ANAESTHETICS IN DENTAL SURGERY

By X. KULAR

1 HISTORY OF LOCAL ANESTHESIA IN DENTISTRY THE COCA LEAF 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 LOCAL ANESTHETICS VASOCONSTRICTORS INSTRUMENTS ANESTHETIC TECHNIQUES TWENTY-FIRST CENTURY DEVELOPMENTS FREQUENCY OF USE OF LOCAL ANESTHESIA IN DENTISTRY REFERENCES APPLIED ANATOMY 2 APPLIED ANATOMY I: MAXILLARY ARCH INTRODUCTION THE TRIGEMINAL NERVE TRIGEMINAL GANGLION TRIGEMINAL NERVE: FUNCTIONS MAXILLARY NERVE (V2) OVERVIEW OF COLLATERAL BRANCHES INTRACRANIAL ZONE PTERYGOPALATINE FOSSA ZONE INFRAORBITAL ZONE PALATINE NERVES GREATER PALATINE NERVE NASOPALATINE NERVE SUPERIOR ALVEOLAR NERVES POSTERIOR SUPERIOR ALVEOLAR NERVE (PSAN) MIDDLE SUPERIOR ALVEOLAR NERVE (MSAN) ANTERIOR SUPERIOR ALVEOLAR NERVE (ASAN) SUPERIOR DENTAL PLEXUS OTHER STRUCTURES OF INTEREST CONTENTS GREATER PALATINE CANAL AND FORAMEN GREATER PALATINE CANAL GREATER PALATINE FORAMEN NASOPALATINE CANAL AND FORAMEN NASOPALATINE CANAL NASOPALATINE FORAMEN CORTICAL BONE THICKNESS PTERYGOID VENOUS PLEXUS INFRAORBITAL FORAMEN PTERYGOPALATINE FOSSA MARGINS CONTENT GLOSSARY 3 APPLIED ANATOMY II: MANDIBULAR ARCH MANDIBULAR NERVE (V3) OVERVIEW BUCCAL NERVE COURSE INNERVATION AURICULOTEMPORAL NERVE LINGUAL NERVE REMARKS INFERIOR ALVEOLAR NERVE MYLOHYOID NERVE BODY OF THE MANDIBLE RETROMOLAR ZONE (TRIGONE AND FOSSA) RETROMOLAR TRIGONE RETROMOLAR FOSSA MANDIBULAR CANAL MENTAL FORAMEN RAMUS OF THE MANDIBLE DIVERGENT ANGLE RAMUS WIDTH LINGULA MANDIBULAR FORAMEN SULCUS COLLI CORONOID NOTCH ACCESSORY FORAMINA PTERYGOMANDIBULAR SPACE ANATOMIC BOUNDARIES OF THE PTERYGOMANDIBULAR SPACE OPEN/CLOSED MOUTH AND PTERYGOMANDIBULAR SPACE CONTENTS OF THE PTERYGOMANDIBULAR SPACE SPHENOMANDIBULAR LIGAMENT POSITIVE ASPIRATIONS AND HEMATOMAS 4 THE PERIPHERAL NERVE AND LOCAL ANESTHESIA PERIPHERAL NERVE MICROANATOMY NEURONS SENSORY NEURONS AXONS MEMBRANES NERVE FIBERS AND MYELIN MYELINATED FIBERS UNMYELINATED FIBERS NERVE FIBER CLASSIFICATION PERIPHERAL NERVE STRUCTURE BASIC MEMBRANE PROTEINS SODIUM–POTASSIUM PUMP SODIUM CHANNELS POTASSIUM CHANNELS PERIPHERAL NERVE NEUROPHYSIOLOGY FUNDAMENTALS MEMBRANE POTENTIALS: MEMBRANE AT REST (POLARIZED) ACTION POTENTIALS: EXCITED MEMBRANE PHASE 1: DEPOLARIZATION PHASE 2: REPOLARIZATION PHASE 3: HYPERPOLARIZATION PROPAGATION OF THE ACTION POTENTIAL MECHANISMS OF LOCAL ANESTHESIA MECHANISM DIFFERENTIAL NERVE BLOCK TONIC AND PHASE BLOCK CRITICAL LENGTH TRANSIENT RECEPTOR POTENTIAL CHANNEL NERVE BLOCK KINETICS INDUCTION STAGE RECOVERY STAGE RE-INJECTION TACHYPHYLAXIS RESISTANCE TO LOCAL ANESTHETICS PHARMACOLOGY 5 LOCAL ANESTHETICS CHEMICAL STRUCTURE PHYSICAL-CHEMICAL CHARACTERISTICS OF LOCAL ANESTHETICS DISSOCIATION CONSTANT OR PKA PARTITION COEFFICIENT