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Local Anesthesia inDentistry
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Local Anesthesia in Dentistry
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A Locoregional Approach
Associate Professor (retired) Pediatric Dentistry School of Dentistry Universidad Complutense. Madrid (Spain)
Mana Saraghi, DMD, DADBA
President, American Dental Board of Anesthesiology Director, Dental Anesthesiology Residency Program, Jacobi Medical Center Assistant Professor of Dentistry, Albert Einstein College of Medicine
Bronx, NewYork (United States)
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This edition first published 2024
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© 2024John Wiley & Sons Ltd
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by law. Advice on how to obtain permission to reuse material from this title is available at http://www.wiley.com/go/permissions.
The right of Jesús Calatayud and Mana Saraghi to be identified as the authors of the editorial material in this work has been asserted in accordance with law.
Registered Offices
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Limit of Liability/Disclaimer of Warranty
The contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting scientific method, diagnosis, or treatment by physicians for any particular patient. In view of ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added warnings and precautions. While the publisher and authors have used their best efforts in preparing this work, they make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of merchantability or fitness for a particular purpose. No warranty may be created or extended by sales representatives, written sales materials or promotional statements for this work. The fact that an organization, website, or product is referred to in this work as a citation and/or potential source of further information does not mean that the publisher and authors endorse the information or services the organization, website, or product may provide or recommendations it may make. This work is sold with the understanding that the publisher is not engaged in rendering professional services. The advice and strategies contained herein may not be suitable for your situation. You should consult with a specialist where appropriate. Further, readers should be aware that websites listed in this work may have changed or disappeared between when this work was written and when it is read. Neither the publisher nor authors shall be liable for any loss of profit or any other commercial damages, including but not limited to special, incidental, consequential, or other damages.
Library of Congress Cataloging- in- Publication Data
Names: Calatayud, Jesús, author. | Saraghi, Mana, author. Title: Local anesthesia in dentistry: a locoregional approach / Jesús
Calatayud, Mana Saraghi.
Description: Hoboken, NJ: Wiley-Blackwell, 2023. | Includes
bibliographical references and index.
Identifiers: LCCN 2023007820 (print) | LCCN 2023007821 (ebook) | ISBN
9781394180158 (cloth) | ISBN 9781394180165 (adobe pdf) | ISBN 9781394180172 (epub)
Subjects: MESH: Anesthesia, Dental-methods | Anesthesia, Local-methods |
Anesthesia, Dental-adverse effects | Anesthesia, Local-adverse effects | Anesthetics, Local
Classification: LCC RK510 (print) | LCC RK510 (ebook) | NLM WO 460 | DDC
617.9/676–dc23/eng/20230420 LC record available at https://lccn.loc.gov/2023007820 LC ebook record available at https://lccn.loc.gov/2023007821
on- demand. Some content that appears in standard print versions
Cover Design: Wiley Cover Image: © Christine von Diepenbroek/Getty Images
Set in 9.5/12.5pt STIXTwoText by Straive, Pondicherry, India
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Contents
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Preface xxiii About the Companion Website
v
xxv
1 History
2 AppliedAnatomyI:MaxillaryArch 17
ofLocalAnesthesiainDentistry 1
The Coca Leaf 1 Cocaine The Development ofthe Syringe The Dangers ofCocaine Adrenaline andthe Vasoconstrictive Effect Novocaine or Procaine The Development ofLocal Anesthesia inDentistry
References
AppliedAnatomy
Introduction 17
Maxillary Nerve (V
Other Structures ofInterest 24
2
3
4
5
Local Anesthetics Vasoconstrictors Instruments Anesthetic Techniques Twenty-First Century Developments Frequency ofUse ofLocal Anesthesia inDentistry
9
5
6
7
7
8
15
) 17
2
19
17
17
The Trigeminal Nerve Trigeminal Ganglion Trigeminal Nerve: Functions 17
Overview ofCollateral Branches 18
Intracranial Zone 18 Pterygopalatine Fossa Zone 18 Infraorbital Zone 19
Palatine Nerves
Greater Palatine Nerve 20 Nasopalatine Nerve 20
Superior Alveolar Nerves 22
Posterior Superior Alveolar Nerve (PSAN) 22 Middle Superior Alveolar Nerve (MSAN) 22 Anterior Superior Alveolar Nerve (ASAN) 23
Superior Dental Plexus 23
4
5
9
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Contents
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vi
Greater Palatine Canal andForamen 24
Greater Palatine Canal Greater Palatine Foramen
24
24
Nasopalatine Canal andForamen
