The document discusses local anesthesia and its complications. It defines local anesthesia and summarizes the history of local anesthetics from cocaine to modern agents like lidocaine. It then categorizes complications as either local (occurring near the injection site) or systemic (involving the whole body). Local complications discussed include needle breakage, soft tissue injury, and paresthesia. Systemic complications include allergy and overdose. The document focuses on specific local complications like facial nerve paralysis, ocular issues, trismus, and provides prevention and management strategies.
This document outlines local and systemic complications that can occur from dental injections. It discusses various local complications including paresthesia, needle breakage, hematoma, pain on injection, facial nerve paralysis, infection, trismus, soft tissue injury, and edema. It also discusses rare ocular complications that can occur from inadvertent injection into blood vessels supplying the eye. Prevention and management strategies are provided for each complication. Systemic complications from overdose or allergy are also briefly covered. Predisposing factors that can increase risks of complications are outlined.
This document discusses factors that can cause pain during and after endodontic treatment. Mechanical, chemical, or microbial injury to the pulp or surrounding tissues during treatment can trigger an inflammatory response and pain. Specifically, vigorous instrumentation beyond the root apex, incomplete cleaning and shaping of the root canal leaving behind bacteria, extrusion of debris into tissues, and leaving the canal open too long after treatment can all cause pain. Ensuring proper working length, thorough cleaning and disinfection of canals, and temporary fillings that don't cause hyperocclusion can help prevent post-operative pain.
- Ankylosis is a stiffening of the temporomandibular joint (TMJ) that results in restricted opening of the mouth. It can range from fibrous restrictions to complete bony fusion of the joint.
- Common causes include trauma, infection, and systemic diseases. Intra-articular fractures lead to bleeding in the joint cavity and bone fragments with high osteogenic potential can fuse the joint.
- Management involves surgical procedures like condylectomy to remove the head of the condyle, gap arthroplasty to create an artificial space, or interpositional arthroplasty using grafts to prevent re-fusion. Post-operative physiotherapy is important to maintain mobility of the joint. Complications include restricted mouth opening
The document discusses temporomandibular joint ankylosis, including its causes, clinical features, diagnosis using radiographs, and various treatment methods. Key points include: TMJ ankylosis is the fusion of the mandibular condyle with the glenoid fossa, immobilizing the mandible. Common causes are trauma, infection, and inflammation. Treatment involves surgical resection of the ankylotic mass with coronoidectomy and interpositional arthroplasty using grafts to prevent re-ankylosis, followed by aggressive physiotherapy. Complications can include recurrence if physiotherapy is not continued long-term.
Local Anesthesia in Oral and Maxillofacial SurgerySapna Vadera
Local anaesthesia is a loss of sensation in a circumscribed area without loss of consciousness. The document discusses the history of local anaesthesia from ancient times to modern developments. It also covers the desirable properties, mechanisms of action, classifications, pharmacology and clinical aspects of local anaesthetics. The summary provides a high-level overview of the key topics covered in the document relating to the definition, history, properties and mechanisms of local anaesthetics.
Extraction of teeth is contraindicated in patients who have a history of radiation treatment in the area due to increased risk of osteoradionecrosis. Teeth located in an area of tumor, especially malignant tumors, should also not be extracted to prevent potential spread of the cancer. Extraction is further contraindicated for teeth near sites of jaw fractures or in patients with limited mouth opening, severe pericoronitis, or acute dental infections unless the infection is first treated.
Local & systemic Complications of Local AnesthesiaIAU Dent
This document discusses local anesthesia (LA), including its mechanism of action, factors influencing injection discomfort and techniques to reduce discomfort, testing the success of LA, causes and management of failed LA, complications of LA including local and systemic complications, and management of specific complications like needle breakage, pain/burning on injection, persistent anesthesia, and trismus. It provides anatomical and technical details related to achieving successful LA and avoiding complications.
This document outlines local and systemic complications that can occur from dental injections. It discusses various local complications including paresthesia, needle breakage, hematoma, pain on injection, facial nerve paralysis, infection, trismus, soft tissue injury, and edema. It also discusses rare ocular complications that can occur from inadvertent injection into blood vessels supplying the eye. Prevention and management strategies are provided for each complication. Systemic complications from overdose or allergy are also briefly covered. Predisposing factors that can increase risks of complications are outlined.
This document discusses factors that can cause pain during and after endodontic treatment. Mechanical, chemical, or microbial injury to the pulp or surrounding tissues during treatment can trigger an inflammatory response and pain. Specifically, vigorous instrumentation beyond the root apex, incomplete cleaning and shaping of the root canal leaving behind bacteria, extrusion of debris into tissues, and leaving the canal open too long after treatment can all cause pain. Ensuring proper working length, thorough cleaning and disinfection of canals, and temporary fillings that don't cause hyperocclusion can help prevent post-operative pain.
- Ankylosis is a stiffening of the temporomandibular joint (TMJ) that results in restricted opening of the mouth. It can range from fibrous restrictions to complete bony fusion of the joint.
- Common causes include trauma, infection, and systemic diseases. Intra-articular fractures lead to bleeding in the joint cavity and bone fragments with high osteogenic potential can fuse the joint.
- Management involves surgical procedures like condylectomy to remove the head of the condyle, gap arthroplasty to create an artificial space, or interpositional arthroplasty using grafts to prevent re-fusion. Post-operative physiotherapy is important to maintain mobility of the joint. Complications include restricted mouth opening
The document discusses temporomandibular joint ankylosis, including its causes, clinical features, diagnosis using radiographs, and various treatment methods. Key points include: TMJ ankylosis is the fusion of the mandibular condyle with the glenoid fossa, immobilizing the mandible. Common causes are trauma, infection, and inflammation. Treatment involves surgical resection of the ankylotic mass with coronoidectomy and interpositional arthroplasty using grafts to prevent re-ankylosis, followed by aggressive physiotherapy. Complications can include recurrence if physiotherapy is not continued long-term.
Local Anesthesia in Oral and Maxillofacial SurgerySapna Vadera
Local anaesthesia is a loss of sensation in a circumscribed area without loss of consciousness. The document discusses the history of local anaesthesia from ancient times to modern developments. It also covers the desirable properties, mechanisms of action, classifications, pharmacology and clinical aspects of local anaesthetics. The summary provides a high-level overview of the key topics covered in the document relating to the definition, history, properties and mechanisms of local anaesthetics.
Extraction of teeth is contraindicated in patients who have a history of radiation treatment in the area due to increased risk of osteoradionecrosis. Teeth located in an area of tumor, especially malignant tumors, should also not be extracted to prevent potential spread of the cancer. Extraction is further contraindicated for teeth near sites of jaw fractures or in patients with limited mouth opening, severe pericoronitis, or acute dental infections unless the infection is first treated.
