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The mid‐term exam will be held on
17/7 at 9:15 – 10:15 in 10h 3,4 labs .
Analgesia : loss of pain sensation .
Anaesthesia : loss of all forms of sensation including pain , touch and
temperature . however we have the proprio ceptive fibers , which able
to feel pressure , so anaesthesia is loss of sensation of pain , touch and
temperature except pressure .
So if we want to extract a tooth for a patient , the patient will not feel pain
but he will fell a pressure .
When we need anaesthesia and when we need analgesia ?
We use analgesia in restoration , we inject the patient to relief the pain
during procedure , while we use anaesthesia in extraction .
Why we don’t use anaesthesia during restoration ?
Because we don’t need it .
Pharmacology of local anaesthetic solution :
we have two main categories :
‐ Ester type .
‐ Amide type .
Local anaesthetic solution consists of : the clinical component of cartridge
1. Local anaesthetic agent : the substance that anaesthetize patient ,
we have :
‐ Long ac ng agent : (4‐6)h , we use it in postopera ve procedure
to relief the pain for along time .
‐ Short ac ng agent : (1‐3)h , we use it in the ordinary situa on in
the clinic .
Examples :
‐ Lidocaine : (standard drug) .
‐ Prilocaine
‐ Bupivacaine (Long acting)
2. Vasoconstrictor : the material that vasoconstrict the blood vessels.
‐ Prevent bleeding : by reducing the flow of blood by reducing the
diameter of the blood vessels .
‐ The duration and depth of anaesthesia will increase : if the flow of
blood reduced , the local anaesthetic solution in that area will take
longer time to go else where .
‐ The absorption of local anaesthetic agent will be delayed : this
mean that it will stay more in the blood .
‐ The vision will be bitter .
Examples :
Mode of action of local anaesthetic agents :
All anaesthetic agents are formed by the combination of a weak base and a
strong acid, which are readily hydrolyzed in the alkalinity of the human
tissues, to liberate alkaloid base which is then free to be taken up by the
lipids in the nerve fibers .
Free week base prevent the sodium permeability through the nerve
membrane .
Instruments :
Dental syringes :
‐ Standard (non aspirating)
‐ Aspirating syringe : this mean that the needle has an ability that
can bring the flow back , so if we inject a blood vessel , we will see
blood come back into the syringe .
Why it’s important ? we said before that if we inject an adrenalin to a
patient has cardiac problem it will cause serious problem , so this
ability help us to avoid that .
Cartridge :
it’s contain 1.8
– 2.2 ml
Types of Local Anaesthesia :
Topical : applied on the skin or in the mucous
membrane , anaesthetize the superficial layer
and then we give injection after that . we use
it mostly in pediatric , because we don’t the
children feel pain during injection procedure
and it comes in flavor : strawberry , banana ,
it has an applicator ; we put it smoothly in the
surface of mucosa . And then we use the
syringe .
Infiltration : we give the patient the
anaesthetic , and the solution deposit near the nerve endings ,
In the maxilla, the outer cortical plate is thin and perforated by
tiny vascular canals and when anaesthetic solution is deposited
outside the periosteum it will infiltrate through the periosteum,
cortical plate, and medullary bone to the nerve fibers. This
anaesthesia of the dental pulp and soft tissues.
We can give it in different areas :
‐ Sub‐mucosal: Not for pulpal anaesthesia, soft tissue surgery, e.g.
long buccal nerve prior to extraction of mandibular molar .
‐ Supra‐periosteal : above periosteum (soft tissue of the bone).
‐ Sub‐periosteal : below the periosteum , on the top of the bone .
‐ Intra‐osseous : inside the bone .
‐ Intra‐ligamentary : inside the PDL .
Regional anaesthesia: Anaesthetic solution deposited near a nerve
trunk will, by blocking all impulses, produce anaesthesia of area
supplied by that nerve. Infiltration may be unreliable in the mandible
because of the dense outer cortical plate of bone. By placing the
anaesthetic solution in the pterygo‐mandibular space near the
mandibular foramen, regional anaesthesia over the whole
distribution of the inferior dental nerve on that side will be obtained.
It is important to remember that pulpal anesthesia of maxillary teeth
after local infiltration lasts much shorter than does pulpal
anaesthesia of mandibular teeth after block anaesthesia. Also, pulpal
anaesthesia disappears 60 to 90 minutes before so ssue
anaesthesia does. Therefore it is quite possible that patient may still
have lip anaesthesia after having lost pulpal anaesthesia and may be
experiencing pain.
Here the doctor start talking about how to inject the needle :
‐ We will anaesthetize the upper right first premolar .
‐ We will inject until the apex of the tooth , we reach the bone , and
inject 1 mm inside it .
‐ We enter the needle in 45ْ .