Updated for
2018
Local anesthetics, the most used drugs in dentistry, are the
safest & most effective drugs for the prevention and management of pain.
However the act of receiving an injection – the ‘shot’ – is the most
fear-inducing part of the dental experience for most patients. 75% of all dental
office medical emergencies are ‘stress’ related and therefore preventable in
most situations. Techniques of managing fear including inhalation and oral
sedation are reviewed. The pain reaction threshold (PRT) is introduced followed
by a discussion of the effect of various clinical situations, e.g. pain,
infection and fear, on the PRT. The currently available (in North America) local
anesthetic formulations are discussed with an emphasis on their expected
duration of clinical action.
This program reviews the development of
local anesthetics and the drug formulations that are currently available in
dentistry. The effect of fear & anxiety on local anesthetic effectiveness is
discussed along with an introduction to sedation – a very important ally in the
quest for effective pain control.
Learning
Objectives
• Describe the effect of dental
fear & anxiety on the pain reaction threshold
•
Describe the normal distribution curve and how the clinical actions of local
anesthetics are reflected by it
• List those medical
emergencies precipitated in the dental environment by fear, anxiety and
inadequate pain control
• List the ester-type local
anesthetics and compare their clinical actions to the currently used amide-type
local anesthetics
• Discuss the chemical &
clinical differences of articaine HCl from other currently available local
anesthetic formulations