Forms of dental anesthesia is a spectrum of anesthesia that includes not only local anesthetics but sedation and general anesthesia.
Local AnestheticsThe most commonly used local anesthetic is lidocaine (also called xylocaine or lignocaine), a modern replacement for novocaine and procaine. Its half-life in the body is about 1.5–2 hours. Other local anesthetics in current use include articaine, septocaine, marcaine (a long-acting anesthetic), and mepivacaine. A combination of these may be used depending on the situation. Also, most agents come in two forms: with and without epinephrine.
The most common technique, effective for the lower teeth and jaw, is inferior alveolar nerve anesthesia. An injection blocks sensation in the inferior alveolar nerve, which runs from the angle of the mandible down the medial aspect of the mandible, innervating the lower teeth, lower lip, chin, and tongue. The inferior alveolar nerve probably is anesthetized more often than any other nerve in the body. To anesthetize this nerve, the dentist inserts the needle somewhat posterior to the patient’s last molar. Several non dental nerves are usually anesthetized during an inferior alveolar block. The mental nerve, which supplies cutaneous innervation to the anterior lip and chin, is a distal branch of the inferior alveolar nerve. When the inferior alveolar nerve is blocked, the mental nerve is blocked also, resulting in a numb lip and chin. Nerves lying near the point where the inferior alveolar nerve enters the mandible often are also anesthetized during inferior alveolar anesthesia. For example, the lingual nerve can be anesthetized to produce a numb tongue. The facial nerve lies some distance from the inferior alveolar nerve, but in rare cases anesthetic can diffuse far enough posteriorly to anesthetize that nerve. The result is a temporary facial palsy (paralysis or paresis), with the injected side of the face drooping because of flaccid muscles, which disappears when the anesthesia wears off. If the facial nerve is cut by an improperly inserted needle, permanent facial palsy may occur.
The superior alveolar nerves are not usually anesthetized directly because they are difficult to approach with a needle. For this reason, the upper are usually anesthetized locally by inserting the needle beneath the oral mucosa surrounding the teeth.
- Nitrous oxide (N2O), also known as "laughing gas", easily crosses the alveoli of the lung and is dissolved into the passing blood, where it travels to the brain, leaving a dissociated and euphoric feeling for most patients. Nitrous oxide is used in combination with oxygen. Often (especially with children) a sweet-smelling fruity scent similar to an auto scent is used with the gas to inspire deep inhalation.
- Topical anesthetics — benzocaine, eugenol, and forms of xylocaine are used topically to numb various areas before injections or other minor procedures
- General anesthesia — drugs such as midazolam, ketamine, propofol and fentanyl are used to put the patient in a twilight sleep or render them completely unconscious and unaware of pain.
- Midazolam (Versed), a drug that represses memories of the procedure, is usually given two hours prior to the procedure in combination with Tylenol in general anesthesia so the patient will go home with no memories of being in surgery.
- Propofol a drug with similar effects to Sodium Pentathol is often used through intravenous infusion through an IV during general anesthesia after gasses are initiated.
- Demerol or Fentanyl is often used to control pain during the dental surgery under general anesthesia. This is usually administered through IV.
- Ketorolac is often administered through IV to suppress both pain and inflammation while under general anesthesia.
Other drugs often used during general anesthesia
- Decadron a steroid is often administered through IV to suppress inflammation and swelling resulting during the surgery while under general anesthesia.
- Ondansetron brand named Zofran is often administered to prevent nausea during the surgery which may result from the blood draining into the stomach while under general anesthesia, or it is given to the patient after the procedure for postoperative nausea which may result from the anesthesia itself which was administered
We are trained in delivering different types of anesthesia to make one’s treatment comfortable. Local anesthesia, nitrous oxide (laughing gas) or intravenous sedation is all offered to our patients.