OR LIPID SOLUBILITY PROTEIN BINDING VASODILATION ASSESSMENT OF ANESTHESIA AND THE ANESTHETIC PARAMETER 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 6 VASOCONSTRICTORS 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®) ORAVERSE® ADVANTAGES AND INDICATIONS TECHNIQUE AND DOSE CLINICAL EFFICACY TOLERANCE, TOXICITY, AND ADVERSE SIDE EFFECTS FELYPRESSIN (OCTAPRESSIN®) CARDIOVASCULAR EFFECTS ADVERSE EFFECTS CONTRAINDICATIONS ADVANTAGES AND DISADVANTAGES COMBINATIONS OF VASOCONSTRICTORS INJECTABLE ANESTHETIC SOLUTIONS USED IN DENTISTRY SOLUTION COMPOSITION LOCAL ANESTHETIC VASOCONSTRICTOR ANTIOXIDANTS (SULFITES) PRESERVATIVES (METHYLPARABEN) PH ADJUSTMENT OTHER COMPOUNDS PROCAINE (NOVOCAINE) METABOLISM PROCAINE WITH EPINEPHRINE LIDOCAINE (LIGNOCAINE) INDICATIONS STANDARD 2% LIDOCAINE: L-100 WITH 1:100 000 (10 ?G/ML) EPINEPHRINE OR L-80 WITH 1:80 000 (12 5 ?G/ML) EPINEPHRINE L-50, 2% LIDOCAINE WITH 1:50 000 (20 ?G/ML) EPINEPHRINE ARTICAINE MAXIMUM DOSE AND TOXICITY ANESTHETIC POTENCY ANESTHETIC EFFECT A-100, 4% ARTICAINE WITH 1:100 000 (10 ?G/ML) EPINEPHRINE A-200, 4% ARTICAINE WITH 1:200 000 (5 ?G/ML) EPINEPHRINE MEPIVACAINE MEPIVACAINE SOLUTIONS PRILOCAINE (PROPITOCAINE) TOXICITY AND SAFETY PRILOCAINE SOLUTIONS INDICATIONS AND CONTRAINDICATIONS BUPIVACAINE 8 CONTRAINDICATIONS FOR LOCAL ANESTHETIC TECHNIQUES IN DENTISTRY LACK OF COOPERATION FROM THE PATIENT PREDISPOSING FACTORS EVALUATION OF RISK APPROACH TO BEHAVIORAL PROBLEMS ASA IV PHYSICAL STATUS ASA I PATIENTS ASA II PATIENTS ASA III PATIENTS ASA IV PATIENTS ASA V PATIENTS CLOTTING ABNORMALITIES HIGH-RISK ANESTHETIC TECHNIQUES SYSTEMIC CAUSES OF THE RISK OF HEMORRHAGE ANTIPLATELET AGENTS ORAL VITAMIN K ANTAGONISTS: ANTICOAGULANTS DIRECT ORAL ANTICOAGULANTS LOW PLATELET COUNTS HEMOPHILIA ALTERNATIVES AND RECOMMENDATIONS OTHER CONTRAINDICATIONS INJECTION SITE INFECTION IMPOSSIBLE PHYSICAL ACCESS SUMMARY 9 CONTRAINDICATIONS FOR LOCAL ANESTHETICS RELEVANT CONTRAINDICATIONS ALLERGY TO LOCAL ANESTHETICS LONG-ACTING ANESTHETICS PRILOCAINE, BENZOCAINE, AND METHEMOGLOBINEMIA CHOLINESTERASE DEFICIENCY AND ESTHER ANESTHETICS MYASTHENIA GRAVIS AND ESTERS MINOR CONTRAINDICATIONS PROCAINE AND SULFONAMIDES LIDOCAINE AND CIMETIDINE LIDOCAINE AND PROPRANOLOL LIDOCAINE AND SUCCINYLCHOLINE BUPIVACAINE AND CARDIOTOXICITY AMIDE ANESTHETICS AND MALIGNANT HYPERTHERMIA 10 CONTRAINDICATIONS FOR VASOCONSTRICTORS ABSOLUTE CONTRAINDICATIONS UNCONTROLLED INSULIN-DEPENDENT DIABETES MELLITUS INTOLERANCE TO SULFITES ASTHMA CONTROLLED WITH CORTICOSTEROIDS PHEOCHROMOCYTOMA-INDUCED ARTERIAL HYPERTENSION RECENT CONSUMPTION OF COCAINE PATIENTS WITH CARDIOVASCULAR DISEASES WHO TAKE AMPHETAMINES AND PSYCHOSTIMULANTS ALLERGY TO VASOCONSTRICTORS