Many citizens in almost every country in the world are afraid of dentists. Basically, the fear is caused by thoughts that we 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 done. In dentistry, anesthesia is a complex and responsible procedure. Consider which drugs doctors use, in which cases they perform anesthesia, and what side effects may be.
General Information on Local Anesthesia
Earlier, carrying out dental procedures without pain was 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 the funds is different. The doctor must select them for each patient individually, so the risk of adverse reactions is minimal. However, no one is safe from mistakes.
Now used in dentistry anesthetics represent the fifth generation. However, patient requirements for treatment conditions continue to grow steadily. Many are interested in what local complications may occur with local anesthesia in dentistry.
It must be clarified that anesthesia has an important difference from anesthesia. When it is performed, it acts on the tissues in a certain place of the human body, which at the same time loses its sensitivity, but the patient himself remains conscious.
In any modern dental clinic, this procedure is very responsible. There are even special standards according to which these manipulations should be carried out qualitatively, painlessly and as comfortable as possible for patients.
Indications for anesthesia
To avoid local complications of local anesthesia in dentistry, you should know a number of indications for this procedure.
There is a list of certain situations when anesthesia is performed without fail:
- Treatment of advanced caries.
- Removal of one or more teeth, including debris, root.
- Manipulation in cases when the teeth have changed their location or side of growth.
- Inflammation of the bone skeleton or soft tissue of a purulent nature.
- Temporomandibular joint contracture.
- Carrying out plastic surgeries - piercing (e.g., tongue), botuloplasty, etc.
- Lesions of the nervous peripheral system of an inflammatory or degenerative nature (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 medicine, have a number of contraindications. The following situations can be distinguished:
- Individual intolerance to the components of anesthetics.
- The presence of myasthenia gravis, hypotension.
- Serious diseases of important internal organs (kidney, liver).
- Pathology in the injection area - infiltrates, abdominal masses with accumulation of purulent mass, ulcers, erosion 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.
- Breast-feeding.
- Arrhythmia.
- Angle-closure glaucoma.
- Heart failure.
- Diabetes.
In addition, it is forbidden to conduct anesthesia in dental clinics if patients take beta-blockers, TAG, MAO inhibitors.
Types of Anesthesia
In the field of dentistry, there are several types of anesthesia procedures:
- Infiltration.
- Application.
- Conductor.
- Computer.
- Karpulnaya.
Each method differs in its features, including both indications and contraindications. For children, the same methods are used. Very young patients (2 or 3 years) undergo short-term anesthesia with the help of the drug "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 allow the doctor to fulfill their duties.
Infiltration
This method takes a leading place in dentistry. Anesthesia is performed using a syringe. The drug is injected into the soft tissue with a needle, gradually (as the sensitivity decreases), moving it deeper until the so-called lemon peel appears on the gum.
Loss of sensation occurs within a few minutes. The duration of exposure is largely due to the type of anesthetic, its dosage, and 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 use, a special syringe.
Application
This method of local anesthesia in dentistry allows anesthesia of superficial soft tissues to a small depth (from 1 to 3 mm). The drugs used for application pain relief are 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. The procedure is carried out without an injection. This type of local anesthesia is relevant in the following cases:
- When it is necessary to anesthetize the area of the needle before the injection.
- To painlessly remove milk teeth.
- To remove small tumors from soft tissues.
To treat 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 the immediate vicinity of the nerve peripheral trunk. Due to this, there is anesthesia of the entire area for which he is responsible. The desired effect occurs in 10-15 minutes and lasts for several hours.
This type of local anesthesia in dentistry is relevant in cases where it is necessary to anesthetize a wide area. Another difference of the conductor method from others is that a smaller amount of anesthetic is used, but in a much higher concentration.
For the lower jaw, torusal and mandibular anesthesia are provided. In this case, the mandibular and lingual nerve are blocked. Patients feel numbness of the entire half of the lower jaw, including the lip, chin, tongue.
In most cases, a hematoma is formed when performing tubular anesthesia . The procedure is difficult to perform, so there is a high degree of likelihood of complications.
Computer
Errors and complications of local anesthesia in dentistry are largely due to the human factor. If you carry out the anesthesia process using a computer using a special electronic system, which includes the system unit and tip, trouble 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 plate of the bone.
The dosage of the administered drug is completely controlled by the electronic “brain”, which excludes the human factor.
