Dental anesthesia

Dental anesthesia represents a significant advancement in pain management during dental treatments, especially in surgical interventions. It temporarily blocks the propagation of electrical signals along the nerves to eliminate the sensation of pain while the dentist performs various procedures. Below are the types of dental anesthesia, their advantages and disadvantages, and their contraindications.

In general, there are two main types of dental anesthesia: local and general. Choosing the right type of anesthesia depends on several factors:

• The procedure the dentist will perform;
• The difficulty level of the procedure (treating a cavity, implant, etc.);
• The time required by the dentist to perform the procedures;
• The patient's perception of injections;
• The patient's medical history (medications taken, possible allergies, etc.).

All these factors are important because, like any medical procedure, dental anesthesia can have side effects and contraindications. Below are the types of dental anesthesia.

Local dental anesthesia

Local dental anesthesia is commonly used for fillings, treating gum diseases, or crown treatments. This type of dental anesthetic temporarily and reversibly stops the excitability of nerve fibers, inhibiting pain. Products containing an anesthetic, such as lidocaine, which may or may not be combined with adrenaline, are used for this purpose. The latter has a vasoconstrictor effect, reducing bleeding and preventing the anesthetic substance from spreading to adjacent regions.

This type of anesthesia is relatively risk-free: dentists are trained to administer the anesthetic in specific parts of the mouth, depending on the procedure they will perform. After 10-15 minutes, the dentist can begin the intended treatment.

Pre-anesthesia

Many people, such as anxious patients or children, are afraid of injections, and pre-anesthesia is used in these cases. This involves numbing the area beforehand with an anesthetic spray, gel, or cryogenic spray (which causes intense localized cold).

Osteocentral anesthesia

Also known as painless anesthesia, this is an interesting alternative to classic local injectable anesthesia. With an electronic device, the anesthetic is administered into the spongy bone around the tooth. The procedure is quick, painless, and without postoperative consequences. The dentist does not have to wait 10-15 minutes for the anesthetic to take effect as with the classic type, and the patient will not feel the specific numbness after the intervention.
 

Wand System

Local anesthesia (by injection) is one of the procedures in dentistry that causes anxiety in both children and adults. Devices used to make needle punctures less painful (slow injection, heated local anesthetic, thin needle, and pre-treatment with topical anesthetic gel) are not sufficient for certain patients, especially anxious children who do not cooperate. A computerized system for the slow administration of local anesthetic, called Wand STA (Milestone Scientific, Livingston, NJ), was developed as a possible solution to reduce pain associated with this procedure, preventing patients from avoiding dental treatment.

The Wand STA system consists of a computer-controlled unit and a handheld component, allowing the anesthetic solution to be delivered at a constant pressure and slow pace, potentially below the pain threshold. Dental anesthesia becomes much more comfortable for the patient and less threatening compared to the traditional dental syringe.
 

What does the Wand STA system consist of?

Using a slow flow, drops of solution can anesthetize the tissues immediately ahead of the needle, resulting in an imperceptible injection. In addition, the lightweight, pen-like handheld piece allows better control of needle insertion, improving patient comfort and reducing pain perception and, consequently, fear of injection.

With this device, all local anesthesia techniques can be performed (maxillary and mandibular infiltration, mandibular block, intraligamentary, upper middle anterior alveolar injection, and even palatal approach injection, which is considered the most painful).

The Wand STA system can be useful in various branches of dentistry, such as pediatric, restorative, endodontics, periodontics, and oral surgery. Several studies have established that the use of the Wand anesthesia system in children and adolescents resulted in a lower perception of pain and was generally better accepted than conventional local anesthesia.

Besides being less painful, the Wand system could be considered more satisfying for patients, reducing soft tissue numbness and avoiding self-inflicted postoperative injuries (biting the tongue or lips) by inducing strictly local anesthesia.

Dentapen

Computer-controlled local anesthesia (C-CLAD) allows much more comfortable injections in any area of the oral cavity. Dentapen is a small, handheld C-CLAD system that allows the administration of any intraoral dental injection. The Dentapen system is easy to use and utilizes traditional local anesthesia needles and dental cartridges. Injections provide a constant anesthetic flow at the right pace, allowing the dentist to focus more on needle insertion. This results in better injection control and pain reduction for the patient.

Advantages of the Dentapen system

Dentapen is an ergonomic, lightweight, autonomous, wireless, intuitive device that requires no console, foot supports, tubes, or disposable items. It can be held in two different ways - by wings, like a manual syringe, or like a pen, for precise injection during special procedures. Dentapen uses standard 2.2 ml cartridges, meaning dentists can use their chosen local anesthetic and preferred dental needle.

It also allows for challenging injections, such as intraligamentary ones, and performs aspirations for a safe procedure. Patients find the small, modern appearance less threatening and more reassuring, helping them to relax.

