Local Anesthesia

Topical, Patch, Infiltration, Block

PAIN CONTROL FACTORS
❂ High pain Threshold
• Hypo-reactive
» Low reaction to pain

❂ Low Pain Threshold

• Hyper-reactive
» High reaction to pain
Pain Reaction Depends On:

❂ Emotional State
❂ Degree of fatigue
❂ Apprehension
❂ Gender
❂ Fear
❂ Age
Local Anesthesia

❂ A drug which upon contact with nervous

❂ tissue renders that tissue incapable of

❂ transmitting an impulse on stimulation.

How Nerve Fibers Transmit
Painful Stimuli
❂ NF extension of single ❂ Stimulus reproduces
cell, nucleus is brain itself
❂ NF is in periphery of ❂ Stimulus called
body & responsible for impulse at this point
receiving initial pain ❂ Impulse proceeds
❂ Pain stimulus irritates along nerve
nerve ending ❂ Continuation of
❂ Creates series impulse called
changes conduction
❂ Brain recognizes pain
How Local Anesthetics Work
❂ Theory : Transmission of impulse along
nerve caused by alteration in nerve
membrane and LA agents alter integrity
factor
❂ Raises threshold for excitation of nerve
❂ Anesthetic must come in direct contact
with nerve tissues
How Local Anesthetics Work

❂ Motor nerves require higher concentration

of anesthetic to cause blockade than do
sensory nerves.

❂ Small fibers blocked earlier than large

fibers.
How Local Anesthetics Work

❂ Pain fibers ❂ The return of function

anesthetized before
those for ❂ in these fibers in in
temperature and
touch.
❂ reverse order.
Chemical Composition
❂ Esters of ❂ Non-ester types
aminobenzoic acid
• Novocaine • Xylocaine

• Monocaine • Dynacaine

• Pontocaine • Carbocaine

• Primacaine • Citanest Forte

Chemical Composition
❂ Clinical significance is not the difference

❂ in chemical composition

❂ but

❂ in allergic potential.
Purpose of Vasoconstrictors
❂ Reduces blood flow through injected area
so that rate of disappearance of local
anesthetic from tissues is reduced.
❂ This results in prolonged anesthesia and
lesser amount or concentration of LA to
produce desired results.
❂ Decrease incidence of toxicity of drug.
Toxicity depends amount in bloodstream.
Vasoconstrictors
❂ Commonly used in dentistry is
❂ Epinephrine--1 : 50,000 to 1 : 200,000

❂ Norepinephrine--1:30,000

❂ Neo-Synephrine--1:2,500

❂ Neo-Cobefrin--1:20,000
Two Basic Types of Injection
❂ Nerve Block: ❂ Infiltration:
Place LA adjacent to Main nerve bundle not
main nerve bundle so accessible OR reason
it will produce to anesthetize entire
anesthetized area area--agent can be
covered by deposited in area
distribution of the where pain emanates-
affected nerve only nerve in local
area affected
Block Anesthesia
❂ Bone of mandible ❂ Blood in anesthetic
dense carpule indicates
❂ Deposit solution near vessel punctured by
nerve needle
❂ Nerve close to artery ❂ DDS must aspirate
and vein before injection
❂ Injecting into vessel ❂ May take 20 minutes
can complicate for full effect
procedure
Block Anesthesia Effects
❂ Produces numbness
and tingling of lip
❂ Lip feels large and
swollen
❂ Tip and side of tongue
will tingle and
become numb
❂ Numbs only one side
of tongue
Areas of Anesthesia & Technique
❂ Mand ibu lar ( Inf er ior Alveol ar )
Nerv e B loc k supplies mandibular teeth is
the inferior alveolar-- can be blocked at
entrance to mandible at inferior alveolar
foramen
❂ Numbness & tingling of lip, anesth of
teeth,buccal gingiva from midline to 1st
PM,possible anesth of tongue same side
Areas of Anesthesia & Technique
❂ Ling ua l Nerv e B lo ck - Branch of
mandibular nerve which lies medial to
inferior alveolar nerve in area of inferior
alveolar foramen
❂ Produces numbness of lateral border of
tongue on same side, anterior two thirds
tongue, floor of mouth same side
Areas of Anesthesia & Technique
❂ Lo ng B uc ca l Ner ve Inject io n - nerve
lies within gingiva of 2nd & 3rd molars on
buccal side of mandible

❂ Performed by few drops placed in tissue

❂ Will anesth buccal gingiva from 1st

premolar to distal of 3rd molar area
Areas of Anesthesia & Technique
❂ Me ntal Ner ve B lock - object of block is to
interfere with nerve conduction along
mental nerve by placing anesth in mental
foramen -- seldom used
❂ Produces numbness of central and lateral
incisors, canine, and 1st premolar and
gingiva, lip, chin area
Areas of Anesthesia & Technique
❂ Pos teri or Superio r Al veolar
Inj ect io n - PSA
❂ Supplies innervation to maxillary sinus and
molar teeth, with exception of mesial
buccal root of first molar second buccal
gingiva around molar teeth
❂ Site is height of mucobuccal fold apex of
max 2nd molar,distal to zygomatic process
of maxilla
Areas of Anesthesia & Technique
❂ Mi dd le Superi or A lveol ar I nject ion -
❂ MSA block

