Types of anesthesia used in dentistry: anesthetics for the treatment and extraction of teeth, classification of drugs. Preparations and types of local anesthesia in dentistry

Anesthesia in dentistry can be local or general. When conducting local anesthesia Only the area that requires dental intervention is anesthetized, and the patient is fully conscious. General anesthesia (general anesthesia) in dentistry is carried out by inhalation or intravenously using anesthetic drugs, through which the patient is put into a state deep sleep and his consciousness turns off.

Local anesthesia for treatment and extraction of teeth

Currently, carpule syringes and carpules with an anesthetic solution are used to administer local anesthesia. Such syringes significantly improve the quality of anesthesia, unlike conventional ones. disposable syringes. In addition, the needles of carpule syringes are of a very thin diameter, so the injection will not be so painful.

Cost of anesthetics and anesthesia

The cost of one carpule of anesthetic is approximately 10-20 UAH. Carrying out one anesthesia in a dental clinic will cost an average of 130 UAH.

What to do if you are afraid of anesthesia

Many people are afraid of injections, because each person has their own pain sensitivity threshold. During anesthesia, the pain from the injection may depend on the professionalism of the doctor, the anesthesia technique, and also on the speed of administration of the anesthetic. An experienced doctor does not save time and administers painkillers for at least 40 seconds. Immediately before the injection, you can ask the doctor to treat the area of the upcoming injection with an anesthetic spray (for example, Lidocaine spray).

Medications to relieve fear and anxiety before visiting the dentist

There are many sedatives, reducing anxiety states, one of which is Afobazole. This drug does not have a hypnotic effect, however, for positive results, you should start drinking it a week before your expected visit to the dentist.

Cheaper drugs (Corvalol, valerian extract, etc.) should be started three days before visiting the doctor, but these drugs are high doses can lead to weakness, drowsiness and decreased performance.

Also, in many clinics you can be given premedication - the administration of sedatives intramuscularly half an hour before dental procedures. Such drugs are classified as tranquilizers and are available by prescription (Seduxen, Relanium, etc.).

Local anesthetics in dentistry

Anesthetics based on Articaine are the most modern in dentistry. Anesthetics of the articaine series are Ultracaine, Ubistezin, Septanest, etc. The effectiveness of these anesthetics is much higher than that of Lidocaine or Novocaine. And Novocain has practically no effect in anesthetizing the area of inflammation.

In addition, most articaine anesthetics contain vasoconstrictors (adrenaline or epinephrine), which reduce the leaching of the anesthetic, which has a positive effect on the duration and active action anesthesia.

Ultracaine– local anesthetic for infiltration and conduction anesthesia in dentistry and during operations on oral cavity, has a pronounced local analgesic effect. Active substance– articaine hydrochloride + adrenaline hydrotartrate (epinephrine). The onset of action is immediately after administration. Duration of action – from 1 to 3 hours

Advantages:

Reliable anesthetic effect - 99% of cases of successful anesthesia
Proven safety - 0.6% adverse events
Possibility of use in children, pregnant women, elderly patients

Available in three versions, which differ in the content of epinephrine in its composition.

Ultracaine DS forte (epinephrine content in solution 1:200,000)
Ultracaine DS (epinephrine content in solution 1:100,000)
Ultracaine D (without epinephrine and preservatives)

Ubistezin– local anesthetic for infiltration and conduction anesthesia for wide application in dentistry. Suitable for standard types of surgical interventions during short procedures. The composition of Ubistezin is no different from the same forms of Ultracain.

Advantages:

Suitable for adults and children over 4 years of age
Average duration of action: 45 minutes for intrapulpal anesthesia, 120-240 minutes for soft tissue anesthesia
The onset of the anesthetic effect is 1-3 minutes after administration.

Ubistezin (epinephrine content in solution 1:200,000)
Ubistezin forte (epinephrine content in solution 1:100,000)

Septanest– a preparation for local anesthesia based on articaine for use in dentistry. Unlike the first two anesthetics, it contains preservatives such as sodium metabisulfite and ethylenediaminetetraacetate, which have a powerful allergenic effect.