Sedation techniques
 

These allow the anxious patient to relax and have an amnesic effect. Although sedation produces a state of relaxation, it does not have the same effect as classic dental anesthesia. The patient will still need a local anesthetic injection to eliminate the pain caused by the procedure. Sedation simply alleviates the nervousness and anxiety that often accompany a visit to the dentist.

Sedation can be conscious, allowing patients to feel relaxed but also remain awake and able to respond. With this sedation, the patient will not remember most of the procedure. Deep sedation places the patient in a state between conscious and unconscious. The patient cannot respond to commands and may need respiratory support.
 

Inhalation sedation with nitrous oxide

Inhalation sedation with nitrous oxide (laughing gas) can be used for anxious patients or children, having analgesic, sedative, and anesthetic properties. It is effective for mild pain and has the advantage of rapid action, allowing the dentist to intervene 2-3 minutes after the patient starts inhaling the gas. Also, at the end, its effect disappears within minutes, and the patient can even drive if necessary.
 

Intravenous sedation

This involves the intravenous administration of one or more anesthetics aimed at reducing the patient's state of consciousness, although the patient can still respond to stimuli and questions from the dentist. Intravenous sedation is effective and safe, real amnesia is induced, and recovery time is shorter. However, the patient needs an escort after the intervention. The disadvantages of intravenous sedation include the need for a catheter for infusion, which can be difficult for some patients to accept, and more careful monitoring.

Intravenous sedation is not recommended for patients who are claustrophobic, have blocked nasal passages, suffer from obesity, or sleep apnea.

General anesthesia
 

For major surgical interventions, which can last several hours, patients with disabilities or certain illnesses, or young children, general anesthesia may be decided. Additionally, this type of anesthetic may be indicated in rare cases of proven allergy to local anesthesia.

General anesthesia is performed by a specialist anesthetist in a clinic or hospital, but the patient does not necessarily need to stay overnight. After general anesthesia, the patient recovers in about an hour but will need an escort.

Adrenaline, a hormone typically associated with anesthetics and used during treatments to enhance their effectiveness and limit bleeding, has side effects such as tremor, reduced blood sugar, tachycardia, and hypertension. For these reasons, patients suffering from diabetes, hypertension, or coronary insufficiency are recommended to have dental anesthesia without adrenaline.

Dental anesthesia is not a complicated procedure, but you should consider a few recommendations before visiting the dentist:

• Avoid consuming caffeine products at least 12 hours before your appointment.
• Eat before receiving anesthesia, as you will not be able to consume anything for a few hours afterward.
• Take your usual medications if necessary.
• Remember to mention any medical conditions you have to the dentist.
• Relax and trust your dentist.

Preparation for sedation

The patient's health must be in good condition before sedation. For inhalation sedation, do not consume food or drinks for an hour before the procedure. For deep sedation, do not eat or drink anything for three hours before the procedure. Otherwise, nausea or vomiting may occur after the dental intervention.

Many dental treatments require anesthesia beforehand. Here are the main side effects that different types of dental anesthetics can have:

• Local anesthesia is most commonly administered via injection with a very thin needle, the required dose being very small and usually without any toxic effect. However, complications such as allergic reactions can occur. It is recommended to inform your dentist if you have a known allergy to any medication, including anesthetic substances.
• Feeling unwell after local dental anesthesia is temporary, and its effects usually disappear within three to four hours.
• Sometimes, however, the secondary effects of local anesthesia last a few days, including hematomas on the lips or cheeks and a slight loss of skin sensitivity.
• The lack of sensitivity in the anesthetized area can be associated with a risk of biting (lips, cheeks, tongue).
• Possible side effects of inhalation sedation with nitrous oxide include nausea/vomiting, dizziness, and agitation.
• Possible side effects of general anesthesia include nausea, headaches, temporary disorientation, and hematomas at the injection site. In rare cases, general anesthesia complications are severe and can even be life-threatening. Higher risks are presented by patients with serious illnesses, severe allergies, or a history of alcohol abuse.
• Sedation and general anesthesia can also have side effects such as sweating/chills, hallucinations, slurred speech, sore throat, and the inability to fully open the mouth.
• Professional athletes should be aware that anesthetics contain an active ingredient that can induce a positive reaction in tests conducted during anti-doping controls.

Despite the extraordinary benefits of dental anesthesia, these substances also have contraindications:

• Patients suffering from allergies to one or more substances in the anesthetic;
• Patients without reasoning ability or those with whom cooperation is not possible (very young children, individuals with mental disabilities, etc.);
• Patients with various anomalies, such as a denser bone structure that prevents the anesthesia from reaching the nerve.

In conclusion, there are various types of dental anesthesia, each with its own characteristics, advantages, disadvantages, and contraindications. The dentist is best suited to provide recommendations in this regard, ensuring that dental treatment proceeds under optimal conditions. To receive adequate care and maintain good oral health, make sure to visit the dentist for a check-up at least once a year.