Complications of local anesthesia and endodontic treatment

Numbness does not go away after dental anesthesia: find out where the problem comes from

Dental treatment is a serious challenge. There are risks of developing unpleasant consequences after improper filling or removal, and there is a possibility of complications after anesthesia. Treatment uses local blockade of pain impulses. In dentistry, anesthesia is used in the treatment of periodontitis, pulpitis, during prosthetics and implantation, during tooth extraction, during tissue extension or incisions. If numbness after dental anesthesia does not go away within the prescribed time, you need to look for causes and methods of elimination.

How long does the anesthesia wear off?

Dentists use special types of anesthesia:

• using applications (in this case, the anesthetic is applied to the area treated with antiseptic substances in the form of a gel, ointment, solution);
• due to the conductor, that is, through injections (carried out for a long-term type of dental intervention, Novocain is used);
• infiltration (three-stage type, indicated for complex manipulations).

Experts have established a maximum threshold for each type of anesthesia and recommend closely monitoring how much time has passed since dental procedures were performed:

• numbness after application of anesthesia can last up to 30 minutes;
• after conduction – up to 5-6 hours;
• after infiltration – up to 3-4 hours.

The characteristics of the patient should be taken into account, such as age, weight, general health.

How long does it take to recover from anesthesia?

Time to recover from anesthesia
The time to recover from anesthesia after surgery or after caries treatment differs, although not significantly. This is usually 15-30 minutes from the end of medical procedures to the moment when the patient fully regains consciousness and is able to think clearly, talk and walk. This is explained by the fact that the introduction of modern drugs for general analgesia is very effective and their effect can be stopped very quickly. These substances are also quickly eliminated from the body. Of course, the speed at which the body regains consciousness depends both on the patient’s age, his sensations, his somatic diseases, and on the stage of treatment, the period of his stay in medicated sleep, and the method of administering medications. But in any case, the time after anesthesia in dentistry is very short and the patient leaves the clinic on the same day.

Complications after local anesthesia

The human factor plays a big role in dental procedures. Often, the inexperience or carelessness of a specialist leads to serious consequences.

General complications that arise during local anesthesia in dentistry can be of different nature:

1. Discomfort at the needle insertion site. This is due to the drug being administered too quickly or too slowly.
2. Hematoma at the injection site. The occurrence and growth of a hematoma indicates problems with blood vessels or an incorrect choice of the needle insertion site.
3. Allergic reactions. Despite the fact that reactions to drugs are determined before anesthesia, cases of severe allergies to the composition of the anesthesia are not uncommon, especially if it consists of two or more components.
4. Inflammation of the gums, development of infection. This case suggests that several mistakes were made during the procedure, as a result of which bacteria entered unprotected tissue and caused inflammation.
5. Numbness of the facial muscles. The symptom is often complicated to the point of paresis, lack of control over facial expressions, inability to close lips, and sagging areas of the face.

Numbness after dental anesthesia: symptoms, causes

The problem with diagnosing complications of anesthesia is that numbness of the jaw is a natural condition after anesthesia. If accompanying symptoms are added to it, you should consult a doctor. Associated symptoms:

• numbness of the tongue, burning and tingling;
• numbness of the cheek;
• sagging part of the face;
• tooth pain;
• pulsation in the gums;
• profuse salivation.

There are only three factors influencing the symptom:

• a needle entering a blood vessel when injecting an anesthetic;
• nerve damage;
• exposure to the anesthetic due to its increased toxicity.

The needle gets into the vessel and may break off. The nerve is damaged when instruments are applied. The toxicity of the anesthetic increases with minimal errors by anesthesiologists.

Some people experience prolonged numbness of the tongue and lips after wisdom tooth removal. This procedure is difficult due to the awkward position of the third molar in the mouth. When performing manipulations, there is always a risk of damage to the mandibular nerve, which is located close to the root. Wisdom teeth often have slopes because they appear later than others and do not have enough space for proper growth. In this position, it can be extremely difficult to grab it with tools. Paresthesia after wisdom tooth removal will spread to the tongue or part of it; the lips and gum areas above the problem area are at risk.

It is also important to remember about possible damage to the facial nerve, in the trunk of which there are sensory and secretory fibers; they are responsible for facial expressions and motor activity. If one of the fibers is damaged, numbness occurs in the lower part of the face.

Complications during and after anesthesia in the maxillofacial area

During anesthesia, various complications may occur, which almost always require emergency therapeutic measures.

COMPLICATIONS DURING AND AFTER LOCAL ANESTHESIA

Syncope is a complication that occurs during both anesthesia and surgery. It is associated with brain anemia, which occurs reflexively, most often as a result of emotional disturbances: overwork, fear of surgery, negative emotions associated with pain and tactile sensations, the sight of instruments, blood, etc.

The patient feels weak, his face turns pale and covered with sweat, and his eyes become dark. Subsequently, loss of consciousness occurs and the patient falls. Breathing becomes shallow, pulse weak, accelerated, barely palpable; Blood pressure decreases, pupils dilate. After 1-2 minutes the patient regains consciousness. To improve cerebral blood flow, the patient needs to be placed in a horizontal position, unbutton the collar, let him smell ammonia, and open the windows. If the condition does not improve, use fast-acting cardiotonic drugs (corazol or caffeine, 1 ampoule subcutaneously). You can perform artificial respiration.

Prevention of syncope involves preliminary mental and medicinal preparation, thorough pain relief and the elimination of negative emotions.

Collapse is a more severe form of disruption of vital functions due to temporary acute heart failure and decreased tone of the walls of blood vessels.

Characterized by sudden onset of pallor and cyanosis, cold sweat, coldness of the extremities. Temperature and blood pressure decrease, the pulse becomes threadlike; the muscles relax. Patients are usually conscious, but relaxed and apathetic. Collapse can be fatal if cardiac activity is not stimulated in a timely manner.

The patient should be placed in a horizontal position, administered fast-acting cardiotonic drugs (corazol, caffeine) and drugs that increase blood pressure (Effortil or Vasoton, 1 ampoule subcutaneously or intravenously in an isotonic solution of sodium chloride or 40% glucose). Surgery should be stopped unless it is urgent.

Prevention of collapse consists of preliminary mental and medicinal preparation of the patient, gentle surgical intervention and infusion of plasma-substituting solutions or blood in case of large blood loss.

Toxic manifestations are possible when an anesthetic is administered in a dose exceeding the permissible dose, or when it enters a blood vessel.

