pediatric dentists are topical and intraligamentous. The combination of these two types allows for completely painless medical intervention.

Before starting treatment for caries or pulpitis, removing a tooth or opening the gumboil, pediatric dentist treats the area around the problem area with an anesthetic in the form of a gel, ointment or spray with lidocaine (preparations for topical anesthesia contain low concentrations of lidocaine that are not dangerous to the child’s body).

When the mucous membrane “goes numb,” the doctor uses a very thin carpule needle to administer intraligamentous anesthesia—the child does not feel any discomfort at this moment. The first injection injects a small amount of medication - 0.1-0.2 ml. After a minute or a minute and a half, the doctor administers the rest of the dose - this way the child does not feel the process of playing the game inside the soft tissues.

The safest injection drug for children under five years of age is scandonest or septanest without adrenaline. For children over five years old, ultracaine with a low concentration of adrenaline (1:200,000) is suitable.

Under no circumstances should drugs such as dicaine, amethocaine, and tetracaine, which are toxic to a fragile organism, be used in pediatric dentistry!

During pregnancy and breastfeeding

Breastfeeding is not a contraindication to anesthesia. Modern anesthetics are used in small doses and are eliminated from the body quickly - from 20 minutes to 2 hours. Given this time, it is better for mothers to feed the baby immediately before going to the doctor or express milk in advance.

But while pregnant, it is better to avoid using anesthetics. If you still cannot do without them, it is recommended to plan a trip to the dentist during the second trimester. At this time, the likelihood of complications is lowest.

Preference should be given to gentle agents that are administered in low concentrations and have the shortest effect. Mepivacaine and bupivacaine are contraindicated for pregnant women! These drugs may cause the fetus's heart rate to slow down. And filipressin and octapressin can cause uterine contractions!

Until recently, treatment and tooth extraction procedures were accompanied by painful sensations, but today dentistry has every opportunity to ensure that the patient does not feel the slightest discomfort even during complex interventions. Anesthesia in dentistry is designed to ensure that any procedure is painless.

Anesthesia is a decrease in the sensitivity of a certain area of ​​​​tissue to pain. Various methods allow you to achieve complete loss of sensitivity for a certain period of time. It is widely used for most manipulations in therapeutic and surgical dentistry, for implantation and prosthetics, and even for routine teeth cleaning.

Indications for the use of anesthesia

Regardless of the types of anesthesia in dentistry , they are used for the following indications:

• the need for superficial anesthesia before the main injection,
• treatment of dental diseases of any degree, pulpitis, periodontitis and many others,
• therapy of gum and periodontal tissue diseases,
• removal of teeth and their roots,
• , i.e. installation large quantity artificial metal roots,
• performing surgical operations,
• treatment of acute purulent inflammation jaw bone tissue,
• neuritis, neuralgia facial nerve.

In addition, pain relief is indicated even for minor interventions, for example, during ultrasonic teeth cleaning, when the patient has increased sensitivity or nervousness.

Main types of anesthesia in dentistry

There are three types of anesthesia: local, general and sedation. Local involves anesthetizing a specific area of ​​tissue for comfortable procedures, while the patient remains conscious. General anesthesia or anesthesia is performed using analgesics that are introduced into the body by inhalation or intravenously, during which the patient is unconscious. During sedation, gas is administered by inhalation; this type involves remaining conscious.

Types of local anesthesia in dentistry

Modern local anesthesia is called carpules - the composition is supplied in disposable containers (carpules or ampoules), where the necessary components are already mixed in the right dosage. The doctor inserts the capsule into a special syringe - compared to disposable syringes, its needle is thinner, so the process of administering the drug is less painful.

1. Application anesthesia

The applique machine is widely used when performing simple operations that do not take much time. The drug is applied with a cotton swab or fingers to the desired area, saturates soft fabrics, as a result of which their sensitivity decreases. It penetrates to a depth of no more than 3 mm. Action time is from 10 to 25 minutes. Very often it precedes another type of pain relief.

2. Infiltration anesthesia

Infiltration is provided by an injection that is injected around its non-medical name - “freezing”. It is more often used in the treatment of teeth in the upper jaw, since the alveolar process has a more porous structure, which means pain relief will be more effective. The action time is about 60 minutes, enough to perform quite complex manipulations - endodontic treatment, pulp removal, therapy of deep caries.

3. Conduction anesthesia

Conduction anesthesia in dentistry is aimed at blocking the nerve that transmits the pain signal. This allows you to “disable” not only one tooth, but also a certain area of ​​the jaw that is connected to this nerve. Most often, this type is used when it is necessary to cure or remove several teeth located nearby, especially in the lower jaw. Action time: 90-120 minutes. The most common option is conductive mandibular. It makes it possible to effectively anesthetize the lower jaw and perform complex interventions in the area of ​​molars.

4. Intraligmentary (intraligamentous) anesthesia

Intraligmentary is also called intraperiodontal. The specificity of this type is to apply more pressure during the insertion process. This allows the product to be evenly distributed in the periodontal space and penetrate into the intraosseous space. Begins to act immediately – after 15-45 seconds. Action time is from 20 minutes to half an hour.

5. Intraosseous anesthesia

Indications – impossibility or ineffectiveness of other types. As a rule, it is used in the treatment and removal of lower molars and operations on the alveolar process. Its implementation involves dissecting the mucous membrane, creating a hole in the bone using a bur, after which a needle is inserted into the hole and the drug is supplied to the spongy substance under high pressure. The advantage of this type is its effectiveness even with small volumes of a weak product. Action time – from 60 minutes.

6. Brainstem anesthesia

Stem involves blocking the branches of the trigeminal nerve at the base of the skull. This is useful when performing extensive surgical interventions V maxillofacial surgery. The effect of this type of anesthesia covers both jaws.

Types of drugs for local anesthesia

Modern anesthesia in dentistry is carried out using ready-made anesthetic compounds. The most common are drugs based on articaine - this is the main active substance many anesthetics. They are 1.5-2 times more effective than lidocaine, and 6 times more effective than novocaine. A big advantage is that such drugs are very safe today.

