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Local Anesthesia Part 1: Introduction & The Drugs
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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:

  1. Describe the effect of dental fear & anxiety on the pain reaction threshold
  2. Describe the normal distribution curve and how the clinical actions of local anesthetics are reflected by it
  3. List those medical emergencies precipitated in the dental environment by fear, anxiety and inadequate pain control
  4. List the ester-type local anesthetics and compare their clinical actions to the currently used amide-type local anesthetics
  5. Discuss the chemical & clinical differences of articaine HCl from other currently available local anesthetic formulations
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