Description:
Updated for 2018
Though local anesthetics are safe and effective, considerable research is
on-going to make them even more effective. Computer-controlled local anesthetic
delivery systems (C-CLAD) and buffered local anesthetic solutions promise to
allow painless injections to be delivered to dental patients almost anywhere in
the oral cavity. Fear of injections is primarily based on the needle. The
development of an intranasal local anesthetic mist has been shown to provide
successful pulpal anesthesia of maxillary teeth – without a needle. Epinephrine
is added to injectable local anesthetics to increase their effectiveness,
duration and safety. However the duration of residual soft tissue anesthesia –
usually unnecessary and occasionally a potential danger – is extended when
epinephrine is used in the anesthetic solution. Self-inflicted soft tissue
injury is a real problem associated with this anesthesia in all patient age
groups but especially pediatric and geriatric patients. Phentolamine mesylate –
an alpha adrenergic antagonist – has been shown to significantly reduce the
duration of residual soft tissue anesthesia when administered at the conclusion
of the traumatic part of dental treatment.
Learning Objectives:
- Discuss the current research on intranasal local anesthesia in dentistry
- Describe the effect of pH on the onset, depth & comfort of anesthesia
with local anesthetics
- Describe the mechanism of action of the buffering agent sodium bicarbonate
on local anesthetics
- List the benefits of local anesthetic buffering in dentistry
- Discuss the local anesthetic reversal agent - phentolamine mesylate
- Describe the advantages & disadvantages of Computer-Controlled Local
Anesthetic Delivery (C-CLAD)
- Describe the clinical effects of the intranasal local anesthetic
mist
