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Sedation and Local Anaesthesia

Sedation

For patients anxious about treatment we can provide intravenous sedation. This is a powerful agent which removes anxiety and gives a comfortable relaxed sensation.

You will remain conscious throughout the procedure and will be vaguely aware of what is happening. However, you will be able to remember very little afterwards. You will need to be accompanied by a third party to the appointment and escorted home again afterwards. You cannot drive, operate machinery or sign documents for 24 hours. More information will be given to you when you attend for the assessment appointment.

Intravenous sedation is used to help relax you during dental procedures.

• The sedative is given by injection into a vein (intravenous) in your arm or the back of your hand.
• You will remain conscious at all times and able to talk and respond to instructions.
• You will also receive local anaesthetic (an injection into your gums) so that the treatment can be carried out.
• Afterwards you will probably have little or no memory of the procedure.

If you are having intravenous sedation there are some rules that you must follow for your safety:

• A responsible adult (friend or relative) must stay in the department during your treatment and drive you home afterwards; if not, you cannot have sedation.
• Remember, to tell your Dentist before your treatment of any changes in your medical history, your medication and if you have asthma or any allergies.

On the day of your treatment:

• You can have a light meal up to 2 hours before your treatment if you wish.
• You can drink fluids and take any medicines as normal unless you have been instructed otherwise.
• Do not drink any alcohol.
• Treatment and recovery time is usually1-11/2 hours.

After your treatment under sedation:

• A responsible adult must drive you home and stay with you for at least 6 hours following the treatment. You must not travel home by public transport such as a bus.
• You should stay at home resting quietly for about 24 hours.
• Do not drive a car, drink alcohol, use machinery (such as a kettle or a bike), do any work or make important decisions for 24 hours, to allow the effects of the sedation to wear off.
• You can eat and drink normally as soon as you feel like it. If you have any pain, then do not hesitate to take the painkillers as directed.

Local Anaesthesia

Local anaesthesia is defined as the localised numbing of a target area. This is often used in dentistry, as your dentist wants to prevent you feeling pain in a specific area. The local anaesthesia allows you to remain conscious throughout the procedure but without you feeling any pain or discomfort.
Local anaesthetic is available in a number of different types. It can be administered as a spray, drops or as an injection. However, in general the most common route of administration is by injection to the area requiring numbing. This works as the anaesthetic selectively targets nerves to block them transmitting pain signals and sending them to the brain.
The level of anaesthesia can be controlled to regulate how long the pain block lasts for, as well as the level of numbness.

What anaesthetic do dentist use?

Many dentists use a local anaesthetic known as Lidocaine, although this is just one of many available. An easy way to know whether the medication your dentist is talking about is an anaesthetic is to listen out for “caine” at the end of the name.

What is contained in local anaesthetic?

Obviously there is a drug aimed primarily at numbing the area into which it is injected, however there is also a liquid component, which contributes further to the effect of the anaesthetic. In this liquid there is often:
Vasoconstrictor – A vasoconstrictor is a type of drug that acts on your blood vessels to narrow them. By doing this, the numb effect of the local anaesthetic will last a longer amount of time.
Chemical – Certain chemicals are included in local anaesthetic to protect the vasoconstrictor drug from being broken down.
Sodium hydroxide – This particular component is included to enhance the numbing effect of the drug.
Sodium chloride – This part of the liquid is used to aid the introduction of the numbing drugs into the blood.

The use of local anaesthetic injections at the dentist

The dentist has two types of local anaesthetic injections available for use depending on the procedure being performed. Firstly, is a block injection that is used to numb a whole section of your mouth, for example, the left side of your upper jaw. Alternatively, the dentist may use an infiltration injection to numb a more local, specific area.
The dentist will often apply a numbing gel so you will not feel the injection. Once this gel has had time to take effect, your dentist will carefully inject the anaesthetic. Any pain felt here is often due to the drugs moving into the mouth tissues rather than the actual needle.
The numb effect of the local anaesthetic injection often last several hours. This means that a lot of the time, by the time you leave the dental clinic, your mouth may still be numb. This can hinder certain everyday tasks such as talking or eating. Although this can often be quite amusing to yourself and others around you, it can also cause some problems. You must still be aware that you have had a procedure and you should take care to avoid biting the area that has been numbed, as it could inadvertently cause damage.

Potential side effect of local anaesthetic injections

As with many drugs, local anaesthetic has potential side effects attached to its use. The actual probability of these side effects happening vary from person to person but it is always important to ensure that you are aware of them.
The possible side effects and complications include:
Temporary problems with eating, drinking and talking immediately after receiving the injection.
You may feel dizzy, suffer blurry vision or endure a short-term loss of your muscle control and coordination, which may be seen as twitching.
It is possible that you might get a headache or feel nauseas or even vomit.
An allergic reaction may occur. Symptoms to look out for include a rash, tingling of the skin (especially the lips) and breathing problems.
In extremely rare circumstances, nerves can suffer damage if the needle accidentally hits them.
Haematomas may occur where the injection was administered. This is a swelling full of blood that occurs if the needle strikes a blood vessel.
The numbing drugs can have an effect on facial areas away from your mouth, such as your eyelids. This can sometimes lead to the inability to blink although this will wear off as the anaesthetic does.
Your heart may beat at a quicker than normal rate due to the vasoconstrictor component.
You should tell your dentist prior to your treatment if you have any allergies. If you are taking any medication, please tell your dentist the name and dosage, as it may interfere with the local anaesthetic. These medications include over-the-counter drugs like Ibuprofen or Paracetamol as well as medically prescribed drugs.

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