Local & systemic Complications of Local AnesthesiaIAU Dent
This document discusses local anesthesia (LA), including its mechanism of action, factors influencing injection discomfort and techniques to reduce discomfort, testing the success of LA, causes and management of failed LA, complications of LA including local and systemic complications, and management of specific complications like needle breakage, pain/burning on injection, persistent anesthesia, and trismus. It provides anatomical and technical details related to achieving successful LA and avoiding complications.
This document provides information on various techniques for local anesthesia in dentistry. It discusses the mechanism of action, classifications, and maximum recommended doses of local anesthetics. It also describes in detail techniques for maxillary injections including inferior alveolar nerve block, Gow Gates, and Vazirani Akinosi techniques for mandibular anesthesia. Complications and contraindications of local anesthesia are mentioned.
This document discusses the history, definition, etiology, clinical characteristics, diagnostic methods, and treatment of myofascial pain dysfunction syndrome (MPDS). Some key points:
- MPDS is a pain disorder caused by trigger points in the muscles of mastication that refer pain to the head and neck. It is the most common cause of masticatory pain.
- Etiology may include occlusal factors, prosthetic problems, malocclusion, psychophysiologic factors, and trauma.
- Clinical characteristics include pain in the head/neck, limited jaw motion, joint noises, and tender muscles.
- Treatment involves a multidisciplinary approach including medications, trigger point injections, physical
Local anaesthesia- composition and dosage in dentistryVikram Perakath
The document defines local anesthesia and describes the desirable properties of local anesthetics, including that they should not be irritating, cause permanent nerve damage, or have high systemic toxicity. It also discusses the components, actions, dosages, techniques, and complications of various local anesthetic injections used to anesthetize the maxillary teeth and surrounding tissues, such as infiltration, posterior superior alveolar nerve block, and anterior superior alveolar nerve block injections. Contraindications to local anesthetics include allergies and risk of overdose.
This document provides an overview of internal derangements of the temporomandibular joint (TMJ). It defines internal derangement as an abnormal relationship between the articular disc and condyle. The most common type is anterior disc displacement, which can be with or without reduction. Causes include trauma, functional overloading, joint laxity, and muscle spasms. Symptoms vary depending on the type but may include clicking, limited opening, and pain. Diagnosis involves clinical exams and MRI imaging. Treatment ranges from splint therapy to arthrocentesis or arthroscopy for lavage and relief of adhesions. Arthrocentesis is shown to improve opening and reduce pain by removing inflammatory factors from the
The document discusses local anesthesia and its potential complications. It defines local anesthesia and lists local and systemic complications. It discusses the principles of drug toxicity and the role of the user in potential toxicity. It describes overdose reactions involving the central nervous system and treatments. It provides guidelines for safe administration of local anesthesia and managing complications like overdose reactions and allergic responses.
This document discusses dental elevators used for tooth extractions. It describes different types of elevators based on their design, principles of use, and applications. Straight, triangular, and pick-up elevators are discussed. Elevators remove whole teeth, roots, or root fragments using lever, wedge, and wheel/axle principles. Proper technique involves supporting the jaws, directing force along the tooth axis, and using finger guards to control forces and prevent damage to adjacent tissues.
MPDS, or myofascial pain disorder syndrome, is a pain disorder characterized by unilateral pain referred from trigger points in muscles of the head and neck. These trigger points are localized tender areas within taut muscle bands caused by micro- or macro-trauma to the musculoskeletal system. Accumulation of chemicals like lactic acid and prostaglandins in the muscles lowers the pain threshold, leading to MPDS symptoms like pain, limited jaw motion, and joint noises. Diagnosis involves assessing range of motion, palpating muscles for tenderness, and grading joint clicks. Treatment aims to inactivate trigger points, prevent recurrence, and correct perpetuating factors through therapies like physical modalities, anesthesia, pharmacotherapy, and occasionally
Managment of hypertensive patient in dental clinic- OMFSAdharsh KM
This document discusses the management of hypertensive patients for dental treatment. It defines hypertension as blood pressure consistently over 140/90 mmHg and classifies it into stages. It describes the causes of essential (primary) hypertension and secondary hypertension due to underlying conditions. The document outlines modifications needed for dental treatment of hypertensive patients, including controlling blood pressure before elective procedures, using short appointments to minimize stress, and careful use of local anesthetics containing epinephrine. It emphasizes the importance of adequate pain control and anxiety reduction during dental visits for hypertensive patients.
This document provides information on bilateral sagittal split osteotomy (BSSO), a common surgical procedure for the mandible. Some key points:
- BSSO involves making sagittal cuts along the ramus and body of the mandible to allow advancement or setback of the mandible. It was first described in the 1950s and has undergone several modifications.
- Indications for BSSO include mandibular deficiencies, prognathism, asymmetries, open bites, and cross bites. Contraindications include decreased posterior body height and ramus hypoplasia.
- The surgical procedure involves incisions, osteotomy cuts, splitting the segments, mobilization, positioning, and
The document discusses focal infection and inflammation in the dental pulp. It describes how microorganisms from infected dental sites can spread through the bloodstream and lymphatic system, potentially causing infection elsewhere. When the pulp becomes inflamed in response to injury or infection, it undergoes degenerative or proliferative changes. The "FISH" study identified four zones of tissue reaction around an infected area: the zone of infection, contamination, irritation, and stimulation. Kronfeld's mountain pass theory applied this concept to explain the inflammatory response in the periapex as a defensive reaction analogous to a military mobilization.
an overview of muscle pain disorder which regularly create some discomfort for patient to live a normal life as well as to the doctor regarding diagnosis of the problem.
This document discusses the dental management of diabetic patients. It begins by defining diabetes and describing the two main types: type 1 resulting from a failure to produce insulin, and type 2 caused by insulin resistance. It then outlines the local and general complications of diabetes, including infections, periodontitis, and retinopathy. Regarding dental management, it stresses the importance of understanding a patient's diabetes status and treatment. For well-controlled diabetics, standard dental care is appropriate while poorly controlled or insulin-dependent patients require special precautions. It also provides guidance on preventing and treating hypoglycemic emergencies during dental visits.
Rene LeFort in 1901 classified midface fractures based on the level of injury into 3 types: Lefort I, II, and III fractures. Since then there have been modifications to the classification system. Lefort I fractures involve the maxilla above the teeth and nasal floor. Treatment involves either closed or open reduction with fixation methods like miniplates or wires. Potential complications include nerve damage, infection, malocclusion, and sinus issues. Contemporary approaches emphasize early open reduction and anatomical fixation with miniplates to achieve accurate reconstruction of the midface structural pillars.
Subluxation and dislocation of temporomandibular joint Zeeshan Arif
This document discusses subluxation and dislocation of the temporomandibular joint (TMJ). It defines key terms, discusses epidemiology and pathogenesis. Acute dislocations can occur unilaterally or bilaterally and are managed initially by reducing muscle spasms non-surgically through reassurance, drugs or manipulation. Manual manipulation techniques for reducing acute TMJ dislocations are described.