With minor intoxication, relaxation, confusion, psychomotor agitation, mild headache and dizziness are observed. Blood pressure rises, pulse quickens. With an average degree of intoxication, these phenomena are more pronounced. Sometimes patients lose consciousness. Cyanosis and respiratory failure may occur. In case of severe intoxication, the patient loses consciousness; Blood pressure decreases, pulse slows, breathing becomes difficult. Breathing may stop and cardiac activity may decrease. For minor intoxication, it is usually sufficient to place the patient in a horizontal position. If there is significant agitation, 50-100 mg of thiopental is administered intravenously, and oxygen can be given. In case of severe intoxication, artificial respiration is performed, an infusion of an isotonic sodium chloride solution or a 5% glucose solution with hypertensive drugs: vasoton or norepinephrine.

Prevention of toxic complications consists of strict adherence to pain management techniques and the use of anesthetics in acceptable quantities and concentrations.

Allergic reactions occur in the form of pain in the joints, swelling of the eyelids, tongue, mucous membranes of the larynx and pharynx in people with allergies to local anesthetics.

If an allergic reaction occurs, 1-2 ampoules of allergosan, 1 ampoule of sopolcort and 1 ampoule of adrenaline or ephedrine are administered intravenously.

Prevention of allergic reactions consists of collecting relevant anamnestic information, conducting allergy tests, and excluding anesthetics to which patients are allergic.

Idiosyncrasy develops when even a small dose of an anesthetic is used, to which the patient is intolerant.

It manifests itself in the form of rapidly occurring respiratory and circulatory disorders, which can subsequently lead to cardiac arrest.

In cases of idiosyncrasy, artificial respiration, indirect cardiac massage are performed, and adrenaline, sopolcort and allergosan are administered intravenously.

Damage to blood vessels from an injection needle leads to the formation of a hematoma or ischemic zone. Hematomas occur when large blood vessels are damaged. Most often they are observed when the pterygoid (venous) plexus is ruptured, during tuberal anesthesia, during infraorbital anesthesia, etc. When a hematoma forms, swelling quickly occurs. Later, the mucous membranes or skin become bluish, then yellow-green, and after 8-10 days the hematoma resolves. When infected, an acute inflammatory process may develop.

In the first 48 hours after the occurrence of a hematoma, cold applications are necessary, and later, physiotherapy (ultrasound, compresses). If a large hematoma occurs, its emptying and preventive administration of antibiotics are indicated.

Ischemic zones are strictly limited areas of anemized skin. They occur due to spasm of blood vessels as a result of contact with a needle or the vasoconstrictor effect of adrenaline. Ischemia is transient and does not require therapeutic measures.

Emergency conditions in dental practice

Damage to the endings of the trigeminal or facial nerves is relatively common. Complications are associated with injury or nerve blockage.

Damage to the endings of the facial nerve is observed with extraoral anesthesia of the infraorbital nerve, with Berchet anesthesia, with anesthesia of the facial skin and sometimes with mandibular anesthesia, when the needle is inserted deeply and the solution is injected near the stylomastoid foramen.

Usually, a few minutes after anesthesia, phenomena of paresis of facial muscles occur: smoothness of the nasolabial fold, drooping of the corner of the mouth on the corresponding side; the patient cannot frown his forehead, close his eyes, or whistle. Sometimes paresis occurs only in individual muscles. These phenomena usually disappear after 1-2 hours without treatment.

During infraorbital anesthesia, transient diplopia may occur.

The endings of the trigeminal nerve are damaged mainly during infraorbital, mental and mandibular anesthesia. Damage may be caused by the sharp end of a needle or endoneurial injection of anesthetic. In such cases, paresthesia may occur, characterized by a decrease in sensitivity (hypoesthesia) in the corresponding area, or the development of neuritis. These phenomena can last for days, weeks and even months.

To treat paresthesia, B vitamins and physiotherapeutic procedures are used.

Air emphysema is associated with the penetration of air into loose subcutaneous or submucosal tissue due to the occurrence of negative pressure in them (for reasons not yet fully understood). Air can penetrate through the hole formed during anesthesia, through an extraction wound, or when soft tissue ruptures.

Emphysema is characterized by the rapid development of diffuse swelling, which can involve the cheeks, eyelids, temples, and neck. Sometimes severe pain occurs. When palpating the swelling, a characteristic “parchment crackle” is usually felt.

Emphysema is not a serious complication, but its occurrence usually makes both the patient and the doctor worry.

If emphysema develops, surgery should be discontinued. The swelling is pressed with your hand, the air is forced out, and a pressure tampon is applied to the hole, which prevents air from being sucked in. Emphysema usually disappears after 2-3 days without special treatment.

An injection needle fracture occurs rarely, most often during intraoral mandibular anesthesia. Typically the needle breaks at the point where it meets the tip. The causes of a fracture may be the presence of rust at the solder site, sudden movement of the patient, or careless conduct of the procedure.

If the edge of the broken needle is visible, then grab it with tweezers and remove the needle. Otherwise, you should not attempt to surgically remove the needle fragment, since this is a very complex intervention. The needle can remain in the tissue and not cause any damage. In case of pain or impaired movement of the lower jaw, as well as in the development of an inflammatory process, the needle should be removed in a specialized institution. The patient should be informed of the incident, but reassured by telling him that foreign bodies can remain in the body and that they rarely cause complications.

Swallowing an injection needle is possible when performing mandibular or palatal anesthesia, when the needle is poorly fixed on the syringe and the patient makes a sudden movement.

If a needle is swallowed, an x-ray should be taken to determine its location. The patient is explained that usually the foreign body is eliminated from the body spontaneously. Prescribed porridge and boiled potatoes, which envelop the needles and protect the gastrointestinal tract from damage.

Usually after 2-4 days the needle is removed from the body. If complications occur, the needle is surgically removed.

Aspiration of an injection needle is a dangerous complication during local anesthesia, i.e. it can lead to asphyxia of the patient. The causes of this complication are poor fixation of the needle and sudden movements of the patient.

In case of needle aspiration, urgent consultation with an otorhinolaryngologist or anesthesiologist and removal of the needle are necessary. In case of spasm of the upper respiratory tract, a tracheostomy is performed.

Pain and swelling very often occur after injection for various reasons: the introduction of non-isotonic, non-isoionic and non-isothermal solutions, rapid and high-pressure injection of an anesthetic, damage to the periosteum with a faulty needle, subperiosteal injection, tissue rupture, failure to comply with asepsis, etc.

Sometimes pain can persist for a long time. They can be relieved with the help of painkillers, rinsing with chamomile, and physiotherapeutic procedures.

