Chapter 20

Management of Pain

and

Anxiety

Anesthesia and anesthetics

General anesthesia Patient becomes unconscious alters CNS, no feeling at all in body special needs patients, high anxiety patients local anesthesia is still used

Anesthesia and anesthetics

Local anesthesia shot / injection control pain during dental procedure blocks feeling and temperature contacts the nerve and blocks impulses to and

from the brain. Delivered in liquid form from pre-measured

carpules. (with or w/out epinephrine).

Anesthesia and anesthetics

Anesthetic solutions aka chemical base

• amides – lidocaine, mepivicaine

• esters – propoxycaine, procaine

Patients may react to one type of anesthetic or another. Note this in their chart.

Anesthesia and anesthetics

Vasoconstrictor• epinephrine (epi) most common added to anesthetic

• constricts vessels around injection site

• causes ‘blanching’ (tissue turns white)

• anesthetic lasts longer

• comes in ratios 1:20,000 (larger 2nd # = less epi)

• CONTRAINDICATED FOR PATIENTS WITH HEART CONDITIONS!

Types of injections

Infiltration flooding anesthetic around the nerve endings.

• Numbs the area of the injection.

• Common on the maxillary

Block placing anesthetic around a large nerve branch.

• Given near a foramen

• Numbs area from injections site to nerve endings.

• Common on the mandibular.

Types of injections

Intraosseous anesthetic is placed in the spongy bone.

• Requires a special system and technique

• Used when profound anesthesia cannot be obtained with other types of injections.

Intrapulpal anesthetic is placed directly in the pulp chamber.

• Used during RCT for a “HOT” tooth.

Anesthetic duration.

Length of time numbness lasts. Short duration

• less than 30 minutes

• no epi Intermediate duration

• 30 to 90 minutes ( about 1 hour)

• may have epi Long duration

• 90 minutes or longer

• contains vasoconstrictor

Paresthesia

When anesthesia lasts longer than intended hours days permanent

• caused by• trauma to the nerve• bleeding near the nerve• pressure from the bleeding• contaminated anesthetic

Topical anesthetic

Gel that numbs gums before injection makes the “pinch” smaller similar to teething medication placed on dry mucosa for one (1) minute prior

to the injection. Reactions are usually to coloring or flavoring in

the topical.

Topical anesthetic

Uses sub-gingival scaling root planing crown seats placing matrix bands placing rubber dam clamps depress gag reflex for impressions and x-rays.

Topical anesthetic

Allergic reactions mild to severe immediate reaction delayed up to 24 hours symptoms

• swelling, redness, sores, difficulty swallowing and or breathing.

Topical anesthetic

Toxic reaction due to an overdose stimulates the CNS symptom

• talkative, excited, apprehensive, increased pulse and or high blood pressure

• can be fatal!

Sedation

Uses: relaxation reduce fear and anxiety. dental phobias children mentally challenged

Sedation

Forms Pills

• Valium Liquid

• Versed Gas

• Nitrous oxide (N20) Intravenous

• Many different medications!

Nitrous Oxide (N2O)

Nitrous oxide and oxygen aka ‘Laughing gas’

Advantages patient remains conscious easy administration no nurse / anesthetist needed quick PO recovery used for most ages

Nitrous Oxide (N2O)

Indications fearful or anxious patients sensitive gag reflex low pain threshold long appointments heart condition high blood pressure

Nitrous Oxide (N2O)

Contraindications upper respiratory infection nasal congestion / breathing disorders very young child severe mental retardation pregnancy (1st trimester) drug addict psychiatric treatment

Nitrous Oxide (N2O)

Facts: DA cannot administer/start N20 DA can adj. flow w/ Dr. instruction Nitrous = Blue tank Oxygen = Green tank Must use an evacuation (scavenger) system Oxygen flush x 5 min. (min)

Closing

Managing pain and anxiety is a very important part of your job as a DA.

Always check the health history of every patient at every visit.

When in doubt, ask your dentist.Any questions?