Many citizens in almost every country in the world are afraid of dentists. Basically, fear is due to thoughts that you have to endure terrible pain, which will inevitably arise in the process of treating a tooth. However, in our time, when performing most manipulations in the oral cavity, local anesthesia is performed. In dentistry, anesthesia is a complex and responsible procedure. Consider what drugs doctors use, in what cases anesthesia is performed, what side effects can be.
Introduction to Local Anesthesia
Previously, pain-free dental procedures were only a dream of mankind for many centuries. When the anesthetic properties of cocaine and other drugs were discovered, it became possible to develop different methods of anesthesia. The composition of funds is different. The doctor mustchoose them for each patient individually, so the risk of adverse reactions is minimal. However, no one is immune from mistakes.
Painkillers currently in use in dentistry are in their fifth generation. However, the requirements of patients for the conditions of treatment continue to grow steadily. Many are interested in what local complications can occur with local anesthesia in dentistry.
It should be clarified that anesthesia has an important difference from anesthesia. When it is performed, the tissue in a certain place of the human body is affected, which at the same time loses sensitivity, but the patient himself remains conscious.
In any modern dental clinic, such a procedure is treated very responsibly. There are even special standards according to which these manipulations must be carried out efficiently, painlessly and as comfortably as possible for patients.
Indications for anesthesia
To avoid local complications with local anesthesia in dentistry, you should know a number of indications for this procedure.
There is a list of certain situations where anesthesia is mandatory:
- Treatment of the advanced stage of caries.
- Removal of one or more teeth, including debris, root.
- Manipulations in cases where the teeth have changed their location or direction of growth.
- Inflammation of the bone skeleton or soft tissuespurulent nature.
- Temporomandibular joint contracture.
- Performing plastic surgery - piercing (for example, tongue), botuloplasty, etc.
- Inflammatory or degenerative lesions of the nervous peripheral system (neuritis).
- Palliative treatment in case of damage to the tissues of the oral cavity by malignant tumors.
Contraindications
It should be understood that anesthetics, like any medical drug, have a number of contraindications. The following situations can be distinguished:
- Individual intolerance to the components of anesthetics.
- Presence of myasthenia gravis, hypotension.
- Serious diseases of important internal organs (kidneys, liver).
- Pathology in the injection area - infiltrates, cavity formations with accumulation of purulent mass, ulcers, erosions and other defects.
The listed contraindications should be known in order to avoid mistakes and complications of local anesthesia in dentistry. If the anesthetic contains a vasoconstrictor component, then their use is prohibited in the following diseases and conditions:
- Pregnancy.
- Breastfeeding.
- Arrhythmia.
- Angle-closure glaucoma.
- Heart failure.
- Diabetes mellitus.
In addition, it is forbidden to perform anesthesia in dental clinics if patients are taking beta-blockers, TAGs, MAO inhibitors.
Types of anesthesia
In the field of dentistry, there are sever altypes of pain relief procedures:
- Infiltration.
- Applique.
- Conductor.
- Computer.
- Carpool.
Each method has its own characteristics, including both indications and contraindications. The same methods are used for children. Very young patients (2 or 3 years old) are given short-term anesthesia with Propofol.
This method of local anesthesia in pediatric dentistry is due to the fact that very young patients do not understand the essence of what is happening and simply will not let the doctor do his job.
Infiltration
This method occupies a leading place in dentistry. Anesthesia is performed using a syringe. The drug is injected into soft tissues with a needle, gradually (as sensitivity is lost) moving it deeper until the so-called lemon peel appears on the gum.
Loss of sensation occurs within minutes. The duration of exposure is largely due to the type of anesthetic, its dosage, the presence of vasoconstrictor components in the preparation.
The technique itself has two subspecies: intraosseous and intraligamentary. They also have a wide range of applications. For their implementation, a special syringe is used.
Applique
This method of local anesthesia in dentistry allows anesthesia of superficial soft tissues to a shallow depth (from 1 to 3 mm). drugs,used for application anesthesia, characterized by rapid penetration into the layers of the mucosa.
During the procedure, the medication is applied in the form of a gel, aerosol or emulsion. For this, the dried mucosa is lubricated with the drug, or it is sprayed using a spray gun. The procedure is performed without injection. This type of local anesthesia is relevant in the following cases:
- When to anesthetize the needle insertion site prior to injection.
- To painlessly remove milk teeth.
- For removing small neoplasms from soft tissues.
For the treatment of stomatitis in children, special pastes and gels are used, which is also an application type of anesthesia.
Conductor
This type of anesthesia is rarely done. The drug is administered in close proximity to the peripheral nerve trunk. Due to this, anesthesia of the entire area for which he is responsible occurs. The desired effect occurs after 10-15 minutes and lasts for several hours.
This type of local anesthesia in dentistry is relevant in cases where you need to anesthetize a large area. Another difference of the conductive method from others is that a smaller amount of anesthetic is used, but in a much higher concentration.
Torusal and mandibular anesthesia are provided for the lower jaw. In this case, blockinginferior lunar and lingual nerve. Patients feel numbness of the entire half of the lower jaw, including the lip, chin, tongue.
In most cases, when tuberal anesthesia is performed, a hematoma is formed. The procedure is difficult to perform, so there is a high degree of possibility of complications.
Computer
Mistakes and complications of local anesthesia in dentistry are largely due to the human factor. If the anesthesia process is carried out using a computer using a special electronic system, which includes a system unit and a handpiece, troubles can be avoided. In this case, due to the special design of the needle, the puncture is done as painlessly as possible. This also applies to perforation of the cortical bone plate.
