anesthesia, sedation, premedication, electronic dental anesthesia, etc

1. PAIN CONTROL
IN OPERATIVE DENTISTRY

2. INTRODUCTION
Dental treatment is often perceived as a painful treatment by
patients
However with emphasis on prevention, minimal intervention
and modern atraumatic treatment techniques, pain and
trauma during restorative procedures have been controlled

3. METHODS TO CONTROL PAIN
1. Local anesthesia
2. Premedication- antianxiety or sedative drugs
3. Inhalation sedation
4. Hypnosis
5. Electronic dental anesthesia

4. LOCAL ANESTHETICS
AMIDE ESTER
LIDOCAINE
PRILOCAINE
BUPIVACAINE
MEPIVACAINE
COCAINE
PROCAINE
CHLOROPROCAINE
TETRACAINE

5. Amide type of local anesthetics are more commonly used in operative
dentistry as they produce less allergy or hypersensitivity reactions
1. 2% Lidocaine + epinephrine 1:50,000
2. 2% Lidocaine + epinephrine 1:1,00,000
3. 0.5% bupivacaine + epinephrine 1:2,00,000
LOCAL ANESTHESIA

6. Patient factors
Before administering LA, certain patient
factors assessed
1. Systemic health
2. Allergy
3. Psychology
Systemic health
Dentist should enquire about health status
of patient regarding CVS, CNS, liver, kidney,
thyroid, etc
e.g:- in hypertensive patients, LA without
vasoconstrictor given as vasoconstrictor
cause increase in BP and heart rate

7. Allergy
Contraindicated in patients allergic to LA
May cause anaphylactic reactions
Psychology
To avoid tension and promote patient
comfort
• Use of kind and gentle approach
• Avoiding harsh words like inject, hurt etc
• Keep syringe and needle away from
patients view
• Constant reassurance during injection

8. INFILTRATION ANESTHESIA
 Consists of supraperiosteal injection where the anesthetic is deposited near
nerve endings at the operating site
 Usually done on maxillary teeth
Techniques of local anesthesia
1. Infiltration anesthesia
2. Regional block anesthesia

9. Topical anesthesia
Before administering anesthesia, topical anesthestic like lidocaine or benzocaine is
applied to reduce discomfort during needle penetration
Regional block anesthesia
Anesthetic solution is deposited near a nerve trunk at a distance from
the operating site
Usually done on mandibular posterior site

10. PRECAUTIONS DURING INJECTION
1. The patient should be kept in a supine or semi- supine position
2. The solution should be deposited slowly to minimize pain
3. Injection into the infected area should be avoided
4. Syringe should have aspirating feature
ADVANTAGES OF LOCAL ANESTHESIA
1. Patient relaxed and cooperate
2. Controls salivation
3. Reduced blood flow
4. Operator efficiency

11. PREMEDICATION WITH ANTI-ANXIETY DRUGS OR SEDATIVES
To calm the patient during dental treatment
Agents used:-
1. Diazepam 2-10 mg
2. Alprazolam 0.25-0.5 mg
3. Midazolam 2-5 mg
1 hour before dental treatment

12. INHALATION SEDATION
Many patients with mild or moderate fear of dental treatment can
benefit from conscious sedation with nitric oxide+oxygen
Advantage – safe when compared to general anesthesia
Disadvantage - costly

13. HYPNOSIS
To control tense patient
Through hypnosis patient can be made more relaxed and cooperative

14. ELECTRONIC DENTAL ANESTHESIA
• Works on the principle of Gate control theory of pain
transmission
• Frequency >120 Hz
• Produces sensation that may be described as “vibrating”,
“throbbing”, “pulsing” or “twitching”

15. MECHANISM OF ACTION
1. Acts by stimulating A-fibres(touch, pressure, temperature)
This inhibits transmission of pain impulses produced by high
speed drill which are transmitted by A-delta and C-fibres
2. Blood levels of serotonin and endorphins are increased
which play secondary role in pain transmission

16. INDICATIONS
1. Needle phobic patients
2. Patient allergic to local anesthesia
3. Pain control prior to LA especially for palatal
injection
CONTRAINDICATIONS
1. Pts with cardiac pacemakers
2. Epilepsy
3. Very young and very old patients
4. Pregnancy

17. ADVANTAGES
1. No need for injections
2. Anesthetic effect only for required time
3. Residual analgesic affect last for several
hours
DISADVANTAGES
1. High cost
2. Learning curve
3. Intraoral electrodes are weak in this system

18. CARE DURING OPERATIVE PROCEDURES
1. Use of mouth mirrors for proper retraction
2. Rubber dam- protection of soft tissues
3. Avoid slow speed drill- time consuming
heat generation
vibration
4. Airotor with coolant
5. For deep caries- use of slow speed burs or spoon excavator to avoid pulp
exposure
6. Proper instrument grasps and rests
7. Avoid dessication of cavity by blowing air through air-water syringe
8. Gingival retraction cord- protect gingiva in subgingival preparation
9. Pulp protective agents during restoration

19. THANK YOU