Classification of Impaction and Methods & Techniques of Third molar/Manidibular impaction removal,Flap designs of impaction removal techniques and more
This document discusses the rationale for endodontic treatment. It begins by explaining the theories of how infections spread from dental sources. Microorganisms enter the pulp through cavities or cracks and cause inflammation. Inflammation results in changes to the pulp and surrounding tissues. The immune system responds through nonspecific inflammatory cells and antibodies. Endodontic treatment aims to remove irritants from the root canal system and seal it to prevent further irritation and allow healing of periapical tissues.
Local anesthetic complications can be classified as local or systemic. Local complications include prolonged anesthesia, needle breakage, hematoma, and soft tissue injury from needle trauma. Systemic complications include toxicity from overdose, idiosyncratic reactions that cannot be predicted, allergic reactions, and potentially life-threatening anaphylaxis. Proper technique, using the minimum effective dose, and aspirating before injection can help prevent complications. Complications are generally managed through reassurance, analgesics, antibiotics as needed, and supportive care until resolution.
The document summarizes common complications that can occur from local anesthesia in dental procedures. It discusses 9 types of local complications: 1) pain on injection, 2) failure to obtain anesthesia, 3) persistent anesthesia/paresthesia, 4) needle breakage, 5) facial nerve paralysis, 6) trismus, 7) soft tissue injury, 8) hematoma, and 9) systemic complications. For each complication, it describes potential causes and recommendations for prevention and management. The goal is to educate dental practitioners about minimizing risks associated with local anesthesia administration.
This document provides information on various techniques for local anesthesia in dentistry. It discusses the mechanism of action, classifications, and maximum recommended doses of local anesthetics. It also describes in detail techniques for maxillary injections including inferior alveolar nerve block, Gow Gates, and Vazirani Akinosi techniques for mandibular anesthesia. Complications and contraindications of local anesthesia are mentioned.
This document discusses the history, definition, etiology, clinical characteristics, diagnostic methods, and treatment of myofascial pain dysfunction syndrome (MPDS). Some key points:
- MPDS is a pain disorder caused by trigger points in the muscles of mastication that refer pain to the head and neck. It is the most common cause of masticatory pain.
- Etiology may include occlusal factors, prosthetic problems, malocclusion, psychophysiologic factors, and trauma.
- Clinical characteristics include pain in the head/neck, limited jaw motion, joint noises, and tender muscles.
- Treatment involves a multidisciplinary approach including medications, trigger point injections, physical
Local anaesthesia- composition and dosage in dentistryVikram Perakath
The document defines local anesthesia and describes the desirable properties of local anesthetics, including that they should not be irritating, cause permanent nerve damage, or have high systemic toxicity. It also discusses the components, actions, dosages, techniques, and complications of various local anesthetic injections used to anesthetize the maxillary teeth and surrounding tissues, such as infiltration, posterior superior alveolar nerve block, and anterior superior alveolar nerve block injections. Contraindications to local anesthetics include allergies and risk of overdose.
This document provides an overview of internal derangements of the temporomandibular joint (TMJ). It defines internal derangement as an abnormal relationship between the articular disc and condyle. The most common type is anterior disc displacement, which can be with or without reduction. Causes include trauma, functional overloading, joint laxity, and muscle spasms. Symptoms vary depending on the type but may include clicking, limited opening, and pain. Diagnosis involves clinical exams and MRI imaging. Treatment ranges from splint therapy to arthrocentesis or arthroscopy for lavage and relief of adhesions. Arthrocentesis is shown to improve opening and reduce pain by removing inflammatory factors from the
The document discusses local anesthesia and its potential complications. It defines local anesthesia and lists local and systemic complications. It discusses the principles of drug toxicity and the role of the user in potential toxicity. It describes overdose reactions involving the central nervous system and treatments. It provides guidelines for safe administration of local anesthesia and managing complications like overdose reactions and allergic responses.
This document discusses dental elevators used for tooth extractions. It describes different types of elevators based on their design, principles of use, and applications. Straight, triangular, and pick-up elevators are discussed. Elevators remove whole teeth, roots, or root fragments using lever, wedge, and wheel/axle principles. Proper technique involves supporting the jaws, directing force along the tooth axis, and using finger guards to control forces and prevent damage to adjacent tissues.
MPDS, or myofascial pain disorder syndrome, is a pain disorder characterized by unilateral pain referred from trigger points in muscles of the head and neck. These trigger points are localized tender areas within taut muscle bands caused by micro- or macro-trauma to the musculoskeletal system. Accumulation of chemicals like lactic acid and prostaglandins in the muscles lowers the pain threshold, leading to MPDS symptoms like pain, limited jaw motion, and joint noises. Diagnosis involves assessing range of motion, palpating muscles for tenderness, and grading joint clicks. Treatment aims to inactivate trigger points, prevent recurrence, and correct perpetuating factors through therapies like physical modalities, anesthesia, pharmacotherapy, and occasionally
Managment of hypertensive patient in dental clinic- OMFSAdharsh KM
This document discusses the management of hypertensive patients for dental treatment. It defines hypertension as blood pressure consistently over 140/90 mmHg and classifies it into stages. It describes the causes of essential (primary) hypertension and secondary hypertension due to underlying conditions. The document outlines modifications needed for dental treatment of hypertensive patients, including controlling blood pressure before elective procedures, using short appointments to minimize stress, and careful use of local anesthetics containing epinephrine. It emphasizes the importance of adequate pain control and anxiety reduction during dental visits for hypertensive patients.
This document provides information on bilateral sagittal split osteotomy (BSSO), a common surgical procedure for the mandible. Some key points:
- BSSO involves making sagittal cuts along the ramus and body of the mandible to allow advancement or setback of the mandible. It was first described in the 1950s and has undergone several modifications.
- Indications for BSSO include mandibular deficiencies, prognathism, asymmetries, open bites, and cross bites. Contraindications include decreased posterior body height and ramus hypoplasia.
- The surgical procedure involves incisions, osteotomy cuts, splitting the segments, mobilization, positioning, and
The document discusses focal infection and inflammation in the dental pulp. It describes how microorganisms from infected dental sites can spread through the bloodstream and lymphatic system, potentially causing infection elsewhere. When the pulp becomes inflamed in response to injury or infection, it undergoes degenerative or proliferative changes. The "FISH" study identified four zones of tissue reaction around an infected area: the zone of infection, contamination, irritation, and stimulation. Kronfeld's mountain pass theory applied this concept to explain the inflammatory response in the periapex as a defensive reaction analogous to a military mobilization.
an overview of muscle pain disorder which regularly create some discomfort for patient to live a normal life as well as to the doctor regarding diagnosis of the problem.
This document discusses the dental management of diabetic patients. It begins by defining diabetes and describing the two main types: type 1 resulting from a failure to produce insulin, and type 2 caused by insulin resistance. It then outlines the local and general complications of diabetes, including infections, periodontitis, and retinopathy. Regarding dental management, it stresses the importance of understanding a patient's diabetes status and treatment. For well-controlled diabetics, standard dental care is appropriate while poorly controlled or insulin-dependent patients require special precautions. It also provides guidance on preventing and treating hypoglycemic emergencies during dental visits.