Available in two versions, which differ in the content of epinephrine in its composition.

Septanest (epinephrine content in solution 1:200,000)
Septanest (epinephrine content in solution 1:100,000)

Scandonest– an anesthetic without a vasoconstrictor component. Suitable for adults and children. The onset of the anesthetic effect is 1 to 3 minutes after administration.

Indications for use:

Anesthesia for simple tooth extraction, tooth preparation
Ideal for treating patients with contraindications to vasoconstrictor supplements, especially for patients with cardiovascular disease

Advantages of the drug Skandonest:

Contains 3% mepivacaine

Does not contain other additives and epiniphrine, therefore, it is suitable specifically for patients suffering from cardiovascular pathology and who have contraindications to vasoconstrictor supplements

The problem of pain in dentistry is always important and relevant. Most patients put off visiting the dentist, fearing the pain of the upcoming procedures. However, today there are modern drugs and pain relief methods that allow you to completely eliminate possible painful sensations.

What types of anesthesia are there?

There are two main types of anesthesia: general and local. General anesthesia(or anesthesia) is used extremely rarely in dentistry. With this type of anesthesia, the patient “falls asleep” during the procedure, i.e. is unconscious and feels nothing. Anesthesia can be used for major operations in the oral cavity or in pediatric dentistry. However, due to the presence of a large number of contraindications and possible complications After anesthesia, local anesthesia is always preferred.

Local pain relief is the familiar “injection in the gum” or “freezing” to all of us. In this case, pain sensitivity is temporarily disabled only in a certain area of the oral cavity. Tactile sensitivity is usually preserved during local anesthesia; the patient can feel touch or pressure on the tooth and gum, vibration, etc. But pain is completely absent.

For tooth pain relief upper jaw it is enough to make several injections into the gum next to the tooth (the so-called “ infiltration» anesthesia). In order to relieve pain lower tooth, sometimes it is necessary to inject an anesthetic near the mandibular nerve (this is “ conductor» anesthesia). During conduction anesthesia, half of the patients go numb. lower jaw and language. In addition, there is the so-called " appliqué» anesthesia, in which only the mucous membrane of a certain area is numbed (by applying a special spray or gel with an anesthetic). This anesthesia is most often used before infiltration so that the needle insertion is painless.

What drugs are currently used for local anesthesia?

Modern dental clinics (including our Le Dent clinic) use carpule anesthetics latest generation. They are called carpules because the drug is not in ampoules, but in special disposable cartridges (carpules), which are inserted into a metal carpule syringe. A very thin disposable needle is screwed onto the syringe.

Thanks to all this carpules anesthetics have a number of benefits:

Absolute sterility of the drug and a guarantee against the entry of foreign substances into the anesthetic, because The doctor does not need to open the ampoule and draw the drug from the ampoule into a syringe, i.e. there is no contact of the anesthetic with air;
Exact dosage of all components of the anesthetic. As a rule, the carpule contains not only the anesthetic drug itself, but also additional substances: vasoconstrictors (adrenaline or norepinephrine), as well as drugs that protect the anesthetic from destruction.
Minimum discomfort from an injection due to the fact that the carpule needle is much thinner than the needle of a conventional disposable syringe.

The previously used lidocaine and novocaine are already a thing of the past due to a large number of shortcomings (low effectiveness, frequent allergic reactions, etc.). Now they are used extremely rarely (mainly in public clinics). In modern dental clinics, drugs based on articaine and mepivacaine are used for local anesthesia.

Artikain is the most modern and effective anesthetic for local anesthesia. Various manufacturing companies produce carpule anesthetics with articaine under different names (“ Ultracaine", "Ubistezin", "Septanest", etc.). The composition of the carpule, together with articaine, usually includes a vasoconstrictor substance (adrenaline). It is necessary in order to prolong the effect of anesthesia and reduce the absorption of the anesthetic into the general bloodstream. Our clinic uses the original German drug with articaine “Ultracaine” with different dosages adrenaline (the most appropriate dosage is selected for each patient).