RELATIVE CONTRAINDICATIONS NONSELECTIVE BETA-BLOCKERS COMT INHIBITOR-TYPE ANTIPARKINSON DRUGS ASA III PATIENTS WITH CARDIOVASCULAR CONDITIONS DIGITALIS GLYCOSIDES (DIGOXIN) AMPHETAMINES AND PSYCHOSTIMULANTS TRICYCLIC ANTIDEPRESSANTS INTERACTIONS INVOLVING DRUGS THAT ARE NO LONGER IN USE OLDER ANTIHYPERTENSIVE AGENTS (ANTI-ADRENERGIC DRUGS) GENERAL ANESTHESIA (HALOTHANE AND THIOPENTAL) CONTRAINDICATIONS OF LITTLE RELEVANCE UNCONTROLLED HYPERTHYROIDISM PHENOTHIAZINES AND ANTIPSYCHOTIC DRUGS VASOCONSTRICTORS AND OSTEORADIONECROSIS CONTRAINDICATIONS OF FELYPRESSIN INSTRUMENTS AND TOPICAL ANESTHESIA 11 INSTRUMENT SET AND EQUIPMENT NEEDLES PARTS OF A NEEDLE ANTERIOR PART MIDDLE PART POSTERIOR PART PROTECTIVE SHEATH LENGTHS AND GAUGES NEEDLES: CRITICAL ASPECTS ASPIRATION AND GAUGE PAIN AND GAUGE DEFLECTION OF THE NEEDLE AND GAUGE LESIONS CAUSED BY A BARBED NEEDLE BREAKAGE OF NEEDLES CRITERIA FOR THE SELECTION OF NEEDLES CARTRIDGES PARTS OF A CARTRIDGE ANTERIOR PART OR NEEDLE ADAPTER NECK CYLINDRICAL BODY OTHER ELEMENTS STORAGE OF CARTRIDGES NORMS FOR ALL CARTRIDGES NORMS FOR CARTRIDGES CONTAINING CATECHOLAMINES PROBLEMS AFFECTING CARTRIDGES DEGRADATION OF DRUGS IN THE CARTRIDGE LOCAL ANESTHESIA SYMPATHOMIMETIC VASOCONSTRICTORS (EPINEPHRINE) SULFITES SYRINGES PARTS OF A CARTRIDGE-TYPE SYRINGE SYRINGE BARREL OR BODY OF THE SYRINGE POSTERIOR PART (BACK) PISTON USING THE SYRINGE SET-UP DISMANTLING CLEANING AND STERILIZATION SELF-ASPIRATING SYRINGES CHARACTERISTICS MECHANISM OF ACTION VARIANTS OF CARTRIDGE-TYPE SYRINGES PLASTIC SYRINGES UNIJECT-TYPE SYRINGES DISPOSABLE ANTINEEDLE STICK SYRINGES POWER-OPERATED SYRINGES OTHER INJECTION DEVICES ADDITIONAL INSTRUMENTS COMPLEMENTARY DEVICES ALKALINIZATION SYSTEM (PH ONSET SYSTEM®) CARTRIDGES FOR THE DEVICE MIXING PEN MIXING VIBRATING DEVICES GATE CONTROL THEORY VIBRAJECT DENTALVIBE CARTRIDGE HEATERS 12 TOPICAL ANESTHESIA FACTORS AFFECTING TOPICAL ANESTHESIA WITH LOCAL ANESTHETICS APPLICATION TIME METHOD OF APPLICATION AMOUNT ADMINISTERED TYPES OF PAIN AREA OF THE MOUTH EFFECT OF TOPICAL ANESTHESIA TOPICAL ANESTHETICS IN DENTISTRY BENZOCAINE MAXIMUM DOSE SPECIFIC ADVERSE EFFECTS LIDOCAINE LIDOCAINE ADHESIVE PATCHES (DENTIPATCH®) EMLA CREAM ADVANTAGES OF THE STRUCTURE AND COMPOSITION OF EMLA TETRACAINE (AMETHOCAINE) FORMULATIONS FOR USE IN DENTISTRY TOPICAL ANESTHETIC COMPOUNDS COMPOSITION ADVANTAGES AND APPLICATION OTHER EXPERIMENTAL FORMULATIONS TOPICAL COOLING COLD AEROSOLS REFRIGERANTS TOPICAL ICE INDICATIONS FOR TOPICAL ANESTHETIC FOR SYMPTOMATIC RELIEF OF PAIN PAIN RESULTING FROM TOOTH DECAY PAINFUL ULCERS AND LESIONS ON THE MUCOSA INDICATION AS ANESTHETIC MINOR SURGICAL INTERVENTIONS CLINICAL PROCEDURES MANAGEMENT OF THE GAG REFLEX