Anesthesia without adrenaline has been used in dentistry for quite a long time; it allows painless treatment even for those patients who have contraindications to common means of local anesthesia. Typically, drugs that do not contain adrenaline are used in cases where it is necessary to treat teeth in patients with high blood pressure, heart disease, and pregnant or breastfeeding women.
What is Articaine and what is its composition?
Articaine is an amide anesthetic intended for local, infiltrative or conductive anesthesia for both simple and complex dental procedures. A local anesthetic blocks the generation and conduction of nerve impulses, presumably by increasing the threshold of electrical excitation in the nerve, slowing the propagation of the nerve impulse, and decreasing the rate of rise of the action potential.
The uniqueness of Articaine as a member of the amide family is that it contains an ester group and a thiophene instead of a benzene ring. The thiophene ring increases the lipid solubility of articaine, facilitating more efficient diffusion of the anesthetic across the lipid membrane of nerve cells into surrounding tissues. Articaine is widely used in dentistry due to its safety during short procedures that require rapid onset of anesthesia.
The onset of action of the drug Articaine is:
- from 1.5 to 1.8 min. with infiltration of the upper jaw;
- from 1.5 to 3.6 min. with block anesthesia of the lower jaw.
Articaine pulp anesthesia lasts from 30 to 120 minutes. Anesthesia of soft tissues with the drug lasts ~ 2.25 hours for infiltration of the upper jaw, 4 hours for blockade of the lower jaw.
The drug is produced in the form of an injection solution - a transparent, colorless or yellowish liquid. For retail sale to pharmacy chains, Articaine is supplied in ampoules made of colorless chemically pure glass, enclosed in blister packs and/or cardboard packs.
Composition of articaine in dentistry:
- active agent - articaine hydrochloride;
- Excipients: sodium chloride (to make the solution isotonic) and distilled water.
1 ml of solution contains 40 mg of active agent.
In odonto-dental anesthesia, articaine is used alone or in combination with epinephrine (adrenaline). Epinephrine, diluted to 1:100,000 or 1:200,000 and added to the solution, slows down the passage of articaine into the general bloodstream and thus ensures long-term maintenance of the concentration of the active substance in the tissues, allowing a small hemorrhagic surgical field to be obtained.
It is possible to replace Articaine with synonyms with the same active substance, such as:
- Artikain-Binergy;
- Ultracaine;
- Artikain-DF;
- Articaine with Epinephrine.
The decision to use analogues is made by the attending physician, taking into account the individual characteristics of the patient.
Possible complications after tooth extraction
After simple extraction of any tooth, complications occur quite rarely, provided that the doctor’s recommendations are followed.
The main thing is that the patient needs to remember that if the blood clot remains in the socket until healing, then infection and suppuration of the wound will not occur, and within two weeks a healthy gum mucosa will appear at the site of the clot. In case of loss of a blood clot, the unprotected wound surface of the socket is exposed to pathogenic microflora of the oral cavity; the accumulation of pathogenic bacteria provokes the development of an inflammatory process - alveolitis.
Infection of the alveolar socket is the most common complication after tooth extraction. In this case, the infection penetrates and affects the soft tissues surrounding the tooth. If an infectious infection of the hole is accompanied by the presence of throbbing pain and suppuration, this signals the development of an abscess. When alveolitis is advanced, there is a danger of the inflammatory process spreading to the jaw bone - the development of osteomyelitis.
Complex (traumatic) tooth extraction has more prerequisites for the development of inflammatory complications. If after removal there remains a piece of tooth infected with caries, curettage of the hole and extraction of the tooth fragment will be required.
Also, after a complex removal, there is a possibility of delayed bleeding, several hours after the operation. The causes of such bleeding can be high blood pressure, severe stress, the body's reaction to certain medications, excessive rinsing and irritation of the wound with hot food.
In rare cases, the nerve trunks of the lower jaw may be damaged during surgery. Simple or complex tooth extraction is an unpleasant operation, but there is no point in postponing a visit to the doctor if the tooth causes discomfort and pain, most likely its removal is only a matter of time. Modern ultrasonic removal of teeth on the upper or lower jaw will save you from unwanted consequences and many troubles associated with the onset of complications after surgery.