Mepivacaine
- This is a different type of anesthetic. The vasoconstrictor substance is usually not included in the mepivacaine carpule, because Mepivacaine itself has the ability to constrict blood vessels. However, the effectiveness of this drug is slightly lower than the effectiveness of articaine. But this drug can be used for anesthesia in children, people with hypertension and in other patients for whom the administration of adrenaline is contraindicated. In these cases, our clinic uses a drug based on mepivacaine produced in France called “ Scandonest».

Despite all the advantages of modern anesthetics, there is always a risk of allergic reactions for any drug. Therefore, you should always warn your doctor about the presence of allergies and allergic manifestations in past. If you want to completely protect yourself from a possible allergic reaction to anesthesia, you can take a blood test in advance to check for hypersensitivity to the drugs used in the clinic.

Don’t be afraid or put off visiting the clinic, because today you can get treatment or even install an implant without experiencing any pain!

IN modern dentistry There are several types of pain relief. IN Lately In addition to local anesthesia, dentists suggest using general anesthesia. But how safe and objective is the choice of general anesthesia?

A doctor will help us understand the specifics of treatment using anesthesia. medical sciences Moscow State Medical and Dental University Alexander Evgenievich Potapov.

– What is general anesthesia and what is its main difference from local anesthesia?

Practicing dentist with 15 years of experience, Ph.D. MGMSU A.E. Potapov

Local anesthesia guarantees selective anesthesia of the required sector for a short period during which the person is awake. With general anesthesia, the effects of drugs occur on the entire body.

A person is put into a state of sleep for a long time, in which he does not feel pain or tactile influence. This allows you to perform volumetric dental work for one visit.

The drugs used for anesthesia tend to reduce salivation, which has a positive effect on the quality of work. Another positive point is the lack of general anesthesia defrosting period.

– In what cases is use indicated? general anesthesia in dentistry?

In dentistry, such anesthesia has wide range indications. It is prescribed for large volumes of work, for example, when it is necessary to remove a group of teeth, and for dental treatment in children.

Anesthesia general type, is indispensable if the patient has or has mental illnesses characterized by increased excitability. General anesthesia is also used in case of ineffectiveness of local anesthesia or detection of allergic reactions to painkillers.

If the patient has a pathological manifestation of the gag reflex, then anesthesia is also used for pain relief. The need for anesthesia is determined by the dentist and anesthesiologist.

– Are there any contraindications to general anesthesia?

Since anesthesia affects the entire body as a whole, there are, of course, contraindications for its use. Anesthesia is contraindicated:

at acute pathologies endocrine system, as well as diseases of the heart and blood vessels;
under drug and alcohol intoxication;
if there are deviations in blood parameters (low coagulability, severe anemia) and its pathologies;
in a postoperative state;
with confirmed dystrophy;
in the post-vaccination period;
for diseases of the lower and upper respiratory tract;
at low-grade fever;
children under 2 years old;
at low or high pressure;
at neurological pathologies, for example, epilepsy.

– What types of general anesthesia are used in dentistry?

In dentistry, two types of anesthesia are most often used: intravenous and inhalation or otherwise masked. For intravenous anesthesia, they administer special drugs or combinations thereof, which turn off a person’s consciousness and pain reflexes.

For this purpose, drugs such as sombrevin, propofol, hexenal and others are used. This anesthesia begins to take effect a couple of minutes after administration and lasts about an hour. If the procedure is prolonged, it is possible to re-administer anesthetics.

During inhalation anesthesia, a special anatomical mask is used to administer drugs, which is applied to part of the patient’s face. Through the mask, the patient inhales a gaseous anesthetic mixture, which enters the bloodstream.

For administration, fluorotane, methoxyflurane, nitrous oxide, and xenon are used. These drugs are used individually or in combination. With the inhalation method, the patient can be put into a state of superficial sleep, aware of the entire treatment process, but without feeling pain.

