Chapter 4. Anesthesia in Oral Surgery (S.A. Rabinovich, S.T. Sokhov)
21 topics with concise breakdowns: definitions, key facts, and class questions.
This chapter provides a detailed analysis of key aspects of pain control in dental surgery. We will examine everything from the classification and mechanism of action of local anesthetics to instrument selection. Special attention is paid to anesthetic techniques: infiltration anesthesia, as well as conduction block techniques in the maxilla (tuberosity, infraorbital, and greater palatine/nasopalatine blocks) and mandible (mandibular, torus, mental, and Gow-Gates techniques).
During practical classes and credit tests, you will be tested primarily not only on the topographic anatomy of target landmarks for anesthesia, but also on the safe anesthesia protocol. You must know emergency response algorithms for complications to the point of automaticity: acute vascular insufficiency, allergic reactions, anesthetic toxicity, as well as coma, epilepsy, and asthma.
The material in this section will serve as your foundation for confident and safe practice. Knowledge of these topics will help you skillfully combine anesthetics with vasoconstrictors and be prepared to perform basic life support in the dental chair.
Why are ester-type drugs rarely used in dentistry today?
The ester bonds in their molecules are unstable, causing the drugs to be rapidly hydrolyzed by blood and tissue esterases. This results in an excessively short duration of anesthesia.
In what form does a local anesthetic penetrate the nerve membrane?
The drug penetrates the nerve fiber membrane strictly according to the law of simple diffusion in its active form as the uncharged anesthetic base.
Why is procaine not used for topical (surface) anesthesia?
It penetrates tissues very poorly and, at the high concentrations (10–20%) required for topical application, exhibits a pronounced irritant effect.
Why is articaine specifically chosen in cases of severe purulent-inflammatory processes?
Articaine is the drug of choice because it loses its pharmacological activity to a much lesser extent than other local anesthetics in the acidic environment that invariably accompanies inflamed tissues.
What is the maximum dose of articaine for a child?
The maximum permissible dose of articaine for children is 5 mg/kg of body weight; however, clinical guidelines recommend using no more than half of this dose.
What is the maximum permissible dose of lidocaine when performing injection anesthesia?
The maximum total dose is 4.4 mg/kg of body weight, but in total should not exceed 300 mg.
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