Home Magazine Issues Dec 2010 - Jan 2011 Health Review: Painless Anaesthesia in Dentistry

Painless Anaesthesia in Dentistry

By Dr Tom Mutyabule

Many patients put off dental treatment because they are worried or scared of the treatment – in fact, many patients confess to being scared of the dentist. Children also present a big problem because of the same fears and it is not uncommon to see children fighting for dear life because of this fear or the discomfort of the treatment. Many children run away at the sight of the dentist. Most patients turn up at a dentist’s office in pain and the dentist, in most cases has to treat the dental problems by using Anaesthesia, amongst others. Even a routine dental procedure requires Anaesthesia even when the patient has not complained about having any pain. Unfortunately, many dental problems get worse if they are not treated and it becomes a vicious cycle because the treatments usually become even more complicated and more painful at times.

In order to be able to treat patients, dentists usually have to give Anaesthesia. Anaesthesia is a total lack of awareness in a part or the whole of the body so that surgery or procedures can be performed without distress or pain, or both.
There are 3 main ways patients are handled when pain or discomfort are anticipated.

Local Anaesthesia
This is where the drug (local anesthetic) is administered locally and directly to an area to induce the loss of sensation (numbness) in the area or region of the body to be operated or worked upon. This is the easiest and most commonly used method in dental clinics.

Sedation
Sedation is where a drug is administered either intravenously or by mouth or through the nose to induce a level of sub consciousness. In this case the drug acts centrally on the brain (there are various levels of sedation). Usually in this case, the breathing and other vital body organs continue to function normally, however vitals like breathing, the pulse and oxygen should be monitored. It is advisable to have the correct equipment available that can support breathing and provide oxygen in the event of an adverse reaction which can occur in some cases. This is one of the ways dentists alleviate discomfort, pain and anxiety and is used in big or extensive procedures. It is also useful in children since they do not remember nor do they experience the pain or discomfort of the procedure. In most instances because children fight against going to the dentist, it can be impossible to restore their teeth since the dentist has to use the drills.
Special attention has to be given to (among other things) the age, health and weight of the patient as well as the use of any medications the patient may be taking. It is the anesthetist or anesthesiologist who is in charge of the sedation procedure and they monitor the patient throughout the entire procedure when dental treatment is being done.
There are advantages to this procedure especially if used in children. Children generally don’t fight against sedation as the medication not only subdues them but children tend to not remember the ordeal since there is an element of amnesia of the whole procedure.

General Anaesthesia
This is where a drug or a set of drugs is administered to induce a total loss of consciousness. In this case breathing must be supported with the use of oxygen and other necessary extensive equipment. This is usually administered for major operations and it usually takes place in a theatre with a qualified anesthetist or anesthesiologist present.

In dentistry local Anaesthesia is the most commonly used method and this enables a dentist to perform various levels of treatment in the mouth, however the administration of the local anesthetic can be painful or uncomfortable, if not both.
The resultant numbness (or feeling of Anaesthesia) in the region being worked on can be very uncomfortable or irritating. To make the injection of the local anesthetic less painful, a topical gel is smeared onto the area where the injection is supposed to be administered – this has been the approach until new technology became available.

Painless Dentistry
New technology has made it possible to give the simpler form of Anaesthesia (Local
Anaesthesia) and make the whole experience of going to the dentist less stressful and a lot more pleasant for both the patient and the dental staff. This new technology makes getting Anaesthesia and having dental care more comfortable and easier. There are 2
Devices which make it possible to have Anaesthesia administered with minimal or no pain at all.

The Dental Vibe
The Dental vibe is a cordless hand held device designed to reduce the pain and fear that one associates with dental injections. The Dental Vibe applies the gate control theory of pain which then enables a painless delivery of Anaesthesia.
The way it works: When a vibration is applied as a counter stimulation to an Anesthetic injection, it will reach the brain before the pain sensation does – the brain can only perceive one sensation at a time, therefore the sensation that arrives at the brain first is the one that will be felt.

The dental vibe uses a microprocessor controlled Vibra – pulse technology to provide a counter stimulation. Vibrapulse delivers a pulsed vibration with enhanced amplitude tapping the gum in a synchronized changing pattern. This sensation travels quickly to the brain via the nerves before the pain sensation of the injection when local Anaesthesia is being given with the result that the experience of dental Anaesthesia is more comfortable and less painful for both adults and children.

Computerised Anaesthesia
Another fantastic device which can take away pain or the fear of dental needles is computerised Anaesthesia. This is where a small computer regulates the flow of Anaesthesia. A much smaller needle is used and because it delivers 1 drop of Anaesthesia per second, it takes away the pain felt from the pressure of Anaesthesia.

The way it works: The same anesthetic is delivered via a small plastic tube which is similar to that of an intravenous line (at the end the anesthetic flows through a very small needle). The machine can easily be turned on and off by a foot control switch. The machine emits a sound and also shows a visible reading to let the dentist know the rate of the flow of Anaesthesia. When the excess pressure in the tissues is sensed by the machine, it emits a very loud sound to alert the dentist and all that the dentist needs to do to ease the pain, is to remove his foot from the switch, which then turns off the flow of the anesthetic. Because of this delivery technique, a drug channel is formed which numbs the whole tooth and so with this device it is possible to only numb the tooth and not the entire jaw. This method is a lot more pleasant as the feeling of the numbness of the jaw is one of the main reasons why people don’t like going to the dentist.

The pain the patient might feel is also greatly reduced as the dentist advances the needle the machine releases the anesthetic in a controlled manner – the rate of flow of the anesthetic is very slow and the machine can sense the pressure in the tissues. Because the device continuously measures and monitors the pressure of the anesthetic drug as it exits the needle tip when specific resistance of the tissue is identified, the computer emits an audible and visible sign and so the dentist can then slow down the rate of delivery of the anesthetic. When injecting through the gum the machine can sense when the dentist has reached the actual tooth surface. The anesthetic is delivered at a controlled pressure and rate which may take 1-2 minutes. Profound Anaesthesia is immediate because there is usually no waiting involved. When used together, these two devices make the anesthetic experience very comfortable for both children and adults.

For more information or treatment, please contact:
Pandental Surgery. Plot 67 Buganda Road, Kampala.
Tel: (031) 2251525 / (041) 4347608. Cell: +256 772 202525
Email: tom@pandentalsurgery.com / tmutyabule@hotmail.com
Website: www.pandentalsurgery.com