Post-injection necrosis is a relatively rare complication, which is mainly observed in the area of ​​the hard palate. Most often, necrosis occurs due to the erroneous administration of formalin, alcohol, and sometimes an anesthetic solution. In these cases, the development of necrosis is associated with rapid and high-pressure injection of the solution under the periosteum, thrombosis of blood vessels and disruption of trophism, anemia of tissue under the influence of adrenaline, infection, etc.

When some solutions are administered incorrectly, severe pain immediately occurs. Subsequently, the mucous membrane becomes inflamed and necrotic, and the bone is exposed. Sometimes part of the hard palate also undergoes necrosis, which can lead to a communication with the nasal cavity.

For tissue necrosis, rinsing with hydrogen peroxide is effective. To stimulate epithelization, I. G. Lukomsky recommends treatment with a 0.2% solution of potassium permanganate.

If very severe pain occurs during anesthesia, the needle should be removed to avoid its penetration under the periosteum. If the pain does not disappear after this, the anesthesia should be stopped and the injection solution checked. If the solution is administered by mistake, it is necessary to cut the tissue and wash the wound with an isotonic sodium chloride solution.

Temporary blindness usually occurs with intraoral mandibular anesthesia. Almost immediately after the injection, the patient reports that he cannot see. This condition can last about 0.5-1 hour, after which vision is restored on its own.

Post-injection abscesses and phlegmons . Local anesthesia is one of the common causes of the development of purulent inflammatory processes in the maxillofacial area. Infection can occur due to the use of non-sterile instruments (after touching the untreated surface of lips, teeth, etc.), solutions.

The clinic depends on the location of the infiltrate. The deeper the source of infection is located, the more severe the complication, for example with phlegmon of the pterygomandibular space and infratemporal fossa.

If purulent inflammatory processes occur, appropriate treatment is carried out.

Traumatic brain injuries

Contractures of the lower jaw . Reflex contractures that occur after anesthesia are associated with spasm of the muscles that lift the mandible, most often the pterygoid muscles, less often the rest. The causes of contracture are perforation or rupture of muscle fibers, which causes pain impulses to be sent to the central nervous system or the development of an inflammatory infiltrate in or near the muscle.

Contractures manifest themselves in the form of limitations in mouth opening and pain when moving the lower jaw. When the occurrence of contracture is associated with an inflammatory process, other signs may be observed: swelling, lymphadenitis, fever.

Contractures are usually observed for 3-4 days, and sometimes weeks and months.

Analgesics, muscle relaxants (mydocalm, bellazone), and physiotherapeutic procedures are used for treatment. For persistent reflex contractures, tissue therapy according to the method of N. I. Krause gives good results.

Treatment

Numbness after anesthesia goes away on its own if no damage or disturbance has occurred. In case of complications after surgery, the help of a specialist is necessary if:

• numbness after treatment or removal does not go away after 24 hours;
• when removing a wisdom tooth - after 1-5 days.

The nerve is completely restored after 2-3 weeks. Associated symptoms should be taken into account. Shooting pain in the tooth, burning sensation in the gums, sagging tissue indicate disturbances that occurred as a result of the operation. Nausea or vomiting is a sign of poisoning in the body. In difficult cases, treatment is required.

Complications after the use of anesthesia are quite common. If the damage is not too complex, and the doctor’s recommendations are fully followed, then surgery can be avoided.

Medicines

To restore damaged nerves and normalize blood circulation, dentists prescribe:

• vitamin complexes containing vitamins B and C;
• Actovegin, Piracetam and other medications.

Folk remedies

At home, rinsing with oak bark and chamomile decoction is used to relieve inflammation. Valerian root is used in an infusion, as it has a sedative effect and relaxes muscles. Furacilin solution has proven itself well; it is used for rinsing.

It is not recommended to use heating or cooling yourself. Despite the feeling of relief in the first minutes, such procedures can cause harm.

Physiotherapy

Dentists resort to prescribing ultrasound therapy to warm up the designated areas. This promotes tissue restoration.

Diagnosis and treatment

• Neurophysiological tests such as EMG and nerve conduction studies, coupled with MRI, often help pinpoint the location of the injury, which can indicate the cause and possible liability.
• Treatment and prognosis depend on the severity of the injury and are best left to neurologists and neurosurgeons.
• Spinal cord compression or cauda equina syndrome requires emergency neurosurgical intervention and decompression.

• Medicines used for neuropathic pain are tricyclic antidepressants (amitriptyline at a dose of up to 150 mg / day, starting with 25 mg at night) or antiepileptic drugs (carbamazepine 100 mg 1-2 times a day up to 200 mg 4 times a day, or gabapentin, best tolerated, 300 mg once daily up to 600 mg three times daily).

Prevention

Before going to see a dentist for treatment or tooth extraction, you should follow a few simple rules that will help you undergo the intervention without further complications:

• do not drink alcoholic beverages (at least 2 weeks before anesthesia);
• monitor blood sugar and blood pressure levels;
• limit the amount of liquid you drink.

As a rule, numbness after anesthesia goes away within the prescribed time. Complications occur together with other symptoms that are difficult to ignore.

Complications

Normally, a hematoma formed in the mucous membrane resolves within 4-10 days (this depends on the volume of blood released and the individual characteristics of the body). But in the presence of pathogenic microorganisms, clotted blood can become a nutrient medium, which leads to their active reproduction.

Depending on the type of pathogen and the location of the bruise, the infection can spread to the periodontium, alveolar process, periosteum and jaw bone tissue. If anesthesia was carried out for painless tooth extraction, pyogenic microbes can penetrate through the hole into all tissues of the dental system and cause purulent complications (periostitis, periodontal abscess, phlegmon of the soft tissues of the face) and necrosis (tissue death).

Consequences of anesthetizing a tooth into a nerve

Pain after injection. Could a muscle or nerve be hurt during anesthesia?

A month ago, my jaw ached below and above on the right, unobtrusively, just a little pulling. I went to the dentist 3 weeks later, found a hole in the top of the tooth, gave 2 anesthesia injections, treated it and sent it home. He told me to come back the next day if he still hurt. He said that all my teeth were in perfect condition and nothing should worry me. In the evening nothing changed, I went again. I found another tiny hole in the tooth from below, which went into the inner layer of the tooth and destroyed it from the inside. He performed a huge anesthesia, numbed the entire cheek, half of the tongue and half of the lip. When I injected it, it was more unpleasant than it should have been, as if I had hit it in the wrong place (a nerve/muscle). The tooth was healed and sent home. After 3 hours, the anesthesia wore off, but my jaw still hurt. By evening the pain became unbearable, stronger than it had ever been before. I decided that these were wisdom teeth and decided to go take a picture on Monday.

