LOCAL

ANALGESIA
Painful procedures are the most important
factor
behind fear and anxiety.

Fear : external threat, anxiety : Internal
threat.

Allergy from Bisulfate (metasulfat)
Two types:

1. Amide LA: Lidocaine, prilocaine, bupivicaine,
levobupivicaine .
- Heat stable, long shelf life, slower onset and long
duration.
- contra indication In malignant hyperpyrexia

2. Ester LA: procaine, cocaine.
benzocaine, tetracaine
- Unstable in solution, fast acting, allergic reaction
- contraindication in choline esterase inadequacy


TOPICAL ANASTHESIA
Types:
1. Lidocaine available as xylocaine in 10% spray
and 5% liquid, its onset 3-5 minutes.
2. Benzocaine available as hurricane gel and
solution 20%, has the lower toxicity than others.
30 sec. The best T.A.
3. Tetracaine not recommended in paediatric
dentistry. Which is 10 times toxic than procaine.
3/14 ML/KG
4.4MG/KG LIDOCAINE
6MG/KG PRILOCAINE
Formulation Max Cartridges
Adult (70) Child (25)

Lidocaine
2% with epinephrine
2%plain

13.9 4.6
8.3 2.8
Mepivacaine
2% with aeocobefrin
3% plain

11.1 3.7
7.4 2.5
Prilocaine
4% with epinephrine
4% plain

8.3 2.8
8.3 2.8
These four mistakes are the most common errors
made by dentists when attempting
to anaesthetize a child:
1. Waving the needle in front of the child.
2. Not getting firm control of the patient head and hands.
3. The use of long needle.
4. The use of inappropriate doses for children.

To avoid systemic reaction (Toxicity):
Slow injection ,aspiration before injection, knowledge of
the
maximum dosage and watchful observation of the patient.
ELECTRONIC DENTAL ANASTHESIA (EDA)
- The electronic signals interfere with the pain message by blocking the
transmission of pain impulse along the neural pathways. (Gate Control
Theory)
- EDA causes some nerve cells to produce local beta endorphins, a
naturally occurring Morphine-like action.
- EDA is known to stimulate the secretion of serotonin which increase the
patient pain threshold.

Advantage :
1. Non invasive, safe, well accepted
2. No risk of allergy, no numbness

Disadvantage:
1. Redness of skin
2. Involuntary twitching of lips, eyelid

Indication:
1. dentally phobic, allergic
2. cavity preparation anterior premolars
3. root scaling and planning
4. myofacial pain

Contraindication:
1. cardiac diseases, pacemakers
2. ocular implants
3. Pregnancy
4. over carotid
COMPLICATIONS OF AN INTRA-ARTERIAL
INJECTION OF MAXILLARY. AND IDA (ARTERY)
Blood supply to the head and face is via THE EXTERNAL CAROTID
ARTERY
Branches to form INTERNAL MAXILLARY ARTERY, Branches to:

1. Infra orbital artery: infra-orbital area (blanching) and greater palatine
(blanching)
2. Middle meningeal artery and forms branches that anastomose with
A. Ophthalmic artery (ipsilateral eye, eyelid ptosis, medial
strabismus and
amaurosis)
B. Lacrimal artery.
3. Inferior alveolar artery
Occlusal surface of the mandibular permanent first
molar mesiobuccal groove (*) and middle point of the
mesial slope of the distolingual cusp ().
The first wire passing from the mesiobuccal groove and
the middle point of the slope of the distolingual cusp of
the first mandibular molar.