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1. NEWER ADVANCES IN LA
Guided By:Dr. Anish Tiwari
Dr. Adarsh Deshi
Dr. Ravi Kalola

2. INTRODUCTION
• Although LA remains the backbone of pain
control in dentistry, research has continued in
both medicine and dentistry to seek new and
better means of managing pain associated with
many surgical treatments
• There are improvements in :
1.Safer needles and syringes
2. Techniques of regional nerve block
3. Newer drugs

3. pH alterations
• The pH of plain LA solution is appx. 5.5,whereas
that of vasopressor containing solution is about
4.5
• The addition of substances to the anesthetic that
alkalinize the solution should make drugs
administration more comfortable
• At higher pH anesthetic drugs should have more
rapid onset of action and greater potency

4. DENTAL LA CARTRIDGE INSERTED
INTO MIXING PEN

5. Addition of sodium
bicarbonate to LA
• It alkalinizes the solution
• Increases the uncharged base molecules
• Because of uncharged base molecules
penetration of LA into nerve will be faster
• Also it will have rapid onset of action and greater
potency

6. Addition of CO2
• It enhances diffusion of LA through nerve
membrane providing a more rapid onset of
nerve block
• As CO2 diffuses through the nerve membrane ,
intracellular pH is decreased ,raising the
intracellular concentration of charged cations ,
the form of anesthetic that attaches to receptor
sites in sodium channels

7. • Because the cationic form of the drug does not
readily diffuse out of the nerve , the anesthetic
becomes concentrated, providing a longer
duration of anesthesia
• The problem clinically has been that if the
carbonated local anesthetic agent is not injected
almost immediately after opening the vial, the
CO2 will diffuse out of the solution ,significantly
diminishing its effectiveness

8. LOCAL ANESTHESIA
• CENTBUCRIDINE
• ROPIVACAINE
• EMLA (EUTECTIC MIXTURE OF LOCAL
ANESTHESIA )
• ULTRA-LONG ACTING ANESTHSIA
1.TTX(TETRODOTOXIN)
2.STX(SAXITOXIN)

9. CENTBUCRIDINE
• Quinoline derivative
• 5-8 times more potent then lidocaine
• Rapid onset and equivalent duration of action
• Does not affect CNS and CVS except in larger
doses
• Used in subarachnoid , extradural
anestheasia,intravenous regional anesthesia
and intraocular surgery

10. ROPIVACAINE
• Long acting amide anesthetic
• Similar to bupivacaine and etidocaine in duration
of activity
• Structurally similar to mapivacaine and
bupivacaine
• Decreased cardiotoxicity
• Used for regional nerve block

11. EUTECTIC
MIXTUTRE OF LA
• Oil in water emulsion containing high
concentration of lidocaine and prilocaine in base
form
• Consists of 5% cream containing 25mg/g
lidocaine and 25mg/g prilocaine
• Provides anesthesia of intact skin profound
enough to permit venipuncture to performed
painlessly

12. TETRODOTOXIN
AND SAXITOXIN

13. ELECTRONIC DENTAL
ANESTHESIA
• Alternative to la injections in most procedures
,fillings ,cleaning etc
• Possible to have pain control without being
numbed by a shot
• We do this with a unit that is powered by a
battery ,two small sponges are placed in the
patients mouth or on the face, which are
attached to the control box that the patient uses
to select the depth of anesthesia

14. EDA UNIT
TREATMENT WITHOUT NEED FOR LA

15. INDICATIONS
• Patient having needle phobia
• Ineffective la
• Instances where la cannot be administered( eg.
allergy)
• TMJ(chronic pain)
• Nonsurgical periodontal pain
• Restorative dentistry
• Fixed prosthodontic procedure

16. CONTRAINDICATIONS
• Cardiac pacemakers
Neurological disorders
• Pregnancy
• Immaturity
very young pediatric patient
older patient with senile dementia
language communication difficulties

17. ADVANTAGES
• No need of needle
• No need for injections of drugs
• Patient is in control of the anesthesia
• No residual anesthetic effect at the end of
procedure
• Residual analgesic effect remains for several
hours

18. DISADVANTAGES
• Cost of the unit
• Training
• ‘Learning curve‘ initial success may be low but
increases with experience
• Intraoral electrode:weak link in the entire
system

19. NEWER DRUGS
• PHENTOLAMINE MESYLATE
• ARTICAINE HCL

20. PHENTOLAMINE
MESYLATE
• It is short acting alpha adrenergic antagonist
receptors
• Includes peripheral vasodilation and tachycardia
• Available as a 5mg/ml solution for parenteral
administration

21. • It is indicated in reversal of soft tissue
anesthesia (eg. Anesthesia of lip and tongue)
and associated functional difficults resulting
from intraoral submucosal injection and local
anesthetic containing vasoconstrictor
• Not recommended for use in children younger
then 6 years of age or weighing less then 15 kg
• Treatment option whenever prolonged STA
presents a potential risk(soft tissue injury) or
will negatively impact the patient’s life style(eg.
Inability to speak or eat)

22. ARTIICAINE HCL
• It is infiltrated in buccal fold adjacent to the 1st
mandibular molar showing significantly greater
success rate compared with lidocaine 2%
infiltration
• minimal volume of LA solution needed to
produce best clinical result recommended a full
cartridge of artricain 4% with epinephrine 1:
100000

23. INTRA NASAL LA
• The nares are extremely vascular so most drugs
instilled into them will be absorbed rapidly and
systemically which numbs upper teeth in dental
application
FOR EXAMPLE:
• Snorting a line of COCAINE
• CNS depressent drug MIDAZOLAM in management
of status epilepticus in young children
• TETRACAINE used to provide a numbing effect
before surgical manipulation in the nose

24. • Vasoconstictor OXYMETHAZOLINE was added
to the tetracaine to enhance the effectiveness
which active ingredient in the nasal decongestant
spray,Afrin

25. COMPUTER
CONTROLLED LOCAL
ANESTHETIC
DELIVERY(C-CLAD)
COMFORT CONTROL SYRINGE SYSTEM
• It is electronic, preprogrammed deliverydevice
that provides the operator with control needed to
make patients LA injection experience as
pleasant as possible

26. C-CLAD
LIGHT WEIGHT HAND PIECE FOR
COMPUTER CONTROL LA DELIVERY

27. ADVANTAGES
• Familiar syringe type of delivery system
• Easy to see exactly how much LA solution has
been dispensed,just as on a manual syringe
• Inexpensive disposables
• All control literally at fingertips

28. DISADVANTAGES
• Requires additional armenterium
• More bulky then other computer control local
(C-CLAD)manual LA device
• Vibration may bother some users
• costly