Dentaltown October 2015 - (Page 43)

general practice feature Safety A.N.E.S.T.H.E.S.I.A L ocal anesthetics were first introduced in the 1880s by William Halsted, MD, when he found injectable cocaine to be useful for surgeries. Local anesthetics are now used for dental treatment on a daily basis. Previously, patients were given ester medications (remember Novocaine?). In today's dental offices, amides such as lidocaine, mepivacaine, bupivacaine, articaine or prilocaine are likely used. Adverse effects from dental injections can range from mild, such as prolonged anesthesia, hematoma or soreness in the injection site, to moderate/severe effects such as an allergic response (rare with amides) or overdosage, which could lead to respiratory arrest and death. With proper precautions, it is difficult to overdose an adult patient. The toxic level of anesthetic is figured by a patient's weight. The smaller the patient, the less anesthetic is needed to reach toxic levels. (See tables on page 48.) To calculate the maximum amount of lidocaine 2 percent with 1:100,000 epinephrine and the number of carpules that can be safely administered to a 30-pound patient, the clinician would perform the following calculations. by Elizabeth J. Fleming, DDS (MRD) Maximum Recommended Dose (mg/lb.)* x weight (lbs.) = Maximum Total Dosage (mg) 3.2mg/lb x 30 lbs. = 96 mgs Maximum Total Dosage (mg) ÷ mg/cartridge* = Maximum number of cartridges 96mg ÷ 36mg/cartridge = 2.67 cartridges *See tables on page 48 for (MRD) maximum recommended dose/lb (or kg) and mg/cartridge for anesthetic used. The type of dental procedure may dictate the duration of local anesthetic needed. Vasoconstrictors such as epinephrine are added to anesthetics to increase duration by concentrating the solution in the injection site. Healthy patients undergoing dental treatment are less apt to suffer from complications from the anesthetic. Contraindications to the use of vasoconstrictors or dental anesthetics include: Recent heart attack (<1 month) Uncontrolled hypertension Uncontrolled diabetes mellitus Uncontrolled hyperthyroidism Documented allergy Recent drug abuse dentaltown.com \\ OCTOBER 2015 43 http://www.dentaltown.com

Table of Contents for the Digital Edition of Dentaltown October 2015

On Dentaltown.com
Howard Speaks: Don’t Go it Alone
Professional Courtesy: Great Patient Relationships? F.U.!
Continuing Education Update
Industry News
All on Four’d Out
A Direct Hit to the Jaw: Bisphosphonates and Osteonecrosis of the Jaw in Osteoporosis and Cancer Patients
Five Components to Team Synergy
Practice Solutions: Clear-Aligner Therapy
In Focus: Microphotography using the Dental Operative Microscope
Anesthesia Safety
The Practice that Perseverance Built
What Kind of Payment Plans to Offer?
Are You Providing Five-Star Service?
Am I Being Too Conservative?
You Should Know: Healthy Grid
The Benefi ts of Mini Dental Implants
Denture Stabilization with Small- Diameter Implants
Independence Day
Post-Treatment Management of Orthodontic Patients
How to Track True Treatment Acceptance
CAD/CAM as a Marketing Tool
New Products
Practice Solutions: Voco
Poll
Surgical Crown Lengthening
Product Profi le: Umbie
And Sealants for All
Ad Index
Human Herpesvirus Infections and What They Mean for Dentists
Quick, Conservative and Highly Esthetic Treatment Planning for Severe Anterior Tooth Wear
Dentally Incorrect

Dentaltown October 2015