Why doesn't anesthesia work on the tooth?

Every person is faced with the need for dental treatment at the dentist and deep in his soul hopes that any intervention will be painless. This is only possible if the anesthesia (“pain relief”) is 100% effective. But few people know that there are factors little known to the average person that lead to a difficult (even worse - absence) effect of this very anesthesia.

Having collected bit by bit these scattered reasons that concern many unsuspecting patients, I, as a dentist with extensive experience, created a useful informative article, written in a language that is simple for any person.

There are a number of reasons why painkillers may not work at the dentist:

• Poor quality drug. It may have been stored or transported incorrectly, or may have passed its expiration date.
• The doctor may play it safe and administer an insufficient dose. Then there will simply not be enough of it.
• The dentist may make a mistake in choosing a medicine. Each remedy has its own indications.
• When injected, the gum mucosa may be damaged. In this case, the drug may simply leak out without having time to be absorbed.
• Individual characteristics of the patient. There are people for whom certain anesthetics have virtually no effect.
• When an inflammatory process occurs at the injection site, anesthesia will not help.
• If the painkillers did not work during tooth extraction, the patient may be so stressed that he needs a larger dosage or took something sedative before the appointment.

The fact is that many people are terribly afraid of the dentist. Therefore, when they sit down in a chair, they begin to produce adrenaline at an accelerated pace. Anesthesia is often not used during dental treatment due to the influence of adrenaline. It raises blood pressure, increases heart rate and causes vasospasm. It is this spasm that interferes with the full effect of the medications.

There are situations when the patient relieves stress with a glass of alcohol before the appointment. The effect has been achieved - there is no fear, but the drugs have practically no effect when there is alcohol in the blood. Doctors also do not recommend using strong painkillers the day before your dentist appointment. They may interfere with anesthesia.

As funny as it may seem, painkillers practically do not help red-haired people. A mutation has occurred in their body, due to which local anesthesia is practically powerless.

The third reason is...

This is the patient's fear of upcoming dental interventions.

Individual cases of insensitivity to certain anesthetics, leading to the same outcome as the first two reasons described. Probably, now you are no longer surprised, since I myself have repeatedly heard about patients’ fear that such and such anesthetic X (“X”) will most likely not work, which has already been tested through “bitter” experience.

The reasons for such tolerance (addiction) most likely lie in the possibility of accumulation of the drug not even at the micro-, but at the nano-level. There are authors who are inclined to believe that the mechanism is similar to the repeated use of those drugs that, after a certain period of time, cease to help the patient, and immediate correction of treatment is required, namely, replacement with its analogue, which is more effective in its pharmaceutical strength.

There are many such medications and there is no point in listing them. There are rumors of examples of long-term use of painkillers (analgesics) that help for the time being and there is a need to use stronger ones, and later it can reach narcotic analgesics (such as Promedol or Morphine). In dentistry, the picture is the same, but with minor adjustments for specifics.

The effectiveness of anesthetics increases in an alkaline environment and decreases in an acidic environment. This is because anesthetics are used in the form of salts, and their anesthetic properties depend on the free bases. In turn, free bases can only form in an alkaline or neutral environment, while in an acidic (pH

We hit a nerve during anesthesia.

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The most common types of pain relief in dentistry

Most often, in order to cure caries, pulpitis, periodontitis, remove a tooth or perform other dental procedures (for example, dental implantation), the doctor administers local anesthesia, namely a pain-relieving injection into the gum. If it is painful for the patient to inject into the gums, and he experiences discomfort during the injection process, the specialist pre-treats the gums with an aerosol or spray (application anesthesia), which reduces the sensitivity of the soft tissues.

Dentists mainly use types of conduction and infiltration anesthesia. With the help of local anesthetics, it is possible to achieve a minimal toxic effect on the patient’s body, because medications administered topically affect only the area of ​​preparation.

The doctor applies infiltration anesthesia to the problem area (for example, near the root of a diseased tooth). After its introduction, neighboring areas retain their sensitivity. The guidewire is effective for carrying out larger-scale interventions, because it affects directly the branch of the nerve that is responsible for a certain area. After the administration of a conductive anesthetic, all periodontal tissues are literally “frozen.”

How long does an injection into the gum last? Infiltration – up to 2-3 hours, conductive – up to 8-10 hours.

Read the article on the topic: anesthesia in dentistry. Find out what modern methods of anesthesia allow you to avoid an injection into the gum.

Options for local anesthesia of a sore tooth

Local anesthesia can be conditionally classified into the following groups:

• application;
• infiltration;
• conductor;
• intraosseous;
• intraligamentary.

Let's look at each in more detail.

Appliqué

This type of anesthesia for tooth extraction can only be used if a simple treatment is planned or if the gum area where the anesthetic will be injected needs to be made insensitive. More often, the application technique is used when providing dental care to young children. Baby teeth do not have branched roots and, when they are already thoroughly loosened, before pulling them out, it is quite possible to limit yourself to applying a local anesthetic. The latter usually contains lidocaine or benzocaine.

Infiltration

A very common option for pain relief. Involves injecting the medication directly into the gums. As a result, the treated area, part of the cheek, lip and tongue become numb.

The technique is suitable if the therapy is simple and takes little time, for example, when pulling out baby teeth. It is offered to adults if the unit is already highly mobile and can be easily grasped with forceps.

Anesthesia wears off after tooth extraction within three to four hours. Then the usual sensitivity gradually returns.

Conductor

A more serious option for pain relief. It is used if several teeth need to be removed at once. This is possible if preparation for prosthetics is underway. The doctor makes an injection into the gum and injects an anesthetic. But the needle is installed in such a way that after the injection, not only individual nerve impulses are blocked, but the peripheral branches of the nerve. Due to this, a large area is covered.

Taking into account exactly where the medicine is injected and which tooth is to be removed, conduction anesthesia is divided into:

• Mental. Suitable if you need to pull out canines, incisors, premolars.
• Tuberal. Only used when working with molars.
• Thorusal. It is used if several lower units located in different zones are to be pulled out.

To select the most appropriate anesthesia option for tooth extraction, the doctor examines the oral cavity. In rare cases, the injection is given extraorally. Then the needle is inserted into the gum tissue directly through the cheek.

Intraosseous

With this type of anesthesia, an injection is made directly into the bone tissue. Using a long needle, they reach the bone plate that forms the frame for the tooth. As a result, the surrounding soft tissues remain sensitive and do not go numb.

The intraosseous technique is indicated if it is necessary to remove unerupted and incorrectly located units of the oral cavity. Sometimes it is used when operating on the lower jaw, since it is easier to perform such technically complex anesthesia.

