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Medical Forum / General / Dentistry / October 2005

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Injection dosing

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JohnCM - 28 Oct 2005 02:13 GMT
Just curious as to the amount of local anesthetic used in various
dental procedures. I notice that when I got my cleaning (they did it in
two visits, each side at a time) that it took longer for the anesthetic
to wear off (a bit over 2 hours) versus when I had my wisdom teeth
extracted (around 90 minutes).
Do they use more for cavities? Root canals?
I still think I get a brief pulse rate increase right after the epi
injection. Seemed to be more pronounced when I had the extractions
versus the cleanings. Thing is when I was younger I don't think they
used epi, because I didn't get an increaseed pulse rate and the
anethetic wore off quickly and they had to re-inject. So I'd rather
deal with the minute or so of fast heart rate, than pain or extra
injections. Also I do take vitamin C alot. I heard it should be avoided
before dental work so the anesthetic works better.
What they use though works pretty well. I hardly feel any pain and
don't even know where the instruments are, which is the way I like it.
The most painful part of dental work is the injection. Once its numb I
really don't feel much pain at all, maybe pressure during extraction
but that's just about it.
Steven Bornfeld - 28 Oct 2005 02:43 GMT
> Just curious as to the amount of local anesthetic used in various
> dental procedures. I notice that when I got my cleaning (they did it in
[quoted text clipped - 15 lines]
> really don't feel much pain at all, maybe pressure during extraction
> but that's just about it.

    This is actually not one question, but a bunch.  Generally, the average
procedure can be done with one cartridge of anesthetic.  There are about
1.8 cc. of anesthetic solution in the cartridge, and anesthetic
solutions tend to be between 2% and 4% anesthetic by weight.  A quick
calculation (correct me if I'm wrong guyz) is about 36 mg of anesthetic
for a 2% anesthetic cartridge.
    Older anesthetic solutions such as procaine (Novocain) wore off very
quickly, and epinephrine was added to increase potency and duration of
anesthetic.  Still, procaine caused vasodilatation, so the epinephrine
was partly to counteract this effect.  Lidocaine also causes
vasodilatation (though not so much as procaine), but some anesthetics
such as mepivacaine and prilocaine cause little or no vasodilatation.
So these anesthetics are available without vasoconstrictors added.  They
are still not as potent as the anesthetics with vasoconstrictors, but
they generally are adequate--and are preferred either with patients with
cardiac history, hypertension, or where shorter duration of anesthesia
is desired.
    Just how much anesthetic is required is determined not only by the
potency of the anesthetic, but also the depth of anesthesia required.  A
root canal (for example) will require much greater depth of anesthesia
than a scaling.
    The duration of anesthesia is also influenced by the location and mode
of administration.  Generally upper teeth can be anesthetized by
depositing anesthetic in the gum next to the roots of the tooth.  This
generally does not work for lower back teeth (though some maintain it
does with certain newer anesthetics) and so the anesthetic is deposited
on the inside of the lower jaw where the nerve trunk enters the jawbone.
 This type of injection (nerve conduction block) generally gives
longer-lasting anesthesia than depositing next to the roots of the upper
teeth (infiltration anesthesia).

Hope this helps,
Steve

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Joel M. Eichen - 28 Oct 2005 12:27 GMT
>> Just curious as to the amount of local anesthetic used in various
>> dental procedures. I notice that when I got my cleaning (they did it in
[quoted text clipped - 22 lines]
>calculation (correct me if I'm wrong guyz) is about 36 mg of anesthetic
>for a 2% anesthetic cartridge.

OK, quite good, now let's calculate molarity!

Joel

>    Older anesthetic solutions such as procaine (Novocain) wore off very
>quickly, and epinephrine was added to increase potency and duration of
[quoted text clipped - 23 lines]
>Hope this helps,
>Steve
Steven Bornfeld - 28 Oct 2005 15:12 GMT
> OK, quite good, now let's calculate molarity!
>
> Joel

yeah, sure.

Steve

>>    Older anesthetic solutions such as procaine (Novocain) wore off very
>>quickly, and epinephrine was added to increase potency and duration of
[quoted text clipped - 23 lines]
>>Hope this helps,
>>Steve

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W_B - 28 Oct 2005 17:08 GMT
>> OK, quite good, now let's calculate molarity!
>>
[quoted text clipped - 3 lines]
>
>Steve

Notice how Joel didn't say Normality.
--

W_B
Take out the G'RBAGE
wubbabubbazG@RBAGEyahoo.com
Joel M. Eichen - 28 Oct 2005 12:25 GMT
>Just curious as to the amount of local anesthetic used in various
>dental procedures. I notice that when I got my cleaning (they did it in
>two visits, each side at a time) that it took longer for the anesthetic
>to wear off (a bit over 2 hours) versus when I had my wisdom teeth
>extracted (around 90 minutes).
>Do they use more for cavities? Root canals?

Good observation. Some anesthetics are more potent, others more long
lasting. Besides we dope some anesthetics with epinephrine at
1:100,000 or 1:200,000 or 1:50,000 for various procedures.

Marcaine has the longest duration ... many hours.

Joel

>I still think I get a brief pulse rate increase right after the epi
>injection. Seemed to be more pronounced when I had the extractions
[quoted text clipped - 9 lines]
>really don't feel much pain at all, maybe pressure during extraction
>but that's just about it.
Dartos - 29 Oct 2005 14:14 GMT
I use it a lot for endo and extractions.

Dartos

> Marcaine has the longest duration ... many hours.
>
> Joel
Joel M. Eichen - 30 Oct 2005 13:12 GMT
>I use it a lot for endo and extractions.
>
[quoted text clipped - 3 lines]
>>
>> Joel

Yup, .....
thanks.
W_B - 31 Oct 2005 20:24 GMT
Same here.

>I use it a lot for endo and extractions.
>
[quoted text clipped - 3 lines]
>>
>> Joel

--

W_B
Take out the G'RBAGE
wubbabubbazG@RBAGEyahoo.com

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