Rene LeFort in 1901 classified midface fractures based on the level of injury into 3 types: Lefort I, II, and III fractures. Since then there have been modifications to the classification system. Lefort I fractures involve the maxilla above the teeth and nasal floor. Treatment involves either closed or open reduction with fixation methods like miniplates or wires. Potential complications include nerve damage, infection, malocclusion, and sinus issues. Contemporary approaches emphasize early open reduction and anatomical fixation with miniplates to achieve accurate reconstruction of the midface structural pillars.
Subluxation and dislocation of temporomandibular joint Zeeshan Arif
This document discusses subluxation and dislocation of the temporomandibular joint (TMJ). It defines key terms, discusses epidemiology and pathogenesis. Acute dislocations can occur unilaterally or bilaterally and are managed initially by reducing muscle spasms non-surgically through reassurance, drugs or manipulation. Manual manipulation techniques for reducing acute TMJ dislocations are described.
Classification of Impaction and Methods & Techniques of Third molar/Manidibular impaction removal,Flap designs of impaction removal techniques and more
This document discusses the rationale for endodontic treatment. It begins by explaining the theories of how infections spread from dental sources. Microorganisms enter the pulp through cavities or cracks and cause inflammation. Inflammation results in changes to the pulp and surrounding tissues. The immune system responds through nonspecific inflammatory cells and antibodies. Endodontic treatment aims to remove irritants from the root canal system and seal it to prevent further irritation and allow healing of periapical tissues.
Local anesthetic complications can be classified as local or systemic. Local complications include prolonged anesthesia, needle breakage, hematoma, and soft tissue injury from needle trauma. Systemic complications include toxicity from overdose, idiosyncratic reactions that cannot be predicted, allergic reactions, and potentially life-threatening anaphylaxis. Proper technique, using the minimum effective dose, and aspirating before injection can help prevent complications. Complications are generally managed through reassurance, analgesics, antibiotics as needed, and supportive care until resolution.
The document summarizes common complications that can occur from local anesthesia in dental procedures. It discusses 9 types of local complications: 1) pain on injection, 2) failure to obtain anesthesia, 3) persistent anesthesia/paresthesia, 4) needle breakage, 5) facial nerve paralysis, 6) trismus, 7) soft tissue injury, 8) hematoma, and 9) systemic complications. For each complication, it describes potential causes and recommendations for prevention and management. The goal is to educate dental practitioners about minimizing risks associated with local anesthesia administration.
Local complication of local anaesthesiaEhsanAnwar6
1. The document discusses several local complications that can occur from local anesthesia administration, including needle breakage, prolonged anesthesia/paresthesia, facial nerve paralysis, trismus, soft tissue injury, and hematoma.
2. Prolonged anesthesia or paresthesia may be temporary or permanent and is usually caused by direct nerve injury during injection. Strict adherence to injection protocols can help minimize this risk.
3. Facial nerve paralysis can be immediate or delayed. Transient paralysis lasts less than several hours and is caused by local anesthetic introduction into the parotid gland capsule. Reassurance and eye patching is usually sufficient management.
Complications of Local anesthesia (part I) for B.D.S & M.D.S bhavana valvi
This document discusses various local complications that can arise from local anesthetic injections. It describes complications such as needle breakage, prolonged anesthesia, facial nerve paralysis, trismus, soft tissue injury, hematoma, pain on injection, infection, and edema. For each complication, it discusses causes, problems associated with the complication, prevention strategies, and management approaches. The document provides detailed information on injection techniques and protocols to minimize risks of various local complications.
Local complications of local anesthesiaKelsyVarghese
This document discusses potential local complications of local anesthesia including needle breakage, persistent anesthesia/paresthesia, facial nerve paralysis, trismus, soft tissue injury, hematoma, pain on injection, burning on injection, infection, and postanesthetic intraoral lesions. It provides details on the causes, problems, prevention, and management of each complication. The management sections emphasize the importance of reassuring patients, applying heat/saline rinses, prescribing analgesics/muscle relaxants, and referring to specialists if issues persist.
This document discusses local anesthetic complications from dental procedures. It begins by defining local anesthesia and describing common local complications like needle breakage and prolonged numbness. It then discusses potential systemic complications and treatments. Risk factors for specific issues like paresthesia and trismus are outlined. Throughout, it provides guidance on best practices to minimize complications and recommendations for managing issues if they occur.
Local anesthesia in dentistry : RECENT ADVANCESPooja Jayan
This document provides an overview of local anesthesia. It begins with definitions of local anesthesia and discusses its history from the isolation of cocaine in 1859 to the development of modern local anesthetics like lidocaine. It describes the ideal properties, theories of action, classification, composition, maximum doses, armamentarium, techniques for maxillary and mandibular injections, and potential complications. The key information is that local anesthesia temporarily interrupts nerve conduction to produce loss of sensation in a circumscribed area, allowing for painless dental procedures.
Pain management in Restorative dentistry and Endodontics - fathima newpdf.pdfNAVANEETH KRISHNA
This document discusses various techniques for pain management in restorative dentistry and endodontics. It begins by defining local anesthesia and describing the mechanism of action and classification of local anesthetics. It then discusses the composition of local anesthetic agents and techniques for administering local anesthesia, including maxillary and mandibular techniques as well as alternative techniques like the Gow-Gates and Vazirani-Akinosi methods. It also covers selecting the appropriate local anesthetic based on factors like duration of the dental procedure and adjunctive analgesics that can provide pain relief.
This document discusses complications associated with local anesthesia. It describes local complications such as needle breakage, persistent anesthesia, facial nerve paralysis, and trismus. It also covers systemic complications including allergic reactions, toxicity from overdose, and idiosyncratic reactions. Prevention and management strategies are provided for various complications. The document emphasizes the importance of proper technique and avoiding overdose when administering local anesthesia.
This document discusses complications associated with local anesthesia. It describes local complications such as needle breakage, persistent anesthesia, facial nerve paralysis, and trismus. It also discusses systemic complications including allergic reactions, toxicity from overdose, and idiosyncratic reactions. Prevention and management strategies are provided for various complications. The document aims to educate dental practitioners about using local anesthesia judiciously and being aware of potential adverse effects.
This document summarizes potential complications from local anesthetics, separating them into local and systemic complications. Locally, complications include needle breakage, paresthesia, facial nerve paralysis, trismus, soft tissue injury, hematoma, and infection. Systemically, complications are overdose, allergy, syncope, asthma, and hyperventilation. For each complication, the document discusses causes, problems, prevention, and management. Overall, it provides an overview of risks from local anesthetics and ways to minimize complications.
