Anesthesia in Dentistry: products (list name, side effects). Prices, reviews

Anesthesia in Dentistry required in 99% of cases, as most dental procedures accompanied by severe pain. And oral facial region provided with a large number of nerves and blood vessels, so they cause irritation systemic response from the body.

for pain relief drugs are selected depending on the individual patient and the duration of the procedure.

classification of drugs

Anesthesia in Dentistry, for which preparations are listed below, classified as follows:

1. On the chemical composition of the active ingredient:

• esters (Novocaine previously been used in practice as Anestezin and Dikain);
• substituted acid amides (lidocaine, articaine, Ubistezin, Bupivacaine and others).

2. For the duration of the action:

• with a short period (Novocaine);
• with an average duration of analgesic effect (lidocaine, articaine with means);
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• with a long duration of action (Bupivacaine, Hirokain, Ropivacaine).

The principle of action of local anesthetics in dentistry is to temporarily suppress the excitability of nerve endings and loss of regional sensitivity. Unlike pain medications for systemic effects, they do not lead to loss of consciousness.

Most often, these drugs are used in injectable form. In pediatric dentistry is possible to use the applicative and aerosol anesthetic.

Top-10 preparations from the chemists

The choice of drug for local anesthesia is based on the patient's history, given existing diseases and intolerance of medicines.

People prone to allergies, blood to identify individual sensitivity is recommended to hand over (Intolerance) for anesthesia, since the introduction of even small quantities of the drug can cause anaphylactic shock.

There are also the following guidelines when assigning painkillers:

• diabetes and pathologies of the thyroid gland should be selected drugs not containing epinephrine;
• at high allergenicity - anesthetics without preservatives (most often sodium disulfide, which is introduced into the composition in order to stabilize epinephrine);
• hypertension preferable products containing epinephrine, but with decompensated heart disease - without him.

Novocaine

Novocaine - one of the oldest local anesthetics, which was introduced in therapeutic practice at the beginning of the XX century. This anesthetic is a list of VED in budget dentists often use his name. Solution concentration and maximum doses are given in the table below.

Concentration,%	The maximum single dose, ml	application
0,25	500	Direct injection anesthesia into the soft tissue of the surgical field in the treatment of medium and deep caries, pulpitis, periodontal
0,5	150
1	100	For administration of the anesthetic to the nerve directly neyrostomatologicheskih in the treatment of pathologies of inflammatory infiltrates
2	25-30

Analgesic effect occurs within 10-15 minutes. after injection and lasts an average of 20-30 minutes.

This anesthetic is unstable and quickly breaks down into parabens and diethylaminoethanol. The first substance is a major cause of allergic reactions. On the other hand, lack of metabolism in the liver can be used Novocaine for patients with serious diseases of that organ.

In recent years, it has been an increase in allergic reactions to the drug, and some patients are not sensitive to it.

Among the side effects are the following:

• inflammation of the oral mucosa;
• skin rash, dermatitis;
• Angioedema;
• anaphylactic shock.

Signs of individual intolerance, as a result of which the shock occurs, are as follows:

• dizziness;
• general weakness;
• loss of consciousness;
• a sharp drop in blood pressure.

In this drug is a high risk of cross-allergy to benzocaine and tetracaine, so you must pay attention to their portability.

Contraindications for use Novocain are the following:

• genetically caused deficiency of the enzyme pseudocholinesterase;
• concomitant use of sulfa antibiotics;
• autoimmune disease myasthenia gravis;
• stable low blood pressure;
• severe cardiovascular disease;
• tendency to allergies.

The average price for the drug in 0.5% concentration (10 ml) - 30 rubles.

lidocaine

Lidocaine belongs to a group of amide anesthetics. Its efficiency is 4 times higher than that of Novocain, it has a profound and prolonged action (up to 1.5 hours), since slowly metabolised in the body. At the same time, and the active drug in a concentration of 1% and 2% to 50% toxic. Pain relief occurs within 1-5 min after injection.

During its decomposition not formed para-aminobenzoic acid, so that the frequency of allergic complications below. It can be used in patients taking sulfa antibiotics. The drug also has a sedative and an antiarrhythmic effect.

For injection of anesthesia used in dentistry 2% solution (maximum single dose - 20 ml), and for applicative - 10% aerosol solution (Lidestin).

Contraindications to this anesthetic:

• severe hepatic disease;
• sick sinus syndrome;
• bradycardia (slow heart rate);
• congestive heart failure;
• Hypersensitivity to amide anesthetics.

Anesthesia in Dentistry, preparations which contain lidocaine, may cause side effects such as:

• lowering blood pressure, heart failure;
• tremor;
• convulsions;
• psychomotor agitation;
• anaphylactic shock (individual intolerance);
• blurred vision;
• hives;
• bronchospasm.

The drug can not be combined with taking the following medications:

• beta-blockers, which are prescribed for high blood pressure, tachycardia and arrhythmias;
• antiarrhythmics;
• antidepressants;
• antibiotic Polymyxin B;
• antiepileptic drug Difenin.