Karpulnaya
This type of anesthesia is performed using special tools - carpul syringes. These are reusable devices. They have a metal body and are equipped with a piston and a needle, which is slightly thinner than the usual intended for injection.
The drug is in special containers-carps, which are placed in the tool body.
Errors of local anesthesia in dentistry due to the human factor
Almost any activity is 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 a mistake. The most serious complication that can be observed when performing local anesthesia is the erroneous introduction of substances of a different kind instead of anesthetics (hydrogen peroxide, ethyl alcohol, calcium chloride, silver nitrate, etc.). Some of them belong to protoplasmic poisons, others to isotonic solutions.
The ingress of the mentioned substances instantly provokes acute pain in the patient. If you believe 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 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 qualified the services are.
The factors that lead to the erroneous administration of the wrong drug may be different. Some of them indicate poor training of specialists or unwillingness to take responsibility:
- Negligence.
- Violation of storage conditions for drugs.
- Ampoules have erased inscriptions.
- Fatigue, depression, illness and other negative conditions of the dentist.
If during the general and local anesthesia in dentistry there was a sharp pain, a feeling of heat, and subsequently tissue necrosis was observed, one conclusion can be made: the dentist made a mistake in choosing an anesthetic.
Complications after anesthesia
A fundamental factor in many adverse reactions following an anesthesia procedure can be associated with trauma due to the movement of the needle through soft tissue. The type of anesthetic administered also affects. The reaction of the patient's body can be:
Many local effects are characterized by the short duration of the manifestation, but can cause serious discomfort to patients. Some unpleasant sensations last for a few seconds (pain, burning), while others do not pass 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 caused not by the action of anesthetics, but directly by the fact of their introduction. Most often in such cases, a short-term syncope of the patient is observed.
Breaking off the needle
Usually, many clinics use modern disposable dental needles made from stainless steel. For this reason, it is extremely rare to encounter a breakdown during the administration of the drug.
However, one cannot exclude the human factor on the part of the patient, which can accidentally twitch during the penetration of the needle into the soft tissue when it touches the periosteum.
To avoid such an incident, specialists need to check the integrity of the syringe and its components before injection. It is also necessary to warn the patient about an injection, and the needle should not penetrate into the soft tissues along its entire length. If the needle breaks during local anesthesia in dentistry, immediately remove the fragment remaining in the patient’s tissues. If the conventional method (with forceps) does not succeed, then the procedure is carried out using x-ray control.
Allergic reaction
Such a 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 when performing the application.
If there is a burning sensation, itching, redness or swelling of the mucous membrane appears, the effects of the anesthetic should be discontinued. You can remove the symptoms with antihistamines.
Paresthesia
Under this term should be understood the phenomenon of residual anesthesia. As a rule, general complications of local anesthesia in dentistry arise in cases where a nerve is damaged.
This can happen for various reasons:
- Under the influence of the needle itself.
- Too fast drug administration.
- Too much concentration of anesthetic.
After administration, the sensitivity of the area that is innervated by this nerve completely disappears. No additional and urgent medical procedures are required here. Within 7-14 days, everything will return to normal. The duration of a full recovery will depend on the degree of damage to the nerve ending.
Hematoma
This is a limited accumulation of blood in case of damage to a blood vessel. Such a complication can occur during conduction or infiltration anesthesia of the lower jaw due to rich vascularization.
As risk factors for local anesthesia in surgical dentistry, coagulation disorders and arterial hypertension should be considered. If a doctor notices the first signs of a hematoma, he should take appropriate measures in a timely manner:
- Stop applying mechanical pressure to the area with the damaged vessel.
- Apply cold to the jaw in the area of soft tissue damage to the mouth.
- Perform local administration of vasoconstrictors.
The patient can be allowed to go home only after the doctor is convinced that the hematoma has ceased to increase. As for the planned dental procedures, they are delayed for several 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 implement.
There are certain preventive measures that all dentists must adhere to:
- Follow the needle insertion technique.
- The selection of drugs should be based on an allergological history.
- Carry out monitoring regarding the shelf life of the medicines used and the integrity of their packaging.
- Use only disposable tools.
- Follow the rules of aseptic and antiseptic.
- Always warn patients before injection.
Dental clinic clients should follow all the recommendations of doctors to care for the area of intervention.
If any pathological symptoms are identified, you should consult the doctor who performed the anesthesia to determine the further treatment regimen.