Local anesthesia interrupts nerve transmission by blocking sodium channels and preventing the propagation of action potentials along nerve fibers. The ideal local anesthetic has rapid onset, prolonged duration, is reversible, selectively acts on sensory nerves, is water soluble, non-irritating, stable, and has no systemic side effects. Complications from local anesthesia can arise from the drugs, injection techniques, or both. Common complications include soft tissue injury, tissue necrosis, needle breakage, hematoma, and failure to achieve anesthesia. Proper injection technique and use of medications can help reduce complications.
Pain control is important for restorative dental procedures. Various techniques can be used including local anesthesia, sedation, hypnosis and electronic dental anesthesia. Local anesthesia blocks pain pathways using agents like lidocaine with epinephrine. Gentle technique, rubber dam isolation, and pulp protective materials can minimize pain during treatment. Proper case history, motivation and premedication can also help control a patient's pain response.
Local anaesthesia is commonly used for cataract surgery as it allows for cataract surgery to be performed as a day procedure with little risk. It provides rapid onset of action, low intraocular pressure, and pupil dilation. Common local anaesthetics used include lignocaine, bupivacaine, and ropivacaine. Regional anaesthesia techniques like retrobulbar, peribulbar, and sub-Tenon blocks are also used and provide anaesthesia of the eye muscles and nerves but carry more risk of complications like haemorrhage and globe perforation. General anaesthesia is reserved for children, anxious patients, or when major eye surgery is required due to the risks of increased intraocular pressure and prolapse
This document discusses the management of pain in operative dentistry. [1] Local anesthesia is the most common method used to control pain and involves infiltration or regional block techniques. [2] Alternative methods include premedication with antianxiety drugs, inhalation sedation, hypnosis, and electronic dental anesthesia. [3] Proper care during procedures like using rubber dams and avoiding excessive heat can further minimize pain.
This document provides an introduction to local anesthesia. It discusses that dentists, not doctors, were responsible for discovering anesthesia due to their motivation to alleviate pain from dental procedures. The first two people to introduce anesthesia were dentists - Horace Wells with nitrous oxide in 1844 and William Morton with ether. Local anesthesia works by preventing the generation and conduction of nerve impulses, setting up a chemical roadblock between the source of pain and the brain. The document then discusses the mechanism of action, factors affecting local anesthetics, and uses and contraindications of local anesthesia.
This document discusses various regional anesthetic techniques including:
- Topical anesthesia which uses creams or ointments to numb skin and mucous membranes.
- Intravenous regional anesthesia (Bier block) which involves injecting local anesthetic around a tourniqueted limb to numb it.
- Peripheral nerve blocks which involve injecting local anesthetic near specific nerves to numb surgical areas. Brachial plexus and lumbar plexus blocks are examples.
- Potential complications include local tissue damage, nerve injury, seizures and cardiac issues if too much drug is absorbed systemically. Proper technique and drug choice can minimize adverse outcomes.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
3. • Local anesthesia has been defined as “Loss of sensation in a circumscribed area of the
body caused by a depression of excitation in nerve endings or an inhibition of the
conduction process in peripheral nerves”
STANLEY F.MALAMED(1980)
4. INTRODUCTION
Local anesthetics allow dentistry to be practiced without patient discomfort.However,
regardless of appropriate preanesthetic patient assessment, good patient communication, and
use of proper technique according to all the recommended guidelines and procedures prior to
the administration of the local anesthetic agent, localized and systemic responses to
anesthetic injections are uncommon but may occur
5. HISTORY OF LOCAL
ANESTHESIA
• In the 1860s, the first local anesthetic COCAINE was isolated from coca leaves by ALBERT
NIEMANN in Germany
• Its anesthetic action was demonstrated by CARL KOLLER an ophthalmologist in 1884
• WILLIAM HALSTEAD (a surgeon) used an injection of cocaine to successfully anesthetize
the inferior alveolar nerve for the painless extraction of a patient’s
mandibular tooth in 1884
Carl Koller
1857 -1944
6. • First effective and widely used synthetic local anesthetic -PROCAINE (novocain) -produced
by ALFRED EINHORN in 1905 from benzoic acid & diethyl amino ethanol
• Its anesthetic properties were identified by BIBERFIELD and the agent was introduced into
clinical practice by BRAUN
• LIDOCAINE- LOFGREN in 1948
• The discovery of its anesthetic properties was followed in 1949 by its clinical use by
T. GORDH
8. DEFINITIONS
• Complication is any deviation from the normally expected pattern during
or after securing local analgesia
• Local complications occur in the region of the injection and can be
attributed to the anesthetic needle, administration technique or to the
anesthetic drug administered.
• Systemic complications occur in the systems of the body and are
attributed to the drug administered such as hypersensitivity and allergy
or overdosage and toxicity
9. LOCAL
prolonged anesthesia (paresthesia)
facial nerve paralysis
ocular complications
trismus
soft tissue injury
hematoma
pain on injection
burning on injection
infection
edema
sloughing of tissues
postanesthetic intraoral lesions
SYSTEMIC
Allergy
Overdosage
Idiosyncracy
Needle breakage
10. •Needle breakage
•Soft tissue injury
•Pain on injection
•Burning on injection
•Allergy
•Overdosage
•Idiosyncracy
Intraoperative
complications
•Paresthesia
•Facial nerve paralysis
•Ocular complication
•Trismus
•Hematoma
•Infection
•Edema
•Sloughing of tissues
•Post anesthetic intraoral lesions
Post operative
complications
12. Causes
•Bending of the needle
•Sudden unexpected movement of
the patient
•Entire length of the needle
inserted into the soft tissue
•Use of the smaller needles ( e.g 40
gauge )
Prevention
•Use large-gauge needles, specially
with Inferior Alveolar Nerve and
Posterior Superior Alveolar Nerve
•Use long needles
•Do not insert a needle into tissues
to its hub
•Do not redirect a needle once it is
inserted into tissue
13. Management
When a needle breaks ( visible) :
• Stay calm
• Instruct the patient not to move and let his mouth open
• If the fragment visible, remove it with hemostat or
a Magill intubation forceps
When a needle breaks ( not-visible) :
• No incision or probing
• Calmly inform the patient
• Take radiograph and determine if it is superficial, remove or leave it and follow up
14. PARESTHESIA
• Paresthesia is defined as persistent anesthesia or altered sensation well
beyond the expected duration of anesthesia
• Include hyperesthesia and dysesthesia, in which the patient experiences
both pain and numbness
• Patient may report feeling NUMB [frozen] for many hours or days after LA
injection.
