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DENTAL ANESTHESIA & SURGICAL EQUIPMENT

What is anesthesia?

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.

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 mans injuries, the latter apparently felt no pain. He pursued his studies on nitrous oxide from whence general anesthesia was born.

GENERAL ANESTHESIA
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
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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

Infiltration Anesthesia
most commonly used local anesthetic technique infiltrated directly into the surgical site by means of either intradermal injection or subcutaneous injection

Block Anesthesia
anesthetic agent is circumferentially injected around the surgical site without injecting the area to be excised prevents the nerve impulses from entering the area

Popularity of Local Anesthesia


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Simplicity of use- economical and nonexplosive; postoperative observation is lessened Undesireable side effects of general anesthesia are avoided Ideal method for ambulatory patients, for short and superficial operations

Why is local anesthesia not widely used?


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Lack of patient acceptance and the desire to be unconscious during operation Impracticality of anesthetizing some bodily areas Insufficient duration of local anesthesia Rapid absorption of local anesthetics into the blood stream

Regional Anesthesia

injection near a cluster of nerves to numb the area of the body that requires surgery may remain awake or may be given a sedative Spinal anesthesia- form of regional anesthesia involving injection of a local anesthetic into the cerebrospinal fluid (CSF), generally through a long, fine needle, usually 3.5 inches long.

IDEALISTIC ANESTHETIC
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Its action must be reversible. It must be non- irritating to the tissues & produce no secondary local reaction. It should have a low degree of systemic toxicity. It should have a rapid onset & be of sufficient duration to be advantageous. It should be relatively free form allergic reactions.

IDEALISTIC ANESTHESIA
6. It should have a potency sufficient to give complete anesthesia w/o using harmful concentrated solutions. 7. It should have sufficient penetrating properties to be effective as a topical anesthetic. 8. It should be stable in solution & readily metabolized by the body. 9. It should be either sterile or capable of being sterilized by heat w/o deterioration.

ADVERSE EFFECTS
Localized prolonged anesthesia or parasthesia Systemic reactions Lack of anesthetic effects

INJECTABLE ANESTHETICS
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Procaine Hydrochloride Lidocaine Hydrochloride Mepivacaine Hydrochloride Pyrrocaine Hydrochloride Tetracaine Hydrochloride Propoxycaine Hydrochloride Butethamine Metabu tethacaine Hydrochloride Meprylcaine Hydrochloride

Topical Anesthetics

form of anesthesia obtained by the direct application of the drug to the mucous membrane surface

Iodocaine, tetracaine, cocaine, benzocaine, and dyclonine hydrochloride

VASOCONSTRICTORS

factors that cause the narrowing of the blood vessels resulting from contracting of the muscular wall of the vessels added to injectable local anesthetics to prolong and increase anesthesia, reduce toxic effect, and reduce bleeding

Antihistaminics

Tripelennamine (Pyribenzamine)

Diphenhydramine (Benadryl)

Action of Local Anaesthesia


Blocks Sensation Produces Numbness Does not cause unconsciousness Reversible Has a certain onset and duration

Nerve Supply of the Dentures

Dental Anaesthesia

Synthetic

Non-ester compounds

Procaine Chloroprocaine

Dibucaine Lidocaine Mepivacaine

Topical Anaesthesia

Pipeprocaine Hexylcaine Tetracaine

Cocaine

The first effective local anesthetic An alkaloid originally extracted from the leaves and bark of South American coco Plants Onset 1min Duration 30mins It is being prevented to use in clinical operations

COCAINE

Procaine

First Synthetic Local Anaesthesia Mostly used in Dentistry Ester base Used for infiltration anaesthesia

Rapid Onset Short duration Low potency Lacks topical anesthetic activity

PROCAINE

Chloroprocaine

Ester base Similar in structure of procaine Onset is 5 to 15mins Duration 30 to 45mins Low potency Very low toxicity

CHLOROPROCAINE

Pipeprocaine

Ester base A derivation of bezoic acid Topical anesthesia Slow onset compared to procaine

Hexylcaine

Topical and infiltration anesthesia Short duration (10mins) Overdose can lead to headache, tinnitus, convulsions and respiratory arrest

Tetracaine

Available in preparations for topical use Ester Type Potent but safe Onset 3-10mins Long Duration More toxic compared to other anesthetics Non-irritating when injected to the tissues

TETRACAINE

Dibucaine

Cinchocaine Amide base Rapid onset Extremely potent High toxicity

LIDOCAINE

Most widely used Amide base Injected for local infiltration Onset 15mins Duration 30-120mins inherent Potency Moderate Toxicity

LIDOCAINE

MEPIVACAINE

Amide base Used in Nerve block and local infiltration Indicated also in regional anaesthesia

Onset 15mins Duration 60-140mins Moderate Potency Moderate Toxicity

MEPIVACAINE

Properties of Local Anaesthesia


Properties
Metabolism Systemic toxicity Allergic reaction Stability in solution Onset of action pKa's

Ester base
rapid by plasma cholinesterase less likely possible - PABA derivatives form breaks down in ampules (heat,sun) slow as a general rule higher than PH = 7.4 (8.5-8.9)

Amide base
slow, hepatic more likely very rare very stable chemically moderate to fast close to PH = 7.4 (7.6-8.1)

Abscess or pus

A dental abscess is an infection of the mouth, face, jaw, or throat that begins as a tooth infection or cavity. caused by bacteria that invade the soft tissue surrounding your tooth or at the root of your tooth.

Abscess or pus
There are several symptoms of an abscessed tooth:

A sharp or shooting pain in the tooth Chewing causes pain Loose tooth Tooth is sensitive to hot or cold fluids or food Fever Bad breath Red and swollen gums Swollen glands in the neck

Equipment for drainage

Gauze and gauze dressing

Rubber drainage

Waste containers

Cotton pliers

scissors

hemostats

Hemorrhage

Excessive discharge of blood from the blood vessels; profuse bleeding.

Methods to stop the Hemorrhage:


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Bite the gauze for a few minutes Application of astringent substances on top of the wound The use of materials which provide a frame or matrix for the blood clot Clotting ingredients Blood transfusion

Surgery Armamentarium
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Anesthesia Dental syringes for block or infiltration anesthesia Syringes for possible emergency scalpel

Surgical Paraphernalia

Mouth mirror

scalpel

Cotton pliers

Sterile cotton

Spatulas

Flashlights

Aspirator

Bone files

Saws

Chisels

Scissors for incising gums and soft tissues.

Cheek retractors, tissue retractors

TISSUE FORCEP

CURETTE

HEMOSTATS

ELEVATORS

SURGICAL NEEDLE

NEEDLE HOLDERS

BONE RONGUER

ASPIRATOR

FORCEPS

MAXILLARY FORCEP

MANDIBULAR FORCEP

FORCEP FOR THE ANTERIORS

BONE CHISEL

MALLET