DENTAL ANESTHESIA


DENTAL ANESTHESIA and other LOCAL ANESTHETICS were a wonderful invention. They allow dental procedures which would otherwise be UNBEARABLE, to be performed in complete comfort.


Some of the commonly used dentist anesthetics are,

  • Lidocaine
  • Septocaine
  • Carbocaine
  • Citanest
  • Marcaine

Novocaine is a generic term for dental anesthetic, but is no longer used on a general scale.


UPPER TEETH: Upper teeth are usually easier to anesthetize than lower teeth because individual teeth can be anesthetized. The bone is also fairly porous, which allows easy diffusion of the anesthetic to the nerves.

The main branches of the maxillary nerve, are the:

  • Posterior Superior Alveolar (PSA)
  • Middle Superior Alveolar (MSA)
  • Anterior Superior Alveolar (ASA)

The diagram below shows these nerves. The dental anesthesia is administered near the tips of the roots, where the nerves enter the teeth.


The upper back teeth area is the easiest place to anesthetize, and is often the least painful.

The ROOF OF THE MOUTH is usually quite painful, but luckily does not need to be anesthetized for most routine dental work, with the exception of EXTRACTIONS.





LOWER TEETH: Anesthetizing the lower teeth is usually done by BLOCKING one nerve. This nerve innervates the whole side, as well as half of the tongue and lower lip. As the diagram shows below, theinferior alveolar nerve enters a foramen near the back of the mouth, which is where the dentist anesthetic is administered.

There is also a mental nerve, which is a branch of the inferior alveolar nerve, which exits from themental foramen. This nerve is also often anesthetized


PERIODONTAL LIGAMENT (PDL) INJECTION: This is a way to anesthetize single lower teeth, usually the molars. For example, if you are just having work done on one tooth in your lower jaw, a peridontal ligament injection can be done instead of a block injecton.

Benefits: It is virtually painless, takes effect very quickly, and does not last very long. It is also very localized to the tooth that is being worked on, so your lip, tongue, and adjacent teeth are not affected.

It takes about 2 minutes to administer, but literally as soon as the anesthetic is given, the tooth will be completely numb and can be worked on. Most patients are grateful that they are not numb for several hours after the procedure as well.

Drawbacks: Not all dentists do these routinely, because it is difficult to learn to do well.


DURATION: Dental anesthesia will last for over an hour, and depending on the amount administered, you may be numb for several hours after your dental appointment.


ORAQIX: Oraqix is a local dental anesthesia that is administered without a needle in the periodontal pockets, and sometimes can be adequate for scaling and root planing.

It is quick acting and lasts only about 30 minutes so you do not have to be numb hours after your appointment is done.


EPINEPHRINE IN DENTAL ANESTHESIA:

EPINEPHRINE

This is a substance which is NATURALLY PRODUCED BY YOUR BODY. So, if you think you are allergic to it, you are not. EVERYBODY produces it. EVERYBODY.

This, or similar component, is commonly mixed with dental anesthetics in a very minute quantity. This causes the anesthetic to be more PROFOUND, as well as longer lasting.

EPINEPHRINE IN PATIENTS WITH HEART CONDITIONS:

WHY NOT TO USE IT: Epinephrine can cause an increase in blood pressure, so some argue that it should not be used in patients with certain heart conditions. On the other hand, the amount in the anesthetic is MINIMAL compared to the amount the body produces in times of STRESS.

WHY TO USE IT: Since EPINEPHRINE makes the dental anesthetics more PROFOUND, some think that without the epinephrine in the anesthetic, the patient will not be as NUMB, and thus more STRESSED, causing the body to produce MORE epinephrine, which in turn could strain the heart more than the negligible amount in the anesthetic.


ALLERGIES: It is POSSIBLE to be allergic to certain anesthetics, but it is VERY UNCOMMON. If you did have a bad experience with an anesthetic, it was probably WHERE the anesthetic was administered, rather than WHAT was administered.

Novocaine was an anesthetic that was used many years ago, but is no longer used. It was what is called an ester type of anesthetic, which did have some allergic reactions.

Lidocaine, which is probably the most widely used dentist anesthetic, and most of the other dentist anesthetics today are amide type anesthetics, which have shown to have almost no allergic reactions.

POSSIBLE EXPERIENCES:

If the anesthetic is administered directly INTO A BLOOD VESSEL, you may feel your heart race for a minute.

If the needle HITS THE NERVE, you may feel a TWINGE down the are where the nerve innervates. This happens much more commonly on the lower, which may cause a shooting sensation down your lip and tongue.


ROOT CANAL TREATED TEETH :

Teeth that have had root canals no longer have nerves, and therefore no longer have any sensation (or should not). Because of this, teeth that have had root canals do not need to be anesthetized prior to having work done.

If the gums are going to be involved however, sometimes a dental anesthetic is necessary. But, if you don't like to get numb (and don't like the shots), see if your dentist will treat it without anesthetic.

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