It is important to understand that intraosseous anesthesia renders only the treated tooth numb. If its roots go very deep or intertwine with neighboring ones, it makes sense to use another option for pain relief.

Intraligamentary

The anesthetic is injected directly into the tissue, and not into the nerve, that is, the work is carried out exclusively with the periodontal space. The injection is given under great pressure, but it causes almost no pain.

The intraligamentary technique is optimal if it is necessary to remove premolars, molars, incisors and canines in a child. Sensitivity is lost almost immediately.

Within a minute after the injection, the unit becomes “frozen.” The freezing effect lasts for about 20 minutes. This is quite enough to perform a simple surgical operation.

Pain in the gums after visiting the dentist: normal or pathological

It is quite normal for the gums to hurt after the injection and after the anesthesia wears off, provided that the discomfort is not severe and is limited to a few days. After all, in order to administer the medicine, the doctor is forced to pierce the soft tissues using a special thin needle located on the syringe. This manipulation, although minimal, injures the mucous membrane. Therefore, pain for several hours or several days after the end of anesthesia can be considered normal.

On a note! Today, private dentistry is increasingly using carpule syringes, which have very thin needles and virtually eliminate injury to soft tissues.

If your gums continue to hurt for a long time after an anesthesia injection, and the discomfort intensifies or becomes unbearable, then you need to consult a dentist.

Causes of pain in the gums

An injection of anesthesia into the gums is a prerequisite for your peace of mind in the dentist's chair when treating diseases of the oral cavity. However, you must be prepared for the fact that in some cases, after treatment, pain may appear, which will indicate various pathologies. Let's look at each reason in detail.

Development of an infectious process in the soft tissues of the oral cavity

This can happen if the patient has a poor oral hygiene index, and there is a large number of sick, decayed teeth in the mouth that need to be removed. When the doctor injects an injection into the gum, a wound then forms on the soft tissues, which needs time to heal. If, during the healing period, pathogenic bacteria penetrate the wound, an inflammatory process begins, which can, if not consulted in a timely manner, be complicated by the occurrence of an abscess or purulent cyst. Inflammation can also penetrate deep into the soft tissues, spread to neighboring organs, and cause swelling of the face.

The infectious process can develop against the background of a weakened immune system in the patient, as well as due to a violation of the aseptic processing of instruments and the workplace in the dentist’s office.

Damage to nerve endings

An inexperienced doctor could touch and injure a nerve when administering an anesthetic. In this case, at first you may be bothered by numbness, and then pain will appear, which will be aching at first, and then unbearable - it may not go away for up to several months in a row, it will be difficult to relieve it with painkillers and syrups. Also, pain can radiate to other parts of the maxillofacial apparatus (eyelids, cheeks, temples, ears). Damage to the facial nerve may be indicated by difficulty opening the mouth and chewing food.

The possibility of touching a nerve most often occurs during the administration of conduction anesthesia.

Hematoma formation

The soft tissues and mucous membrane of the oral cavity are penetrated by blood vessels and capillaries; if the doctor inserts the needle carelessly or too quickly, the doctor could touch one of these vessels or capillaries. This in turn provokes their damage and the formation of a blood clot. Because blood cannot flow out, a hematoma forms under the mucosa, which puts pressure on the surrounding soft tissue, which causes pain.

Allergic reaction

Some patients have an individual reaction not only to the components that make up anesthetic drugs, but also to filling materials, to medications that the doctor uses in the process of work. This may cause irritation to the oral mucosa.

According to some studies, 1 allergies and side effects occur more often in patients with anesthetics that include novocaine, dicaine and anesthesin. But the likelihood of allergies when using drugs containing lidocaine, mepivacaine and articaine is much less.

Soft tissue necrosis

Necrosis is the death of living cells and tissues, provoked by a number of circumstances. This complication is quite rare. It may occur due to the fact that the doctor gave the injection traumatically, injected the anesthetic too quickly, due to which the blood vessels were compressed. The reason could be an incorrect calculation of the drug, leading to vasospasm - most often this reaction is caused by adrenaline. In a very rare case, the doctor mistakenly administered not an anesthetic, but, for example, calcium chloride or alcohol.

Local complications and errors during the anesthesia procedure

Before any surgical intervention in the maxillofacial region, it is necessary to carry out complete tissue analgesia, since anesthesia in dentistry is not only a humane attitude towards the patient, but also a method of pathogenetic therapy, which is used in the treatment of any inflammatory process and diseases of a traumatic nature that develop in shock zone.

The doctor cannot expect that the disease will proceed without complications if he performed the intervention without providing complete anesthesia in the area of ​​injury or inflammation.

Inadequate pain relief is one of the most common mistakes made by clinic doctors when treating patients in all areas of their specialty.

Another common mistake doctors make is administering the anesthetic too quickly. Under no circumstances should it be allowed during infiltration anesthesia of soft tissues. The anesthetic is injected under high pressure, so a depot of anesthetic solution, which is necessary for tissue infiltration near the needle tip, is not formed. Instead, the solution is shot into the depths in the form of a jet and disperses. The desired analgesic effect is not achieved.

When introducing an anesthetic into the bone, for example, when performing intraligamentary anesthesia, the desired effect is achieved precisely when the drug is administered under high pressure. However, even in this case, it must be taken into account that too rapid administration of the drug can cause rupture of the periodontal ligaments of the tooth and its displacement from the socket.

Another type of complication is damage to the vessel by the injection needle and the formation of a hematoma. This complication is common with intraoral “tuberal” anesthesia. In rare cases, it occurs during anesthesia of the infraorbital nerve. Taking into account the fact that anesthesia of the area near the tubercle of the upper jaw almost always leads to the formation of a hematoma, and its suppuration leads to the formation of phlegmon of the pterygopalatine fossa and infratemporal space, which seriously threatens the patient’s health, it is necessary to abandon the use of this method of anesthesia. In addition, infiltration anesthesia using modern means ensures the achievement of the desired anesthetic effect for any type of dental intervention in the area of ​​the anatomical structures of the upper jaw.

In order to prevent the occurrence of a hematoma during anesthesia at the lower orbital foramen, it is necessary to advance the needle in the direction of distribution of the solution. You should not insert a needle into the canal, since modern anesthetics have diffusion capabilities that allow the injected drug to quickly spread and block the nerve trunk. If there is a suspicion of the development of a hematoma, then it is necessary to clamp the area of ​​​​tissue with a tampon for several minutes. After the analgesic effect is achieved, the planned intervention can begin. You can also use hypothermia, and after three days - resorption therapy.