The dosage of the administered drug is fully controlled by the electronic "brain", which eliminates the human factor.
Carpool
This type of anesthesia is carried out using special tools - carpool syringes. These are reusable devices. They have a metal body and are equipped with a plunger and a needle that is slightly thinner than conventional injection needles.
The drug is in special containers-carpules, which are placed in the body of the instrument.
Mistakes in local anesthesia in dentistry due to human error
Practically all activities are carried out by people, not machines, although they are also exploited to a certain extent. For this reason, the human factor cannot be ruled out.
And dentists can make mistakes. The most severe complication that can be observed when performing local anesthesia is the erroneous administration of substances of a different kind instead of anesthetics (hydrogen peroxide, ethyl alcohol, calcium chloride, silver nitrate, etc.). Some of them are protoplasmic poisons, others are isotonic solutions.
Ingestion of these substances instantly provokes acute pain in the patient. According to the stories of the victims, not all specialists take into account this important factor, continuing to introduce the wrong anesthetics for local anesthesia in dentistry.
The most common complication after such an "anesthesia" is soft tissue necrosis at the injection site. In addition, the patient may experience severe pain, nausea, dizziness, allergic reactions, including breathing problems. Treatment in dental clinics depends on how well the services are provided.
Factors that lead to erroneous administration of the wrong drug can be different. Some of them indicate poor training of specialists or unwillingness to take responsibility:
- Negligence.
- Violation of drug storage conditions.
- Ampoules have erased inscriptions.
- Fatigue, depression, illness and other negative dental conditions.
If during the course of general and local anesthesia in dentistry there is a sharp pain, a feeling of heat, and subsequentlytissue necrosis, one conclusion can be drawn: the dentist made a mistake in choosing an anesthetic.
Complications after anesthesia
The underlying factor in many adverse reactions after pain relief procedures may be related to trauma due to the advancement of the needle through soft tissue. The type of anesthetic administered is also affected. The reaction of the patient's body can be:
- Local.
- System.
Many local effects are characterized by a short duration of manifestation, but can cause serious discomfort to patients. Some unpleasant sensations last a matter of seconds (pain, burning), while others do not go away for several hours or days (trismus, hematoma, infection, edema, paresis of the facial nerve).
Complications of a systemic nature after local anesthesia in dentistry can occur in the form of psychogenic reactions, the appearance of which is not due to the action of anesthetics, but directly to the fact of their administration. Most often in such cases, there is a short-term fainting of the patient.
Needle breakage
Usually, many clinics use modern disposable dental needles made of stainless steel. For this reason, it is extremely rare to encounter breakage during the administration of the drug.
However, the human factor on the part of the patient cannot be ruled out, which can inadvertently twitch during the penetration of the needle into soft tissues when it comes into contact with the periosteum.
To avoid thisincident, specialists need to check the integrity of the syringe and its components before injection. It is also necessary to warn the patient about the injection, and the needle should not penetrate into the soft tissues for its entire length. If the needle breaks during local anesthesia in dentistry, the fragment remaining in the patient's tissues should be immediately removed. If the usual method (forceps) fails to do this, then the procedure is carried out using X-ray control.
Allergic reaction
This complication may occur due to individual intolerance to the components of the drug (lidocaine, novocaine). The appearance of an undesirable reaction in this case does not depend on the type of anesthesia and may appear even during the application.
If there is a burning sensation, itching, redness or swelling of the mucosa, the effect of the anesthetic should be stopped. You can remove the symptoms with the help of antihistamines.
Paresthesia
This term should be understood as the phenomenon of residual anesthesia. As a rule, common complications with local anesthesia in dentistry occur when a nerve is damaged.
This can happen for various reasons:
- Under the influence of the needle itself.
- Injection too fast.
- Too high concentration of anesthetic composition.
After the introduction, the sensitivity of the area that is innervated by this nerve completely disappears. Any additional and urgentmedical procedures are not required here. Within 7-14 days everything will return to normal. The duration of full recovery will depend on the degree of damage to the nerve ending.
Hematoma
This is a limited collection of blood in case of damage to a blood vessel. Such a complication may occur during conduction or infiltration anesthesia of the lower jaw due to rich vascularization.
Blood clotting disorders and arterial hypertension should be considered as risk factors for local anesthesia in surgical dentistry. If the doctor notices the first signs of hematoma development, he should take appropriate measures in a timely manner:
- Stop exerting mechanical pressure on the area with the damaged vessel.
- Apply cold to the jaw in the area of damage to the soft tissues of the oral region.
- Perform local administration of vasoconstrictors.
The patient can be allowed to go home only after the doctor makes sure that the hematoma has stopped growing. As for scheduled dental procedures, they are being postponed for a few days.
Conclusion
Complications after local anesthesia in dentistry can happen not only because of a medical error. In many dental clinics, specialists give patients clear recommendations that they do not always try to follow.
There are certain preventive measures that all dentists should adhere to:
- Follow the needle insertion technique.
- Select drugs based on allergic history.
- Monitor the expiration date of used medicines and the integrity of their packages.
- Use only disposable instruments.
- Follow the rules of asepsis and antisepsis.
- Always warn patients before injection.
Clients of dental clinics should follow all the recommendations of doctors for caring for the area of intervention.
If any pathological symptoms are detected, you should contact the doctor who performed anesthesia to determine the further treatment regimen.