1. "Ultracaine"

The result of developments by the French pharmaceutical company Sanofi Aventis. This drug based on articaine is available in three versions, differing in the concentration of the component and the presence/absence of a vasoconstrictor component:

• "Ultracaine DS forte" - epinephrine concentration 1:100,000,
• "Ultracaine DS" - epinephrine concentration 1:200,000, can be used during pregnancy, breastfeeding, and the presence of cardiovascular diseases,
• "Ultracaine D" - without epinephrine, can be used in patients prone to allergic reactions, since it does not contain preservatives necessary to stabilize drugs with a vasoconstrictor component.

2. "Ubistezin"

A German-made anesthetic, the composition is similar to Ultracaine, or more precisely, to its two forms containing epinephrine.

3. "Mepivastezin" or "Scandonest"

Scandonest is an anesthetic produced by the French company Septodont, the main component of which is mepivacaine 3%. It contains no vasoconstrictor components or preservatives. This explains its popularity when performing dental procedures in patients at risk. "Mepivastezin" is a hollow analogue of "Scandonest", but already made in Germany (3M).

4. "Septanest"

Produced in two forms by Septodont:

• articaine + epinephrine 1:100.000,
• articaine + epinephrine 1:200.000.

The difference between this drug and others is the relatively larger number of preservatives in the composition, which increases the likelihood of developing allergic reactions.

5. "Novocaine"

“Novocaine” in combination with a vasoconstrictor component is much weaker than articaine drugs. In addition, its effectiveness decreases if it is necessary to anesthetize the area of ​​​​inflamed tissue. “Novocaine” has a vasodilating effect, and therefore is very “dependent” on vasoconstrictors. It is difficult to call such a manipulation safe, especially if it is necessary to anesthetize an area of ​​the oral cavity for a patient at risk, a pregnant or lactating patient, or a child.

Complications associated with the use of local anesthesia

Complications are quite rare, but it is impossible to completely eliminate them from practice. They are divided into two groups:

1. local: damage to soft tissues by a needle, breakage of a needle, infection of tissues with poorly disinfected instruments, damage to a vessel (resulting in hematoma), tissue necrosis, paresis of the facial nerve, contracture of the temporomandibular joint,
2. are common: allergic reactions, toxic reactions, change blood pressure, dizziness.

General anesthesia (anesthesia)

Anesthesia is performed only by an anesthesiologist. By delivery method medicine it is divided into inhalation (drugs "Prichlorethylene", "Sevoran") and intravenous ("Hexenal", "Propanidid", "Propofol", "Ketamine", etc.). The drugs put you to sleep and the patient does not feel pain. How long a specific anesthesia lasts is determined by the doctor, taking into account how much time the dentist will need.

Anesthesia requires certain indications:

• pronounced dental phobia and mental disorders,
• pronounced gag reflex,
• complex surgical interventions,
• a large number of teeth subject to extraction or complex treatment,
• ineffective use of local anesthetics.

Such anesthesia is completely justified if a child needs to have a lot of baby teeth treated - it is very difficult to “force” children to be in the doctor’s chair, especially for a long period of time.

Contraindications to anesthesia are as follows:

• relative – exacerbation chronic diseases, viral infections, pregnancy and lactation, respiratory infections and etc.,
• absolute – cardiac, renal failure, some types of heart defects, decompensated diabetes and other severe endocrine diseases, respiratory dysfunction.

In order to decide on the possibility of using anesthesia, the doctor will prescribe an extensive diagnosis of your health condition.

Side effects of anesthesia can be reversible and severe, requiring immediate medical attention. The first group includes nausea, vomiting, confusion, fainting, behavioral disorders, and coordination of movements. As a rule, they pass with minor intervention from specialists and with the provision of rest. Serious complications are cardiac and respiratory problems: they require immediate medical attention.

On a note! Failure to pay attention to the advice of an anesthesiologist regarding preparation for anesthesia can cause a serious complication - aspiration of the respiratory tract. The doctor must explain the day before for how long it is forbidden to eat and drink - it is important to strictly follow the recommendation.

Sedation in dentistry

Sedation is an immersion in a state similar to drowsiness or intoxication - the patient is conscious, but feels calm and relaxed. There are three methods of sedation: inhalation, intravenous, and oral. Sedation is effectively used for both children and adults. It is effectively combined with local anesthesia.

Unlike general anesthesia, sedation is safer and does not entail unpleasant treatment consequences.

Features of anesthesia in pediatric dentistry

Effective pain relief in pediatric dentistry must take into account a number of features:

• most local anesthetic drugs are approved for use from 4 years of age,
• dosage calculation is carried out taking into account weight,
• Children often suffer from allergic reactions to anesthetics.

The correct choice of pain relief method is very important - the child’s attitude towards dental procedures in the future and trust in the dentist depend on this.

Features of the use of anesthesia during pregnancy

Today there are ample opportunities to ensure maximum comfort for a pregnant woman. Local anesthetics with a minimal content of vasoconstrictor components are approved for use in expectant mothers. Restrictions apply to general anesthesia and drugs with a maximum content of adrenaline or epinephrine.

Video on the topic

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Local anesthetics are sodium channel blockers in sensitive nerve endings and conductors. From a chemical point of view, these drugs are salts of weak bases, the property of which is good solubility in water. When introduced into tissues, the local anesthetic hydrolyzes with the release of the anesthetic base, which, due to lipotropy, penetrates the nerve fiber membrane and binds to the terminal groups of phospholipids of the sodium channel leaflets, disrupting the ability to generate an action potential.

The degree of penetration depends on ionization, dose, concentration, site and speed of drug administration, and the presence of a vasoconstrictor, which is usually used as adrenaline. The latter slows down the flow of anesthetic into the blood, reduces systemic toxicity and prolongs the effect. The release of the anesthetic base occurs more easily at slightly alkaline values. pH value environment, therefore, under conditions of tissue acidosis due to inflammation, the penetration of the anesthetic through the nerve fiber membrane slows down and its clinical effect decreases.

Local anesthetics are divided into two groups based on their chemical structure: esters and amides. The group of esters includes novocaine, anesthesin, dicaine and benzofurocaine. Amides include: lidocaine, trimecaine, mepivacaine, prilocaine, bupivacaine, etidocaine, articaine. Local anesthetics are classified according to their duration of action: I) short acting(30 minutes or less) - novocaine, mepivacaine; 2) medium action (1-1.5 hours) - lidocaine, trimecaine, prilocaine, articaine; 3) long-acting (more than 2 hours) - bupivacaine, etidocaine. When choosing a drug, take into account the duration of the upcoming intervention, the possibility of using a vasoconstrictor, and the patient’s allergic anemnesis. In dentistry, along with superficial (application), infiltration and conduction anesthesia, methods of intraligamentary, intrapulpal and intraosseous administration of local anesthetics are used. Methods for prolonged conduction blockade of the 2nd and 3rd branches of the trigeminal nerve have also been developed.