Nasopalatine Canal
Nasopalatine Foramen Cortical Bone Thickness Pterygoid Venous Plexus Infraorbital Foramen Pterygopalatine Fossa
Margins
Content
Glossary References
26 27
27
28
24
24
25
25
25
26
3 AppliedAnatomyII:MandibularArch 31
31
32
33 33
34
35
36
) 31
3
36
36
33
34
36
Mandibular Nerve (V
Overview
31
Buccal Nerve
Course
32
Innervation Auriculotemporal Nerve
33
Course
Innervation Lingual Nerve
33
Course
Innervation
Remarks
34
Inferior Alveolar Nerve
34
Course
Innervation
Remarks
35
Mylohyoid Nerve
36
Course
Innervation
Body ofthe Mandible
Cortical Bone Thickness Retromolar Zone (Trigone andFossa) 37
Retromolar Trigone 37
Retromolar Fossa 37 Mandibular Canal 37 Mental Foramen 38
Ramus ofthe Mandible 39
Divergent Angle 39 Ramus Width
39 Lingula 39 Mandibular Foramen 39 Sulcus colli 40 Coronoid Notch 41 Accessory Foramina 41
Pterygomandibular Space 41
Anatomic Boundaries ofthe Pterygomandibular Space 42 Open/Closed Mouth and Pterygomandibular Space 44
24
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Contents ofthe Pterygomandibular Space 44
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Sphenomandibular Ligament
Positive Aspirations andHematomas Glossary References
4 ThePeripheralNerveandLocalAnesthesia 50
Peripheral Nerve Microanatomy 50
Basic Membrane Proteins
Peripheral Nerve Neurophysiology
Mechanisms ofLocal Anesthesia
Nerve Block Kinetics
References 62
46
46
Neurons
Sensory Neurons
Axons
Membranes
Nerve Fibers andMyelin
Peripheral Nerve Structure
Sodium–Potassium Pump
Sodium Channels
Potassium Channels
Fundamentals
Membrane Potentials: Membrane at Rest (Polarized)
Action Potentials: Excited Membrane
Propagation ofthe Action Potential
Mechanism
Differential Nerve Block
Tonic andPhase Block
Critical Length
Transient Receptor Potential Channel
Induction Stage 60
Recovery Stage 60
Re-Injection 61
Tachyphylaxis 61
Resistance toLocal Anesthetics 61
50
50
50
51
Myelinated Fibers Unmyelinated Fibers Nerve Fiber Classification
Phase 1: Depolarization Phase 2: Repolarization Phase 3: Hyperpolarization
58
51
52
54
54
55
56
59
59
60
44
45
51
52
52
54
56
56
57
57
57
58
58
58
60
Contents vii
56
Pharmacology
5 Local
Anesthetics 67
Chemical Structure 67 Physical-chemical Characteristics ofLocal Anesthetics 67
Dissociation Constant or pKa 68
Partition Coefficient or Lipid Solubility 69
Protein Binding 70
Vasodilation 70
65
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Contents
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viii
Assessment ofAnesthesia andthe Anesthetic Parameter 70
Assessment ofLocal Anesthesia inDentistry Anesthetic Parameter
Anesthetic Concentration
Concentration andVolume Concentration andSafety Concentration andAnesthetic Potency
Concentration andTissue Irritation Maximum Doses Maximum Doses forChildren Pregnancy andLactation
Pregnancy
Lactation Mixing Local Anesthetics Isomers
78
References
6 Vasoconstrictors 85
Introduction 85
Advantages
Disadvantages
Dilutions andConcentrations Catecholamines
Isomers andCatecholamines
Adrenergic Receptors
Systemic Effects
Heart Circulatory System Respiratory Tract Endocrine System andMetabolism
Uterus Vasoconstrictive Effect Catecholamine Metabolism Epinephrine Norepinephrine Levonordefrin
Phentolamine (OraVerse®) 95
OraVerse® 96 Advantages andIndications 96 Technique andDose 96 Clinical Efficacy 97 Tolerance, Toxicity, andAdverse Side Effects 97
Felypressin (Octapressin®)
Cardiovascular Effects 98 Vasoconstrictive Effect 99 Adverse Effects 100 Contraindications 100 Advantages andDisadvantages 100 Maximum Doses 100
Combinations ofVasoconstrictors 101 References 101
70
72
72
72
73
73
73
74
75
76
76
77
77
79
85
85
87
87
88
88
90
90
91
91
91
91
91
92
92
93
94
98
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7 InjectableAnestheticSolutionsUsedinDentistry 107
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Solution Composition 107
Local Anesthetic Vasoconstrictor Antioxidants (Sulfites) Preservatives (Methylparaben) pH Adjustment Other Compounds
Procaine (Novocaine)
Metabolism Procaine withEpinephrine Remarks
109
Lidocaine (Lignocaine)
Metabolism Remarks
111
Indications
Standard 2% Lidocaine: L-100with 1:100 Epinephrine L-50, 2% Lidocaine with 1:50
Articaine
113 Metabolism Remarks
115 Maximum Dose andToxicity Anesthetic Potency Anesthetic Effect
Indications
A-100, 4% Articaine with1:100 A-200, 4% Articaine with1:200
Mepivacaine
Metabolism Remarks
119 Maximum Doses Mepivacaine Solutions
Indications
Prilocaine (Propitocaine)
Metabolism
107
107
107
108
108
109
109
109
109
109
111
111
000 (10 μg/ml) Epinephrine or L-80with 1:80 000 (12.5 μg/ml)
111
000 (20 μg/ml) Epinephrine 113
115
115
115
116
116
000 (10 μg/ml) Epinephrine 116 000 (5 μg/ml) Epinephrine 117
117
117
119
119
119
120
120
Remarks 120
Toxicity andSafety 120 Clinical Efficacy 122 Prilocaine Solutions 122
Indications andContraindications 122
Indications 122 Contraindications
123
Bupivacaine 123
Metabolism 123 Remarks 123 Indications andContraindications 125
Indications 126 Contraindications 126
References 126
Contents ix
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