Incorrect position of the wisdom tooth in the row
When a wisdom tooth takes an incorrect position during growth or is partially erupted, pericoronitis (inflammation of the tissues around the tooth) often develops, this is due to the fact that part of the tooth remains in the gum, and the formed periodontal pocket covering the tooth is difficult to clean from food debris , which accumulate and create an environment favorable for the development of pathogenic microflora.
A common disease of wisdom teeth is caries, since food particles remain in the interdental space with the adjacent tooth due to difficult access for cleaning, and plaque forms on the teeth. In this case, carious destruction spreads to the adjacent second molar.
Doctors recommend removing wisdom teeth if they have partially erupted or are incorrectly positioned in the dentition as early as possible, before complications occur and before their roots are fully formed.
Removal of impacted wisdom tooth
Defects in the development of third molars are caused by injury and destruction of the wisdom tooth itself and, if it puts pressure on the adjacent tooth, it damages the roots and surrounding tissues. This situation is observed due to improper growth, damage by caries, often inaccessible to treatment, surfaces of the wisdom tooth with the formation of a focus of infectious inflammation. These complications diagnosed by a doctor are absolute indications for tooth extraction.
This includes the removal of an impacted (unerupted) figure eight, when the tooth failed to erupt and remained embedded in the gum or bone.
Immersion may be tissue if the tooth has passed through the bone but is unable to penetrate the gum tissue, or bone if the tooth remains completely in the jawbone.
Follicular cyst of wisdom tooth
The formation of a follicular cyst can be asymptomatic, but the appearance of pain and high temperature already signals its active development and the presence of an inflammatory process. An increase in the size of a follicular cyst is dangerous due to the thinning of the jawbone tissue due to its replacement with a new growth.
Also, impacted and semi-impacted (partially erupted) figure eights are indicated for removal, since remaining covered by a large layer of dense mucous membrane, they put pressure on the surrounding soft tissues.
Prolonged injury to the mucous membrane from the inside contributes to the formation of pathogenic microflora. The appearance of redness, pain, and swelling indicates the occurrence of an inflammatory process, pericoronitis.
Simple tooth extraction
Simple tooth extraction, including wisdom teeth, is in most cases permissible in the upper jaw, which has a looser and softer structure and allows the tooth to be successfully grasped with forceps. If the tooth has fused roots and can be rocked, then its removal will not be difficult.
Simple removal of a wisdom tooth in the upper jaw can be done with little resistance.
Complex tooth extraction
The anatomy of the lower jaw itself prevents not only the eruption of third molars without complications, but also complicates the process of wisdom tooth extraction.
Difficult tooth extraction from below is due to the fact that the mandibular bone has a denser and stronger structure, and the roots of such teeth in the lower jaw are often curved and may have several processes, which complicates their smooth removal.
Bent or damaged roots of the eighth tooth below or above and its incorrect location, including complete or partial immersion in bone tissue, create a serious obstacle to its extraction. This situation is non-standard and requires labor-intensive efforts to remove wisdom teeth in difficult conditions. To provide quick access to the area where the tooth is located, the surgeon cuts the gum and periosteum.
During such an operation, it is possible to drill out a certain amount of bone covering the tooth or extract the problematic tooth in parts.
Ultrasound removal of wisdom teeth
At the Apex-D Dental Implantation Clinic, wisdom teeth are removed using an ultrasonic instrument.
Ultrasound surgery allows the removal of wisdom teeth, especially in complex cases, in the most atraumatic way.
The use of ultrasound in dental surgery makes it possible to perform surgery in extremely hard-to-reach places, minimize trauma to the soft and bone tissues surrounding the tooth, reduce the likelihood of complications after surgery and speed up the healing of the wound surface of the socket after tooth extraction.
