NECROSIS AS A COMPLICATION OF LOCAL ANESTHESIA IN DENTISTRY
Local anesthesia largely depends on the preliminary preparation of the patient before it is executed, individual topographic anatomical features of the area, which is carried out anesthesia, the selected local anesthetic, the correct execution of technique of anesthesia, the general condition of the patient, concomitant diseases, and diseases, where local anesthesia held.
The choice of local anesthetic is always done individually for each patient, taking into account:
- The pharmacological properties of the drug;
- Contraindications in the usage of local anesthetic with the addition of vasoconstrictors;
- Contraindications to the use of a local anesthetic;
- Interaction with other local anesthetic drugs.
However, as a rule, most of the groups of painkillers contain vasoconstrictors of the cartridge, such as adrenaline hydrochloride, noradrenaline, although the last one is currently banned for use because of the complications that it can cause.
Despite the effectiveness of local anesthesia, simplicity and accessibility of its application, dentists encounter complications that arise both during anesthesia and after the meeting.
Tissue necrosis may result from erroneous insertion into tissue anesthetic instead of hypertonic solutions other substances protoplasmic poison to the tissues (ethyl alcohol, calcium chloride, hypertonic saline solution, ammonia, hydrogen peroxide, formalin, etc.). The introduction of these solutions in the fabric there is a sharp pain, forcing the doctor to stop the further implementation and figure out the cause of the pain and above all to find out which solution is injected. It is necessary to introduce as quickly as possible to the injection of 0.25-0.5% solution of novocaine in the amount of 50-100 ml. The complication may result in tissue edema. If the doctor did not pay attention to sharp pain and continued the introduction, at the injection site necrosis produced, its magnitude will depend on the amount of injected solution of its kind, the site of administration of the drug.
One of the most common complications is currently necrosis of soft tissues.
Necrosis of the oral mucosa may occur as a result of:
- The introduction of more than 0.5 ml of the anesthetic in the palatal anesthesia;
- The rapid introduction of the anesthetic subperiosteal;
- In patients with severe vascular sclerosis;
- At very high concentrations of the vasoconstrictor, when injected a large amount of anesthetic;
- When applying infiltration anesthesia with vasoconstrictor in the mandible.
Complications often encountered in the lower jaw. This is due to the fact that the lower jaw is insufficient blood supply to the intraosseous and supplied with blood mainly due to vascular periosteum. With the introduction of anesthetic with vasoconstrictor by infiltration anesthesia takes a long vasospasm periosteum disrupted the blood supply decreases the supply of oxygen to tissue hypoxia. Furthermore, as used vasoconstrictors 0.2% norepinephrine, epinephrine tartrate, and 0.18% epinephrine hydrochloride 0.1% solution.
However, norepinephrine often causes tissue necrosis, because it is not applied in dentistry, in the same way and adrenaline tartrate. The most safe adrenaline hydrochloride 0.1% solution.
In this context, the aim of our study was to investigate the causes of tissue necrosis, as complications of local anesthesia and the development of preventive measures.
Objects and methods of research. Clinical studies in the surgical department of the clinic 5 patients with complications of local anesthesia.
Results of the study.
We observed 5 patients with a complication of local anesthetic - soft tissue necrosis after anesthesia.
Patients ranged in age from 35 to 50 years, 4 women and 1 man.
Necrotic ulcers are diagnosed as a result of infiltration anesthesia in the mandible in 3 patients after bilateral mandibular anesthesia - at first the patient and the first patient in the upper jaw necrosis.
All patients complained of pain at the site of occurrence of necrosis.
An objective study, in 2 patients necrosis was found on a transitional fold in 4.3 and 4.5 of the teeth. Ulcers were rounded, within soft tissue without damaging , the mucous membrane around the damaged tissue swollen, painful when touch, the surface is covered with patches of damage nepotic gray fabrics.
In the 1 st patient with the diagnose of necrosis of the mucous membrane of the alveolar ridge to the vestibular surface of the tooth at 3.6 over the entire width of the crown on top of the transition to the fold, the bone exposed, measuring 1 cm by 1.5 cm. Fabrics transition folds swollen, hyperemic, painful on palpation.
In the 1st patient whose doctor restored teeth in the anterior mandible under the bilateral mandibular anesthesia occurred necrosis of the gums with the vestibular surface symmetrically between 4.3 and 4.2, between 3.3 and 3.2 teeth. Necrotic ulcers oval, arranged vertically, the tissue around the swollen, bloodshot, palpation is painful.
And the first patient with the diagnose of necrosis of the mucous membrane of the alveolar bone in the upper jaw between 1.1 and 1.2 teeth, measuring 0.3 by 0.4 cm, redness and swelling of the surrounding tissues, pain when touched.
As it turned out, necrosis appeared after anesthesia in all patients. In 3 patients infiltration anesthesia in 4.3 and 4.5 of the teeth was performed, as well as in the treatment of pulpitis at 3.6 tooth. As it turned out, a doctor added a solution of adrenaline tartrate 0.18% in the anesthetic lidocaine that patient who had a symmetric necrosis , one patient with necrosis of the upper jaw has also been applied vasoconstrictor epinephrine tartrate 0.18%. Everyone else was injected with an anesthetic vasoconstrictor epinephrine hydrochloride 0.1% solution.
Treatment of complications conducted using antiseptic agents, anti-inflammatory, analgesic drugs and in further improving regeneration. All 4 patients had a complication as ulcers . And only the 1st patient with tooth necrosis at 3.6 in the future there was sequestration of the outer wall of the alveoli and the tooth had to be removed 3.6.
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