Instructor:-
Tamirat Tadesse(Dr)
Anesthetic consideration in
dental practice
History of Anesthesia
Horace Wells, a dentist in Connecticut, U.S.A.
founded anesthesia
Wells was astounded to see a man inhale
Nitrous Oxide and despite the man’s
injuries, the latter apparently felt no
pain. He pursued his studies on nitrous
oxide from where general anesthesia was
born.
What is anesthesia?
Anesthesia
Anny –absence absence of
Esthesia-pain pain
Traditionally, it means the condition of
having sensation blocked.
This allows patients to undergo surgery and
other procedures without the distress and
pain they would otherwise experience
GENERAL ANESTHESIA
1. Inhalation Anesthesia
- nitrous oxide, ether, chloroform,
ethylene, cyclopropane, ethyl chloride
- inhalation anesthesia not widely used:
trichlorethylene & divinyl ether
2. Intratracheal Anesthesia
3. Intravenous Anesthesia
4. Rectal Anesthesia
Regional Anesthesia
injection near a cluster of nerves to numb the
area of your body that requires surgery
may remain awake, or you may be given a
sedative
Spinal analgesia, (or commonly called spinal
anesthesia or sub-arachnoid block (S.A.B.)) is a
form of regional anaesthesia involving injection
of a local anaesthetic into the cerebrospinal
fluid (CSF), generally through a long, fine
needle, usually 3.5 inches long.
Local Anesthesia
drugs that have little or no irritating
effects when injected into the tissues, and
that will temporarily interrupt
conduction when absorbed into the nerve
produce a loss of function in pain,
temperature, touch, proprioception, and
skeletal muscle tone.
anesthesia of a small part of the body
Infiltration and block anesthesia
Method of Action
Local anesthesia temporarily blocks the
normal generation and conduction action of
the nerve impulses.
Local anesthesia is obtained by injecting the
anesthetic agent near the nerve in the area
intended for dental treatment.
Induction time is the length of time from the
injection of the anesthetic solution to
complete and effective conduction blockage.
Duration
Length of time from induction until the
reversal 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
Techniques/methods of local
anesthesia
There are two methods:-
Topical anesthesia
Parentral anesthesia
Topical anesthesia
Topical Anesthesia provides a temporary
numbing effect on nerve endings that are
located on the surface of the oral mucosa.
Supplied as:
spray
Ointment
solution form
gel
Cont…
Parentral anesthesia
Infiltration
block anesthesia
Infiltration is achieved by injecting the
solution directly into the tissue at the site
of the dental procedure.
– Most frequently used to anesthetize the
maxillary teeth.
– Used as a secondary injection to block
gingival tissues surrounding the mandibular
teeth.
Block anesthesia
– The solution is injected near a major nerve, and
the entire area served by that nerve is numbed.
– anesthetic agent is circumferentially injected
around the surgical site without injecting the area to
be excised
– prevents the nerve impulses from entering the area
• Type of injection required for most
mandibular teeth.
Popularity of Local Anesthesia
1. Simplicity of use- economical and
nonexplosive; postoperative observation
is lessened
2. Undesireable side effects of general
anesthesia are avoided
3. Ideal method for ambulatory patients,
for short and superficial operations
6 methods of block anesthesia
in dentistry
zygomatic
Infra-orbital
Incisive
Palatal
Mandibular
mental
Nerve Supply of the jaw
Desirable charx. Of ideal
anesthesia
Low toxicity
reduction of blood flow
long duration f action
rapid speed of onset
good anesthetic efficacy
Be completely reversible
Complication of L.anesthesia
trauma to nerve
trauma to blood vessels
allergic rxn
Prevention of complication
Use of proper technique
Use of proper syringe and needle
good knowledge of innervations and
blood supply of the face and teeth
aspiration before the release of anesthetic
solution
Failure of anesthesia
Addiction
Inadequate volume of anesthesia
Improper technique
Injection in muscle
Intra vascular injection
Infected area
Dense compact bone
Tooth extraction
It is the process of taking out of tooth
from its socket.
Why tooth is extracted?
Indication of tooth extraction
-If hopelessly decayed-where restoration is
impossible
-acute/chronic pulpitis, necrosis, gangrene
of the pulp-where RCT is impossible
- retained root (buried-delayed during
eruption)
-sever marginal periodontitis-mobile tooth
-impacted tooth/malerupted
Conti..
misplaced tooth where orthodontic Rx
is impossible
supernumerary tooth/extra tooth
fractured tooth with open pulp
chamber
fractured root
tooth that are localized on the line of
fracture…etc
Contraindication to tooth
extraction
There is no absolute contraindication for
tooth extraction but it is relative and
multidisciplinary
E.g-blood disorder
-cvs disease
-uncontrolled DM
-tooth located in area of malignancy
Complication of tooth
extraction
fracture of tooth
fracture of jaw
damage of soft tissues
penetration to maxillary sinus
loss of tooth-swallowing...
extraction of wrong teeth
post operative infection like-dry socket,
bleeding…
syncope- vaso-vagal reflex…etc
Instruments for extraction
The main instruments are-
dental forceps
To pick out the tooth.
Elevators
burs
–are rotary instruments used to cot bone-in
case of surgery
Instruments for minor operation
Scalpel-
surgical burs
suture material ,
needle holder
Periosteal elevator
chisel and mallet
Scissor
tissue forceps
Conti…
-Retractor
-bone file
-surgical forceps
-hemostat
-mouth opener …
Steps of tooth extraction
1.detach the gum from the crown part of the
tooth
2. put beaks of the forceps
3. push the forceps down under the gum
4. fix/grip the forceps well
5. dislocate/luxate tooth
6. applying traction-removal
