Dental Pharmacology 11

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Anesthetic agents

Inhalation sedation

Antianxiety agents


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The practice of various psychological, physical, andchemical approaches to the prevention andtreatment of preoperative, operative, andpostoperative anxiety and pain to allow dentaltreatment to occur.

Psychological strategies should include simplerelaxation techniques for the anxious patient andmore comprehensive behavioral techniques tocontrol pain

Methods of pain control Anesthetic agents

Inhalation sedation

Antianxiety agents

Intravenous sedation

General anesthesia

IntroductionIntroduction


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Topical Anesthesia provides a temporarynumbing effect on nerve endings that are

located on the surface of the oral mucosa.

Supplied as: Ointments

Liquids

Sprays

AnestheticAgentsAnestheticAgents


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local anesthesia the elimination ofsensation, especially pain, in one part of thebody by the topical application or regionalinjection of a drug.

Note: Although the use of local anesthetics isthe foundation of pain control in dentistry andhas a long record of safety, dentists mustalways be aware of the maximum, safe

dosage limits for each patient. Large doses oflocal anesthetics in themselves may result incentral nervous system depression especiallyin combination with sedative agents.

LocalAnesthesiaLocalAnesthesia


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Local anesthesia temporarily blocks thenormal generation and conduction action of

the nerve impulses.

This happens in theAXON

wall by blockingthe sodium channels.

Local anesthesia is obtained by injecting

the anesthetic agent near the nerve in the

area intended for dental treatment.

Method ofActionMethod ofAction


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Length of time from induction until thereversal process is complete.

Short-acting:

Local anesthetic agent lasts less than 30 minutes. Intermediate-acting:

Local anesthetic agent lasts about 60 minutes.

Long-acting:

Local anesthetic agent lasts longer than 90

minutes.

DurationDuration


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Criteria foruse: Prolongs the duration and increases depth of action of an

anesthetic agent by decreasing the blood flow in the

immediate area of the injection.

Decreases bleeding in the area during surgical procedures.

Types:

Epinephrine

Norepinephrine

Contraindications for the use of vasoconstrictors

Recent coronary artery bypass surgery.

Untreated or uncontrolled severe hypertension.

Untreated or uncontrolled congestive heart failure.

VasoconstrictorVasoconstrictor


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Lidocaine 2% with epinephrine 1:80 000 Prilocaine 3% with epinephrine 1:300 000

Prilocaine 4%

Articaine 4% with epinephrine 1:100 000 Other local anesthetic agents less commonly

used are mepivacaine, which is shorter

acting, and bupivacaine, which is a long-

acting anesthetic and may act for 6-8 hours,

procaine, benzocaine and lignocaine.

Commonly used agentsCommonly used agents


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Maximum safe doses:

Calculated on the basis of possible effects of LA and thevasoconstrictor.

Lidocaine with epinephrine 4.4 mg\kg

prilocaine 6 mg\kg

Articaine 7 mg\kgThese figures when translated into volumes of the LA

solution for a fit, healthy patient of average weight,

suggest the following:

2% Lidocaine with epinephrine 6-7 cartridges of 2.2ml 3% prilocaine with epinephrine 5-6 cartridges of 2.2ml

4% prilocaine 4 cartridges of 2.2ml

4% articaine with epinephrine 4 cartridges of 2.2ml


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Table 37-2 LocalAnesthesia Setup: AnestheticSyringe


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A noninvasive method to block pain electronicallyby using a low current of electricity through

contact pads that target a specific electronic

waveform directly to the nerve bundle at the root

of the tooth. Benefits to the patient:

No needles.

No post-operative numbness or swelling.

Chemical-free method of anesthesia. No risk of cross-contamination.

Reduces fear and anxiety.

Patients have control over their own comfort level.

ElectronicAnesthesiaElectronicAnesthesia


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Nitrous oxide/oxygen (NO/O)is acombination of these gases that the patient

inhales to help eliminate fear and to help the

patient relax.

Effects Non addictive.

Easy onset, minimal side effects, and rapid recovery.

Produces stage I anesthesia.

Dulls the perception of pain.

Inhalation SedationInhalation Sedation


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Pregnancy: First trimester Nasal obstruction: Problems inhaling

through the nose

Emphysema: Increased O Multiple sclerosis: Breathing difficulties

Emotional stability: Altered perception of

reality

Contraindication of UsingNO/O

Contraindication of UsingN

O/O


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Used only for patient treatment. Never administered for recreational

purposes.

How to reduce NO hazards to dental

personnel Use a scavenger system.

Use a patient mask that fits well.

Discourage patients from talking.

Vent gas outside the building.

Routinely inspect equipment and hoses for leaks.

Use an NO monitoring badge system.

Exposure to Nitrous OxideExposure to Nitrous Oxide


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For the relief of anxiety.

Sedatives

Criteria foruse:

Patients are very nervous about a procedure.

Procedures are long or difficult.

Mentally challenged patients.

Very young children requiring extensive treatment.

AntianxietyAgentsAntianxietyAgents


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Commonly prescribed:

Secobarbital sodium (Seconal)

Chlordiazepoxide HCl (Librium)

Diazepam (Valium) Chloral hydrate (Noctec): For children

SedativesSedatives

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Dental Pharmacology 11