• Clinical response :sensation , swelling ,tingling , itching , oral dysfunction ,
tongue biting , drooling ,loss of taste ,speech impediment
15. Causes
• Trauma to any nerve may lead to paresthesia
• It is a common complication of oral surgical procedures and mandibular
dental implants
• Injection of LA solution with alcohol or cold sterilising solution near a nerve
produces irritation and edema of the tissue and subsequent pressure on
the nerve
• Haemorrhage around the neural sheath also causes pressure on the nerve,
leading to paraesthesia
16. Prevention
• Strict adherence to injection protocol
• Proper care and handling of dental cartridges help minimize risk of
paresthesia
17. Management
• Most case resolve within 8 weeks
• Reassurance to the patient
• Examine the patient
• Determine degree and extend of paresthesia
• Record findings in patient’s own words such as “hot” ,“cold” , “painful”,
“increasing” , “decreasing” , “staying the same”
• Reschedule the patient until paresthesia is resolved
• Continue dental treatment but avoid administering local anesthesia into
the previously traumatized region
18. TRANSIENT FACIAL NERVE PARALYSIS
• Usually occur in inferior alveolar nerve block
• Facial nerve –motor supply to muscles of facial expression
• Loss of motor action of the muscles of facial expression produced by the
L.A lasts for 1 -7 hours
• Patient suffers unilateral paralysis of facial muscles
20. Cause
• Induction of local anesthetic into the deep lobe of the parotid gland which
is located at the posterior border of mandibular ramus through which
terminal portions of the facial nerve extend
• Usually it occur during IANB or Vazirani - Akinosi nerve block.
21. Problem
Facial nerve paralysis.
Inability to close eyelid and
drooping of lip on affected side
(patient’s right)
• Usually minimal or no sensory loss occurs
• The protective lid reflex of the eye is abolished
• Winking and blinking become impossible
• Corneal reflex is intact, and tears lubricate the eye
• Transient facial nerve paralysis lasts no longer than several hours
depending on the L.A formulation used and proximity to the facial nerve
22. Transient Delayed Facial Nerve Palsy After Inferior Alveolar Nerve Block Anesthesia
Fotios H. Tzermpos, Alina Cocos, Matthaios Kleftogiannis, Marissa Zarakas, Ioannis Iatrou
Anesth Prog. 2012 Spring; 59(1): 22–27
It can be of :
Immediate
Delayed
23. Prevention
• Proper care and handling to injection control and cartridge
• A needle tip that comes in contact with bone before depositing local
anesthetic solution essentially precludes the possibility that anesthetic will
be deposited into the body of the parotid gland during an IANB
Management
• Reassure the patient
• Contact lenses should be removed until muscular movement returns
• Hygiene measures such as an eye patch should be applied to the affected
eye or manually close the affected eyelid periodically to keep the cornea
lubricated
24. • In cooperation with the neurologist, prednisolone was prescribed as
follows:
• 20 mg, 3 times a day for the first week;
• 20 mg, 2 times a day for the second week;
• 20 mg, once a day for the third week; and
• 10 mg, once a day for the fourth week.
26. Endophthalmitis Horner’s syndrome
Ogurel, T., Onaran, Z., Ogurel, R., & Örnek, K. (2015). Endophthalmitis after tooth extraction in a
patient with previous perforating eye injury. The Pan African medical journal, 20, 72.
https://doi.org/10.11604/pamj.2015.20.72.6080
27. • Hemifacial flushing, conjunctival injection and enophthalmos
• Impaired visual acuity (double vision)
• Mydriasis (dilation of the pupil))
• Ophthalmoplegia (internal or external, partial or total)
• Ptosis (droopy eyelid)
• Strabismus (convergent or divergent)
From Alamanos C, Raab P, Gamulescu A, Behr M. Ophthalmologic complications after administration of
local anesthesia in dentistry: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol.
2016;121:e39–e350
28. The nerve blocks which are prone for ocular complications are as follows:
29.
30. INFERIOR
ALVEOLAR
NERVE BLOCK
The central
retinal artery is
a small branch
of the
ophthalmic
artery
any anesthetic
solution
flowing
through the
middle
meningeal
artery may
enter the
ophthalmic
artery
retinal artery
causing
blindness and
loss of
pupillary light
reflex.
31.
32. Prevention
• Aspiration before actual injection
• Inject slowly
Management
• Reassure the patient
• Cover the affected eye with gauze dressing
• Refer patients to an ophthalmologist for evaluation if it last more than 6 hours
• Regular follow-up
33. TRISMUS
• It is from Greek ‘prismos’ is defined as a prolonged tetanic spasm of the jaw
muscle by which the normal opening of the mouth is restricted
• Normal healthy individuals mouth opening is around 30-50mm
• When the mouth opening is limited to a maximum of 20mm the individual is
said to have a reduced mouth opening or trismus
34. Causes
• Trauma to the muscles and blood vessels in the infratemporal space
• Trauma to the muscle caused by repeated needle insertion especially medial
pterygoid in inferior alveolar nerve block
• Low grade infection
• Excessive hemorrhage or hematoma which produces irritation of the tissue
and muscles dysfunction
• Solution which contain alcohol or other cold sterilizing solutions irritate the
tissue and produces trismus
35. Problem
Limitation of movement
associated with post injection
trismus is usually minor
In the acute phase of
trismus pain produce by
hemorrhage lead to
muscle spasm and
limitation of movement
Chronic phase develops if
treatment is not begun
Chronic hypomobility occurs
secondary to organization of
the haematoma with fibrosis
and scar contracture
Infection may produce
hypomobility through
increase pain, increase
tissue reaction and
scarring
36. Prevention
• Use sharp, sterile, disposible needle
• Do not use contaminated needles
• Atraumatic injection and avoid repeating of it
• Clean the area of needle insertion with an antiseptic solution before injection
• Change needle for every new insertions made
• Use minimal effective volumes of LA
• Trismus is not always preventable
37. Management
Heat therapy
Soft diet
Warm saline rinse
Analgesic, aspirin
325 mg
Muscle relaxation
if necessary
Diazepam 10 mg
bid
Physiotherapy for
5 min. Each 3-4
hours
If there is
infection,
describea ntibiotic
for 7 days
Improvement
start within 2-3
days and recovery
range 4-20 weeks
Surgical
intervention in
some cases.
38. SOFT-TISSUE INJURY
• Trauma to the lip or the tongue caused by biting or chewing while still
anesthetized, specially with children
39. Prevention
• A cotton roll placed between the lips and the teeth
• Warn the patient
• Self-adherent warning sticker
40. Management
• Analgesic for pian.
• Antibiotic if there is infection.
• Warm saline rinse to aid in decreasing the swelling.