A rare, but more serious complication is the breaking off of an injection needle. Most often this happens if the anesthesiologist makes too sudden a movement when the syringe needle is already in the muscle tissue. The risk of complications increases if the needle is completely immersed in the tissue. In order to avoid complications, it is necessary to control the quality of the needles used for injections, as well as the extent to which the doctor adheres to the rules of anesthesia. Do not allow the needle to be completely immersed in the tissue or make sudden movements with the injector. If the needle does break off, it can be removed on an outpatient basis only if the end is visible above the surface. If tissue dissection is necessary to remove a broken needle, the patient must be hospitalized. An X-ray examination must be done before surgery. X-rays should also be taken at the stage of the operation, the volume of which can be significant.

Damage to the nerve trunk by an injection needle is relatively common, resulting in the development of traumatic neuritis, which is accompanied by paresthesia or severe pain. To prevent this from happening, the needle must be advanced in the direction of the anesthetic flow. If paresthesia or pain appears, it can last from 3 days to a week and even up to several months. In this case, taking B vitamins and analgesics, as well as physiotherapeutic procedures, are indicated.

If the fibers of the internal pterygoid muscle are damaged by an injection needle, its contracture may develop and the function of the lower jaw may be impaired. In order to prevent complications from developing during anesthesia of the inferior alveolar nerve, you must carefully follow the technique of advancing the needle to the bone of the inner surface of the jaw branch to the mandibular foramen. Most often, contracture can be eliminated within a few days using physical therapy and painkillers. If its course is prolonged, then mechanotherapy should be performed. Even more severe damage to the nerve trunk or muscle fibers can occur when the tip of the injection needle is bent; for this reason, syringes with a deformed needle should not be used.

Post-injection pain and swelling can occur due to trauma to the periosteum, or as a result of too intense injection of anesthetic into the soft tissue. Another cause of complications lies in the use of expired painkillers. Prevention of such complications comes down to compliance with the rules of anesthesia. It is necessary to exclude subperiosteal and too intense injection of an anesthetic solution into the tissue, as well as the use of anesthetics that have been certified and have not expired.

Treatment of complications is reduced to physiotherapeutic procedures. It is also recommended to use painkillers and antiallergic drugs, such as diphenhydramine and suprastin.

Paresis of facial muscles develops as a result of blocking the branches of the facial nerve with an anesthetic drug. This can be observed during extraoral anesthesia on the maxillary tubercle and during anesthesia of the inferior alveolar nerve. The paresis of individual facial muscles that develops as a result goes away after the painkiller wears off and does not require treatment.

The development of diplopia (double vision) is possible when the anesthetic solution spreads into the infraorbital canal with appropriate anesthesia, resulting in paresis of the extraocular muscles. This complication goes away on its own after the effect of the anesthetic wears off.

The most serious complication that threatens the health and even the life of the patient is tissue necrosis; it develops as a result of the introduction of a non-isotonic solution by mistake. This could be alcohol, calcium chloride, gasoline, or some other drug. The first sign of necrosis is severe pain that occurs at the beginning of solution administration. It is necessary to immediately stop administering the drug, infiltrate the tissues with a diluted anesthetic and, if possible, cut the tissues wide to allow intensive drainage. If a non-isotonic solution was injected into deep tissues, then after first aid the patient should be immediately hospitalized. This is necessary because severe tissue swelling may soon develop, possibly spreading to the neck, causing difficulty breathing and requiring emergency resuscitation.

When observing patients who were mistakenly injected with aggressive liquids during anesthesia, in one of the patients, due to the administration of a non-isotonic solution near the mandibular foramen, necrosis of the pterygomaxillary, perimaxillary space and the lateral surface of the neck began to rapidly develop. On the eleventh day, bleeding appeared, which is why the external carotid artery had to be ligated. Another patient was mistakenly injected with alcohol into the pterygomaxillary space, which resulted in persistent contracture of the lower jaw and extensive tissue scarring. This required extensive surgical intervention. The erroneous administration of 2 ml of a vasoconstrictor drug to a teenager ended tragically.

For preventive purposes, to avoid such complications, carpule technology is used. This eliminates errors when selecting an anesthetic drug.

Symptoms that should alert you

Have you had an injection in your gums before having your teeth treated, and after treatment the discomfort increases day by day? Then you need to know that pain is not the only symptom that should alert you. Pay attention to a number of other alarming symptoms that may indicate pathology and require prompt consultation with a doctor:

• increase in local and general body temperature,
• burning and itching on the mucous membrane,
• the appearance of ulcers on the mucous membrane,
• swelling and hyperemia of the mucous membrane,
• facial asymmetry,
• the appearance of a cyst or flux,
• general weakness and loss of appetite,
• the appearance of bad breath,
• difficulty opening the mouth and chewing food,
• irradiation of pain to other parts of the maxillofacial apparatus.

“There was such a situation: the doctor touched a nerve. But only I didn’t have any pain in my gums, but on the contrary, everything became numb, so that I couldn’t feel the taste of food or anything at all, and my face was also distorted. I went to the doctor only a week after this, I was prescribed physiotherapy and pills to take. I finally got rid of the problem only after 5 weeks! And he only treated caries. So much for 21st century medicine!”

Alexander K, review from otzovik.com

Home treatment

Methods used at home can help both relieve swelling after an injection in the gum and speed up the resorption of the hematoma:

• Avoid stress on the teeth and gums in the area of ​​the hematoma - try to chew food on the healthy side, or switch to semi-liquid and liquid foods for several days.
• Regularly, after each meal, rinse with a saline or soda solution (1 teaspoon of sea salt or baking soda per 200 ml of warm water).
• Before taking any painkiller, carefully study the list of side effects and contraindications - if it indicates a tendency to bleeding and changes in the blood coagulation system, choose another drug.
• Do not use hot or cold compresses on the gums - the former expand the lumen of the blood vessels, which in the early recovery period can lead to resumption of bleeding, while the latter, on the contrary, narrow the blood vessels, which can slow down tissue regeneration.

If any symptoms or formations appear in the oral cavity, contact your dentist immediately.

Category Miscellaneous Published by kosmetik-dent

How to relieve pain: what you can do and what you can’t do

What can and should be done

If, after visiting the dentist and receiving an injection in the gums, pain appears that causes concern, then the following measures can be taken:

1. sign up for an appointment with the doctor,
2. alleviate your condition with painkillers and antipyretics (if your body temperature has increased), antihistamines (in case of allergies). For example, “Nise”, “Ketanov”, “Nurofen”, “Erius”. You can use any drugs that suit your indications and usually save you in such circumstances,
3. carry out antiseptic treatment of the oral cavity using Miramistin, Chlorhexidine, soda-salt solution, decoction of pharmaceutical herbs (for example, chamomile and sage),
4. rinse your mouth after every meal so that bacteria do not have the opportunity to cause an inflammatory process.

