Local Anaesthesia in Dentistry

LocalAnaesthesiainDentistryDepartmentofstomatology,Xuanwuhospital,CapitalMedicalUniversityTangLuDefinition•Localanestheticsaredrugsthatblocksensoryandmotornerveconductiontoproducetemporarylossofsensationwithoutlossofconsciousness.Localanestheticsarereadilyabsorbedthroughmucousmembranesanddamagedskin.IndicationsForLocalAnesthesia•Extractionofteeth•Apicetomy•Gingivectomy•Periodontalsurgery•Pulpectomy,Pulpotomy•Alveloplasty•Bonegrafting•Implants•Gingivoplasty•Treatmentofjawfracture(reductionandwiring)•Replacementofavulsedtooth•Dentalcyst•Removaloftumors•Pericoronitis•Stitchingandmuco-periostealflapping.RegularlyusedlocalanaestheticsOnsetofactionafterDurationofactionConcentrationofClinicCharacteristicProcaine5min90min1-2%AllergicreactionsLidocaine5min30-120min1-2%antiarrhythmicdrugBupivacaine8min3-7hrs0.5%Articaine5min1-3hrs4%withepinephrine(1:100000)HypertensionTetracaine5min20-40min1-2%TopicalanestheticsRegularlyusedlocalanesthesia•Topicalanaesthesia•Infiltrationanaesthesia•BlockanaesthesiaTopicalanaesthesiaInfiltrationanaesthesiaBlockanaesthesiaMiddlesuperioralveolarnerveblockPosteriorsuperioralveolarnerveblockDrawing(A)andphoto(B)ofthepalatalregionalblockanaesthesiaofthegreaterpalatinenerve.Carefulaspirationpriortoinjectionisrequired!Mandibularblockanaesthesiafromtherightcornerofthemouth(directtechnique).Themouthisopenedasmuchaspossibleandtheneedleisinsertedcarefullyonthelingualsideofthemandibularramussothat1cmoftheneedleremainsvisible.Theinjectionisgivenafteraspiration.ComplicationofLocalAnesthesia•Syncope•Toxicity•Allergicreactions•Infection•Hematoma•Nervedamage•Temporaryfacialparalysis•TemporarylockjawExtractionofteeth(Exodontia)Indicationoftoothextraction•Cariesreachingfarunderthegingivaorintotheroot•SeverelooseningduetoparodontitisIndicationoftoothextraction•Lackofspace•Orthodontallackofspace•Longitudinaldentalfractures•Rootcanalpreparationinviafalsa(rootwallwasdrilledthroughaccidentally)•Relocatedorexcessteeth•Severetippingofteeth•Severeanduncontrolleddiabeticpatients•Patientsundergoingradiationtherapyontheoralcavity•Infectedextractionsitewithacutecondition•Pericoronitis•Severecardiacproblems•Bleedingdisorders•PregnancyContraindicationoftoothextractionPreoperativepreparationInterrogationWhichtoothextraction?(Complaints)Whyextractthetooth?(indications)Whetherextractthetooth?(contraindications)examinationSystemicexamination、oralexamination、X-rayexamination（Contraindications）（Indications）（Preoperativepreparation）ToothextractioninstrumentscuretLocalanesthesiaPeelingawaythegumsLuxatethetoothPlacedextractionforcepsToothdislocationExaminationaftertoothextractionScrapingextractionwoundResettoothsocketCottonoppression30minutesTorsionShakePrincipleofthewedgeLeverageMaxillaryrootforcepesMandibularrootforcepesHealingofextractionwoundsExtractionwoundbleedingandclotformation（15～30min）Granulationtissueformation（24h～7d）Connectiveandepithelialtissuereplacementgranulationtissue（3d～1m）Theoriginalfibrousbonetissuereplacementconnectivetissue（38d～3m）Maturebonetissuereplacementimmaturebone,alveolarfunctionalalterations（3～6m）Complicationsduringextraction•Softtissueinjury•Fracturedroot•Alveolarinjury•Orantralcommunication•Bleedingafterextraction•DrysocketDrysocket•DefinitionDrysocket,oralveolarosteitis,isapainfulcomplicationofthehealingprocessfollowingtoothextractionthatresultsinexposureofthespacewherethetoothwasformerlylocated.•CauseDrysocketoccurswhentheprotectivebloodclotthatformsatthesiteoftoothextractionfallsout,isdamaged,ordissolves.Thisexposestheboneintheareaoftheemptytoothsocketandcausesseverediscomfort•Symptoms1.Severepainwithinafewdaysafteratoothextraction,2.Partialortotallossofthebloodclotatthetoothextractionsite,whichyoumaynoticeasanempty-looking(dry)socket,3.Visibleboneinthesocket,4.Painthatradiatesfromthesockettoyourear,eye,templeorneckonthesamesideofyourfaceastheextraction,5.Badbreathorafoulodorcomingfromyourmouth,6.Unpleasanttasteinyourmouth,7.Swollenlymphnodesaroundyourjaworneck,8.Slightfever•TreatmentTreatmentofdrysocketismainlygearedtowardreducingitssymptoms,particularlypain.1.Medicateddressingsandpastes.Thisisthemainwaytotreatdrysocket.2.Flushingoutthesockettoremoveanyfoodparticlesorotherdebristhathascollectedinthesocketandthatcontributestopainorinfection.3.Painmedication.4.Self-care.Conclusion•DefinitionofLocalanesthetics•IndicationsForLocalAnesthesia•Regularlyusedlocalanesthesia•ComplicationofLocalanesthesia•Indicationoftoothextraction•Contraindicationoftoothextaction•Complicationoftoothextraction•Drysocket’sdefinition,symptoms,andtreatment