Questions and answers on this topic: Tooth extraction, wisdom teeth removal
You can make an appointment at Apex-D Dentistry by calling the administrator at +7 and +7, or filling out an electronic form (the administrator will contact you at the specified phone number and agree on the date and time of the appointment).
Manufacturers Articaine
On the Russian pharmaceutical market, the anesthetic Articaine and its analogues are represented by domestic and foreign manufacturers. You can buy articaine in St. Petersburg and Moscow using the link.
The products of the following enterprises are most in demand:
- JSC "Biokhimik" (Russia);
- CJSC "Binergy" (Russia);
- LABORATORY INIBSA, SA (Spain);
- Welfarm LLC (Russia);
- Armavir biofactory FKP (Russia);
- Borisov Medical Preparations Plant (Republic of Belarus);
- Sanofi-Aventis Deutschland GmbH (Germany).
Preparations based on articaine, created at different enterprises, may have certain differences due to production technology, quantitative and qualitative composition of excipients, but at the same time retain the main direction of action of the active substance.
How to improve the quality of pain relief?
A patient who is indicated for anesthesia without adrenaline in dentistry can make sure that the effect of the painkiller lasts longer and is of better quality. To do this, he only needs to follow a few general recommendations:
- Before visiting a doctor, if there is strong anxiety and fear of treatment, it is better to take a sedative, preferably based on herbs (for example, about 30 drops of valerian root tincture).
- The day before visiting the dentist, you should not drink alcohol, since alcohol in the blood weakens the effect of the anesthetic.
- If you are taking any medications or have any allergic reactions, you should inform your dentist at the treatment planning stage.
- It is better not to visit a doctor if you feel unwell or during menstruation.
Articaine: side effects
Such qualities of Artican as low fat solubility, high% binding to blood proteins, low half-life ensure low toxicity of the drug. However, depending on the general condition, age, individual reactions of the patient and his existing systemic diseases, side effects may be observed during anesthesia with the drug, such as:
- disturbance or confusion;
- vertigo;
- headache;
- nausea;
- dyspnea;
- decreased blood pressure;
- diplopia;
- muscle tremors;
- allergic and local reactions, manifested in symptoms of urticaria, conjunctivitis, rhinitis, skin hyperemia, swelling and inflammation at the injection site.
Articaine should be used with caution during dental procedures in patients with impaired cardiovascular function, vascular diseases, liver and kidney failure.
Local anesthesia for treatment and extraction of teeth –
If previously novocaine and lidocaine were produced in the form of vials or ampoules, and injections with these drugs were performed using ordinary disposable 5.0 ml syringes, now all modern anesthetics are produced in the form of disposable carpules (cartridges). Each carpule usually contains 1.7 ml of anesthetic, and before anesthesia it is inserted into a special carpule syringe. Next, a very thin needle is screwed on (many times thinner than ordinary needles on disposable syringes), after which the syringe is ready for use.
What does an assembled carpule syringe look like?
Carpule of anesthetic and a special needle –
The cost of anesthetics and anesthesia - the cost of one anesthetic carpule for 2022 (be it ultracaine, ubistezin, septanest or others) - will be approximately 40-50 rubles. This is the price at which dental clinics purchase anesthetics. But the total cost of anesthesia for dental treatment in a dental clinic will be about 400-500 rubles per 1 carpule of anesthetic.
It is also worth noting that pain relief during the treatment and extraction of teeth in dentistry is included in the guarantee program of the health insurance fund. Therefore, anesthesia in public dental clinics should be provided free of charge, but only when using Lidocaine or Novocaine (imported anesthetic will be paid for). Next, we will talk about the types of anesthesia in dentistry.
Articaine during pregnancy in dentistry
Articaine is usually well tolerated at all stages of pregnancy. There is no data on the long-term effects of the drug on the neurophysiology of the newborn. Also, no teratogenic damage was observed after use of the drug in the first trimester.
There are no data from clinical studies of the penetration of Articaine into breast milk. To minimize possible risk to the baby, breastfeeding mothers may choose to express milk for approximately 4 hours after the injection. After which breastfeeding can be resumed.
