Contemporary anaesthesia enables total pain control in 90-99% cases. Nowadays anaesthesia application is recommended with respect to all painful dental procedures. Stress which is connected with a visit at a dental surgery results in the need for the patient to be psychologically and pharmacologically prepared for the dental operation. This preparatory procedure is called premedication. A skilfully conducted conversation is often sufficient means to release tension in the patient. However, in some cases it is necessary to administer sedatives or painkillers. The decision is always made by the general dental practitioner, who in certain cases might even recommend Martel lamp. In outpatient clinics, the effect of painless dental procedure is often achieved by means of local anaesthesia. General anaesthesia (narcosis) is applied in exceptional cases. Local anaesthesia alleviates the feeling of pain by means of inhibiting peripheral nerve conduction while the patient is fully conscious. The use of local dental anaesthetics such as lidocaine, bupivacaine, mepivacaine, articaine is well-established in clinical dental practice. The majority of anaesthetics cause vasodilation; in order to prevent it, we introduce to the anaesthetics vessel contracting agents: adrenaline, L-noradrenaline, suprarenine. Localised vascocontraction slows the absorbtion of the medicine, thus prolonging its activity and decreasing toxicity. In addition, during surgical procedures, it stems bleeding in the operative field. Anaesthesia in conjunction with the use of vessel contracting agents should be applied with caution and it cannot be administered with all patients. Contraindications: myocardial failure, coronary failure, heart arrhythmia, hypertension, hyperthyreosis, glaucoma, uncontrolled diabetes, pregnancy, taking MAO inhibitors, tricyclic antidepressants or phenotiazine by the patient. Therefore it is vital to provide the dentist with general information about the state of health. In the case of patients with allergic history, it is recommended to perform allergy tests.
Local anaesthesia techniques.
Depending on the method of local anaesthetic application, we distinguish: surface anaesthesia, infiltration anaesthesia, intramural anaesthesia, block anaesthesia.
Surface anaesthesia involves covering of oral mucose with anaesthetic in the form of aerosol, gel, ointment, or solution. Due to weak anaesthetic action, it is mainly used with minor pain procedures, such as: exploratory puncture, intraoral incision of submucous abscess, extraction of considerably mobile milk tooth. This technique might be also used to insensibilize the place of insertion of a needle when infiltration or block anaesthesia are applied.
Infiltration anaesthesia involves jet injection of tissues with anaesthetic solution. This anaesthesia is sufficient for painless extraction of or treatment of upper teeth. Outer bone lamella of alveolar process is thin and porous, which fosters the absorbtion of the anaesthetic into the bone. The situation differs in the case of lower jaw, as the structure of the bone lamella enables anaesthetic solution to effectively penetrate only the anterior part of alveolar process, hence infiltration anaesthesia is effective solely with respect to incisors. Other cases require block anaesthesia.
Intramural anaesthesia involves injection of anaesthetic liquid into the periodontium fissure. It is performed by means of special high-pressure injectors (Paroject, Citoject, Ligmaject). Intramural anaesthesia is mainly used in conservative dentistry. The merits of this technique: small dose of anaesthetic, rapid onset of anaesthesia, insensibilization of only one tooth. Insufficient hygiene or parodontitis constitute contraindications for induction of this method of anaesthesia. Block anaesthesia involves disruption of nerve conduction in the nerve stem, contrary to the previously presented methods, where the disruption concerned nerve tips. For this purpose anaesthetic is introduced in the area or within the limits of the nerve stem. This method of anaesthesia is most often used with respect to lower alveolar nerve. "Elimination" of this nerve enables painless treatment of teeth and alveolar process.
In 1970s special syringe without needle was introduced. However, the use of such syringes in dental practice is not well-established in Poland. The application involves injecting narrow jet of anaesthetic solution under high pressure (150 kg/cm 2). Although a needle is not used, the moment of medicine application is unpleasant for the patient. Not that long ago it would be unthinkable that local anaesthesia can be applied by means of a microchip. Today it is a fact. "The Wand" is a new computer method of local anaesthesia application, which has already been available on the market for several years. This tool enables to perform all kinds of local dental anaesthesia. Its greatest advantage is the possibility to administer anaesthetic with practically no pain. Administering anaesthetic with the use of classical syringe is accompanied by the unpleasant feeling of tissues being stretched by anaesthetic solution. This phenomenon might be eliminated by microchip control of anaesthetic application. For those terrified of dentists, we offer dental procedures with the use of nitrous oxide (laughing gas).