For topical anesthesia of the mucous membrane and wound surface, drugs are used that penetrate well into the tissue and create an effective concentration in the membrane of the nerve fiber and sensory endings. For such anesthesia, dicaine, pyromecaine, anesthesin, and lidocaine are used.

For infiltration and conduction anesthesia novocaine, trimecaine, lidocaine, mepivacaine, prilocaine, bupivacaine, etidocaine, articaine are used.

For prolonged conduction blockade of the 2nd and 3rd branches of the trigeminal nerve, lidocaine and articaine are used, for intraligamentary anesthesia - articaine, lidocaine, mepivacaine in a volume of 0.2-0.3 ml.

Novocaine(0.5-2% solution) is used by electrophoresis (from the positive pole) for trigeminal neuralgia, paresthesia, and periodontal disease. Dicaine is prescribed for hyperesthesia of hard dental tissues in the form of a 2-3% solution, anesthesin is prescribed for the treatment of desquamative glossitis (in the form of a suspension with hexamethylenetetramine).

Anestezin(Anaesthesinum). Synonyms: Aethylis aminobenzoas, Benzocain.

pharmachologic effect : causes superficial anesthesia of the skin and mucous membrane.

Indications: used for stomatitis, alveolitis, gingivitis, glossitis and for topical anesthesia.

Mode of application: in dentistry, they are used topically in the form of 5-10% ointment or powder, 5-20% oil solutions, as well as tablets of 0.005-0.01 g (for sucking). Maximum dose for local application— 5 g (25 ml 20% oil solution). Included in (3%) of the anti-burn ointment "Fastin".

Side effect : When applied to a large surface due to absorption, it can cause methemoglobinemia.

: manifests itself in a weakening of the effect of sulfonamides. Increased effect is observed after preliminary use sleeping pills and tranquilizers.

Contraindications: do not use in case of individual hypersensitivity, treatment with sulfonamide drugs.

Release form: powder, tablets (0.3 g).

Storage conditions: in a dry, cool place. List B.

Rp: Anaesthesini 3.0
Dicaini 0.5
Mentholi 0.05
Aetheris pro narcosi 6.0
Spiritus aethylici 95% 3.3
Chloroformii 1.0
M.D.S. For superficial anesthesia of the mucous membrane.
Rp: Mentholi 1.25
Anaesthesini 0.5
Novocaini 0.5
Mesocaini 0.5
Spiritus vini 70% 50.0
M.D.S. Liquid according to L. A. Khalafov for application anesthesia of hard dental tissues.
Rp: Anaesthesini 1.0
01. Persicorum 20.0
Rp: Anaesthesini 2.0
Glycerini 20.0
M.D.S. For anesthesia of the mucous membrane.

Benzofurokai(Benzofu rocaipum).

pharmachologic effect: is a local anesthetic with a central analgesic component.

Indications: in dentistry it is used for infiltration anesthesia, for pulpitis, periodontitis, for opening abscesses, and postoperative pain relief. It can also be used to relieve spastic pain in renal and hepatic colic and traumatic pain.

Mode of application: for infiltration anesthesia and others Indications m inject 25 ml of 1% solution, it is possible to add 0.1% adrenaline hydrochloride to this solution. For pain relief, 0.1-0.3 g (10-30 ml of 1% solution) is prescribed intramuscularly and intravenously 1-3 times a day. Maximum daily dose is 100 ml of 1% solution (1 g of drug). When administered intravenously, the drug solution is diluted in an isotonic sodium chloride solution or in a 5% glucose solution for injection. The rate of intravenous drip is 10-30 drops per minute.

Side effect: With rapid intravenous administration, dizziness, weakness, nausea and vomiting occur.

Contraindications: pathology of the liver and kidneys, disorders cerebral circulation, atrioventricular block.

Interaction with other drugs: benzofurocaine solutions are not combined with drugs that have an alkaline reaction.

Release form: 1% solution in ampoules of 2, 5 and 10 ml.

Storage conditions: in a place protected from light. List B.

Bupivacaine hydrochloride(Bupivacaine hydrochloride). Synonyms: Anecain, Marcain, Duracain, Narcain.

pharmachologic effect: local anesthetic from the aminoamide group, is a butyl analogue of mepivacaine. Long-acting anesthetic (up to 5.5 hours with conduction anesthesia and 12 hours with infiltration anesthesia). It acts more slowly than solutions of lidocaine, mepivacaine and cytanest. It is 6-16 times more active and 7-8 times more toxic than novocaine. It has a strong vasodilating effect and is therefore used in combination with adrenaline. In dentistry it is used in the form of a 0.5% solution. The anesthetic effect occurs quickly (within 5-10 minutes). The mechanism of action is due to the stabilization of neuronal membranes and the prevention of the occurrence and conduction of a nerve impulse. The analgesic effect continues after the cessation of anesthesia, which reduces the need for postoperative pain relief. Metabolized in the liver, not broken down by plasma esterases.

Indications: used for postoperative analgesia, therapeutic blockades, anesthesia during surgery, when there is no need for muscle relaxation, as well as for infiltration and conduction anesthesia.

Mode of application: for infiltration anesthesia, 0.125-0.25% solutions are used. If adrenaline is not used, the maximum total dose of bupivacaine can be up to 2.5 mg/kg body weight. When adding adrenaline to the solution (in a ratio of 1:200,000), the total dose of bupivacaine can be increased by 1/3.

For conduction anesthesia, 0.25-0.5% solutions are used in the same total dose as for infiltration anesthesia. With anesthesia of mixed nerves, the effect develops after 15-20 minutes and lasts 6-7 hours.

For epidural anesthesia, use a 0.75% solution in the same total dose of the drug.

Side effect: the drug is usually well tolerated, but with a massive overdose, central nervous system depression, loss of consciousness, and respiratory arrest occur. Possible decrease in blood pressure, tremor, depression of cardiac activity up to cardiac arrest. When adding adrenaline to solutions, one should take into account its possible side effects(tachycardia, increased blood pressure, arrhythmias).