PERIODONTAL ORAQIX® GEL ORAQIX SYSTEM (NEEDLE-FREE ANESTHESIA) EFFICACY LOCAL ANESTHETIC TECHNIQUES IN DENTISTRY 13 BASIC INJECTION TECHNIQUE COMMENT ON RETRACTION PHASES OF THE INJECTION INITIAL PREPARATION PREPARATION PHASE APPLICATION OF TOPICAL ANESTHETIC OBSERVATIONS ON AEROSOLS TRANSFER OF THE SYRINGE INSERTION OF THE NEEDLE ASPIRATION FALSE POSITIVES AND NEGATIVES HOW TO INTERPRET A POSITIVE ASPIRATION ASPIRATION TECHNIQUE INJECTION FINAL PHASE EVALUATION OF ANESTHESIA POST-TREATMENT PHASE CAUSES OF PAIN DURING THE INJECTION FACTORS THAT CAUSE PAIN FACTORS THAT PLAY A ROLE IN PAIN UNIMPORTANT CAUSES (MYTHS) TERMINOLOGY APPENDIX 14 MAXILLARY ANESTHESIA I: PULPAL ANESTHESIA MAXILLA BUCCAL ANESTHESIA OF THE UPPER MOLARS BUCCAL INFILTRATION ZONES ANESTHETIZED TECHNIQUE EFFICACY OF THIS TECHNIQUE COMPLICATIONS SPECIFIC TO THIS TECHNIQUE FACTORS THAT LEAD TO SUCCESS MODIFIED COTTON ROLL APPROACH INFRAORBITAL NERVE BLOCK USES INTRAORAL TECHNIQUE EXTRAORAL TECHNIQUE POSTERIOR SUPERIOR ALVEOLAR NERVE BLOCK MODIFIED ADATIA TECHNIQUE HIGH TUBEROSITY APPROACH ZONE ANESTHETIZED TRANSPALATAL TECHNIQUE COMPLICATIONS SPECIFIC TO THIS TECHNIQUE FINAL REMARKS 15 MAXILLARY ANESTHESIA II: COMPLEMENTARY ANESTHESIA OF THE PALATE THE NASOPALATINE NERVE INNERVATES LESS THAN PREVIOUSLY THOUGHT THE POTENCY OF THE ANESTHETIC IS NOT IMPORTANT ANESTHESIA OF THE PALATE WITHOUT COMPLEMENTARY PALATAL ANESTHESIA METHODS FOR REDUCING PAIN IN PALATAL TECHNIQUES TOPICAL ANESTHESIA PRESSURE TECHNIQUES PERIODONTAL LIGAMENT TECHNIQUE MINIMAL INTERVENTION TECHNIQUE NASOPALATINE NERVE BLOCK ANESTHETIZED AREA SPECIFIC COMPLICATIONS OF THIS TECHNIQUE INTRANASAL VARIANT GREATER PALATINE NERVE BLOCK AREA ANESTHETIZED PARTIAL VARIANT OF THE PALATE TRANSPAPILLARY TECHNIQUE IN CHILDREN 16 MANDIBULAR ANESTHESIA I: PULPAL ANESTHESIA MANDIBULAR BLOCK: GENERAL REMARKS FACTORS TO CONSIDER FOR THE MANDIBULAR BLOCK EFFICACY IS CORRELATED TO THE LOCATION OF TOOTH IN THE MANDIBLE HIGH FAILURE RATE UNRELIABILITY OF LOWER LIP ANESTHESIA SEQUENTIAL NATURE THE LONGER THE TIME, THE MORE INTENSE THE ANESTHESIA MINOR EFFECT OF THE TYPE OF ANESTHETIC IMPACT OF THE VOLUME INJECTED MINOR EFFECT OF THE SPECIFIC MANDIBULAR BLOCK TECHNIQUE BILATERAL MANDIBULAR BLOCKS LONG, CALIBER 25G NEEDLES SLOW INJECTION MANDIBULAR BLOCK: CONVENTIONAL OR DIRECT TECHNIQUE DISTRIBUTION OF THE ANESTHETIC SOLUTION MANDIBULAR BLOCK: GOW-GATES TECHNIQUE ADVANTAGES, DISADVANTAGES, AND NON-ADVANTAGES NON-ADVANTAGES REMARK ON THE GOW-GATES TECHNIQUE MANDIBULAR BLOCK: LAGUARDIA–AKINOSI TECHNIQUE USE DOUBLE INFILTRATION IN ANTERIOR TEETH KEYS TO SUCCESS 17 MANDIBULAR ANESTHESIA II: COMPLEMENTARY ANESTHESIA LINGUAL NERVE BLOCK COMPLICATIONS OF THIS TECHNIQUE