Instructions for use
To exclude or minimize intravascular administration of Articaine, an aspiration test is required before using the drug. An accurate and slow technique for injecting the drug is required with control of the pressure on the syringe plunger depending on the sensitization of the tissue.
The instructions for use in dentistry recommend using Articaine in a dosage corresponding to the nature of the manipulation:
- 1.7 ml of solution per tooth for uncomplicated extraction of the upper jaw tooth;
- 0.1 ml for anesthetizing incisions when creating a palatal depot and suturing;
- 0.5-1.7 ml per tooth for grinding teeth for crowns and in case of cavity preparation.
After each injection of Articaine, careful and constant monitoring of vital signs of the cardiovascular and respiratory systems (adequacy of ventilation) and the patient’s state of consciousness should be carried out.
using Articaine in dentistry for infiltration anesthesia during extirpation of mandibular premolars.
No pain – anesthesia in modern dentistry
General dentist Lelekov Alexander Mikhailovich tells.
Dentists don't like to hurt. Civilized dentistry strives for complete painlessness at all stages of treatment.
The most unpleasant procedures, such as treatment of deep caries and pulpitis, tooth extraction, are unthinkable without effective anesthesia.
There are many everyday myths and outdated ideas associated with anesthesia. I’ll tell you more about this useful tool, which makes treatment comfortable, without suffering, pain and tears.
Why is it painful to be treated in some clinics, but not in others?
The patient’s sensations depend on many factors, but the most important is the anesthetic drug itself. At the beginning of the twentieth century, dentists began to use novocaine, and from the middle of the century - the more powerful lidocaine. At one time, this was a real breakthrough in medicine. The treatment became tolerable, but the pain could not be completely eliminated.
Modern clinics use anesthetics based on articaine.
Before treatment, be sure to ask what drug is used to relieve pain:
- Based on articaine, it shouldn’t hurt.
- Lidocaine, novocaine - most likely get ready for a test of patience.
For comfortable and safe treatment of my patients, I use:
- Articaine Inibsa (Spain),
- Ultracaine Sanofi (France),
- Scandonest Septodont (France).
I use Articaine in most situations. Ultracaine D, Scandonest, which do not contain adrenaline - if the patient has health problems. They can be used in elderly people, patients with diabetes mellitus, hypertension, cardiovascular diseases, and bronchial asthma. The listed anesthetics do not penetrate the placental barrier and are approved for pregnant women.
Do anesthetics contain adrenaline?
Many patients are afraid that they will be injected with adrenaline along with the anesthetic. Adrenaline (epinephrine), indeed, is contained in anesthetics; dentists value it for its vasoconstrictor effect:
- The removal of anesthetic from tissues is slowed down, so the anesthesia lasts longer.
- Bleeding is reduced, which is important when removing a tooth, treating gums or caries in the gingival area of the tooth.
But there are also undesirable effects: adrenaline can increase your heart rate and increase your blood pressure. A healthy person, as a rule, does not even notice this. But for children and patients with cardiovascular diseases, drugs with adrenaline are contraindicated.
They are given an anesthetic with reduced or no adrenaline. Earlier I mentioned the drugs Scandonest and Ultracain D - they do not contain adrenaline at all.
A mosquito is about to bite
Whether the injection will be unpleasant depends on several factors:
- Which tooth are we treating: anesthesia can be very sensitive when placed in the area of the upper and lower incisors. Mandibular anesthesia is unpleasant: an injection into the area of the mandibular nerve.
- Doctor's manual skills. If the doctor has “trained his hand” properly, is not in a hurry and has set himself the goal of making the treatment as pleasant as possible for the patient, then the injection may not be felt at all.
- The equipment of the clinic: for the patient’s comfort, thin needles and special carpule syringes were invented. For children, topical anesthesia is used - the gel is applied to the gum and “freezes” it before the injection.
Carpule syringe
You may have noticed the unusual but recognizable shape of an anesthesia syringe. It has rings on the sides to make it fit more comfortably in the doctor's hand.