Interaction with other drugs: does not affect the antimicrobial effect of sulfonamides (unlike novocaine). When used simultaneously with barbiturates, the concentration of bupivacaine in the blood may decrease.

Release form: 0.25; 0.5 and 0.75% solutions in ampoules, bottles of 20, 50 and 100 ml.

Anecaine is a solution for injection in bottles of 20 ml, in a package of 5 pieces (1 ml contains 5 mg of bupivacaine chloride).

Storage conditions: list B.

Dicaine(Dicainum). Synonyms: Tetracaine (Tetracainum), Rexocaine (Rexocaine).

pharmachologic effect: is a local anesthetic, superior in activity to novocaine, but more toxic. Well absorbed through the mucous membrane.

Indications: used for stomatitis, alveolitis, gingivitis, glossitis, for local anesthesia of hard dental tissues, as part of pastes for pulp devitalization, with an increased gag reflex before taking impressions or taking intraoral radiographs to anesthetize the injection site.

Mode of application: applied to the mucous membrane in the form of 0.25; 0.5; 1 and 2% solutions or rubbed into hard tissues tooth

Side effect: The drug is toxic; intoxication causes agitation, anxiety, convulsions, respiratory distress, cardiovascular failure, hypotension, nausea, and vomiting. Locally, a cytotoxic effect may occur in the epithelial layer and deeper layers.

Interaction with other drugs: weakens the effect sulfa drugs. An increase in effect is observed after preliminary use of sleeping pills and tranquilizers.

Contraindications: do not use in case of individual intolerance, prescription, sulfonamides.

Release form: powder, solutions of various concentrations (0.25; 0.5; 1; 2%).

Included in combination drugs;

— fibrous paste “Anesthopulpe”, consisting of several components (hydrochloride tetracaine - 15 g, thymol - 20 g, guaiacol - 10 g, filler up to 100 g - per 100 g), baked in jars of 4, 5 g. Has an anesthetic and antiseptic effect and is used mainly as an analgesic during preparation. carious cavity without pre-treatment and as an additional remedy after mechanical treatment of a carious cavity in the treatment of pulpitis (an Anestopulpa ball is placed into the cavity, washed with a solution of hydrogen peroxide after dentin removal, and closed with a temporary filling);

- Perylene ultra - a means for superficial anesthesia (composition per 100 g; tetracaine hydrochloride - 3.5 g, ETHYL para-aminobenzoate - 8 g, peppermint oil - 3 g, filler up to 100 g), in bottles of 45 ml.

Designed to eliminate sensitivity and antiseptic treatment of the mucous membrane before injections, superficial anesthesia for the removal of baby teeth and dental plaque, fitting of fixed denture structures (crowns, bridges, etc.), suppressing the gag reflex when taking impressions, opening abscesses under the mucous membrane, additional anesthesia during pulp extirpation.

Mode of application: lubricate the previously dried mucous membrane with a tampon rolled into a ball, soaked in perylene ultra:

— Peryl-spray — a bottle in an aerosol package with a capacity of 60 g (3.5% tetracaine hydrochloride).

Storage conditions: in a well-closed container. List A.

Rp: Dicaini 0.2
Phenoli puri 3.0
Chloroformii 2.0
M.D.S. Liquid No. according to E.E. Platonov
Rp: Dicaini 0.2
Spiritus vini 96% 2.0
M.D.S. Liquid No. 2 according to E. E. Platonov.

Mode of application: Liquids No. 1 and No. 2 are mixed and rubbed with a cotton swab into the sensitive surfaces of the teeth. Lidocaine. Synonyms: Xylocaine, Xycaine, Lidocaine hydrochloride, Lignocaine hydrochloride (Lignocain HC1), Lidocaton.

pharmachologic effect: is a local anesthetic of the amide group, an amide derivative of xylidine. The anesthetic effect is 4 times greater than that of novocaine, toxicity is 2 times higher. It is quickly absorbed, slowly decomposes, and acts longer than novocaine, usually 1-1.5 hours. It is used for all types of local anesthesia: terminal, infiltration, conduction. Stabilizes cell membranes, blocks sodium channels. Adding adrenaline prolongs the effect of the drug by 50%. Lidocaine is metabolized mainly in the liver and excreted through the kidneys.

Indications: used for application, infiltration or conduction anesthesia before tooth extraction, incisions and other dental operations, before preparation of hard tissues and devitalization of dental pulp, before treatment of stomatitis and periodontopathies, taking impressions and obtaining intraoral photographs with an increased gag reflex (in the latter case it can be used When using elastic impression materials, do not use them when taking plaster impressions to avoid aspiration of pieces of plaster). Used for novocaine intolerance. A 10% solution is used intramuscularly as an antiarrhythmic agent.

Mode of application: for anesthesia it is used intramuscularly, subcutaneously, submucosally in the form of 0.25-0.5-1-2% solutions, 2.5-5% ointment, 10% aerosol. The drug should be administered slowly with preliminary or continuous aspiration to avoid accidental intravascular injection. In most cases, to achieve an optimal analgesic effect, it is recommended to administer 20-100 mg to physically healthy adults, and 20-40 mg to children under 10 years of age. After application of lidocaine in aerosol form to the oral mucosa, local anesthesia is provided for 15-20 minutes. In case of increased sensitivity of dentin, before applying and fixing fixed dentures, it is better to use a heated 10% solution rather than an aerosol, since the contents of the aerosol essential oil peppermint irritates the pulp and reduces the adhesion of cement to the wound surface of dentin.

Side effect: The safety and effectiveness of local anesthesia using lidocaine hydrochloride depend on the correct dose and administration technique, precautions taken and willingness to provide emergency care. Lidocaine may cause acute toxic effects following accidental intravascular administration, rapid absorption, or overdose.

The reaction from the central nervous system can manifest itself as agitation or depression, ringing in the ears, euphoria, drowsiness, and pallor, nausea, vomiting, decreased blood pressure, and muscle tremors. Such phenomena can be more pronounced (up to collapse) when concentrated solutions of lidocaine quickly enter the bloodstream. In this regard, during the administration of the drug, an aspiration test should be constantly performed, and possible movements of the patient after anesthesia should be limited to a minimum.

