Dental Anesthesia


Dental anesthesia (or dental anaesthesia) is a field of anesthesia that includes local anesthetics, sedation, and general anesthesia. In dentistry, the most commonly used local anesthetic is lidocaine (also called xylocaine or lignocaine), a modern replacement for procaine (also known as novocaine). Its half-life in the body is about 1.5–2 hours. Other local anesthetic agents in current use include articaine (also called septocaine or ubistesin), bupivacaine (a long-acting anesthetic), Prilocaine (also called Citanest), and mepivacaine (also called Carbocaine or Polocaine).

Different types of local anaesthetic drugs vary in their potency and duration of action. A combination of these may be used depending on the situation. Most agents come in two forms: with and without epinephrine (adrenaline) or other vasoconstrictor that allow the agent to last longer. This controls bleeding in the tissue during procedures. Usually the case is classified using the ASA Physical Status Classification System before any anesthesia is given.

Drugs with a short duration of action (approximately 30 minutes of pulpal anaesthesia) include Mepivacaine HCl 3%, and Prilocaine HCl 4% without vasoconstrictor.Drugs with an intermediate duration of action (enabling pulpal anaesthesia for roughly 60 minutes) include Articaine HCl 4% + epinephrin 1:100,000, Articaine HCl 4% + epinephrin 1:200,000, Lidocaine HCl 2% + epinephrine 1:50,000, Lidocaine HCl 2% + epinephrine 1:80,000; Lidocaine HCl 2% + epinephrine 1:100,000 and Prilocaine HCl 4% + epinephrine 1:200,000.

Bupivicaine HCl 0.5% + epinephrine 1:200,000 gives a long duration of action of pulpal anaesthesia at more than 90 minutes. Multiple factors affect the depth and duration of local anaesthetics' action. Examples of these factors include the patients individual response to the drug, vascularity and pH of tissues at the site of drug administration, the type of injection administered etc. Hence figures citing the duration of action of local anaesthetics is an approximation, as extreme variations may occur among patients.

Maxillary Anesthesia

Local anaesthesia is deposited at the buccal (cheek) side of the maxillary alveolus which can diffuse through the thin cortical plate of the maxilla, then further into the pulp of the tooth in order to achieve dental anaesthesia effect.

Mandibular Anesthesia

Both regional block and infiltration techniques are considered the first choice injections for anaesthetising the mandibular teeth.

Different techniques are chosen based on different factors:

  1. Patient age
  2. Tooth to be anaesthetised

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Anesthesiology Case Reports
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