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Various techniques

of achieving
LOCAL
ANESTHESIA
LOCAL ANESTHESIA

Local anesthesia is defined as a loss of


sensation in a circumscribed area of the
body caused by a depression of excitation
in nerve ending or an inhibition of the
conduction process in peripheral nerves.
- Malamed 1980
Different techniques of
achieving LA
Local infiltration
Field block
Nerve block
Intraligamentry
Intraseptal
Intrapulpal
Intraosseous injection
Jet injector
Computer controlled local anesthetic delivery system
Electronic dental anesthesia
Topical anesthesia
Local infiltration
In local infiltration, small terminal nerve
endings in the area of the surgery are
flooded with local anesthetic solution,
rendering them insensitive to pain or
preventing them becoming stimulated &
creating an impulse.

Incision is made
into the same area
in which the LA has
been deposited.
Field block
Method of securing regional anesthesia
consisting of depositing a suitable LA
solution in proximity to the large terminal
nerve branches so that the area to be
anesthetized is circumscribed to prevent
the central passage of afferent impulses

Incision is made
into an area away
from the site of
injection
Nerve block
Method of securing regional anesthesia by
depositing LA solution within close
proximity to a main nerve trunk

Usually at a distance
from the site of
operative intervention
Periodontal ligament injection
Indications
1. Pulpal anesthesia of one
Contraindications
or two teeth in a quadrant 1. Infection or inflammation
at the site of injection
2.Treatment of isolated teeth in
mandibular quadrant
2. Primary teeth when the
3. Patient for whom residual soft tissue
anesthesia is undesirable
permanent tooth bud is
present
4. Situations in which regional block is
contraindicated
3. Patient who requires a
“numb” sensation for
psychological discomfort
Intraseptal injection
Indications
When both haemostasis & pain control are
desired for soft tissue & osseous
periodontal treatment

Contraindications
Infection or severe
inflammation at the
site of injection
Intrapulpal injection
Deposition of LA
directly into the pulp
chamber of a pulpally
involved tooth
provides effective
anesthesia for pulpal
extirpation &
instrumentation where
other techniques have
failed.
Intraosseous injection
Indications Contraindications

Pain control for Infection or severe


dental treatment inflammation at the
on single or
multiple teeth in a site of injection
quadrant
Jet injector
Principle- based on principle that liquid forced
through very small openings, called jets, at very
high pressure can penetrate intact skin or mucous
membrane

The primary use of jet injector is to obtain topical


anesthesia before the insertion of a needle

In addition it may be used to obtain mucosal


anesthesia of palate.
Advantages Disadvantages

1. Does not require 1. Is inadequate for pulpal


use of needle anesthesia or regional
anesthesia
2. Delivers very small
amount of LA
2. May damage periodontal
tissue
3. Used in lieu of
topical anesthesia
3. Many patients dislike the
feeling accompanying use
of the jet injector

4. Post-injection soreness of
soft tissue may develop
Computer-controlled local
anesthetic delivery system

The system enables a dentist or hygienist to


accurately manipulate needle placement with
fingertip accuracy and deliver the LA with a foot-
activated control
Advantages
1. Precise control of flow rate & pressure, hence a
more comfortable injection

2. Increased tactile feel

3. Non-threatening

4. Automatic aspiration

5. Rotational insertion technique minimizes needle


deflection
Disadvantages

1. Need for additional armamentarium

2. Increased cost
Electronic Dental Anesthesia

The method of achieving local anesthesia


involves the use of the principle of
transcutaneous electrical nerve stimulation
{TENS} which has been used for the relief
of pain
Indications
1. In patients with needle phobia

2. Ineffective LA

3. Instances where LA cannot be administered

Contraindications
1. Cardiac pacemakers

2. Neurological disorders

3. Pregnancy

4. Very young pediatric patients

5. Older patients with senile dementia


Topical anesthesia
Anesthesia obtained by the application of a
suitable agent to an area of either the skin or
mucous membrane which it penetrates to
anesthetize superficial nerve endings

Spray
Ointments & jelly
EMLA (Eutectic mixture of LA)
Reference
s:-
Shobha tandon –Text book of pedodontics, 1st
edition 2001, published by Divyesh a kothari, page
no.464-469

Stanley F. Malamed –Handbook of local


anesthesia, fifth edition, published by Elsevier, page
no. 255-268 & 352-358

Goran koch & Sven poulsen –Pediatric dentistry


a clinical approach, 1st edition 2001, page no. 155-159

Richard R. welbury –Paediatric dentistry, second


edition, page no. 78