Dental anesthesia

Dental anesthesia (or dental anaesthesia)

is a field of anesthesia that includes not
only local anesthetics but sedation and
general anesthesia.

Dental anesthesia
MeSH D000766

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), bupivacaine (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
Nerve block — a common form of local
dental anesthesia; blocks the reception
of pain in one region of the mouth at a
time.
Infiltration given inferior to the root of
the tooth involved in the dental work;
used usually for minor procedures such
as restorations. However, also used for
periodontal surgeries, and with the
advent of anesthetics that diffuse more
readily through the bone, such as
articaine, infiltration can be used
routinely for most extractions, grafting
and even implant placements.
Palatal block given into the hard palate
using pressure anesthesia; useful in
anesthetizing the palate side of the
maxillary teeth.
Intraosseous an injection of local
anesthetic given directly into the
osseous (bone) structure of the tooth
for more involved dental procedures
such as surgery or endodontic therapy
(root canals).
Intrapulpal an injection of local
anesthetic given directly into the pulp of
the tooth to completely desensitize the
tooth.
Pressure anesthesia — pressure with a
cotton swab in the area to distract the
nerve sensation of pain when the needle
enters certain areas such as palatal
tissue.[1]
Electrical nerve blocks— a technology
that involves using electric current to
block the reception or generation of pain
 signals; the pain control can be
transient.
Acupuncture or accupressure An
alternative to chemical or electrical
blocks, but is rarely used.

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[4]. It consists
of a breech-loading syringe fitted with a
sealed cartridge containing anesthetic
solution.

In the UK and Ireland, manually operated

hand syringes to inject Lidocaine in to
patient's gums. [5][6][7]
Other anesthetics used in
dentistry
Topical anesthetics benzocaine,
eugenol, and forms of xylocaine are
used topically to numb various areas
before injections or other minor
procedures.
Nitrous oxide (N2O), also known as
"laughing gas", easily crosses the alveoli
of the lung and is dissolved into the
passing blood, where it travels to the
brain, leaving a dissociated and
euphoric feeling in most cases. Nitrous
oxide is used in combination with
oxygen. Often (especially with children)
a sweet-smelling fruity scent similar to
an auto scent is used with the gas to
inspire deep inhalation.
General anesthesia drugs such as
midazolam, ketamine, propofol and
fentanyl are used to put a person in a
twilight sleep or render them completely
unconscious and unaware of pain.
Dentists who have completed a training
program in anesthesiology may also
administer general IV and inhalation
anesthetic agents.
Nebotamine, a drug with similar effects
to ketamine, is injected into the anterior
lingual glands blocking action potentials
from sending signals to the myelinated
nerve. The potency of the anesthetic is
directly related to its lipid solubility,
since 90% of the nerve cell membrane is
composed of lipid.
Midazolam (Versed), a drug that
represses memories of the procedure, is
usually given two hours prior to the
procedure in combination with Tylenol in
general anesthesia so the person will go
home with no memories of being in
surgery.
Sevoflurane gas in combination with
nitrous oxide and oxygen is often used
during general anesthesia followed by
the use of isoflurane gas to maintain
anesthesia during the procedure. In
children sweet fruity scents are often
used with the gases to inspire deep
inhalation. Scents come in cherry, apple,
bubblegum, watermelon, etc...
Propofol, a drug with similar effects to
Sodium Pentathol, is often used through
intravenous infusion through an IV
during general anesthesia after gasses
are initiated.
Morphine is often used to control pain
during the dental surgery under general
anesthesia. The morphine is usually
administered through IV.
 Ketorolac is often administered through
IV to suppress both pain and
inflammation while under general
anesthesia.

Other drugs used in

combination with general
anesthesia in dentistry
Decadron a steroid is often
administered through IV to suppress
inflammation and swelling resulting
during the surgery while under general
anesthesia.
Ondansetron brand named Zofran is
often administered to prevent nausea
during the surgery which may result
 from the blood draining into the
stomach while under general
anesthesia, or it is given after the
procedure for postoperative nausea
which may result from the anesthesia
itself which was administered.

See also
Dental surgery
American Society of Dentist
Anesthesiologists
American Dental Board of
Anesthesiology
National Dental Board of
Anesthesiology
 American Dental Society of
Anesthesiology

References
1. Illustrated Anatomy of the Head and
Neck, Fehrenbach and Herring, Elsevier,
2012, page 216
2. Local Anesthesia for the Dental
Hygienist, Logothetis, Elsevier, 2012
3. Local Anesthesia for the Dental
Hygienist, Logothetis, Elsevier, 2012
4. "Lidocaine Hydrochloride (Local)
Monograph for Professionals -
Drugs.com" .
5. Zakrzewska, J. M.; Boon, E. C. (23
August 2003). "Use of safety dental
syringes in British and Irish dental
schools" . British Dental Journal. 195 (4):
207–209. doi:10.1038/sj.bdj.4810445 –
via www.nature.com.
6. Zakrzewska, J. M.; Greenwood, I.;
Jackson, J. (27 January 2001). "Cross-
infection control: Introducing safety
syringes into a UK dental school – a
controlled study" . British Dental Journal.
190 (2): 88–92.
doi:10.1038/sj.bdj.4800891 – via
www.nature.com.
7. "Lidocaine Hydrochloride (Local)
Monograph for Professionals -
Drugs.com" .

External links
Endo T, Gabka J, Taubenheim L (January
2008). "Intraligamentary anesthesia:
benefits and limitations" . Quintessence
International. 39 (1): e15–25.
PMID 18551207 .

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