But the main thing about it is a mechanism that allows you to carry out anesthesia quickly, effectively and safely in absolutely sterile conditions. The capsule with the drug is opened by this mechanism right inside the syringe. Fewer hands means fewer germs.
The needles for the carpule syringe are thin and flexible, they are easy to bend at the desired angle. With them you can get close to awkwardly located teeth and provide pain relief in the best possible way.
If anesthesia is contraindicated
In most cases, anesthesia is not completely contraindicated, but only requires a more careful, balanced approach. The doctor takes into account the patient’s age, health characteristics and selects the optimal drug and dosage.
Be sure to tell your doctor if you have the following diseases:
- Heart diseases: arrhythmia and tachycardia, previous heart attacks and heart surgery.
- High blood pressure.
- Problems with the endocrine system: diabetes and thyroid lesions.
- Glaucoma.
- Liver failure.
- Psychoneurological diseases, including epilepsy.
- Individual intolerance to the components of the drug.
Allergy to local anesthetics deserves special attention. If you have ever had an allergic reaction to an anesthetic, be sure to remember its name.
In diagnostic laboratories you can order an allergy panel - an analysis of the body's reactions to various drugs. This way you will find the anesthetic approved for you. There is no need to buy it or bring it to your appointment! When making an appointment with a dentist or for a consultation, check whether the clinic can purchase the required anesthetic for you.
General anesthesia
If it is impossible to use any local anesthetic, we will not torment the patient with pain anyway. In such cases, anesthesia is used - dental treatment during sleep.
The procedure is carried out under the supervision of an anesthesiologist-resuscitator, who monitors the patient’s condition using special equipment.
To make the anesthesia work better
A few tips for maximum pain relief:
- Don’t be nervous before your appointment; you can take a mild sedative;
- Do not drink alcohol or liters of coffee, they can reduce the effectiveness of anesthesia;
- Don't delay treatment. If pus forms near the tooth, it will prevent the anesthetic from working.
High-quality anesthesia is not only about the comfort and peace of mind of the doctor and the patient.
Most patients who are afraid of dental treatment are actually afraid of the pain, not the treatment itself. And the fear goes away when they come to the clinic, where reliable pain relief is used.
Having got used to good anesthesia, the patient does not delay treatment and keeps his teeth healthy!
Articaine in pediatric dentistry
The pharmacodynamics of local anesthetics in children is comparable to that in adults. In pediatric dental practice, extreme caution must be exercised when using amide local anesthetics as lower intrinsic clearance or decreased serum protein binding may easily lead to an increased risk of toxic reactions. The route of administration is one of the main safety factors when using local anesthetics in neonates and children.
Anesthesia in dentistry with the drug Articaine , carried out using intraosseous injection, is effective in achieving deep anesthesia of teeth affected by MIG with hypersensitivity associated with chronic inflammation of the pulp in children.
In pediatric dentistry, it is recommended to use Articaine 2% due to the lower Cmax and shorter half-life of the drug.
Why is adrenaline needed in anesthesia?
Adrenaline is a vasoconstrictor - a substance that narrows blood vessels. Therefore, on the one hand, its presence in the drug provides a longer-lasting analgesic effect, and on the other hand, it reduces the risk of bleeding during dental procedures (for example, during tooth extraction).
Given this, dentists always warn patients that anesthesia without epinephrine in dentistry has a shorter lasting effect and is not suitable for long procedures. In cases where the patient is indicated for pain relief using non-adrenaline anesthetics, treatment must be carried out very quickly or divided into stages so that the doctor has the opportunity to provide anesthesia before each subsequent stage of manipulation.
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Reviews from dentists about the drug Articaine
Most practicing dentists consider Articaine to be the best representative of local anesthetics due to its high effectiveness. At the same time, when using the medication, there is a low incidence of allergic reactions, the possibility of safe use in pregnant women, and the absence of addiction. The only small drawback of Articaine, according to experts, is the inability to prescribe it to children under 4 years of age. In all other cases, Articaine is rightly called one of the drugs of choice.
This information is intended for medical professionals and specialists.