– Which type of general anesthesia is preferable: intravenous or masked?

The use of one or another type of pain relief is decided individually. Each case requires an objective approach to choosing anesthesia, because they have their own characteristics.

Intravenous anesthesia quickly puts a person into a state of sleep and is clearly controlled. Since the use of this type of anesthesia requires puncture of a vein, it is most often prescribed to adults or children over 10 years of age. Intravenous anesthesia begins to act quickly and guarantees full access to the oral cavity.

Mask anesthesia does not require any physical impact or prolongation. That is, the patient sleeps while the mixture enters the lungs. This makes this method convenient for dental treatment in children. preschool age.

But there are some disadvantages of inhalation anesthesia: it is intended for short-term dental procedures and the mask limits the working space.

In dentistry, a combination of these methods is most often used. This allows you to achieve complete pain relief and perform more dental operations. In any case, the anesthesiologist, but not the patient, should select the type of general anesthesia.

– How safe is the use of general anesthesia? Especially in children?

Modern drugs used for general anesthesia are no more dangerous than drugs for local anesthesia. After them, a person comes to his senses a maximum of a quarter of an hour after treatment and does not experience drowsiness or any discomfort.

The inhalational anesthetic Sevoflurane is most often used for anesthesia in children. This allows you to avoid injections, and therefore psychological discomfort for the child.

The main part of the inhalational anesthetic is quickly eliminated from the body through the lungs. Even in combination with other drugs, anesthetics do not irritate Airways, do not affect the growth of hepatic and renal failure, and do not increase intracranial pressure.

The safety of general anesthesia is affected by proper organization procedures and qualifications of doctors. General anesthesia has the right to be performed only by dental clinics with a special license. For this purpose, a separate equipped office must be allocated.

During treatment, standard monitoring of life-supporting organs should be used, which allows monitoring blood pressure, body temperature, and heart rhythm. In addition to the dentist, the presence of an anesthesiologist and resuscitator is required.

The safety of use does not always depend only on specialists. The patient must strictly comply with all training requirements and provide all information about his health. This is especially true for young patients.

Parents need to be attentive and inform specialists about any changes in the child’s condition. In any case, if anesthesia poses a danger to the patient, the resuscitator will definitely report this and will not allow the procedure to be carried out.

– What is the preparation for treating or removing teeth under anesthesia?

Like any other procedure surgical intervention, dental treatment using anesthesia requires full examination the patient and his careful preparation. Before the procedure, a clinical detailed blood test is performed no more than 10 days before the procedure.

The clotting time of blood and the duration of bleeding are determined. If general anesthesia is indicated for a child, a health certificate is additionally required.

In case of any pathologies, a certificate with a diagnosis and a list of prescribed medications is required from the specialist who is seeing the patient. In addition, radiography, sugar testing, ECG and some other examination methods may be prescribed. All methods are determined on an individual basis.

A few days before using general anesthesia, you should stop drinking alcohol and exclude heavy and fatty foods from your diet. Food intake should be taken at least 6 hours before the procedure, and liquid intake at least 4 hours before.

– How is treatment carried out under anesthesia?

Before using anesthesia, premedication is prescribed, which includes some sedatives. It is aimed at relieving fear and anxiety. Sedatives are most often administered intramuscularly, but for children, tablets and mixtures can be used.

After the patient has calmed down, he assumes a lying position on the dental chair. If anesthesia is used in a preschool child with increased level anxiety, you should place him on your lap, where he will remain temporarily until the anesthesia takes effect.

If anesthesia is carried out using the inhalation method, the doctor brings a special anatomical mask to the patient’s face, which smoothly follows the part of the face. Through this mask, the anesthetic drug in a gaseous state begins to be delivered.

A minute later the person begins to fall asleep. During sleep, most often in children, a stage of excitement is observed, during which disorientation and disturbance of the breathing rhythm are observed.

