Local Anesthesia and Extractions for Dental Students: Simple Notes and Guidelines

The primary sensory nerve of the Oro-facial area is the trigeminal nerve. Understanding the anatomy of this nerve is essential for the dental practitioner to understand the pain mechanism and dental pain pathway. Most of the anatomy books discuss the details of the anatomical relation of Trigeminal nerve instead of an understanding of neural fibers carry by the nerve. This chapter discusses the anatomy, the neural fibers of each branch and the neural connection (nuclei) of the nerve.

In this chapter, the mechanism of pain, pain pathway from Oro-facial area and the physiological principle of pain have been discussed in detail. In order to understand the mode of action of local anesthesia, it is essential to understand the pain physiology. This chapter contains the essential details of pain physiology that may be needed for an understanding of the mechanism of local anesthesia. The endogenous analgesic system is an important modulator part for pain intensity and a major contributor to pain gate theory, all that has been discussed in a concise and precise way to give the complex information in a simple way to understand and remember.

The pharmacology of local anesthesia is considered as the gate to dental anesthesia techniques. In the biomedical field, the human should not be injected with any medication unless the practitioner is well oriented about the nature of the medicine, the mechanism of action, the recommended dose, the maximum allowed dose, and possible complications. In this chapter, the techniques of local dental anesthesia have been discussed in detail as well, including the anatomical landmarks and regional nerve anatomy. The possible local and systemic complications have been added with the proper way of management and percussions. The relation of common systemic diseases to possible complications of local anesthesia medication has been discussed with emphasis on some wrong practioner,s opinion regarding using of vasoconstrictors in hypertensive patient (for details about management of medically compromised patients, read chapter 5, page: 131-195).

Understanding of the basic principles of exodontia is the essential part for understanding of this subject of dentistry. This introductory chapter discusses the indications, the instrumentation, the definitions and basic steps of simple extraction.

Many dental practitioners do not differentiate between the complex extraction and the surgical (trans-alveolar) extraction. By definition, the surgical extraction is one of complex extraction procedures, but the complex extraction is not limited to surgical extraction. In this chapter, the complex extraction has been defined. The pre-operative, intra-operative and post-operative factors that may contribute to the complexity of dental extraction have been discussed. This chapter contains a separated part about the management of medically compromised patients, as those patients can be considered under the definition of complex extraction. This chapter also contains a separated part about physics of elevator’s uses.

Any tooth that fails to erupt to its normal anatomic position in the jaw, by the end of its eruption time; despite of having eruptive forces, due to a specific physical (bone/soft tissue) barrier or ectopic position is said to be impacted. The removal of impacted mandibular third molars is the most common procedure in the specialty of oral and maxillofacial surgery. The third molars are the last teeth to erupt therefore by far the most frequently impacted teeth. This chapter includes the Impaction of maxillary mandibular wisdom teeth and maxillary mandibular canine impactions. Association of clinical, radiology clinical variables which combined level of difficulties: 1. Age, 2. Radiological variables to the combined level of difficulty are a. Angulation b. Relation to second molar c. Depth from point of elevation. With the above topics classifications and surgeries of wisdom teeth are also illustrated with figures, tables and diagrams. Mandibular and maxillary canine impactions are also discussed with diagrams .All the Pre, Intra and post-surgical aspects are covered in details. The chapter also deals with different types of incisions, radiographs, surgical anatomy and surgical procedures.