What not to do

1. do not eat “irritating” foods: ban hot and cold, salty and spicy, carbonated drinks and alcohol, solid foods,
2. do not prescribe antibiotics on your own,
3. you cannot stop performing oral hygiene with a toothbrush: if the injection site in the gum hurts very much, then try not to put pressure on this area and not injure it again, but you need to brush your teeth to remove plaque and bacteria from the oral cavity,
4. stop smoking: exposure to nicotine and tar will impair blood circulation in the mucous membrane and also slow down the natural processes of regeneration of damaged tissues,
5. Do not heat a swollen gum or cheek, because if there is inflammation, the infection will quickly spread to nearby areas, which will very quickly worsen your condition and be fraught with blood poisoning,
6. Do not treat the wound with alcohol-containing preparations and garlic, because this can burn the delicate mucous membrane and aggravate the situation,
7. do not touch the gums with your hands or foreign objects,
8. Do not apply crushed tablets such as Aspirin or Analgin to the inflamed area.

“The anesthesia won’t work?!” “Medusa” is afraid to go to the dentist, but the “Agami” clinic reassures us

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Dental treatment is not the most pleasant experience: 60% of patients are nervous and afraid to go to the dentist. We have already told you how treatment and dental implantation are carried out. And now, so that you (and us!) worry less, Meduza asked the chief physician of the Agami clinic, Mikhail Agami, to comment on the most popular fears and explain how modern medicine makes dental treatment comfortable, painless and safe.

I've been afraid of dentists since childhood. I can’t even enter the clinic—my legs are giving way! I’m generally silent about sounds...

Mikhail Agami: There are quite a lot of people who are afraid of visiting the dentist. At the same time, everyone is afraid of different things: some are afraid of complications, others are afraid of the procedure itself. That is why an individual approach is important - the doctor must listen to the patient (in no case scare) and collect anamnesis. This will avoid unnecessary fears and anxieties during treatment.

At Agami, consultations take place in a calm, friendly atmosphere - the doctor talks with the patient and analyzes the images. The hallways and offices of the clinic are bright and comfortable. We have also been using sedation for a long time, that is, dental treatment during sleep. It allows you to painlessly carry out any intervention - from simple cleaning to surgical operations. The entire process - the administration of sedatives and the treatment itself - takes place under the supervision of an anesthesiologist, he controls the entire process. Unlike general anesthesia, there are no side effects: the patient breathes on his own, quickly comes to his senses and leaves the clinic on his own feet. If the doctor finds no contraindications, then sedation can be considered.

Agami also has special gadgets that allow you to watch movies directly in the dental chair - this helps to take your mind off the noise. But people who are afraid of dental treatment still, as a rule, choose sedation.

Sarah Dorweiler / Unsplash

I'm afraid that the doctor will be young and inexperienced. It seems to me that a good doctor should be at least 40–45 years old

Mikhail Agami: Many people think that a good doctor is certainly a gray-haired professor with glasses. But that's not true. Modern young doctors have access to any information, they can travel around the world and take advanced training courses. They have the strength and ambition to develop. The results they demonstrate are no worse, and sometimes even better, than those of many older and conservative professors who have been sitting in the same place for years. So a person from 30 to 45 years old with more than eight years of experience may well be a good doctor. For example, Agami also has a young team - most of the doctors are under forty years old.

In my opinion, the hallmark of a good doctor, and in principle the most important criterion for good private medicine, is narrow specialization. When a doctor knows related areas, but at the same time deals in depth with his particular field. Plus, a good doctor should have a busy schedule and many patients who come to him on recommendations. He must constantly develop and take advanced training courses, including abroad.

The portfolio plays an important role, but this applies mainly to doctors who are engaged in aesthetic dentistry, prosthetics, and microprosthetics. There must be photographs of the work - before and after. At the same time, the clinic itself is also important - is it equipped with diagnostic tools, does it have its own laboratory, or does it have a tomograph? In general, it is important that the doctor does not work on his own, but that there is an infrastructure around him. So that the patient understands: he can come and do everything in one day.

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The doctor will shame me - he will say that I have the most terrible and neglected teeth he has ever seen. I don't want to listen to all this!

Mikhail Agami: This is primarily a question of ethics. The doctor should offer a solution to the problem, and not put pressure on the patient and tell him how bad his teeth are - this is counterproductive. At Agami, each patient first undergoes an initial consultation - it includes pictures, a conversation with a doctor and an examination. Sometimes people complain about one thing, but the actual scope of work is completely different - more extensive. Next, the patient, depending on his problem, is examined by a specialized specialist. And only when all the information has been collected, a detailed treatment plan is drawn up and discussed with the patient. With us, everything is voluntary: the clinic identifies the problem, shows possible solutions, and the choice remains with the patient.

It is also important that contact between the doctor and the patient is maintained during treatment. If the patient is uncomfortable, then the doctor will definitely pay attention to any sign or sign and take action. At Agami, doctors always talk in detail about what they will do and maintain feedback with the patient. In addition, using a special device - an intraoral camera - the doctor can show the patient the problem (for example, caries or the degree of tooth decay) and the result of treatment. This is the effect of controlling the situation.

Alina Kholopova / Shutterstock

What if the anesthesia doesn't work? This happens after all

Mikhail Agami: It happens, but very rarely. There are people for whom the anesthetic simply dissolves. In such cases, it is replaced with another one. But there is no need to be afraid of this. There are certain signs that the anesthesia has taken effect, such as a characteristic numbness. The doctor asks the patient questions, asks about sensations, and if there are no characteristic signs, he changes the treatment tactics without starting work. It also happens that anesthesia does not work if there is an inflammatory process - in such a situation, the doctor uses a different type of anesthesia. But these are already details. The bottom line is that if the doctor chooses the right anesthesia, it will work. There should be no pain after the injection.

At the Agami clinic, for patients who are scrupulous about injections, there is a special device - it administers local anesthesia in small doses and painlessly. In addition, there are application ointments containing lidocaine - they allow you not to feel the injection itself. As for allergies to anesthesia, most often patients know that they have it and report it at the stage of collecting an anamnesis. But even if this is not the case, after administering anesthesia, doctors always monitor the patient’s well-being.

During treatment, I will be x-rayed several times, and this is harmful!