Patients need to be explained how to avoid accidental injuries to the lips, tongue, buccal mucosa, and tissues of the soft palate after the onset of anesthesia. Eating should be postponed until sensitivity is restored.

Allergic reactions are possible, but they occur less frequently than with the use of novocaine, although lidocaine in high concentrations is more toxic.

Interaction with other drugs: Lidocaine should be used with caution in patients receiving antiarrhythmic drugs such as tocainide, as increased toxic effects may occur. It is recommended to avoid the use of solutions containing epinephrine in patients receiving monoamine oxidase inhibitors or tricyclic antidepressants, as prolonged arterial hypertension. When using the drug with adrenaline during or after inhalation anesthesia with halothane, various cardiac arrhythmias may develop.

Contraindications: not recommended for myasthenia gravis, cardiovascular failure, severe liver and kidney dysfunction, 11-3 degree atrioventricular block, as well as hypersensitivity to this anesthetic. Use with caution in patients with untreated arterial hypertension.

Release form: domestic lidocaine is produced in the form of 1% and 2% solution in ampoules of 2, 10 and 20 ml; 10% solution in ampoules of 2 ml; 2.5-5% ointment and aerosol (65 g can).

Imported analogue lidocaine Xylocaine (Xylocaine) is available without adrenaline in the form of 0.5%, 1% and 2% solution (1 ml of the drug contains 5, 10 and 20 mg of lidocaine hydrochloride, respectively) and with adrenaline (5 mcg in 1 ml). In dental practice, a 2% solution with adrenaline (20 mg/ml + 12.5 μg/ml) is mainly used.

The imported analogue of lidocaine Xylonor (Xylonor) is available in carpules (box of 50 carpules of 1.8 ml, vacuum packed): ""

— Xylonir without vasoconstrictor effect (Xylonir sans vasoconstricteur), containing 36 mg of lidocaine;

— Xylonor 2% special (Xylonor 2% special), containing lidocaine hydrochloride (36 mg), adrenaline (0.036 mg) and norepinephrine (0.072 mg);

- Xylonor 2% (Xylonor 2% noradrenaline), containing lidocaine hydrochloride (36 mg) and norepinephrine (0.072 mg);

- Xylonor 3% (Xylonor 3% noradrenaline), containing lidocaine hydrochloride (54 mg) and norepinephrine (0.072 mg). To achieve anesthesia, as a rule, 1 carpule is sufficient. The maximum dose is 2 carpules.

Lidocaine is part of combination drugs containing 2 or more active substances: lidocaine + benzalkonium chloride (see Dinexan A); lidocaine + cetrimide (a bactericidal substance such as quaternary ammonium), which is recommended for use in patients with allergies to para-aminobenzoic acid derivatives; is issued in the following form:

— Xylonor 5%, in bottles of 12 and 45 ml;

— dragees, 200 pieces in a bottle;

— Xylonor-spray, contains 15% lidocaine (aerosol container capacity 60 g).

Mode of application: Xylonor in solution and Xylonor gel are applied to the mucous membrane on a cotton swab; Xylonor in tablets - placed for a few seconds on the previously dried mucous membrane; Xylonor spray - the nebulizer cannula is placed 2 cm from the mucous membrane and 23 presses are made (1 press corresponds to 8 mg of lidocaine on the surface of the mucous membrane with a diameter of 1 cm) in no more than 45 different places of the mucous membrane during one visit.

Storage conditions: store the drug without adrenaline at room temperature. Store the drug with adrenaline in a cool place, protected from light. List B.

Mepivacaine(Mepivacaine). Synonym: Mepicaton, Scandicaine, Scandonest.

pharmachologic effect: short-acting amide-type local anesthetic (30 minutes or less). Used for all types of local anesthesia: terminal, infiltration, conduction. It has a stronger anesthetic effect than novocaine. Its toxicity is lower than that of lidocaine. Compared to novocaine and lidocaine, the anesthetic effect is achieved faster.

Indications: for local anesthesia during various therapeutic and surgical interventions in the oral cavity, including lubrication of mucous membranes during tracheal intubation, bronchoesophagoscopy, tonsillectomy, etc.

Mode of application: the amount of solution and the total dose depend on the type of anesthesia and the nature of the surgical intervention or manipulation. For the drug "Mepicaton" the average dose is 1.3 ml; if necessary, the dose can be increased. The maximum daily dose for adults and children weighing over 30 kg is 5.4 ml; for children weighing up to 20-30 kg - 3.6 ml.

Side effect: possible (especially if the dose is exceeded or the drug enters the vessel) - euphoria, depression; impaired speech, swallowing, vision; convulsions, respiratory depression, coma; bradycardia, arterial hypotension; allergic reactions.

Contraindications: hypersensitivity to amide-type local anesthetic drugs and parabens. Prescribe with caution during pregnancy and elderly patients.

Interaction with other drugs: at joint use mepivacaine with beta-blockers, calcium channel blockers and other antiarrhythmic drugs increases the inhibitory effect on myocardial conductivity and contractility.

Release form: solution for injection (Mepicaton), in bottles (1 ml of solution contains 30 mg of mepivacaine hydrochloride).

Scandonest - 2% solution in 1.8 ml carpules (contains 36 mg of mepivacaine hydrochloride and 0.018 mg of adrenaline); 2% solution in 1.8 ml carpules (contains 36 mg of mepivacaine hydrochloride and 0.018 mg of norepinephrine tartrate); 3% solution in 1.8 ml carpules (contains 54 mg of mepivacaine hydrochloride without a vasoconstrictor component).

Storage conditions: in a cool place.

Novocaine(Novocainum). Synonyms: Procaine hydrochloride (Procaini hydrochloridum), Aminocaine, Pancain, Syntocain.

pharmachologic effect: local anesthetic with moderate anesthetic activity and a wide range of therapeutic effects. Reduces the excitability of the motor areas of the brain, myocardium and peripheral cholinoreactive systems. It has a ganglion-blocking effect, including an antispasmodic effect on smooth muscles, and reduces the formation of acetylcholine.

Indications: used for infiltration or conduction anesthesia before preparation of hard dental tissues, amputation and pulp extirpation, tooth extraction, incisions and other dental operations, as well as for pain relief in diseases of the temporomandibular joint, stomatitis, gingivitis, glossitis.

