Chapter 20 Management of Pain and Anxiety

Anesthesia and anesthetics §General anesthesia l Patient becomes unconscious l alters CNS, no feeling at all in body l special needs patients, l high anxiety patients l local anesthesia is still used

Anesthesia and anesthetics §Local anesthesia l shot / injection l control pain during dental procedure l blocks feeling and temperature l contacts the nerve and blocks impulses to and from the brain. l Delivered in liquid form from pre-measured carpules. (with or w/out epinephrine).

Anesthesia and anesthetics §Anesthetic solutions l aka chemical base amides –lidocaine, mepivicaine esters –propoxycaine, procaine l Patients may react to one type of anesthetic or another. Note this in their chart.

Anesthesia and anesthetics l Vasoconstrictor epinephrine (epi) most common added to anesthetic constricts vessels around injection site causes ‘blanching’ (tissue turns white) anesthetic lasts longer comes in ratios 1:20,000 (larger 2nd # = less epi) CONTRAINDICATED FOR PATIENTS WITH HEART CONDITIONS!

Types of injections §Infiltration l flooding anesthetic around the nerve endings. Numbs the area of the injection. Common on the maxillary §Block l placing anesthetic around a large nerve branch. Given near a foramen Numbs area from injections site to nerve endings. Common on the mandibular.

Types of injections §Intraosseous l anesthetic is placed in the spongy bone. Requires a special system and technique Used when profound anesthesia cannot be obtained with other types of injections. §Intrapulpal l anesthetic is placed directly in the pulp chamber. Used during RCT for a “HOT” tooth.

Anesthetic duration. §Length of time numbness lasts. l Short duration less than 30 minutes no epi l Intermediate duration 30 to 90 minutes ( about 1 hour) may have epi l Long duration 90 minutes or longer contains vasoconstrictor

Paresthesia §When anesthesia lasts longer than intended l hours l days l permanent caused by trauma to the nerve bleeding near the nerve pressure from the bleeding contaminated anesthetic

Topical anesthetic §Gel that numbs gums before injection l makes the “pinch” smaller l similar to teething medication l placed on dry mucosa for one (1) minute prior to the injection. l Reactions are usually to coloring or flavoring in the topical.

Topical anesthetic §Uses l sub-gingival scaling l root planing l crown seats l placing matrix bands l placing rubber dam clamps l depress gag reflex for impressions and x-rays.

Topical anesthetic §Allergic reactions l mild to severe l immediate reaction l delayed up to 24 hours l symptoms swelling, redness, sores, difficulty swallowing and or breathing.

Topical anesthetic §Toxic reaction l due to an overdose l stimulates the CNS l symptom talkative, excited, apprehensive, increased pulse and or high blood pressure can be fatal!

Sedation §Uses: l relaxation l reduce fear and anxiety. l dental phobias l children l mentally challenged

Sedation §F§Forms lPlPills Valium lLlLiquid Versed lGlGas Nitrous oxide (N 2 0) lIlIntravenous Many different medications!

Nitrous Oxide (N 2 O) §Nitrous oxide and oxygen l aka ‘Laughing gas’ §Advantages l patient remains conscious l easy administration l no nurse / anesthetist needed l quick PO recovery l used for most ages

Nitrous Oxide (N 2 O) §Indications l fearful or anxious patients l sensitive gag reflex l low pain threshold l long appointments l heart condition l high blood pressure

Nitrous Oxide (N 2 O) §Contraindications l upper respiratory infection l nasal congestion / breathing disorders l very young child l severe mental retardation l pregnancy (1st trimester) l drug addict l psychiatric treatment

Nitrous Oxide (N 2 O) §Facts: l DA cannot administer/start N 2 0 l DA can adj. flow w/ Dr. instruction l Nitrous = Blue tank l Oxygen = Green tank l Must use an evacuation (scavenger) system l Oxygen flush x 5 min. (min)

Closing §Managing pain and anxiety is a very important part of your job as a DA. §Always check the health history of every patient at every visit. §When in doubt, ask your dentist. §Any questions?