These phenomena quickly pass, and the child enters a state of deep sleep. The complete anesthesia phase begins.

If intravenous anesthesia is used, a catheter is inserted into the patient's vein in the elbow or hand, through which the anesthetic drug is delivered. The catheter insertion site is pre-treated with an anesthetic gel.

Unlike inhalation method, intravenous anesthesia does not have an arousal stage, so deep sleep occurs within 1 minute.

During the deep sleep stage, the dentist performs necessary procedures, after which the supply of anesthetic is stopped, and the patient returns to normal within 15 minutes. Acceptable maximum time anesthesia lasts 1.5 hours, but most often anesthesia is used for no more than 30 minutes.

After general anesthesia, children may experience some agitation or lethargy, which disappears after an hour.

– What procedures can be performed in 30 minutes of anesthesia?

With highly qualified specialists and a favorable course of treatment, in 30 minutes of general anesthesia you can perform:

turning from 1 to 5 teeth;
removal of 1 to 10 teeth;
formation carious cavities on 5 crowns, without filling;
formation of one affected cavity and its further filling with a light-curing composite;
depulpation of a single-rooted tooth;
osteotomy in the area of 5 teeth;
opening and treatment of an abscess;
curettage of gum sockets for alveolitis.

– How often can teeth be treated under general anesthesia?

Since all drugs used for general anesthesia are precisely dosed and selected individually, their use does not have negative consequences. Therefore it is possible frequent treatment dental problems under general anesthesia.

To avoid side effects and consequences in the future, it is necessary to undergo a thorough examination before each procedure. Depending on the condition of the body, the anesthesiologist each time prescribes the necessary treatment regimen.

– What negative consequences can occur during treatment with general anesthesia?

When treated using general anesthesia, negative consequences may occur, such as sharp increase or low blood pressure, short-term dizziness, agitation, nausea.

TO negative consequences Poor quality treatment can also be attributed to this, which is caused by the lack of an X-ray machine in the office. Therefore, decide on a procedure with general anesthesia only in specialized clinics with properly equipped offices.

And, if the dentist, without any reason, offers you only local anesthesia, you should think about visiting another dentist.

– Thank you for taking the time to give us detailed answers that helped us understand all the intricacies of using general anesthesia in dentistry.

Interviewed Angelina Tkacheva, interviewer for the online magazine “Your Dentist”.

If you find an error, please highlight a piece of text and click Ctrl+Enter.

Painlessness is already a familiar principle of modern dentistry. Treatment should not cause discomfort, much less be accompanied by feelings of stress or fear.

Most dental procedures are performed under anesthesia. Pain relief methods are selected depending on the individual characteristics body, age and health status, patient preferences and complexity of treatment procedures.

Methods and types of pain relief

Local and general anesthesia

There are two main types of anesthesia - local and general. In the first case, pain sensitivity is “switched off” while the person’s consciousness and other types of sensitivity (to touch, exposure to cold) are preserved. In the second, there is a temporary and reversible loss of consciousness, accompanied by complete anesthesia of the entire body and relaxation of the skeletal muscles.

Local anesthesia is indicated for simple and short procedures - it is the most popular in dental practice, since it has practically no contraindications.

General is recommended for complex and time-consuming maxillofacial operations, as well as in cases where the patient responds inadequately to treatment, experiences panic fear before the dentist, etc. It has many contraindications and sometimes causes a number of complications, so it is practiced only in exceptional cases.

Anesthesia methods

Both types of anesthesia are carried out in the following ways: injection and non-injection.

Injection anesthesia is given through an injection - the drug is injected into the tissue of the oral mucosa, into the periosteum or bone, intravenously. With non-injection anesthesia, the medicine is applied to the surface of the mucous membrane, delivered through inhalation - that is, inhaled through the lungs.

Local anesthesia

Aimed at blocking nerve impulses in the area surgical field. On average, its effect lasts 1-2 hours. Patients do not feel pain, but feel touch and cold.