Mode of application: for anesthesia, use intramuscularly, subcutaneously, submucosally in concentrations of 0.25% (up to 500 ml in the first hour of surgery). 0.5% (up to 150 ml in the first hour of surgery); 1-2% (up to 25 ml), for rinsing the mouth 23 ml of 0.25-5% solution. The drug is also administered by electrophoresis into the area of ​​the temporomandibular joint (5-10%), and is also used to dissolve penicillin (0.25-0.5%). During anesthesia, you can add 1 drop of 0.1% adrenaline solution to 2.5-3% ml of novocaine solution.

Side effect: may cause dizziness, weakness, hypotension, allergic reactions.

Interaction with other drugs: increased effect is observed after preliminary use of sleeping pills and tranquilizers. Reduces the bacteriostatic effect of sulfonamides.

Contraindications: individual intolerance.

Release form: 0.5%, 1% and 2% solution in ampoules of 1, 2, 5 and 10 ml; bottles with sterile 0.25% and 0.5% solution of the drug, 400 ml each; 0.25 and 0.5% solution in ampoules of 20 ml.

Storage conditions: ampoules and vials are stored in a cool place, protected from light. List B.

Pyromecaine(Pyromecainum).

pharmachologic effect: is a local anesthetic.

Indications: used for topical anesthesia for stomatitis, gingivitis, glossitis, residual pulpitis, to weaken the increased gag reflex before taking impressions or taking intraoral radiographs, to anesthetize the injection site.

Mode of application: A 1% solution or 5% ointment is lubricated on the oral tissues or the root pulp is anesthetized through the carious cavity.

Side effect: Acute inflammatory reactions can sometimes occur in the subepithelial connective tissue stroma and muscle layer.

Interaction with other drugs: increased effect is observed after preliminary use of sleeping pills and tranquilizers.

Contraindications: individual intolerance and hypersensitivity to the drug.

Release form: 0.5%; 1% and 2% solution in ampoules of 10 ml, 5% ointment in tubes of 30 g.

Storage conditions: list B.

Prilocaine(Prilocain). Synonyms: Cytanest, Xilonest.

pharmachologic effect: amide-type local anesthetic (toluidine derivative) with a rapid onset of effect and average duration actions. The drug is approximately 30-50% less toxic than lidocaine, but also less active, with a longer action. A 3% solution of itanest with octapressin provides a local anesthetic effect on the dental pulp for 45 minutes. Unlike norepinephrine and epinephrine, octapressin does not interact with tricyclic antidepressants. When combined with it, cytanest does not cause ischemia at the injection site, so the hemostatic effect is not pronounced. When used in doses above 400 mg, cytanest metabolites promote the formation of methemoglobin.

Indications: used for conduction and infiltration anesthesia.

Mode of application: for local anesthesia (infiltration and conduction anesthesia) use a 2-3-4% solution with adrenaline 1:100,000, 1:200,000, with felypressin (octapressin).

Side effect: a quickly passing illness may appear: headache, chills, feeling of anxiety. Allergic reactions are possible.

Contraindications: not recommended for use in cases of hypersensitivity to amide-type local anesthetics, congenital or idiopathic methemoglobinemia. It should be used with caution for pain relief in children, pregnant women and the elderly.

Release form: 1.8 ml carpules, 2-3-4% solution with adrenaline 1:100,000, 1:200,000, with felypressin.

Storage conditions

Trimekain(Trimecainum). Synonym: Mesocain.

pharmachologic effect: local anesthetic. Causes quickly onset, long-lasting conduction, infiltration, epidural, spinal anesthesia. Non-irritating and relatively low toxic. The addition of norepinephrine to the trimecaine solution causes local vasoconstriction, which leads to a slower absorption of trimecaine, providing an increase and prolongation of the anesthetic effect and a decrease in the systemic effect.

Indications: used for application, infiltration or conduction anesthesia before tooth extraction, incisions and other dental operations, before preparation of hard tissues and devitalization of dental pulp, treatment of stomatitis and periodontopathies, taking impressions and obtaining intraoral photographs with an increased gag reflex (in the latter case it can be used for When using elastic impression materials, do not use them when taking plaster impressions to avoid aspiration of pieces of plaster).

Used for novocaine intolerance.

Mode of application: for anesthesia, use intramuscularly, subcutaneously, submucosally in the form of 0.25; 0.5; 1; 2% solutions. The maximum permissible dose of a 2% solution is 20 ml. To slow down absorption, add a 0.1% solution of adrenaline at the rate of 1 drop per 3-5 ml of anesthetic. For topical anesthesia of hard dental tissues, it is used in the form of a 70% paste (according to N. M. Kabilov et al.), as well as a 10% solution for electrophoresis into the carious cavity.

Side effect: may cause facial pallor, headache, anxiety, nausea, allergic reactions in the form of urticaria.

Interaction with other drugs: see Pyromecaine.

Contraindications: not used for sinus bradycardia(less than 60 beats/min), complete transverse heart block, liver and kidney diseases, as well as hypersensitivity to the drug.

Release form: 0.25% solution in ampoules of 10 ml, 0.5 and 1% solution in ampoules of 2.5 and 10 ml, 2% solution in ampoules of 1, 2, 5 and 10 ml, 2% solution with 0.004% norepinephrine solution 2 ml.

Storage conditions: in a cool place, protected from light.

List B.

Rp: Trimecaini 2.5
Dicaini 0.5
Prednizoloni 0.25
Sodium hydrocarbonates 1.0
Lydasi 0.3
Glycerini 5.0
M.D.S. Paste for application anesthesia of hard dental tissues. Rub into wound surface dentin.
Rp: Trimecaini 6.0
Dicaini 0.3
Sodium bicarbonici 1.0
Lydasi 0.2
Glycerini 3.0
M.D.S. Anesthetic paste "Medinalgin-1".

Ultracaine(Ultracain). Synonyms: Articaine hydrochloride, Ultracain D-S, Ultracaine D-S forte(Ultracain D-S forte), Septanest.

pharmachologic effect: is a strong local anesthetic of the amide type with a rapid onset of action (0.3-3 minutes after injection). Ultracaine is 6 times stronger than novocaine and 3 times stronger than lidocaine and scandicaine (mepivacaine), due to its exceptional diffusion into the connective and bone tissue. This allows, when using articaine, to reduce Indications to conduction anesthesia methods, which not only simplifies the technique of pain relief (for example, in children), but also reduces the likelihood of potential complications associated with conduction anesthesia, the number of postoperative bites of the lips and tongue.

