AHMED LABIB

Pain is an unpleasant sensation

that is experienced by the patient;

however, an interpretation of pain

always exists, which is

disproportionate to the

stimulation.

Methods of pain control:

Raising the pain threshold by using drugs of analgesic nature.

Using cortical depressants (general anesthesia).

Using subcortical depressants either barbiturates or non-barbiturates sedation.

Blocking the pathway of painful

stimuli by means of local anesthesia,

which is considered one of the effective

means of relieving dental pain.

Local anesthetic agents are esters of

amino benzoic acid ,either:

Para group (as Novocaine,

Monocaine, Pentocaine).

Meta group (as Uracaine, Primacaine).

Non-ester types of local anesthesia are

also available such as Xylocaine and

carbocaine.

The problem of inadequate pain

control during endodontic treatment is

explained through alterations in the

pulp and periapical tissues.

Inflammation of pulpal and periapical

tissues leads to decrease of tissue pH below

normal .

This decreased pH will lead to incomplete

dissociation of the anesthetic solution

resulting in weak anesthetic effect.

Techniques of local anesthesia

in endodontics

1-Local infiltration anesthesia

The tip of 25 –27-gauge needle is pushed through the mucosa until the fibrous periosteal tissue overlying the bone is pierced in the area of root apex.

Then the anesthetic solution is deposited beneath the periostium.

2-Regional nerve block

Nerve block anesthesia is achieved by depositing the local anesthetic solution close to the main nerve trunk.

Nerve block anesthesia is more successful when the infiltrating solution (anesthetic solution) is deposited some distance from the inflamed or infected tissues.

II- Supplementary techniques

Complete anesthesia of pulp tissue is necessary if vital pulp tissue is to be removed without pain. This requires supplementary injections beside the routine infiltration or nerve block anesthesia.

It is accomplished by passing the needle tip through the previously anaesthetized gingival papilla and thin cortical plate, penetrating into the cancellous bone of inter dental septum.

Few drops of anesthetic solution are deposited under pressure.

Two separate inter septal injections are usually used, one mesial and one distal to the tooth to be anaesthetized.

The angulation of the needle should be 45 to

the long axis of the tooth.

The needle should contact bone at the height

of the interdental crest of bone where the

cortical layer is thinnest and most easily

penetrated, by rotation of the needles as it

pressed into the crystal bone.

Perforating the alveolar plate of bones using

Busch power reamer if the dentist cannot

penetrate the bone by the needle. Through this

entrance, a needle can enter the cancellous

bone and a solution deposited under pressure

to anaesthetize the particularly refractory

cases.

This technique depends on the injection of the anesthetic solution into the pulp tissue itself.

Profound anesthesia will only be obtained if a drop of anesthetic solution is deposited directly into the partially anesthetized pulp.

The tooth is isolated and any debris in the area of the pulp exposure is removed.

A sharp explorer is used to pinpoint the

exposure, then the needle deliver few drops

of anesthetic solution into the pulp tissue.

This profoundly anesthetizes the pulp

tissue.

Additional intrapulpal injections are necessary to anaesthetize completely the deeper tissue within the root canal(s); the needle must fit tightly in the canal.

Technique

The needle is inserted at 30 angle, wedged with force into the periodontal ligament space between crystal bone and root surface.

The fingers of the operator should support the needle to prevent buckling, and then the anesthetic solution is injected with maximal pressure on mesial and distal surfaces of the treated tooth.

Thank you, merci, gracias,obrigado, grazzie, danke, arigato,

kitos, shukran, danku, shishie, graciñas, moltes gracies, yuspajara, spassiba, dankie, tak, eskerrik asko, tesekkür, motshakeram, efkaristo,

dziekuje, aguije, maururu, ramsammita, salamat, ngiyabonga,

ke yaleboha …

THANK YOU