DH-DTherap I/2-Local Anesthetics and Topical Anesthetics
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| What are local anesthetics? | Injected locally these agents penetrate tissue and inhibit the movement of nerve impulses along sensory fibers.
They block the transmission of peripheral nerve conduction thus reduce or block pain sensation along sensory nerves.
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| Local Anesthetics was released |
Procaine (Novocain) was synthesized by Einhorn in 1905.
Xylocaine (lidocaine) was released in 1952.
The search for the perfect local anesthetic agent is still ongoing.
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| How Do Anesthetics Work? (1-3) | Natural nerve impulse conduction (called an action potential) works by opening sodium channels allowing an inward flux of Na++ and an outward movement of K++.
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| How Do Anesthetics Work? (2-3) | As a nerve impulse is initiated, there is a change in polarity along the entire length of the nerve.
Local anesthetics bind to a receptor and decrease the permeability of the nerve membrane to Na++, thereby decreasing the rate of depolarization.
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| How Do Anesthetics Work? (3-3) | Without depolarization of the membrane, the nerve impulse is prevented from occurring.
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| Ideal Properties of a Local Anesthetic (1-2) | In general a local anesthetic should possess the following qualities:
Be potent
Be reversible
Be absent of local reactions
Be absent of allergic reactions
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| Ideal Properties of a Local Anesthetic (2-2) | Have rapid onset
Have satisfactory duration
Have adequate tissue penetration
Have low cost
Have long stability or “shelf life”
Be sterilizable by normal methods
Be easily metabolized and excretable
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| Composition | In addition to the anesthetic agent, there are several other chemicals in local anesthetics:
Vasoconstrictor
Antioxidants
Sodium hydroxide
Sodium chloride
Preservatives
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| Vasoconstrictor | -Prolong duration of the anesthetic
-Increase depth of the anesthetic
-Delay systemic absorption
-Reduce hemorrhage at site of injection
-keeps the anesthetic in the area longer, keeping the patient anesthetized for a longer period of time.
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| examples of vasoconstrictors used in local anesthetics | Epinephrine &
Neo-Cobefrin
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| Antioxidants | -reduce the oxidation or breakdown of the epinephrine.
-Sodium bisulfite or sodium meta-bisulfite.
-if allergic to this component & it can be especially hazardous with asthmatic patients: it may cause wheezing, stridor or chest tightness.
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| if allergic to Antioxidants it can be especially hazardous with asthmatic patients and can cause | wheezing, stridor or chest tightness
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| Sodium Hydroxide | An alkylinizing agent.
Adjust the pH to between 6.0 and 7.0.
Prevents pain at site of injection.
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| Sodium Chloride | Makes the injected solution Isotonic.
Allows the solution to penetrate tissue better and work better.
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| Preservatives | Methylparaben and Propylparaben.
Added to multiple dose injectable (parenteral) drugs to prevent bacterial contamination. Commonly used in Medicine.
NOT found in Dental anesthetic carpules. Dental carpules are single use only.
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| What is not NOT found in Dental anesthetic carpules | Preservatives
Methylparaben and Propylparaben.
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| What makes injected solution Isotonic. | Sodium Chloride
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| Classification of anesthetics BQ! | Two main chemical types of local anesthetics:
Amides
Esters
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| Two main chemical types of local anesthetics: BQ! | Amides
Esters
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| Esters | Less commonly used in dentistry today.
Have a higher allergenicity potential.
Butacaine
Cocaine
Benzocaine
Piperocaine
Tetracaine
Procaine- “novocaine”
Propoxycaine
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| Not used in therapeutics drugs | Cocaine
Benzocaine
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| 95% no allaregies are to | Amides
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| Amides | Most common types used today.
Low allergenicity potential.
Lidocaine- “xylocaine”
Mepivacaine- “carbocaine”
Bupivacaine- “marcaine”
Prilocaine- “citaneste”
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| Topical Anesthetics in Dentistry | Benzocaine (esther)- 20% topical gel
Lidocaine (amide)- 2% viscous solution
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| Long lasting Amides | "pinetocaine" - Septocaine (newest)
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| Epinephrine | Vasoconstrictors in local anesthetics.
Most common one used.
Sympathomimetic or adrenergic agonist, will increase blood pressure.
Available in three common concentrations:
1 in 50,000
1 in 100,000
1 in 200,000
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| Which is most concentrated? 1 in 50,000 1 in 100,000 1 in 200,000 BQ! | 1 in 50,000 high
1 in 100,000 medium
1 in 200,000 low
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| Natural adrenaline is similar to | Epinephrine
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| With this anesthetics will increase blood pressure | Epinephrine
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| Not injection anesthetics | Benzocaine (esther)- 20% topical gel
Lidocaine (amide)- 2% viscous solution
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| Neo-Cobefrin | Vasoconstrictors in local anesthetics.
This is a synthetic vasoconstrictor.
Chemical name is levonordefrin.
