This document discusses methods for managing dental pain, including through local anesthesia. It describes techniques for local infiltration anesthesia and regional nerve blocks to block painful stimuli. When inflammation is present, supplemental techniques may be needed like interseptal injections between teeth to complete anesthesia of pulp tissue so vital pulp can be removed painlessly. Intrapulpal injections directly into exposed pulp tissue can also profoundly anesthetize it.

2. AHMED LABIB

3.  Pain is an unpleasant sensation
that is experienced by the patient;
however, an interpretation of pain
always exists, which is
disproportionate to the
stimulation.

4. Methods of pain control:
 Raising the pain threshold by using
drugs of analgesic nature.
 Using cortical depressants (general
anesthesia).
 Using subcortical depressants either
barbiturates or non-barbiturates
sedation.

5.  Blocking the pathway of painful
stimuli by means of local anesthesia,
which is considered one of the effective
means of relieving dental pain.

6.  Local anesthetic agents are esters of
amino benzoic acid ,either:
 Para group (as Novocaine,
Monocaine, Pentocaine).
 Meta group (as Uracaine, Primacaine).
 Non-ester types of local anesthesia are
also available such as Xylocaine and
carbocaine.

7.  The problem of inadequate pain
control during endodontic treatment is
explained through alterations in the
pulp and periapical tissues.

8.  Inflammation of pulpal and periapical
tissues leads to decrease of tissue pH below
normal .
 This decreased pH will lead to incomplete
dissociation of the anesthetic solution
resulting in weak anesthetic effect.

9. Techniques of local anesthesia
in endodontics

11. 1-Local infiltration anesthesia

12.  The tip of 25 –27-gauge needle is pushed
through the mucosa until the fibrous
periosteal tissue overlying the bone is pierced
in the area of root apex.
 Then the anesthetic solution is deposited
beneath the periostium.

13. 2-Regional nerve block

14.  Nerve block anesthesia is achieved by
depositing the local anesthetic solution close
to the main nerve trunk.
 Nerve block anesthesia is more successful
when the infiltrating solution (anesthetic
solution) is deposited some distance from the
inflamed or infected tissues.

15. II- Supplementary techniques

16.  Complete anesthesia of pulp tissue
is necessary if vital pulp tissue is to
be removed without pain. This
requires supplementary injections
beside the routine infiltration or
nerve block anesthesia.

18.  It is accomplished by passing the needle tip
through the previously anaesthetized
gingival papilla and thin cortical plate,
penetrating into the cancellous bone of inter
dental septum.
 Few drops of anesthetic solution are
deposited under pressure.
 Two separate inter septal injections are
usually used, one mesial and one distal to
the tooth to be anaesthetized.

19.  The angulation of the needle should be 45 to
the long axis of the tooth.
 The needle should contact bone at the height
of the interdental crest of bone where the
cortical layer is thinnest and most easily
penetrated, by rotation of the needles as it
pressed into the crystal bone.

20.  Perforating the alveolar plate of bones using
Busch power reamer if the dentist cannot
penetrate the bone by the needle. Through this
entrance, a needle can enter the cancellous
bone and a solution deposited under pressure
to anaesthetize the particularly refractory
cases.

21.  This technique depends on the injection of
the anesthetic solution into the pulp tissue
itself.
 Profound anesthesia will only be obtained if
a drop of anesthetic solution is deposited
directly into the partially anesthetized pulp.
 The tooth is isolated and any debris in the
area of the pulp exposure is removed.

22.  A sharp explorer is used to pinpoint the
exposure, then the needle deliver few drops
of anesthetic solution into the pulp tissue.
 This profoundly anesthetizes the pulp
tissue.

23.  Additional intrapulpal injections are
necessary to anaesthetize completely the
deeper tissue within the root canal(s); the
needle must fit tightly in the canal.

24. Technique
 The needle is inserted at 30 angle, wedged
with force into the periodontal ligament space
between crystal bone and root surface.
 The fingers of the operator should support the
needle to prevent buckling, and then the
anesthetic solution is injected with maximal
pressure on mesial and distal surfaces of the
treated tooth.

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