PARTIAL VARIANT AS COMPLEMENTARY ANESTHESIA BUCCAL NERVE BLOCK SPECIFIC COMPLICATIONS OF THIS TECHNIQUE 18 SUPPLEMENTARY TECHNIQUES IN CASES OF FAILURE INTRAPULPAL ANESTHESIA TRADITIONAL TECHNIQUE KEYS TO A SUCCESSFUL APPROACH INTRAPULPAL TECHNIQUE TOPICAL ANESTHETIC TECHNIQUE PERIODONTAL LIGAMENT TECHNIQUE (PDL) DIFFUSION OF THE SOLUTION FACTORS THAT DETERMINE EFFICACY MAJOR FACTORS MINOR FACTORS INSTRUMENT SET EFFICACY OF THIS TECHNIQUE SPECIFIC COMPLICATIONS OF THE TECHNIQUE COMPLICATIONS DUE TO PERFORMANCE OF THE TECHNIQUE PERIODONTAL ABNORMALITIES PULPAL ABNORMALITIES CARDIOVASCULAR ABNORMALITIES INTRASEPTAL TECHNIQUE FACTORS UNDERLYING A SUCCESSFUL TECHNIQUE INTRAOSSEOUS TECHNIQUE INDICATIONS, CONTRAINDICATIONS, AND DISADVANTAGES STABIDENT® X-TIP® ANESTHETIC SOLUTIONS SPECIFIC COMPLICATIONS COMPLICATIONS DUE TO MECHANICAL ASPECTS POSTOPERATIVE COMPLICATIONS 19 FAILURE OF DENTAL LOCAL ANESTHESIA FREQUENCY CONSEQUENCES OF FAILURE FAILURES: GENERAL CAUSES HIGHLY ANXIOUS PATIENTS PATIENTS WITH DRUG ADDICTION AND ALCOHOLISM TEETH AFFECTED BY IRREVERSIBLE ACUTE PULPITIS REASONS FOR FAILURE OF ANESTHESIA IN ACUTE PULPITIS APPROACH OTHER CAUSES OF FAILURE SPECIFIC FAILURES AFTER MAXILLARY INFILTRATION CAUSES OF MAXILLARY FAILURE SPECIFIC FAILURES AFTER MANDIBULAR BLOCK REASONS FOR FAILURE AFTER MANDIBULAR BLOCK FAILURE OWING TO INAPPROPRIATE TECHNIQUE FAILURE FOR ANATOMICAL REASONS FAILURE ARISING FROM ACCESSORY INNERVATION 20 ALTERNATIVES TO CONVENTIONAL TECHNIQUES JET INJECTION DISTRIBUTION OF THE SOLUTION EQUIPMENT SYRIJET® INJEX® ELECTRONIC ANESTHESIA: ELECTRONIC DENTAL ANESTHESIA COMPUTER-CONTROLLED INJECTION SYSTEMS (THE WAND®) DESCRIPTION OF THE DEVICE CENTRAL PROCESSING UNIT FOOT CONTROL HANDPIECE P-AMSA EFFICACY OF THE P-AMSA TECHNIQUE ADVANTAGES OF THE P-AMSA TECHNIQUE P-ASA EFFICACY OF P-ASA SPECIFIC COMPLICATIONS WITH THIS TECHNIQUE ADVANTAGES OF P-ASA THE WAND AND CONVENTIONAL TECHNIQUES MANDIBULAR BLOCK OTHER COMPUTER-CONTROLLED INJECTION SYSTEMS COMFORT CONTROL SYRINGE FROM MIDWEST QUICKSLEEPER TRANSCORTICAL TECHNIQUE EFFICACY OF QUICKSLEEPER INTRANASAL MAXILLARY LOCAL ANESTHESIA (KOVANAZE®) COMPOSITION OF THE SOLUTION PREPARATION EFFICACY OF THE TECHNIQUE 21 LOCAL ANESTHESIA IN CHILDREN THE PROBLEM WITH CHILDREN AND ADOLESCENTS LOCAL ANESTHETIC SOLUTIONS ANESTHETIC TECHNIQUE IN CHILDREN ANESTHESIA OF THE PRIMARY MANDIBULAR MOLARS NEEDLES AND MANDIBULAR BLOCK REMARKS ON BUCCAL INFILTRATION COMPLICATIONS 22 LOCAL COMPLICATIONS OF DENTAL LOCAL ANESTHESIA PERSISTENT POST-INJECTION PAIN SELF-INFLICTED INJURY FACIAL BLANCHING ANESTHETIC TECHNIQUES INVOLVED CLINICAL MANIFESTATIONS CAUSES AND PATHOPHYSIOLOGY PROPOSED CAUSES PATHOPHYSIOLOGY LOCALIZED LATE-ONSET