Similar effects as epinephrine but to a much lesser extent. Safer to use compared to epinephrine in similar quantities.
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| Duration of anesthesia | Short acting plain anesthetics (no epinephrine or any vaconstrictor) 30 minutes pulpal anesthesia
Lidocaine (xylocaine) plain
Mepivacaine (carbocaine) plain
Prilocaine (citaneste) plain
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| Pulpal and soft tissue Duration of anesthesia | Lidocaine w/epi: 60 minutes pulpal, 3-5 hrs soft tissue
Mepivacaine w/epi: 60-90 minutes pulpal, 3-5 hrs soft tissue
Prilocaine w/epi: 60-90 minutes pulpal, 3-8 hrs soft tissue.
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| Contraindication for vasoconstrictors BQ! | Uncontrolled hypertension
Tricyclic antidepressants
Cardiovascular disease
Recent heart attack
Angina
Arrhythmia
Hyperthyroidism (it self cause HBP)
MAO (monoamineoxidase) inhibitors
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| Maximum Safe Dose of Epinephrine for Cardiac Patients 1 in 50,000 | 1 in 50,000
Healthy pt: 0.2 mg, 5 carpules
Cardiac pt: 0.04mg, 1 carpule
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| Maximum Safe Dose of Epinephrine for Cardiac Patients 1 in 100,000 | 1 in 100,000
Healthy pt: 0.2mg, 11 carpules
Cardiac pt: 0.04mg, 2 carpules
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| Maximum Safe Dose of Epinephrine for Cardiac Patients 1 in 100,000 | 1 in 200,000
Healthy pt: 0.2mg, 22 carpules
Cardiac pt: 0.04mg, 4 carpules
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| Delivering Anesthetic Infiltration | Depositing anesthetic solution in the area of dental treatment.
Aimed at flooding the area of small terminal nerve endings with anesthetic.
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| Delivering Anesthetic Block | Depositing anesthetic at the nerve trunk providing a blockage of sensory input from the entire nerve.
The injection is usually at a separate site from where the treatment will be provided.
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| Components of the Syringe | Anesthetic carpule
Color coded
All information printed on cartridge
Always check expiration date prior to loading syringe
Always check for problems with the carpule
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| Dental needles | Dental needles are usually 27 gauge.
Blue- 1.0 inch ( 27x1)
Yellow- 1.5 inch (27x1.5)
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| Components of the Syringe What type to use? | Must always be autoclaved.
Always use an “aspirating” type syringe.
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| Syringe Assembly | Always check for problems with the anesthetic carpule:
Air bubbles trapped
Cracks in the glass
Discolored solution
Stopper pushing out end of glass carpule
Breakdown of stopper
Expiration date
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| What may cause shatter Syringe | exert force on the plunger.
Never, ever hit!
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| Local Anesthetics Complications | Lip biting
Paresthesia
Hematoma
Trismus
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| Prolonged use of topical anesthetic can cause | epithelial desquamation (sloughing)
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| Local Anesthetics Complications Systemic Complications | Angioedema-type of allergy-(life threatening)
Other allergies-rash ,itching, erythema etc.
Toxicity-accidental intravascular injection
Hypothermia
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| Local complications are managed by | symptomatic treatment
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| Systemic complications are managed | based on the severity and may need emergency intervention
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| Primary Prevention (1-3) | In order to prevent complications, it is important to use excellent injection technique
Use aspirating syringe and always aspirate before injecting
Inject v-e-r-y…… s-l-o-w-l-y
Be alert & watch patient reaction
Be ready for any emergencies
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| Primary Prevention (2-3) | When using topical anesthetic, know what agent is used
Use lowest concentration.
Use smallest volume possible
Limit area of application
Avoid sprays
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| Reason why you should Avoid sprays | Oral mucosa is highly vascular and majority is NOT keratinized. Topically applied can be quickly absorbed from the nonkeratinized mucosa into the circulation. As more topical is used, more concentrates in the circulation and can build a “Toxic” amount
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| Primary Prevention (3-3) | Get medical history and know allergies
Give appropriate instructions to patient about lip biting and cheek biting & tongue biting (especially children)
Instructions about hot beverages and foods
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| Paresthesia |
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| Hematoma |
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| Trismus |
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| Allergy-Angioedema |
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| Briefly describe the ionization factors |
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| an ideal local anesthetic agent |
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| List the composition of local anesthetic agent |
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| Classify local anesthetic and give examples for each class |
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| Name two methods of local anesthetic injection. |
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| List the precautions before giving local anesthetic injections. |
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| List the possible complications of local anesthetic injections. |
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| List the adverse effects of these agents – including toxic effect. |
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| Describe the role of vasoconstrictor in local anesthetics. |
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| List the contraindications for the use of vasoconstrictor. |
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| Describe the care of local anesthetic cartridges. |
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| Define “Topical Anesthesia.” |
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| List the agents used in topical anesthesia and classify these agents. |
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| Discuss the role of topical anesthetics in dentistry and dental hygiene. |
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