• Petroleum jelly to cover the lesion and minimize the irritation
41. HEMATOMA
• The effusion of the blood into extravascular spaces can result from inadvertent
nicking of blood vessel during administration of LA
42. Cause
• Damage to blood vessel during penetration of needle
• Denser the surrounding tissues (palate) less likely a hematoma is to
develop
• Most occur with IANB and PSA nerve block
• Hematomas that occur after the IANB are usually visible only intraorally
• Hematomas that occur after the PSA nerve block are visible extraorally
44. • Possible complications are include trismus and pain
• Bruise which may or may not be visible extraorally
• Complete resolution of Swelling and discoloration of the region usually subside
gradually occurring between 7 and 21 days
Problem
45. Prevention
• Knowledge of normal anatomy
• Use shorter needle for PSA nerve block ,eg: 27 gauge
• Minimize the number of the needle penetration
• Never use a needle as a probe in the tissue
46. Management
• Direct pressure applied on to the site of bleeding
• Ice may be applied to the region immediately- analgesic and vasoconstrictor -
minimize the size of hematoma
• Heat may be applied to the region beginning the next day
• Heat should not be applied to the areas after incident -risk of hematoma due to
vasodilatation
• Apply cold moist towels to affected area each 20 min every hour
• Advice the patient about soreness and limitation of the mouth opening possibility
47. PAIN ON INJECTION
Causes
• Careless injection and callous attitude “ Palatal Injection always hurt ”
• Dull of the needle because of multiple injection
• Rapid deposition of the local anesthetic solution
• Needles with barbs (from impaling bone) as they are withdrawn from
tissue
48. Problem
• Increases patient anxiety
• Increases risk of needle breakage
• Traumatic soft tissue injury to the patient or needle stick injury to the administrator
49. Prevention
• Adhere to proper techniques of injection, both anatomical and
psychological
• Sharp needles
• Topical anesthetic
• Inject slowly, ideal rate is 1.0 mL per minute; the recommended rate is
1.8 mL or a 2.2- mL cartridge over 1 minute
• A solution that is too hot or too cold may be more Uncomfortable than one
at room temperature
• Ph approximately 7.4
50. BURNING ON INJECTION
A burning sensation that occurs during injection of a local anesthetic is not uncommon
Causes
• Ph of the solution
Ph of “plain” local anesthetics (no vasopressor included) is approximately 6.5
Solutions that contain a vasopressor are considerably more acidic (3.5- 4.5)
• Rapid injection of local anesthetic in the denser, more adherent tissues of the palate
• Contaminated solution, or an overly warm solution
51. Problem
• Tissue irritation
• Burning caused by the ph of the solution rapidly disappears as the anesthetic
action develops
• Postanesthetic trismus
• Edema
• Possible paresthesia
52. Prevention
• Buffering the local anesthetic solution to a ph of approximately 7.4
immediately before administration
• Slowing the speed of injection also helps
Ideal rate of injectable drug administration is 1 ml per minute. Do not
exceed the recommended rate of 1.8 ml per minute
• Stored at room temperature in container without alchohol or other
sterilizing agents
53. Management
• Most instances of burning on injection are transient and do not lead to
prolonged tissue involvement
• Formal treatment is usually not indicated
• In those few situations in which postinjection discomfort, edema, or
paresthesia becomes evident, management of the specific problem is
indicated.
54. INFECTION
• Extremely rare occurrence since the introduction of single-use sterile
needles and glass cartridges
Causes
• Contamination of needle
• Improper technique in the handling of local anesthetic equipment and
improper tissue preparation for injection
• Administering local anesthetics through areas of dental infection
55. Problem
• Contamination of needles or solutions may cause a lowgrade infection when the needle
or solution is placed in deeper tissue
• This may lead to trismus
Prevention
• Use disposable syringes and needles
• Use appropriate sterilized needle
• Avoid cross contamination between different sites within the oral cavity
56. Management
• Treat with appropriate antibiotics
• Manage trismus: heat and analgesic if needed, muscle relaxant if needed,
and physiotherapy
57. EDEMA
Swelling of the tissue is not a syndrome but a clinical sign of the presence of some disorder
Causes
• Trauma during injection
• Infection
• Allergy
• Hereditary angioedema
• Hemorrhage
• Injection of irritating solution (alcohol, cold solution)
58. Problem
• Pain and dysfunction of the region
• Angioneurotic edema produced by a topical anesthetic can compromise
the airway, edema of the tongue, pharynx, or larynx
Management
• Proper care and handling of the local anesthetic armamentarium.
• Use atraumatic injection technique.
• Complete an adequate medical evaluation of the patient before drug
administration.
59. • Traumatic edema resulting from inflammation resolves in one to three days
with antiinflammatory drugs
• Edema after hemorrhage resolves more slowly (over 7 to 21days) as
extravasated blood elements are resorbed into the vascular system
• Allergic edema
Requires immediate assessment to avoid the risk of anaphylaxis
treated with Antihistaminics and steroidal anti-inflammatory drugs
60. If edema
compromises
breathing :
P(position):
unconscious,
the patient is
placed
supine A-B-C: basic
life support is
administered
as needed
D:emergency
medical
services is
summoned
Epinephrine :0.3mg
adult ,0.15mg
child,every 5 minute
until respiratory
distress dissolves
Histamine
blocker IM
OR IV
Corticosteroid
IM OR IV
Cricothyrotomy
if total airway
obstruction
appears to be
developing
61. SLOUGHING OF TISSUES
• Prolonged irritation or ischemia of gingival soft tissues
Causes
• Epithelial desquamation - topical anesthesia – long time,
Heightened sensitivity to LA
• Sterile abscess – secondary to prolonged ischemia- site usually develops: hard
palate
Problems
• Pain & infection
62. Prevention
• Vasoconstrictors - do not use overly concentrated solutions
• Allow the solution to contact the mucous membranes for 1 to 2 minutes
• Norepinephrine (levophed) 1:30,000 - most likely to produce ischemia and
sterile abscess
Management
• Resolution in 7-10 days
• Analgesics
63. POSTANESTHETIC INTRA ORAL LESIONS
• Ulcers develop in the mouth after 2 days of application of LA
Causes
• Recurrent aphthous stomatitis or herpes simplex
• Trauma to tissues
Problem
• Burning or itching sensation
• Acute sensitivity in the ulcerated area-tissue infected-risk of secondary
infection-chance very less
64. Prevention
• Treatment of extraoral herpes simplex in its prodromal phase – antiviral
agents
Management
• Rinse mouth using diphenhydramine & milk of magnesia
• Orabase, a protective paste, without triamcinolone acetonide (Kenalog)
can provide a degree of pain relief.
