Local anesthesia short in dentistry.pptx

Local anesthesia in dentistry

1. L ocal anesthesia in dentistry By; Dr. Alelign A. Tahisas 18, 2011

2. Introduction Local anesthetics Sensory innervations of jaws Local anesthesia techniques complications Max. dose and adrenaline titration calculations overview

3. An esthesia local and Regional sedation general Par esthesia Hypo esthesia Heper esthesia An algesia Hypo algesia Hyper algesia Cont….

4. Amino Ester aminoamide classes Local anesthetics

5. Cocaine Prcaine Tetracaine Chloroprocaine Benzocaine ester

6. Lidocaine prilocaine Mepivacaine Bupivacaine Articaine Polocaine ropivacaine amide

7. Cont …

8. LA differ from other drugs in one manner Other drugs start their action after attained peak plasma level conc. However, LA stop their action when uptake to circulation. Are potent vasodilators except cocaine Cont…

9. MOA Absorption, distribution, metabolism, and excretion Crosses BBB, placenta Cont…

10. Trauma, abscess, cyst,tumor Endo tx Contraindications, absolute/relative benefit vs risk Allergy Distorted anatomy Anxiety altered mental satus Infected tissues Bleeding dis Indications and contraindications

11. Increased toxicity Liver disease hepatic hypoperfusion from heart failure Renal failure/ dialysis glomerulonephritis Hereditary atypical pseudocholinestrase . pregnancy Cont …

12. Sensory and motor innervation of face

13. Cont …

14. Cont …

15. Topical Infiltration Field block Nerve block techniques

16. Insertion MB fold Landmark crown of tooth Root outline infiltration

17. 17 Cont …

18. Maxillary nerve block Via tuberosity approach Via greater palatine canal Target the maxillary nerve trunk on its course of pterygopalatine fissure Maxillary nerve block

19. Innervation Insertion Landmark Depth of needle complications Cont …

20. Cont …

21. PSA Nerve Block

22. IO NB

23. MSA

24. 24 nasopalatine

25. Inferior alveolar nerve Mental nerve Long buccal nerve Mandibular anesthesia

26. Mental NB

27. Varizoni-akinosi

28. gowgate

29. Needle breakage Hamatoma Bleeding Trismus Prolonged anesthesia and Paresthesia Bell palsy Allergy and anaphylactic inj La toxicity complications

30. LA toxicity common than allergic rxn Iv inj Max. dose Pedi and olds are at risk Cont…

31. 1.CNS manifestation tinnitus, metallic taste, disorientation, dizziness, convulsions, unconc , coma , cardiorespiratory arrest collapse may occur in higher dose. 2.CVS manifestation palpitation, hypotension, syncope. 3. Hematologi c - methemoglobinemia La toxicity

32. Decrease rate of absorption=lower plasma level=minimize risk of toxicity & help in success of anesthesia. Duration of action Hemostasis But avoid it in pts taking beta blockers, MAO inhibitors, antidepressants, hyperthyroid, CVD like HPT,.. Use of adrenaline

33. At rate of 4.5mg/kg for without adrenaline At a rate of 7 mg/kg with adrenaline Example 60 kg man can receive a max. of 270 mg without E or 420mg with E Volume conversion for 2% lido=2g/100ml=20mg/ml 13.5 and 21 ml respectively. Maximum dose calc..

34. Adrenaline titr

35. 1mg/ml=1;1000……………eq1 1;100,000 in 20ml lidocaine titration 1g/100,000ml 10mcg/ml*2oml=200mcg=0.2mg…eq2 add 0.2 mg of E to 20 ml 0f Lid how??? (Refer eq 1) Adrenaline titration calc…

36. Stanley F.malamed , handbook of local anesthesia 4th edition Fonseca oral and maxillofacial trauma 3 rd edition references

37. Thank you for your attention!!! ..