Articaine does not contain the preservative paraben, which most often causes allergic reactions. The content of metabisulfite (adrenaline antioxidant), compared to other anesthetics, is minimal (0.5 mg per 1 ml of solution). The stability of the anesthetic is achieved by the high quality of glass, rubber parts of the cartridge and the high chemical purity of the active substance.

Inactivation of ultracaine occurs (by 90%) by hydrolysis in the blood immediately after administration of the drug, which practically eliminates the risk of systemic intoxication in cases of repeated administration of the anesthetic during dental intervention. The duration of local anesthesia, depending on the concentration of the solutions used and the method of administration, is 1-4 hours. In addition to anesthetic properties during resorption, it can exhibit ganglion-blocking, antispasmodic, and also mild anticholinergic effects.

Indications: used for infiltration, conduction, epidural, spinal anesthesia. In dentistry, they are used in the preparation of hard dental tissues for fillings, inlays, half-crowns, crowns; during incisions of the oral mucosa, amputation and pulp extirpation, tooth extraction, resection of the apex of the tooth root, cystotomy, especially in patients with severe somatic diseases

Mode of application: in dental practice, it is injected into the submucosal layer, intraligamentary, subperiosteally, into the projection of the root apex. Disposable maximum dose the drug for adults - 7 mg/kg body weight (up to 7 carpules), which is approximately 0.5 g of the drug or 12.5 ml of a 4% solution. For anesthesia during the preparation of hard dental tissues with intraligamentary or subperiosteal administration of the drug, a dose of 0.12-0.5 ml is sufficient, while the time for the maximum effect to occur is 0.4-2 minutes, and the duration of effective pain relief is 20-30 minutes. With endopulvar injection of 0.06 ml of ultracaine, the effect appears after 5-6 seconds, the duration of effective anesthesia is 10 minutes. For submucosal administration, 0.5-1 ml is used (the maximum effect occurs after 10 minutes, and the duration of effective anesthesia is 30 minutes). For conduction anesthesia, 1.7 ml of ultracaine is administered (the maximum effect of anesthesia occurs in 10-15 minutes, the duration of effective anesthesia is 45-60 minutes). When removing upper teeth and lower premolars, in most cases only a vestibular injection is sufficient.

Side effect: the drug is well tolerated, but in case of overdose, nausea, vomiting, and muscle tremors are possible. Massive resorption causes depression of cardiac activity, decreased blood pressure and respiratory depression, including cardiac arrest. Allergic reactions cannot be ruled out anaphylactic shock. The side effects of adrenaline, which is included in the Ultracaine D-S and Ultracaine D-S Forte solutions, should also be taken into account.

Contraindications: hypersensitivity to articaine and epinephrine (adrenaline). Given the presence of epinephrine, there are the following

Contraindications: decompensated heart failure, narrow-angle glaucoma, tachyarrhythmia, Adams-Stokes syndrome, bronchial asthma. Intravenous administration contraindicated. Injection into the area of ​​inflammation should be avoided.

Release form: “Ultracaine A” - 1 and 2% solution for injection in ampoules of 20 ml (1 ml contains 10 and 20 mg of articaine and 0.006 mg of adrenaline).

"Ultracaine D-S" - solution for injection in ampoules of 2 ml, carpules of 1.7 ml, in packages of 100 and 1000 pieces (1 ml contains 40 mg of articaine hydrochloride and 6 μg of adrenaline hydrochloride, i.e. 1:200 000).

"Ultracaine D-S forte" - solution for injection in ampoules of 2 ml, carpules of 1.7 ml in packages of 100 and 1000 pieces (1 ml contains 40 mg of articaine hydrochloride and 12 μg of adrenaline hydrochloride, i.e. 1:100 000).

Injection solution "Ultracaine Hyperbar", containing 50 mg of articaine and 100 mg of glucose monohydrate in 1 ml (for spinal anesthesia).

Storage conditions: in a place protected from light. Store at a temperature not exceeding +25°C. The drug should not be frozen or used thawed. The anesthetic solution in the carpul is stored for 12 to 24 months. Partially used carpules should not be stored for use in other patients due to the risk of transmitting infection.

Disinfection of carpules: before injection, the rubber stopper and metal cap should be wiped with gauze soaked in 91% isopropyl or 70% ethyl alcohol. Do not autoclave or store in disinfectant solutions. When using an anesthetic packaged in blisters, the sterility of each carpule is ensured, which eliminates the need for additional processing.

Etidocaine(Ethidocaine). Synonym: Duranest.

pharmachologic effect: is a local anesthetic drug (lipophilic homologue of lidocaine). In dentistry, it is used in the form of a 1.5% solution with a vasoconstrictor. For conduction anesthesia in the lower jaw, it is equally effective with 2% lidocaine, but for infiltration anesthesia in the upper jaw it does not provide satisfactory dental anesthesia. Anesthesia of soft tissues in the area of ​​infiltration is quite long - 2-3 hours more than when using 2% lidocaine with adrenaline. Has a pronounced vasodilating effect.

Indications: used for infiltration and conduction anesthesia.

Mode of application: for infiltration and conduction anesthesia and others Indications m use a 1.5% solution with a vasoconstrictor (1:200,000).

Side effect: in addition to the side effects characteristic of amide-type local anesthetics, postoperative bleeding is possible (for example, after tooth extraction).

Contraindications: not recommended for use in cases of potentially major surgical trauma due to possible bleeding in patients with blood diseases, after conditions accompanied by blood loss, in case of dysfunction of cardio-vascular system, with individual intolerance to the drug and during pregnancy.

Release form: 1.5% solution for injection with vasoconstrictor 1:200 LLC.

Storage conditions: at room temperature.

Dentist's Guide to medicines
Edited by Honored Scientist of the Russian Federation, Academician of the Russian Academy of Medical Sciences, Professor Yu. D. Ignatov

For modern dentistry, the administration of an anesthetic is a common procedure. Its purpose is to block the nerve that transmits pain impulses to the brain.

Due to the action of the anesthetic, the patient feels numbness in the area of ​​the mouth where the tooth is being treated. .