• A tannic acid preparation (Zilactin) can be applied topically to the lesions
extraorally or intraorally
65. SYSTEMIC COMPLICATIONS
Principle 1:
No drug ever
exerts a
single action
Principle 2:
No clinically
useful drug is
entirely
devoid of
toxicity
Principle 3:
The potential
toxicity of a
drug rests in
the hands of
the user
66. Classification of adverse drug
reactions- toxicity
1. Toxicity caused
by direct extension
of pharmacological
effects
•Side effects
•Over dose
•Local toxic effects
2. Toxicity caused
by alteration in the
recipient
•Presence of disease
•Emotional
disturbances
•Genetic aberrations
•Idiosyncrasy
3. Toxicity caused by
allergy to the drug
67. TOXICITY OF LA
• It refers to the symptoms manifested as a result of overdosage or
excessive administration of the solution
• Toxins are poison
• All drugs are poison when administered too much
• Methylparaben has been excluded from all L.A Cartridges manufactured in
USA from 1984
• Overdose is also a synonym for toxic reaction because 99% of total toxicity
is due to overdose
68. LOCAL ANESTHETIC OVERDOSE
Pre disposing factors:
•Age
•Weight
•Sex
•Presence of
disease
•Genetics
•Mental attitude
and environment
PATIENT
FACTORS
• Vasoactivity
• Concentration
• Dose
• Route of
administration
• Rate of injection
• Vascularity of
injection site
• Presence of
vasoconstrictor
DRUG
FACTORS
69. CLINICAL MANIFESTATION OF
LOCAL ANESTHETIC OVERDOSE
Signs:
MINIMAL TO MODERATE OVERDOSE LEVELS:
• Apprehension
• Talkativeness
• Excitability
• Slurred speech
• Generalized stutter
• Muscular twitching
• Nystagmus, dysarthria
• Sweating , vomiting
• Elevated BP, heart rate and respiratory rate
MODERATE TO HIGH BLOOD LEVELS:
• Generalized tonic clonic seizure, followed by
• Generalized CNS depression
• Depressed BP, heart rate and respiratory
71. Pathophysiology
Local anesthetics cross blood-brain barrier,
producing CNS depression as level rises
Blood level Action produced
< .5 ug/ml - no adverse CNS
defects
0.5-4 ug/ml - anticonvulsant
4.5-7.5 ug/ml – agitation,
irritability
> 7.5 ug/ml – tonic clonic
seizures
Local anesthetics exert a lesser effect
on the cardiovascular system
Blood level Action produced
1.8-5 ug/ml-treat PVCs,
tachycardia
5-10 ug/ml – cardiac depression
>10 ug/ml- severe depression
Bradycardia, vasodilatation, arrest
72. Management
Place patient in supine position
If seizure occurs, protect from nearby objects and suction oral cavity if vomiting occurs
Medical assistance
Monitor vital signs
Administer oxygen
Start IV
Administer diazepam 5-10 mg slowly or midazolam 2-5 mg slowly
Institute BLS if necessary
Transport to emergency care facility
73.
74. EPINEPHRINE
Maximum Dose for Dental
Appointment
Normal healthy patient:
0.2 mg per appointment
Significant cardiovascular
impairment:
0.04 mg per appointment
75. How much is too much ?
• 2% solution has.... 20mg/ml
• A cartridge of 2ml, therefore has 40mg of L.A
• M.L.D for lignocaine hydrochloride with epinephrine is 7mg/kg
• For a 70kg man, the maximum dosage of L.A he can receive is 7x70kg =490mg
• In 1 cartridge there is 2ml of L.A which contains 40mg of L.A, therefore the number
of cartridges needed to achieve maximum lethal dose is 12.25 cartridges
(490 x 1/40)
77. ALLERGIC REACTIONS
• 1% of all reactions occuring during administration of LA are allergic in nature
• Caused by antigen – antibody reaction leading to release of histamine or
histamine like substances
• Most commonly methylparaben has been implicated in production of allergic
reactions
80. Prevention:
• Medical History Questionnaire –
-Describe your Reaction
-How was your reaction treated
-What position were you in at the time of the reaction
-What is the name, address, and telephone number of a Doctor in whose office this
reaction occurred
• Allergy Testing – though no form of allergy testing is 100% reliable
• Alternative Techniques of Pain Control
81.
82. Delayed skin reactions (Developing 60 mnts or post exposure)
P A B C D
Position the conscious patient comfortably
A,B,C are assessed as adequate
Definitive care:
• Oral histamine blocker: 50mg diphenhydramine or 10mg chlorpheniramine
• Patient should remain in the office under observation for 1 hour before discharge to ensure
that the reaction does not progress
• Obtain medical consultation ,if necessary to determine the cause of reaction
• A complete list of all the drugs and chemicals administered to or taken by the patient should be
compiled for use by the allergy consultant
83. Immediate skin reactions (Developing within 60 mnts or post exposure)
P A B C D
Position the conscious patient comfortably
A,B,C are assessed as adequate
Definitive care:
• Oral histamine blocker: 50mg diphenhydramine or 10mg chlorpheniramine
• Monitor and record vital signs for every 1 hour
• Patient should remain in the office under observation for 1 hour
• Prescribe an oral histamine blocker for 3 days
• Fully evaluate the patient’s reaction before further dental care is provided
• If uncertainity exists activate emergency medical services
84. Bronchospasm
• P-A-B-C-D
• Administer Oxygen
• Administer Epinephrine or Other Bronchodilator such as Albuterol via inhalation
• Activate emergency medical services.
• Administer AntiHistamines (50 mg Diphenhydramine or 10 mg Chlorpheniramine)
Syringe preloaded with epinephrine 1:1000
85. Laryngeal edema
• P-A-B-C-D
• If airway is maintained and the victim’s chest is making spontaneous respiratory
movements but no air is being exchanged, immediate and aggressive treatment is
mandatory to save the victim’s life
Definitive care:
• Administer epinephrine IM
• Activate emergency medical services
• Administer oxygen
• Maintain the airway
• Administer histamine blocker im/iv and corticosteroid im/iv
• Perform cricothyrotomy if the preceding steps have failed to secure patent airway
86. Bronchodilator inhaler (Albuterol)
Skin Reaction
1. Oral histamine blocker 50 mg diphenhydramine or 10 mg
chlorpheniramine, one q6h for 3-4 days
2. Observation for 1 hour
3. Medical consultation
4. If skin reaction is immediate , administer epinephrine
0.3 mg IM
87. IDIOSYNCRASY
• Any reaction to LA that cannot be classified as toxic or allergic is often
called idiosyncrasy
Treatment
• Purely symptomatic
• Aimed at maintenance of patent airway and cardiovascular support
88. CONCLUSION
Local anesthesia is required for almost all the procedures performed in present day
dentistry. Hence we as the dentists should be aware of various techniques, adverse
effects, actions and indications along with the pharmacological aspects so that we
can use it judiciously according the patients condition.
89. REFERENCE
• Handbook of local anesthesia stanley malamed
• Bennett C. Monheim's local anesthesia and pain control in dental practice.
New delhi: CBS; 1990
• Alamanos C, Raab P, Gamulescu A, Behr M. Ophthalmologic complications
after administration of local anesthesia in dentistry: a systematic review.
Oral Surg Oral Med Oral Pathol Oral Radiol. 2016;121:e39–e350
• Arodiya, A., Thukral, R., Agrawal, S. M., Rai, A., & Singh, S. (2017). Temporary
blindness after inferior alveolar nerve block. Journal of clinical and
diagnostic research : JCDR, 11(3), ZD24–ZD25
• Ogurel, T., Onaran, Z., Ogurel, R., & Örnek, K. (2015). Endophthalmitis after
tooth extraction in a patient with previous perforating eye injury. The Pan
90. • Transient Delayed Facial Nerve Palsy After Inferior Alveolar Nerve Block
Anesthesia Fotios H. Tzermpos, Alina Cocos, Matthaios Kleftogiannis,
Marissa Zarakas, Ioannis Iatrou Anesth Prog. 2012 Spring; 59(1): 22–27