Introduction to Local Anesthesia

Reading Assignment
Chapter 1-2
See syllabus for objectives.
 General Terminology
• Analgesia-diminishes or eliminates pain

• Local anesthesia- the elimination of sensation especially pain

in one part of the body by topical application or regional
injection of a drug

• Minimal sedation- minimally depressed consciousness

produced by a pharmacological method

• Moderate sedation- a drug-induced depression of

consciousness

• Deep sedation- a drug-induced depression of consciousness

during which patients cannot be easily aroused

• General anesthesia- a drug-induced loss of consciousness

during which patients are not arousable even by painful
stimulation
History of Local Anesthesia
Origin & History of Local Anesthetics
• Local anesthetics can be traced to medieval times.

• Medieval anesthetics used plants & herbs including berries, roots

& seeds.

• Examples include:
▫ Opium
▫ Coca leaves
▫ Henbane
▫ Arsenic
▫ Mandrake
▫ Alcohol
▫ Cannabis
Origin & History of Local Anesthetics

• 1700’s most commonly used was opium, when

converted to a more potent form, morphine was
discovered.

• Morphine when injected into the bloodstream, was very

effective.

• Both caused severe side effects and were addictive.

Origins & History of Local Anesthetics
• 1884 - first local anesthetic was introduced in dentistry.
▫ Cocaine: very effective and very addictive
▫ Many researchers and dentist became addicted, because
they tried the drug on themselves.

• 1901- epinephrine was developed

▫ Mixed epinephrine with cocaine to decrease systemic
absorption, toxicity, and side effects.
▫ This allowed for lower doses of cocaine to be
administered.
▫ Longer duration of the anesthetic.
Origins & History of Local Anesthetics
• Patients and professionals were becoming addicts of
cocaine, therefore, research continued.

• 1905 – the first drug procaine (novocaine) was

developed. Procaine would be classified as an ester.
▫ When mixed with epinephrine was effective and safe.
▫ Cons of Procaine
 took a long time to produce desired anesthetic
 wore of quickly – cocaine lasted longer
 not as potent as cocaine
 many patients became allergic to procaine
Origins & History of Local Anesthetics

• 1940s - amide local anesthetic was developed.

▫ 1st was lidocaine
▫ Lidocaine revolutionized pain control for dentistry
▫ Potent and less allergenic than procaine
▫ Became the MOST popular anesthetic used in dentistry
 Origins & History of Local Anesthetics
• To follow lidocaine were other amides over the next 20
years.
 Bupivacaine
 Mepivaciane (carbocaine?)
 Prilocaine
 Articaine; available in U.S. 2000 – developed in
1969 (Septocaine?)
Origins & History of Local Anesthetics

• Patients do not comprehend the difference between

local agents. Therefore, patients still use the term
novocaine, which is no longer used in dentistry. Funny
how it has been over 100 years and novocaine stuck!

• Lidocaine with epinephrine is the MOST popular

anesthetic used in dentistry!
History of Local Anesthetics
• First manual of local anesthesia
was published in 1947.

• Development of nerve block

anesthesia techniques were
introduced in the 1970’s.
 History of the Syringe
• Origin of dental syringe
▫ Breech-loading
▫ Cartridge-type

• First manual aspirating syringe –1957

▫ With a harpoon to engage the stopper
within the carpule of anesthetics
▫ Determine if tip of needle is within a
blood vessel
▫ Most common in dentistry still today
History of the Syringe
• Self-aspirating syringe – 1970’s
▫ With OUT a harpoon – change in pressure allowing for aspiration
▫ Determine if tip of needle is within a blood vessel

• Computer controlled delivery - 1997

LA in the Dental Hygiene Practice
• LA has been added to the scope of dental hygiene
practice over the past several years.

• Washington state passed the provision of local

anesthesia in 1971, followed by New Mexico 1972, and
Missouri in 1973.

• Today, there are only a few states that do not allow

dental hygienists to administer local anesthesia.
LA in the Dental Hygiene Practice
• Unfortunately, the requirements for certification and the type of
injections vary from state to state.

• Therefore, when applying for a license in another state, the

program you completed in one state may or may not met the
criteria of another state.

• Take time to review the type of injections you can administer as

well as the extent of supervision by DDS.

• Clinicians must be knowledgeable regarding the specifics of the

practice acts governing their particular practice location.
References
• Bassett, DiMarco, & Naughton. Local
Anesthesia for Dental Professionals. Pearson
Education, Inc. Curent Edition.

• Logothetis. Local Anesthesia for the Dental

Hygienist. Elsevier and Mosby.