❂ Nerve supplies premolar teeth and the

mesial buccal root of the first molar

❂ Site over apex of 1st premolar

Areas of Anesthesia & Technique
❂ Anterior Sup erior Alve ola r Inj ect io n
-

❂ Nerve supplies the incisors and canines

❂ Given slightly mesial to apex of canine -

bilateral to anesth six anterior teeth
Areas of Anesthesia & Technique
❂ Mi dd le Superi or A lveol ar I nject ion :

❂ Nerve supplies premolar teeth and mesial

buccal root of 1st molar

❂ Site over apex of 1st premolar

Areas of Anesthesia & Technique
❂ Anterior Sup erior Alve ola r Inj ect io n :

❂ Nerve supplies incisors and canines

❂ Site slightly mesial to apex of canine-

bilateral six anterior teeth
Areas of Anesthesia & Technique
❂ Grea ter P alat ine (Ant erior )
Inj ect io n : Nerve supplies mucosa of hard
palate opposite molar and premolar teeth
❂ Site opposite 2nd molar about 1 cm toward
midline of palate-greater palatine nerve
❂ Usually used forsurgical procedures
because palatal gingiva attaches to teeth-
will numb palatal area opposite M & PM
Anesthesia & Techniques
❂ Na sopal at ine Ner ve Inject ion : Nerve
emerges from nasopalatine (incisive)
canal to supply mucosa of palate opposite
incisors and canines
❂ Site is nasopalatine foramen- few drops
only
❂ Anesthetizes palatal mucosa opposite six
anterior teeth
Reactions to Local Anesthesia
❂ Syncopy ❂ Loss of blood flow-
fainting-psycho-
Trendelburg position

❂ High level of drug in

❂ Toxic
circulation-agitation-
restless-HR& BP up-
then CNS depression-
nonester have
depression only
Reactions to Local Anesthesia
❂ Allergic ❂ Immediate- target
lungs and circulatory
❂ Delayed-minor type-
hours to days after -
IM or IV or oral
antihistamines-
Benadryl 50 mg
eitherIM or PO
❂ Document patient
chart
Complications of Injections
❂ Injury to nerve ❂ Broken needle
• Inferior alveolar block • Infrequent,removal
• Burning sensation lip ❂ Infections
❂ Injury to blood vessels • previously used
• Torn vessel-hematoma needle
• warm rinse/warm • passage of needle thru
compress reduce infected area
swelling ❂ Idiosyncrasy
❂ Blanching of skin • unknown reaction
• spasm, time heals
Anesthetics Used In CCSU Clinic

❂ Carbocaine 2% with Neo-Cobefrin

• mepivacaine hydrochloride and levonordefrin

• 1:20,000
• No epinephrine
• Use for hypertensive patients
Anesthetics Used In CCSU Clinic
❂ Octocaine 100
• Lidocaine HCI 2% and Epinephrine 1:100,000

❂ 2% Xylocaine
• Lidocaine HCI and epinephrine 1:100,000
Indications for Use
❂ Dental Hygiene
• Scaling and root planing in deep periodontal
pockets
• Gingival curettage
• Extreme cases of soft tissue inflammation and
discomfort
• Instrumentation of extremely hypersensitive
teeth
Correct Documentation
❂ ALWAYS enter on procedures any
anesthesia used on patient

• 2% lidocaine1:100,000 epi 2 cc (Dr. Lemons)

RSP UR
Preparation for Local Anesthesia
❂ Sterile 2X2 gauze ❂ Long: mandible block
❂ cotton tip applicator ❂ Short: maxilla &
❂ topical anesthetic mandible infiltration
❂ aspirating syringe
❂ needle ❂ Gauge: larger number
❂ stick shield means smaller
diameter of needle
❂ anesthetic carpules
• eg. 27, 30
Procedure for Local Anesthesia

❂ See CCSU Clinic

Manual

❂ Section 5.12
Transoral Delivery Anesthesia

❂ Dentipatch
❂ 2 cm patch contains Lidocaine
❂ Acts on INTACT mucosa to produce local
anesthesia
❂ Anesthesia occurs within 2.5 minutes of
application and can last up to -present for
15 minute application period and 30
minutes after removal
Transoral Delivery Anesthesia
❂ Has one fifth level of intravenous dose
❂ Not for pregnant individual/nursing/child
❂ Reactions: rare, mild, taste
perversion,stomatitis,erythema,mucosal
reactions
❂ Gently dry area-remove clear protective
liner- allow patch to remain in place-no
longer than 15 minutes
Topical Anesthesia
❂ 20% Benzocaine in a water soluble base
❂ Can be liquid or gel
❂ Fast action
❂ Short duration
❂ Virtually no systemic absorption
❂ Apply to small area to be anesthetized
❂ Anesthesia accomplished 15 to 30 seconds