Dental Anesthesia Options
Dental procedures are essential processes that help you achieve optimal dental health. Prevention, restoration, diagnosis, endodontic, and orthodontic procedures are all classes of dental procedures. However, dental procedures can sometimes be painful. This article comprehensively covers dental anaesthesia and its role in the administration of dental procedures.
Please note that Savina Clinic – Dental & Implantology Centres (Malta & Gozo) offer Dental Sedation for anxious patients who otherwise would not be able to proceed with a dental treatment. You can read more about the process in our dedicated Dental Sedation section or contact us directly to book an appointment.
What is Dental Anesthesia?
Dental Anesthesia is the administration of drugs that cause temporary insensitivity to pain during dental procedures. It can be administered through inhalation or needle injection.
The first use of dental anaesthesia can be traced back to 1844 when a Connecticut-based dentist, Howard Wells used nitrous oxide on himself to undergo a tooth extraction. This was after he noticed that nitrous oxide brought about anaesthesia. However, his Harvard demonstration failed.
Two years later, William Morton successfully used an agent of ether to show its efficacy in dental extraction at a Massachusetts public showing. This success expanded the dental industry at the time.
Local anaesthesia, however, can be credited to Carl Koller in 1884 when he accidentally numbed his tongue while testing cocaine. He repeated the experiment with a frog and realised that it didn’t respond to touch when a cocaine solution was placed in its eye. The first case of cocaine as local anaesthesia was a successful eye operation. Koller received significant awards for his work.
In 1905, Procaine mixed with Epinephrine was introduced. In the 1940s, Lidocaine was introduced as a safe and effective local anaesthesia. However, the public perception fed demand for general anaesthesia, but poor operative standards led to fatalities mainly in children. Professor David Poswillo was responsible for introducing guidelines that would see local anaesthesia become preferable where possible.
Types of Anesthesia
Dentists use local anaesthesia when they want to operate in a specific area of the body. Local anaesthesia is administered in minor surgical procedures. It is also used in cases where it is unnecessary for the patient to be admitted after the procedure. It allows you to remain alert and aware throughout the process.
Total or general anaesthesia is administered when the patient is required to be unconscious. With total anaesthesia, the patient cannot feel any sensation during surgery. Here, the specialist uses gas or injection to administer the anaesthetic.
Local anaesthesia has developed in recent times proving to be efficient in pain management during dental procedures. The most common anaesthetic used during dental work is Lidocaine. Lidocaine is considered a modern upgrade from an anaesthetic that was common in the past, Novocaine. However, there are other local anaesthetics used in dental work, including mepivacaine and prilocaine.
An anaesthetic may be used with a combination of other substances to make it more efficient. Here are some of them:
- Vasoconstrictors which slow down the transportation of blood to numb the site for an extended period
- Sodium Hydroxide that adds to the efficacy of the drug
- Sodium Chloride, which aids in getting the anaesthetic into the blood
After an introduction to the pain site, Lidocaine (or the anaesthetic of choice) temporarily blocks the paths that transmit pain signals to the brain. It stops the sodium ions from binding to nerve endings at the painful site. Without the ion, there is no electrical signal build up and passage.
Procedures Requiring Anesthesia
There are procedures where local anaesthesia is most useful such as:
Dental procedures such as fillings, root canals, and tooth removals
With the exception of tooth removals, these procedures may involve some form of drilling. The dentist may use a local anaesthetic to numb the target region or an analgesic to alleviate post-operative pain.
Stitching (suturing) a wound
To lessen the pain during stitching, the administrator or technician may inject the anaesthetic at the site.
During a biopsy
A biopsy is an invasive procedure that requires a surgeon to remove cell tissue for examination.
Cases that require general/total anaesthesia
- Where the patient will be exposed to a cold environment
- Where the procedure involves massive blood loss
- Where the operation carries respiratory risks
- Where the process takes a long time
- Overly invasive procedures
Dental Anesthesia Side Effects
Local anaesthetics are safe. However, there are some side effects that patients may experience, including:
Toxicity can be local or systemic. Symptoms of anaesthetic toxicity typically do not last long. However, they can cause a significant level of discomfort and in extremely rare cases, can be fatal. Some of the symptoms include prolonged tongue numbness, dizziness, metallic taste, difficulty in visual and auditory focus and disorientation. These signs dissipate after about 4 hours, during which the concentration of the anaesthetic will have reduced.
In serious cases, symptoms may include cardiac arrest, respiratory problems, and hypertension.
Most dental anaesthetics contain a preservative, sodium bisulfite or metabisulfite. These are added to the anaesthetic to aide the epinephrine in staying active. Allergic reactions to these preservatives or the epinephrine in the anaesthetic may manifest themselves as rashes, reddish patches on the skin and intense itching. Methylparaben (another preservative that may be used in local anaesthetics) can also cause an allergic reaction. A reaction to the adrenaline or epinephrine can also cause severe tachycardia (very rapid heart rate) for some time.
This is a neurological disorder where the patients experience a burning or prickling feeling in the limbs. This happens when there is prolonged pressure on a nerve, and usually goes away after the pressure is reduced.
Postoperative soft tissue injury
Cases of postoperative soft tissue injury are quite common in dentistry. Although they heal relatively quickly, it is important to monitor the site closely after the dental work. Soft tissue injuries may result in fever, redness of the trauma site, bleeding, tooth mobility, flap instability among others.
You should notify your dentist immediately you notice any of these signs after your dental work.
To know if you will react negatively to the anaesthetic, a dentist can perform a prick test on the skin. If a skin prick test turns up negative, then the dentist can perform an intradermal test using low concentrations of allergens. Assessment of medical history also helps to know whether you are allergic to any of the substances used in anaesthetics.
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Savina Clinic – Dental & Implantology Centres are friendly, state-of-the-art practices in Malta and Gozo dedicated to comprehensive quality dental care. Savina Dental is an innovative dental practice in Malta and prides itself on the high-quality customer service, low waiting room times, attention to detail and the advanced dental technology at their disposal.
Dr Joseph Xuereb
Dental & Implant Surgeon. Principal
Savina Dental Clinics