SKIN LESION ISCHEMIC NECROSIS DUE TO VASOSPASM TYPE III ALLERGIC REACTION FACIAL HEMATOMAS TECHNICAL FACTORS CONTRIBUTING TO HEMATOMAS MANAGEMENT BY THE DENTIST NERVE LESIONS ANATOMICAL LESIONS GENERAL CAUSES IMMEDIATE ELECTRIC SHOCK SENSATION ELECTRIC SHOCK SENSATION AFTER THE TRANSPALATAL APPROACH LONG-TERM PARESTHESIA CAUSES OF LONG-TERM LESIONS ALTERATIONS OF THE SENSE OF TASTE HOARSENESS TRISMUS LOCAL ANESTHETIC TECHNIQUES IMPLICATED IN THE DEVELOPMENT OF TRISMUS CAUSES OF TRISMUS CLINICAL TYPES OF TRISMUS ACUTE EARLY-ONSET TRISMUS CHRONIC LATE-ONSET TRISMUS DUE TO FIBROUS BAND FORMATION CHRONIC LATE-ONSET TRISMUS DUE TO INFECTION TREATMENT OF TRISMUS CONSERVATIVE TREATMENT (MECHANICAL THERAPY) FORCED OPENING UNDER GENERAL ANESTHESIA SURGICAL DRAINAGE FACIAL PALSY FACIAL PALSY ASSOCIATED WITH MANDIBULAR BLOCK IMMEDIATE ONSET AND SHORT DURATION LATE ONSET AND LONG DURATION FACIAL PALSY ASSOCIATED WITH MAXILLARY INFILTRATION OCULAR COMPLICATIONS OTHER CLINICAL ASPECTS OF INTEREST ONSET AND DURATION PREDICTORS OF SEQUELAE PATHOPHYSIOLOGY OF COMPLICATIONS RETROGRADE ARTERIAL FLOW RETROGRADE VENOUS FLOW PASSIVE DIFFUSION TO THE ORBIT IRRITATION OF THE SYMPATHETIC SYSTEM SYMPATHETIC SYSTEM BLOCK (HORNER-LIKE SYNDROME) OTHER PROPOSED CAUSES NEEDLE-INDUCED INFECTION POST-INJECTION MUCOSAL ULCERATION BREAKAGE OF THE NEEDLE CAUSES OF NEEDLE BREAKAGE ASSOCIATED FACTORS OF INTEREST DECISION TO RETRIEVE (OR NOT) PREVENTIVE MEASURES BREAKAGE OF THE CARTRIDGE IN THE MOUTH AURAL COMPLICATIONS TECHNIQUES RESPONSIBLE 23 GENERAL COMPLICATIONS OF DENTAL LOCAL ANESTHESIA BASIC MANAGEMENT OF COMPLICATIONS INITIAL MEASURES UNCONSCIOUS PATIENT P: POSTURE A: AIRWAY B: BREATHING C: CIRCULATION ROUTES OF ADMINISTRATION OF DRUGS CALLING THE EMERGENCY SERVICES PSYCHOGENIC REACTIONS VASOVAGAL SYNCOPE PREVENTION HYPERVENTILATION SYNDROME DIFFERENTIAL DIAGNOSIS ALLERGIC-LIKE REACTIONS TOXICITY INDUCED BY SYMPATHOMIMETIC VASOCONSTRICTORS SYMPTOMS OF REACTION TO EPINEPHRINE SYMPTOMS OF REACTION TO NOREPINEPHRINE SYSTEMIC TOXICITY INDUCED BY LOCAL ANESTHETICS CAUSES OF LOCAL ANESTHETIC-INDUCED TOXICITY INADVERTENT INTRAVASCULAR INJECTION OVERDOSE RAPID ABSORPTION FIRST PHASE: INITIAL SECOND PHASE: ADVANCED THIRD PHASE: CONVULSIONS FOURTH PHASE: FINAL CLINICAL VARIATIONS RECOVERY AND DISCHARGE TOXIC METHEMOGLOBINEMIA LOCAL ANESTHETICS INVOLVED PRILOCAINE OTHER ANESTHETICS AGGRAVATING FACTORS ALLERGY ALLERGY TO THE COMPONENTS OF LOCAL ANESTHETIC SOLUTION ESTERS AMIDES PRESERVATIVE (METHYLPARABEN) CONFUSION WITH OTHER REACTIONS MINOR MANIFESTATIONS MAJOR MANIFESTATIONS DIAGNOSIS TREATMENT OF MINOR MANIFESTATIONS TREATMENT OF MAJOR MANIFESTATIONS SUPPORT MEASURES FOR MAJOR MANIFESTATIONS THE DEVELOPMENT