The price of lidocaine in pharmacies on average 25 rubles. 10 ampoules of 2 ml.

ultrakain

Ultrakain drug produced by the French pharmaceutical company «Sanofi» 3 variants:

• Ultrakain D - without the introduction of epinephrine;
• Articaine D-C - with epinephrine at 1: 200 000;
• Ultrakain D-C forte - with epinephrine at 1: 100,000.

Along with lidocaine and novocaine, it is one of the most popular anesthetic in dentistry. The main component in the composition is articaine having a high analgesic properties. This substance started to be used in the dental practice in the late 70s. XX century. Formulations based on it stronger novocaine Lidocaine 6 and 3 times, respectively.

Anesthetic effect comes very quickly - within 0.5-3 min. after administration, and its length may be up to 3 hours by the addition of epinephrine (adrenaline). Last introduced in order to increase the depth of anesthesia and duration of action.

This makes it possible to reduce the dosage, the maximum value of which for adults is:

• Articaine forte D-C - 2 ml;
• Articaine D-C - 2.5 ml;
• Articaine M - 3 ml.

In pediatric dentistry to 5 years allowed ultrakain without epinephrine, as it can dramatically increase blood pressure, heart rate worsen and cause other disorders. Children after 5 years are allowed to enter Ultrakain D-C.

The following phenomena may occur as a side effect:

• headache;
• split view, and clouding of the eyes, blindness;
• respiratory disorders up to a complete stop;
• convulsions;
• tremor;
• allergic reactions - inflammation of the oral mucosa, swelling at the site of injection, rashes, anaphylactic shock.

Ultrakain contraindicated in the following diseases and conditions:

• Hypersensitivity to the drug;
• bronchial asthma;
• hypoxia;
• Tumor comprised of chromaffin cells;
• anemia;
• myocardial infarction, and coronary artery bypass grafting in history that have been transferred in the last 3-6 months;
• high content of methemoglobin in the blood;
• severe arrhythmias;
• increased thyroid function;
• congestive heart failure;
• lowering blood pressure;
• closure glaucoma.

Drugs with ultrakain not apply for children under 4 years of age, as there are no clinical studies on their safety at this age. You can not combine it with the use of beta-blockers (as this is a high risk of hypertensive crisis, and bradycardia) and antidepressants.

Ultrakain be prescribed with care for patients who have the following diseases:

• angina;
• enzyme deficiency, cleavage choline esters;
• atherosclerosis;
• a history of stroke;
• diabetes;
• Chronical bronchitis.

1 ampoule articaine D-C of 2 ml on average is about 110 rubles.

Ubistezin

Ubistezin - is a complete analog ultrakain D-C.

This drug is produced by the German firm "ZM Espe AG" in two forms:

• Ubistezin (concentration of epinephrine 1: 200,000);
• Ubistezin forte (concentration of epinephrine 1: 100,000).

Price per apmulu Ubistezina forte volume 1.7 ml - 44 rubles.

Orablok

Orablok (Orabloc) - another trade name anesthetic articaine with epinephrine compositions. It is a pain reliever - Italian production (company Pierelle Pharma). It is available in two versions: with epinephrine 1: 100 000 (red packaging), and 1: 200 000 (blue packaging).

Interest in drugs with articaine in modern dentistry due to the fact that the means of this group have the following advantages:

• rapid and sustained action;
• good tolerability among patients;
• minimum vasoconstrictor effect;
• little effect on the cardiovascular system: the change in pressure and the heart rate does not take place.

1 ampoule of 1.8 ml with epinephrine at a concentration of 1: 100,000 is about 35 rubles. Other analogues of the composition articaine and adrenaline are Septanest (SEPTANEST ADRENALINEE AU 1 / 100000.1 / 200000), with epinephrine and Primakain Articaine inibsa (Articaine INIBSA).

Ksilonor gel

Ksilonor gel (Xylonor Gel) - anesthetic gel is made in France (the company «Septodont») on the basis of lidocaine (5%) and Cetrimide antiseptic active against gram-negative and gram-positive bacteria. This drug is most often used in pediatric dentistry.

It is also used in the following cases:

• pre-anesthetic administration before injection;
• for patients who are allergic to para-aminobenzoic acid (Anestezin, Dikain, Novocaine);
• anesthesia prior to excision of the gingiva, gingival pockets during cleaning;
• to facilitate the oral X-ray at an elevated emetic reflex.

The maximum daily dose should not exceed 4 grams, and a contraindication to its use is the increased sensitivity to lidocaine. Analogue of this anesthetic is domestic preparation Desensil Anesti gel, the major component of which (lidocaine) is contained in higher concentrations - 12%. The average price for a tube of 15 g Ksilonora is 2000 rubles.

Skandonest

Skandonest (Scandonest) - a short-acting anesthetic (30 min.), The major active component of which is mepivacaine hydrochloride.

The drug is available in three versions:

• Scandonest 2% NA (noradrenaline in a concentration of 1: 100,000);
• Scandonest 2% SP (with epinephrine at 1: 100 000);
• Scandonest 3% SVC (without epinephrine).