Mikhail Agami: Modern X-ray is not the same X-ray as it was 20 years ago. Now the radiation dose is tens of times less. In addition, other tomographs are used in dentistry, and the doses for such a study are much lower. At the Agami clinic, when performing a CT scan on a NewTom 5G machine, a person receives 0.19 mSv - this is comparable to a transatlantic flight on an airplane (if you fly there and back). In addition, patients are additionally covered with a special apron so that they feel psychologically comfortable. At the same time, you need to remember: during treatment, photographs are required, without this it is simply impossible to monitor the result - to see how the implant was placed, how the canal was filled.

Standret/Shutterstock

What if the dentist prescribes treatment that I don’t need? For example, he will tell you to remove the nerve, but in reality you can do without it! How will I understand?

Mikhail Agami: Let's start with the fact that the correctness of treatment directly depends on high-quality diagnosis. Today, the most optimal and accurate method is computed tomography. At the planning stage, and especially at the implantation planning stages, we are talking about the smallest details - volume and shape, microns, angle of inclination. About things that are not visible in a regular panoramic photo. Tomography in this case allows you to avoid mistakes, plan and predict the result.

At the Agami clinic we have our own tomograph and dental laboratory - this allows us to avoid mistakes not only in treatment, but also in the result. In addition, it is very convenient for patients and doctors. Also, don’t forget about a second opinion - now everything can be checked, there’s no need to rush.

Implants are not only expensive, but also dangerous, and rejection is sure to occur!

Mikhail Agami: Cases of rejection, to be honest, do happen, but they are rare. In our clinic, about 98% of implantations are successful. In order to reduce risks, the doctor conducts an examination, carefully interviews the patient, and refers him for tests and studies. If a person has no health problems, then most likely there will be no problems with implantation either, but it is necessary to strictly follow the doctor’s recommendations, for example, limit smoking, as this may negatively affect the results of treatment.

Rejections, which can occur five, ten, fifteen years after implantation, are associated with many factors, but mainly hygiene, general health and lifestyle. We have been working for over 20 years, and the vast majority of our patients have all their implants in order.

At Agami, doctors recommend that all clients, after implantation and prosthetics, come for professional oral hygiene once every six to eight months. The mouth and areas around implants and crowns that are inaccessible to a regular toothbrush are kept clean, which reduces the risk of disease and increases the life of the implants. It is much easier to act preventatively than to try to solve a problem when it has already arisen.

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What if I get infected with hepatitis or something worse? How to make sure everything is sterile?

Mikhail Agami: All large clinics should have a centralized sterilization department with employees who monitor the process and are personally responsible for each instrument, handpiece and hose. Plus, all this is controlled: both at the clinic level and at the state level - by Rospotrebnadzor and other special services. Agami has such a department; it has certified equipment from leading Israeli and German brands. Each office has bactericidal irradiators. Plus, at Agami, patients who require surgical treatment must undergo special tests.

After any appointment, all equipment is sterilized according to all sanitary rules. Each instrument is marked and packaged in special vacuum packaging. Those packages that have been sterilized but have expired are re-sterilized. At Agami, the package with instruments is opened in the presence of the patient so that he can see the markings. The patient may even ask to show him how instruments are sterilized. This is a completely normal request.

I'm scared to even think that I will be deceived with the price! The receipt always has a long list of procedures, but what I’m actually paying for is completely unclear

Mikhail Agami: People are afraid to pay extra, and this is understandable. Some clinics charge money for each related service: for suturing, for taking pictures, for anesthesia. All this together turns into a round sum, which the patient learns about only during the treatment process. In “Agami” there is no such thing; each service already implies all the necessary manipulations, for example, if we are talking about the treatment of a tooth canal, then pictures, anesthesia and everything else are already included in the price. When a client comes for a consultation, he receives a detailed treatment plan, a list and cost of services. Next, based on this, a payment schedule is drawn up. This is due to the fact that treatment, especially when it comes to implantation, is divided into stages and can last months - a person must understand that he does not need to pay for everything at once. Moreover, he immediately sees the total amount, which is already fixed and will not change until the end of treatment (even if it takes more than one year).

At Agami, during a consultation, the doctor offers several options for solving the problem, the cost of which is usually different. Choosing the optimal treatment plan is a joint decision, taking into account the medical indications and wishes of the client. We take an individual approach to each case and are flexible in terms of payment.

Liane Metzler / Unsplash

There are too many dental clinics! I'm afraid that I'll choose a bad one - expensive and of poor quality

Mikhail Agami: When choosing a clinic, there are several things to consider. Firstly, it must be a clinic that has been on the market for a long time - at least more than ten years. If there were problems there, it would have closed already. A normal clinic will not skimp on safety.

Secondly, the clinic must have a license for all manipulations - sedation, surgery. This can be checked. A separate topic is doctors who work in one clinic one day and in another the next. They allegedly operate under their own license, and clinics rent out their offices. There's a big threat here. Today he made your tooth, and tomorrow you will no longer see it. He may not even have a job. One of the obvious signs of such clinics and dentists is payment only in cash or in person to the doctor. A serious clinic will definitely have a cash register and the ability to pay with bank cards.

Thirdly, you need to read the contract carefully. A good clinic has a detailed one - it clearly states what is considered a warranty case and what is not. Such an agreement indicates that the clinic is serious and experienced. Unscrupulous medical centers, as a rule, use a small standard agreement in which they disclaim all responsibility, but at the same time promise a lifetime guarantee. These are the kinds of organizations that should be immediately discarded.

There is a special offer for Meduza readers at the Agami clinic: until August 31, you can get a consultation for 1,000 rubles. To do this, during recording you need to say the code word - “jellyfish”.

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Measures to help prevent complications from developing

First of all, it is important to find a professional doctor who will carry out all medical procedures carefully and efficiently. After all, with an experienced specialist, you don’t have to worry about whether it’s possible to give anesthesia injections into your gums, and the pain after treatment either won’t arise at all or won’t bother you for more than a few days. However, finding a good dentist is only half the battle. To avoid complications, try to follow simple rules.

Rule #1: Avoid eating food immediately after treatment procedures. It is recommended to have a snack only after 2-3 hours, otherwise you yourself may injure the mucous membrane or introduce bacteria and pieces of food into the wound that has not yet healed.

Rule No. 2: on the first day after treatment, refrain from eating spicy and hot foods, sunbathing and visiting steam rooms and saunas, because this can cause a rush of blood and swelling of the soft tissues.

Rule No. 3: For the first few days, perform oral hygiene very carefully and carefully to allow the soft tissues to heal.

1 Karpuk I.Yu. Allergic reaction to local anesthetics: diagnosis and prevention. Bulletin of Vitebsk State Medical University, 2009.