In dentistry it is most often used for:

preparation of carious tooth tissues;
canal treatment;
cyst removal;
turning for a crown or bridge;
excision of the hood above the figure eight;
implantation;
gum surgeries;
tooth extraction.

Depending on the technology, the method of exposure to tissue and the duration of the effect, several types of local anesthesia are distinguished.

Let's look at them in more detail:

General anesthesia

General anesthesia is rarely used in dental practice. And only in those clinics where there is full-time position an anesthesiologist and the equipment necessary to “give” anesthesia to the patient and in case of emergency resuscitation, which may be required in case of complications.

Most often, general anesthesia is indicated for people who have a panic fear of dentists, as well as for complex long operations- multiple implantations, correction of the so-called cleft palate, etc.

General anesthesia according to the “delivery” method

inhalation - a vaporous anesthetic or narcotic gas is inhaled through the nose using a special mask;
non-inhalation - intravenous administration drug.

Sometimes these two types are combined. For example, with extensive facial surgery.

The main disadvantages of general anesthesia are: a large number of contraindications and a high probability of complications.

Inhalation anesthesia: 1. Inhale, the valve is open. 2. Exhale, valve closed

Drugs

For local anesthesia

Are used:

ultracaine - in pure form or with epinephrine, which constricts blood vessels and provides a prolonging effect;
ubistezin - similar in action to epinephrine-containing ultracaine;
Septanest - an alternative to ubistezin and ultracaine, contains preservatives;
scandonest - for patients for whom medications containing epinephrine and adrenaline are contraindicated (including suitable for asthmatics, hypertension, diabetics).

The first three names are drugs based on articaine, a potent anesthetic that has received widest application in dentistry.

Injections are performed with special carpule syringes with the thinnest needles - only 0.3 mm in diameter. They are two times thinner than conventional medical needles and are practically not felt by patients.

To ensure the longest possible anesthetic effect, bupivacaine is also used - it “works” for up to 13 hours, but is highly toxic.

But lidocaine is no longer used for injections in modern clinics - just like novocaine, trimecaine - they are too toxic and have low effectiveness.

For general anesthesia

For inhalation anesthesia, doctors most often use nitrous oxide and trichlorethylene. For intravenous use - ketamine, hexenal, propanidide, sodium hydroxybutyrate and other drugs that have hypnotic, sedative, muscle relaxant properties.

Complications

The most frequent complications after local anesthesia:

soft tissue injury - while the anesthetic is still in effect, you need to be careful not to accidentally bite your lip, cheek, or tongue;
bruise - hematomas occur if the needle touches a vessel during an injection.

Other complications include spasms of the masticatory muscles (if injured by a needle), allergies to painkillers, and temporary loss of sensitivity in the facial muscles. Even less often, the needle breaks off, and in isolated cases, infection occurs.

It is worth noting that complications from local anesthesia are extremely rare. This is the safest and simplest type of pain relief.

But complications from general anesthesia occur more often:

nausea;
vomit;
fainting, collapse;
inappropriate behavior.

The most dangerous consequences are disruption of respiratory and cardiac activity, in which death can occur without resuscitation measures.

Application in pediatric dentistry

The two most commonly used types of anesthesia used by pediatric dentists are topical and intraligamentous. The combination of these two types allows for completely painless medical intervention.

Before starting treatment for caries or pulpitis, removing a tooth or opening the gumboil, the pediatric dentist treats the area around problem area an anesthetic in the form of a gel, ointment or spray with lidocaine (preparations for topical anesthesia contain low concentrations of lidocaine that are not dangerous to the child’s body).

When the mucous membrane “goes numb,” the doctor uses a very thin carpule needle to administer intraligamentous anesthesia—the child does not feel any discomfort at this moment. The first injection injects a small amount of medication - 0.1-0.2 ml. After a minute or a minute and a half, the doctor administers the rest of the dose - this way the child does not feel the process of playing the game inside the soft tissues.

Most secure injectable drug for children under five years old - scandonest or septanest without adrenaline. For children over five years old, ultracaine with a low concentration of adrenaline (1:200,000) is suitable.