Just as articaine, it has a stronger effect of the anesthetic. The average dose is 1.3 ml. The maximum daily dosage for adults - 10 ml.

Anesthesia in Dentistry with mepivacaine based drugs may be associated with the following side effects:

• state of euphoria or depression;
• convulsions;
• dizziness;
• vomiting;
• drowsiness;
• blurred vision;
• a sharp drop in pressure;
• dyspnea;
• deceleration or acceleration of the heart rate;
• loss of consciousness;
• coma.

Allergic reactions occur very rarely. This drug is widely used for the treatment of patients with pathologies of the cardiovascular system. 1 ampoule of 1.8 ml of 3% Scandonest costs about 45 rubles.

Skandinibsa

Skandinibsa anesthetic released a Spanish pharmaceutical company LABORATORY INIBSA S.A. The main component of the preparation is mepivacaine hydrochloride. This substance belongs to the tertiary amines, but the clinical anesthetic properties more similar to lidocaine.

The drug causes mild vasoconstriction, so its effect by about 25% longer than that of lidocaine, and can be used without epinephrine. This feature allows you to assign the drug to people with narrow-angle glaucoma, diabetes and cardiovascular disease.

Analgesic effect is 2-3 minutes and duration -. At least 45 min. After disintegration in tissues most of the metabolic products derived through the liver. In the presence of diseases of the body possible accumulation. The average dosage for adults is 1 vial (1.8 mL). maximum daily dose - 5.4 ml.

Contraindications for anesthetic applications are the following diseases and conditions:

• Hypersensitivity to the active component and the other series of amide anesthetics;
• myasthenia gravis;
• severe hepatic disease;
• Children under 4 years old.

Side effects are the same as those Skandonesta; the following additional adverse manifestations may occur:

• violation of the sensitivity of the lips and tongue;
• chest pain;
• involuntary urination or defecation;
• sleep apnea;
• methemoglobinemia;
• edema and inflammation at the site of injection;
• allergic reaction (very rare).

For sale is also a form of release of epinephrine - Skandinibsa forte. Price per 1 ampoule 1.8 ml averages 35 rubles.

bupivacaine

Anesthesia in Dentistry, formulations for which are made on the basis bipuvakaina serves for prolonged analgesia. Anesthetic effect develops slowly over 5-10 minutes, but kept much longer in comparison with lidocaine and mepivacaine -. 12 hr.

Another advantage of the drug is less toxic to the cardiovascular system when properly administered.

Possible side effects:

• numbness in the mouth;
• dizziness;
• blurred vision;
• apnea;
• muscle tremors or convulsions;
• drowsiness;
• drop in blood pressure;
• arrhythmia;
• heart failure;
• fainting;
• allergic reactions - from skin rashes to anaphylactic shock.

The drug is contraindicated in dentistry in the following cases:

• Hypersensitivity to the components;
• purulent lesion at the site of injection;
• inflammation of the membranes of the brain;
• swelling;
• heart failure;
• low blood pressure.

The average price per 1 vial of 4 ml - 130 rubles.

Hirokain

Hirokain (Chirocaine) is produced by the pharmaceutical company EbbVi LLC (Russia). The main active ingredient of the anesthetic - levobupivacaine hydrochloride. According to the clinical purpose is similar Bipuvakainu. As shown by experiments on animals, its toxicity to the cardiovascular system is less but if it enters the vein, it can also cause serious disturbances in the functioning of the heart.

Hirokain as Bipuvakain - a long-acting analgesic. Blockade of nerve impulse transmission takes place mainly due to the influence on the sodium channels of cell membranes. The drug is almost completely metabolized in the liver and is not detected in the feces and urine. Metabolic products are derived primarily through the kidneys.

The analgesic effect develops over 10-15 min., And its average duration is 6-9 hours. The maximum daily dose - 150 mg.

Side effects are similar to those when using Bipuvakaina:

• drop in blood pressure;
• nausea, vomiting;
• dizziness and headache;
• allergic reactions in hypersensitivity;
• drowsiness;
• convulsions;
• loss of consciousness;
• numbness at the site of drug administration (after its expiration);
• arrhythmia;
• temperature rise;
• heart failure.

Contraindications to the use of anesthetic include:

• sensitivity to the active ingredient and preparations amide group;
• lowering blood pressure;
• severe liver disease.

Anesthesia in Dentistry, long acting preparations of levobupivacaine and Bipuvakainom possess a common disadvantage - when incorrectly entered during dental procedures (enters into a vein), they can cause severe systemic complications.

Therefore, this group of agents are used less frequently. During the procedure, the physician should constantly monitor the performance of cardiac and respiratory function in patients. Average cost per 1 vial of 10 ml active drug is 110 rubles.

Anesthesia in Dentistry - one of the most urgent problems of medical technologies. Until recently, the most widely used drugs are essential series (Novocain), but they have low efficiency. The most promising anesthetic, which numbed quickly with a minimum of complications are anesthetic with articaine.

Registration of the article: Vladimir the Great

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