Esters - Are compounds formed from alcohols and acids by the removal of water. Ester compounds are rarely used in dentistry today. Examples of ester solutions are procaine and propoxycaine.
The two most common local anesthetics used in dentistry today are 2% lidocaine hydrochloride and 2% mepivacaine. Both solutions take effect quickly, and provide a complete anesthetic effect of the dental pulp, tissues, and surrounding bone for up to 90 minutes. The use of vasoconstrictors with local anesthetics has been discussed earlier. Both lidocaine and mepiva- caine are available with or without epinephrine.
In dentistry topical anesthetic agents are used to temporarily anesthetize (numb) the tiny nerve endings located on the surfaces of the oral mucosa. This can reduce the discomfort of dental injections and eliminate the gag reflex when performing radiographic, periodontal, and prosthetic impression procedures. You must be aware that the concentration of topical anesthetic solutions are much higher than injectable anesthetics. Also topical anesthetics take longer for the full effect compared to injectable anesthetics. One to five minutes after application is the recommended time for topical anesthetics to reach their full effectiveness. Whenever you are using topical anesthetics, you must have permission from the dental officer. Follow all safety precautions and manufacturer's instructions. The three most commonly used topical anesthetics in dentistry are ointments, sprays, and liquids.
OINTMENT TOPICAL ANESTHETICS. - You may be asked by the dental officer to place an ointment topical anesthetic at an injection site before injection of dental anesthesia. Always follow the manufacturer's instructions before use. To start this procedure, take a sterile 2-inch × 2-inch gauze and gently wipe and dry the area of the mucosa where the topical anesthetic is to be placed. Next take a sterile cotton tipped applicator and open the container and place a small amount of the ointment on it. Always use a sterile applicator each time you use the ointment to prevent contamination and replace the cover when not in use. Place the cotton portion of the applicator with the ointment on the area to be anesthetized. Patients must be told NOT to swallow any of the anesthetic. Have the saliva ejector or high-speed evacuator (HVE) standing by to remove any fluids the patient may have accumulated while the topical anesthetic is taking
effect. After the dental officer has completely anesthetized the patient, use the 3-way syringe and HVE to rinse the patient's mouth completely, paying attention to the area where the topical anesthetic and anesthesia have been placed and injected.
TOPICAL DENTAL SPRAY. - The use of topical dental sprays is an effective means to assist patients, who may have an exagerated gag reflex to complete dental procedures. Always consult with a dental officer, when treating a patient who has a gag reflex. It may even be documented on his/her health history form. Use of lidocaine spray in some cardiac patients or children could cause problems. Certain patients are very sensitive to any objects placed in the oral cavity, especially posterior X-rays, and prosthetic impressions. Special care and time must be given to these patients to ensure the patient does not have a bad experience, such as gagging or vomiting, during the procedure. The time you spend to make your patient comfortable will benefit your patient and the quality of the procedure you are doing. When using a topical spray, follow the directions the dental officer will give you, along with the manufacturer's instructions.
LIQUID TOPICAL ANESTHETICS. - Liquid topical anesthetic come in the form of a viscous (thick) liquid. They produce the same effect as spray topical anesthetics by numbing the oral mucosa and the mouth, but in addition can be used to gargle to anesthetize the pharynx. Under the direction of a dental officer, the patient takes the liquid and swishes it around in the mouth, which is removed by a saliva ejector HVE or by spitting. It is useful for patients who need to be anesthetized for gag reflexes when taking prosthetic impressions or dental radiographs. In addition the dental officer may prescribe liquid topical anesthetics to patients for the temporary relief of pain from ulcers, wounds, and periodontal treatment in the mouth.
Numerous other drugs are used in dentistry. Some drugs, for example, are used as antisialagogues. Such drugs as atropine sulfate, scopolamine hydrobromide, and methantheline bromide reduce a patient's salivary flow, thereby providing a drier field of operation. Other drugs are used in specialized areas of dentistry and will be discussed, where appropriate, in later chapters.
For a patient to receive drugs, both controlled and noncontrolled, the dental officer will use the DOD Prescription (DD 1289) or PolyprescriptionContinue Reading