Under no circumstances should drugs such as dicaine, amethocaine, and tetracaine, which are toxic to a fragile organism, be used in pediatric dentistry!

During pregnancy and breastfeeding

Breastfeeding is not a contraindication to anesthesia. Modern anesthetics are used in small doses and are eliminated from the body quickly - from 20 minutes to 2 hours. Given this time, it is better for mothers to feed the baby immediately before going to the doctor or express milk in advance.

But while pregnant, it is better to avoid using anesthetics. If you still cannot do without them, it is recommended to plan a trip to the dentist during the second trimester. At this time, the likelihood of complications is lowest.

Preference should be given to gentle agents that are administered in low concentrations and have the shortest effect. Mepivacaine and bupivacaine are contraindicated for pregnant women! These drugs may cause the fetus's heart rate to slow down. And filipressin and octapressin can cause uterine contractions!

Anesthetics in dentistry are drugs that provide pain relief. All local anesthetic agents must have the following properties: low toxicity, rapid onset of effect, easy permeability through tissue, reversibility, easy permeability, long shelf life. Some products comply more with these standards (modern drugs), others less (as a rule, outdated analogues).

	toxicity	duration min (without adrenaline)	maximum dose (mg/kg) (with and without adrenaline)	other names
Cocaine	4	20-25	1,5	other no name
Novocaine	1	15-20	8/10	Aminocaine, Procaine Cytocaine, Neocaine
Lidocaine	2	50-60	5/7	Lidokart, Lidostezin Xylocard, Solcaine
Mepivacaine	2	40-90	5/7	Mepivastezin, Scandicaine Skandomest, Meaverin
Artikain	1,5	60-120	7	Ultracain, Ubistezin Septanest, Supracain

clarifications: the groups that have the highest and lowest scores are highlighted in bold (so to speak, champion and underdog)

Classification

Classification of local anesthetics in dentistry involves division by chemical structure and generation. According to their chemical structure they are:

Esters (Cocaine, Novocaine, Anestezin)
Amides (Lidocaine, Articaine aka Ultracaine, Mepivacaine)

By generation (counting according to the time of discovery) there are: I - cocaine in 1860, II - novocaine in 1905, III - lidocaine in 1943, IV - mepivacaine in 1957, V - articaine in 1972. All substances will be considered according to this classification of local anesthetics in dentistry. For clarity, look at the table, which discusses toxicity, duration, and maximum dose.

Anesthetics in dentistry without adrenaline

As you know, ephedrine derivatives are added to painkillers to increase the duration of action. They are vasoconstrictors, that is, they narrow blood vessels. In some cases, such exposure is contraindicated (for pregnant women, people with heart and vascular diseases). The following are “safe” anesthetics in dentistry without adrenaline: Ultracaine D (do not confuse with prefixes D-S And D-S Forte), Mepivastezin 3%, Scandonest CVS 3%. They can be safely used.

Modern anesthetics in dentistry

As you may have guessed, these are V generation drugs. Modern anesthetics in dentistry include Articaine derivatives: Ultracaine, Ubistezin, Septanest. However, Mepivacaine and its analogues are not yet in a hurry to throw them into the dustbin of history, and they are ordered in dental clinics. And what kind the most powerful anesthetic in dentistry? The award goes to Ultracain. To make sure, go to the dentist and ask him to do mandibular anesthesia. They will have time to heal your tooth, you will get home and for another couple of hours you will not feel anything and all this “pleasure” is from 1 ampoule.

Mechanism

The mechanism of action of all drugs is the same. In short, they reduce the penetration of sodium ions onto membranes nerve cells. In more detail, the scheme looks like this: the membranes of neurons are overcome by molecules of an anesthetic substance in an inactive form. There they become active, attaching (binding) hydrogen ions to themselves, and remain on sodium channels. The transmission of the pain impulse is blocked by stopping the rapid input of sodium ions, which is felt by the body as anesthesia.