Modern treatment

For pain relief, more effective and less toxic drugs are used, replacing traditional lidocaine and novocaine.

In addition, developed different types anesthesia in dentistry, which is used in accordance with the purpose of treatment.

Indications for use

Pain relief is necessary when:

• treatment of complicated forms of caries;
• pulp removal;
• removal of a tooth or its root;
• removal of an impacted or dystopic tooth;
• preparation for prosthetics;
• orthodontic treatment;
• purulent inflammation of the jaws;
• neuritis or neuralgia of the facial nerve.

Types of anesthesia in dentistry

There are two types of anesthesia used in dentistry: local and general.

Local

Local anesthesia is the most common and less dangerous to human health than anesthesia. After the injection, the patient does not feel pain, but only feels the dentist’s manipulations.

Local anesthesia includes the following types anesthesia:

• application;
• infiltration;
• conductor;
• intralegal;
• intraosseous;
• stem

Appliqué

Application anesthesia does not involve the use of a syringe. The drug is applied only with a cotton swab or fingers. Next, the medicine penetrates inside and has an analgesic effect for 10-20 minutes.

Dentists use this anesthesia to remove tartar, open abscesses (suppuration), and when treating the oral mucosa. Sometimes the application form is used before local anesthesia so that the patient does not even feel the injection.

There is another option for application anesthesia. It can be carried out using aerosols. But due to the fact that the sprayed product can get into Airways, this method has not become widely used in dentistry.

Infiltration

Infiltration anesthesia has gained great popularity among dentists. This is the form most familiar to patients. It is used in the treatment of pulpitis, dental canal, tooth extraction. The injection is injected next to the tooth into the gum. The patient does not feel pain for an hour.

There are direct and indirect infiltration anesthesia. The direct line penetrates under the mucous membrane of the teeth and anesthetizes the injection site. The indirect one also covers the nearby area. But the denser the surrounding tissue, the less effective the product.

Conductor

The area of ​​effect of conduction anesthesia is much wider and can cover almost half of the jaw. It is used for extensive surgical operations, treatment of root teeth and gums. The effect of such an injection lasts an hour and a half.

The anesthetic is injected close to the nerve. This is an important process, because if it is injected further, pain relief will not occur, and if it is injected into a nerve, complications will occur, including neuropathy. The safety of pain relief is enhanced by the use of ultrasound.

Intraligamentary

Intraligamentary or intraligamentous anesthesia is injected into the gingival sulcus. Most often it is used for children, since this form does not cause numbness of the cheeks and tongue. The drug acts for approximately 20-30 minutes.

In order for pain relief to be effective, drugs are administered at more high blood pressure and much slower.

Video: How it works

Intraosseous

The intraosseous form is characterized by a complex technique. First, the injection is injected into the gum, and then between the teeth, into the spongy bone.

It is used when it is necessary to remove teeth and when operating on the alveolar process. This procedure is effective even with a small dose of anesthetic. The numbness does not extend to the cheeks, tongue and lips, but it does not last long.

Stem

This procedure is carried out only in stationary conditions. Trunk anesthesia is used for acute pain, jaw injuries, neuralgia. The effect of the drug lasts a very long time and covers the lower and upper jaws, because the needle is inserted into the base of the skull.

For children

Children are afraid of pain, but the painkiller injection itself becomes unbearable and causes fear in children. Therefore, anesthesia is most often carried out in two stages. Before the injection, dentists use topical anesthesia. Thanks to the pleasant taste of the applied product, children are better able to make contact.

It is also important to consider that children's bodies are more sensitive to drugs. Therefore, the anesthetic is administered to the child in a smaller dose. But even in this case, the child may lose consciousness.

Sedation is sometimes used to calm the child. This method is not anesthesia. Sedation only has a relaxing effect and is therefore accompanied by an injection with local anesthesia. It is often used in children because the risk of side effects is very low.

Contraindications

An important contraindication to the administration of an anesthetic is an allergy to drugs.

Local anesthesia is also not given to those who are sick:

• cardiovascular diseases (myocardial infarction or stroke that the patient suffered six months earlier);
• endocrine diseases (for example, diabetes mellitus and thyrotoxicosis).

Drugs

Modern drugs are made on the basis of effective anesthetics: mepivacaine and articaine.

Today, the most commonly used anesthetics are:

1. ultracaine;
2. ubistezin;
3. septanest;
4. Scandonest.

The most effective of them is ultracaine. It contains the anesthetic articaine and epinephrine, which prolongs the effect of anesthesia and reduces the toxicity of the main component. Safe properties allow the drug to be used to treat children and pregnant women.

The action and composition of ubistezin and septanest are almost similar to ultracaine. Scandonest is made on the basis of mepivacaine. This drug does not contain preservatives or adrenaline.

Therefore, if the patient is intolerant to anesthetics with adrenaline, then this drug is used.

Most common complications

Despite the frequency of the anesthesia procedure, complications can sometimes occur. They can be caused by both errors in the work of the attending physician and the behavior of the patient himself.

The most likely complications after the procedure are shown in the table.

Before anesthesia, it is important not to drink alcoholic beverages, as they reduce the effectiveness of the painkiller. It is recommended to take a sedative the night before.

You should not attend an appointment if the patient has a cold or flu. Before going to the doctor, in order to avoid complications, patients should take into account that during menstruation, sensitivity to anesthetic drugs increases.

After the procedure, patients should not eat too hot food, as this may cause burns. Swelling and pain after anesthesia should not frighten the patient; these symptoms should subside within a couple of hours. If the condition worsens, you should consult a doctor.

Anesthesia

During anesthesia, the patient remains unconscious. Dental treatment is performed under anesthesia if there is a need for serious and long-term intervention. For example, general anesthesia used to remove several teeth or during jaw surgery.

In addition, you cannot do without anesthesia if the patient cannot adequately respond to the actions of the dentist due to fear or mental illness. Another indication for anesthesia is the patient’s high gag reflex.

General anesthesia is contraindicated if the patient has the following diseases:

• of cardio-vascular system;
• respiratory system (eg asthma, pneumonia);
• infectious nature.

Photo: How the procedure is done

Thus, anesthesia and various techniques for its implementation are a very effective and at the same time responsible procedure. An essential advantage of dental treatment accompanied by anesthesia is that the patient does not have to suffer from unbearable pain.