OF ANESTHESIA IN GENERAL AND LOCAL ANES- THETICS IN PARTICULAR REQUIRED A CULTURAL CHANGE THE CON- CEPT OF PAIN (ESPECIALLY OBSTETRICAL PAIN) WAS LINKED TO THE CONCEPT OF ORIGINAL SIN, AND THE ABILITY TO ENDURE PAIN WAS REGARDED AS A SIGN OF CHARACTER AND, IN MEN, WAS EVEN ASSO- CIATED WITH VIRILITY (GREENE 1971) THE CHANGES TAKING PLACE IN WESTERN EUROPE BETWEEN 1750 AND 1850, WITH THE ENLIGHTENMENT, INDUSTRIALIZATION, PROGRESSIVE DEMOCRATIZATION, AND HUMANIZATION OF SOCIETY, CREATED AN ATMOSPHERE FAVORABLE TO THE DISCOVERY OF ANES- THETICS NOTHING COMPARABLE OCCURRED IN ASIA, RUSSIA, OR THE ISLAMIC COUNTRIES, WHERE FEUDALISM PERSISTED IN A VARI- ETY OF FORMS THIS GENERAL PROCESS ALTERED THE CULTURAL, POLITICAL, AND RELIGIOUS CLIMATE, AFFECTING A SIGNIFICANT NUM- BER OF INDIVIDUALS (GREENE 1971) DENTISTS, NOT MEDICAL DOCTORS, WERE RESPONSIBLE FOR THE DIS- COVERY OF ANESTHESIA, GIVEN THEIR CLOSE DAY-­TO-­DAY CONTACT WITH PAIN AND HENCE THEIR MOTIVATION TO SEEK THE MEANS TO ALLEVIATE IT (GREENE 1971) DOCTORS FOCUSED MORE ON INFEC- TIONS THAN ON PAIN, FOR PEOPLE WERE DYING OF ­PNEUMONIA, DIPHTHERIA, GANGRENE, TUBERCULOSIS, TETANUS, PUERPERAL FEVER, AND APPENDICITIS (GREENE 1971; VANDAM 1973) TWO DENTISTS WERE THE FIRST TO INTRODUCE ANESTHESIA: HORACE WELLS (1815–1848), WITH NITROUS OXIDE IN 1844 (WELLS 1847; MENCZER AND JACOBSOHN 1992; JACOBSOHN 1994), AND WILLIAM THOMAS GREEN MORTON (1819–1868), WITH ETHER IN 1846 (GREENE 1979) LOCAL ANESTHESIA, THE BASIS OF MODERN LOCAL ANESTHETICS FOR DENTISTRY, DEVELOPED LATER THIS CHAPTER REVIEWS THE DIS- COVERY AND EVOLUTION OF LOCAL ANESTHESIA FROM THE SPANISH DISCOVERY OF THE COCA LEAF IN AMERICA TO RECENTLY ESTAB- LISHED FORMS OF LOCAL ANESTHESIA IN DENTISTRY ­THE COCA LEAF COCA LEAVES ARE TAKEN FROM A SHRUB OF THE GENUS ERYTHROXYLUM, A MEMBER OF THE ERYTHROXYLACEAE FAMILY, SO NAMED BY PATRICIO BROWNE BECAUSE OF THE REDDISH HUE OF THE WOOD OF THE MAIN SPECIES (LOZA-­BALSA 1992) OF THE VARIOUS SPECIES IN THIS GENUS, ERYTHROXYLUM COCA CONTAINS THE HIGHEST CONCENTRATION OF THE ALKALOID KNOWN AS COCAINE IN ITS LEAVES, UP TO 0 7–1 8% BY WEIGHT (CALDWELL AND SEVER 1974; VAN DYKE AND BYCK 1982) MANY SPECIES OF THIS GENUS HAVE BEEN GROWN IN NICARAGUA, VENEZUELA, BOLIVIA, AND PERU SINCE PRE-­COLUMBIAN TIMES (LOZA-­BALSA 1992) THE EARLIEST CULTIVATION AND USE OF THE COCA LEAF IN THE BOLIVIAN AND ANDEAN REGION DATE BACK TO 700 BCE (LOZA-­ BALSA 1992), ALTHOUGH RECENT DISCOVERIES IN ECUADOR INDICATE HUMAN USAGE MORE THAN 5000 YEARS AGO (VAN DYKE AND BYCK 1982) ALFRED BÜHLER PREMISED THAT THE ARHUACO, A TRIBE FROM THE NEGRO RIVER REGION, WERE THE FIRST TO DIS- COVER THE PROPERTIES OF THE DRUG AND SPREAD THIS KNOWLEDGE TO NEIGHBORING PEOPLES (BÜLHER 1944A,B) SIXTEENTH CENTURY SPANISH CHRONICLERS ASSOCIATED THE APPEARANCE OF COCA WITH FRANCISCO PIZARRO’S (1475–1541) CONQUEST OF THE INCA OR TAHUANTINSUYO EMPIRE IN 1532 THE EARLIEST CHRONICLERS MADE NO MENTION OF THE PLANT THE ­REASON FOR THE BELATED MENTION OF THE COCA LEAF AND ITS ­CONSUMPTION MAY LIE, AS THE SIXTEENTH CENTURY SPANISH CHRONICLERS AVER, IN THE FACT THAT ITS USE WAS RESTRICTED TO THE RULING CLASS OF THE INCA EMPIRE AND TO CERTAIN RELIGIOUS RITES, BUT DID NOT EXTEND TO THE POPULATION AS A WHOLE (CALATAYUD AND GONZÁLEZ 2003) MODERN AUTHORS HAVE VERI- FIED THOSE ASSUMPTIONS; NOTING THAT AFTER THE FALL OF THE EMPIRE IN 1532 COCA CONSUMPTION BECAME POPULAR AMONG THE POPULATION AT LARGE (GUTIERREZ-­NORIEGA AND ZAPATA 1947; LOZA-­BALSA 1992) AS THE ENTIRE SOCIAL SYSTEM UNDERWENT DRASTIC CHANGE, PARTICULARLY AFTER 1540 (LOZA-­BALSA 1992) THE FIRST RELIABLE ACCOUNT OF COCA LEAF CONSUMPTION IS A MANUSCRIPT LETTER FROM THE BISHOP OF CUZCO, FRIAR VICENTE DE VALVERDE (15–1542), TO EMPEROR CHARLES V IN (CARTA 1864) HIS LETTER IS IMPORTANT BECAUSE VALVERDE ACCOMPANIED FRANCISCO PIZARRO THROUGHOUT THE CONQUEST OF PERU AND WAS PRESENT AT ALL THE SIGNIFICANT EVENTS THE SECOND RELIABLE REFERENCE IS ANOTHER MANUSCRIPT, ALSO A LET- TER, FROM THE PRESIDENT OF THE PERUVIAN ASSEMBLY, MEMBER HISTORY OF LOCAL ANESTHESIA IN DENTISTRY HISTORY OF LOCAL ANESTHESIA IN DENTISTRY OF THE CLERGY AND MAN OF LETTERS PEDRO DE LA GASCA (1485–1567), TO THE COUNCIL OF THE INDIES IN 1549, IN WHICH HE DESCRIBED THE MEASURES TAKEN BY FRANCISCO PIZARRO TO DISTRIBUTE COCA (CARTA 1954) THE THIRD REFERENCE, AND THE FIRST TO BE PUB- LISHED IN PRINT, IS ATTRIBUTED TO TRAVELER PEDRO CIEZA DE LEÓN (1520–1554) WHOSE CHRONICLE OF PERU, PUBLISHED IN SEVILLE IN 1553, REFERS TO THE CHEWING OF COCA LEAVES WITH A CHALK-­ LIKE POWDER TO ASSUAGE HUNGER, AND INCREASE STRENGTH AND STAMINA (CIEZA DE LEON 1553) PEDRO CIEZA TRAVELED THROUGH AMERICA BETWEEN 1530 AND 1550, AND LIVED IN PERU FROM 1548 TO 1550 (CIEZA DE LEON 1984) ALL THESE CHRONICLERS OBSERVED THAT COCA CONSUMPTION WAS WIDESPREAD THROUGH- OUT THE POPULATION (TABLE 1 1) THE FIRST REFERENCE TO THE ANESTHETIC EFFECTS OF COCA IS ATTRIBUTED TO SPANISH JESUIT BERNABÉ COBO (1582–1657) (TORRES 1943), WHO, IN HIS 1653 MANUSCRIPT WORK ON THE NEW WORLD, MENTIONED THAT TOOTHACHES COULD BE ALLEVIATED BY CHEWING COCA LEAVES (COBO 1890) IN SUBSEQUENT CENTURIES, MOST WRITERS TENDED TO BE ­APOLOGISTS, STRESSING THE STIMULANT EFFECTS OF COCA BUT PAYING LITTLE OR NO HEED TO ITS DANGERS PHYSICIANS SUCH AS PERUVIAN JOSÉ HIPÓLITO UNANÚE (1755–1833) (VICUÑA-­MACKENNA 1914) RECOMMENDED THE USE OF COCA LEAVES IN 1794 (UNANÚE 1914) WHILE AUSTRIAN PHYSICIAN SIGMUND FREUD