8/4/2019 Dental Pharmacology 11
1/16
Anesthetic agents
Inhalation sedation
Antianxiety agents
8/4/2019 Dental Pharmacology 11
2/16
The practice of various psychological, physical, andchemical approaches to the prevention andtreatment of preoperative, operative, andpostoperative anxiety and pain to allow dentaltreatment to occur.
Psychological strategies should include simplerelaxation techniques for the anxious patient andmore comprehensive behavioral techniques tocontrol pain
Methods of pain control Anesthetic agents
Inhalation sedation
Antianxiety agents
Intravenous sedation
General anesthesia
IntroductionIntroduction
8/4/2019 Dental Pharmacology 11
3/16
Topical Anesthesia provides a temporarynumbing effect on nerve endings that are
located on the surface of the oral mucosa.
Supplied as: Ointments
Liquids
Sprays
AnestheticAgentsAnestheticAgents
8/4/2019 Dental Pharmacology 11
4/16
local anesthesia the elimination ofsensation, especially pain, in one part of thebody by the topical application or regionalinjection of a drug.
Note: Although the use of local anesthetics isthe foundation of pain control in dentistry andhas a long record of safety, dentists mustalways be aware of the maximum, safe
dosage limits for each patient. Large doses oflocal anesthetics in themselves may result incentral nervous system depression especiallyin combination with sedative agents.
LocalAnesthesiaLocalAnesthesia
8/4/2019 Dental Pharmacology 11
5/16
Local anesthesia temporarily blocks thenormal generation and conduction action of
the nerve impulses.
This happens in theAXON
wall by blockingthe sodium channels.
Local anesthesia is obtained by injecting
the anesthetic agent near the nerve in the
area intended for dental treatment.
Method ofActionMethod ofAction
8/4/2019 Dental Pharmacology 11
6/16
Length of time from induction until thereversal process is complete.
Short-acting:
Local anesthetic agent lasts less than 30 minutes. Intermediate-acting:
Local anesthetic agent lasts about 60 minutes.
Long-acting:
Local anesthetic agent lasts longer than 90
minutes.
DurationDuration
8/4/2019 Dental Pharmacology 11
7/16
Criteria foruse: Prolongs the duration and increases depth of action of an
anesthetic agent by decreasing the blood flow in the
immediate area of the injection.
Decreases bleeding in the area during surgical procedures.
Types:
Epinephrine
Norepinephrine
Contraindications for the use of vasoconstrictors
Recent coronary artery bypass surgery.
Untreated or uncontrolled severe hypertension.
Untreated or uncontrolled congestive heart failure.
VasoconstrictorVasoconstrictor
8/4/2019 Dental Pharmacology 11
8/16
Lidocaine 2% with epinephrine 1:80 000 Prilocaine 3% with epinephrine 1:300 000
Prilocaine 4%
Articaine 4% with epinephrine 1:100 000 Other local anesthetic agents less commonly
used are mepivacaine, which is shorter
acting, and bupivacaine, which is a long-
acting anesthetic and may act for 6-8 hours,
procaine, benzocaine and lignocaine.
Commonly used agentsCommonly used agents
8/4/2019 Dental Pharmacology 11
9/16
Maximum safe doses:
Calculated on the basis of possible effects of LA and thevasoconstrictor.
Lidocaine with epinephrine 4.4 mg\kg
prilocaine 6 mg\kg
Articaine 7 mg\kgThese figures when translated into volumes of the LA
solution for a fit, healthy patient of average weight,
suggest the following:
2% Lidocaine with epinephrine 6-7 cartridges of 2.2ml 3% prilocaine with epinephrine 5-6 cartridges of 2.2ml
4% prilocaine 4 cartridges of 2.2ml
4% articaine with epinephrine 4 cartridges of 2.2ml
8/4/2019 Dental Pharmacology 11
10/16
Table 37-2 LocalAnesthesia Setup: AnestheticSyringe
8/4/2019 Dental Pharmacology 11
11/16
A noninvasive method to block pain electronicallyby using a low current of electricity through
contact pads that target a specific electronic
waveform directly to the nerve bundle at the root
of the tooth. Benefits to the patient:
No needles.
No post-operative numbness or swelling.
Chemical-free method of anesthesia. No risk of cross-contamination.
Reduces fear and anxiety.
Patients have control over their own comfort level.
ElectronicAnesthesiaElectronicAnesthesia
8/4/2019 Dental Pharmacology 11
12/16
Nitrous oxide/oxygen (NO/O)is acombination of these gases that the patient
inhales to help eliminate fear and to help the
patient relax.
Effects Non addictive.
Easy onset, minimal side effects, and rapid recovery.
Produces stage I anesthesia.
Dulls the perception of pain.
Inhalation SedationInhalation Sedation
8/4/2019 Dental Pharmacology 11
13/16
Pregnancy: First trimester Nasal obstruction: Problems inhaling
through the nose
Emphysema: Increased O Multiple sclerosis: Breathing difficulties
Emotional stability: Altered perception of
reality
Contraindication of UsingNO/O
Contraindication of UsingN
O/O
8/4/2019 Dental Pharmacology 11
14/16
Used only for patient treatment. Never administered for recreational
purposes.
How to reduce NO hazards to dental
personnel Use a scavenger system.
Use a patient mask that fits well.
Discourage patients from talking.
Vent gas outside the building.
Routinely inspect equipment and hoses for leaks.
Use an NO monitoring badge system.
Exposure to Nitrous OxideExposure to Nitrous Oxide
8/4/2019 Dental Pharmacology 11
15/16
For the relief of anxiety.
Sedatives
Criteria foruse:
Patients are very nervous about a procedure.
Procedures are long or difficult.
Mentally challenged patients.
Very young children requiring extensive treatment.
AntianxietyAgentsAntianxietyAgents
8/4/2019 Dental Pharmacology 11
16/16
Commonly prescribed:
Secobarbital sodium (Seconal)
Chlordiazepoxide HCl (Librium)
Diazepam (Valium) Chloral hydrate (Noctec): For children
SedativesSedatives
Top Related