NON-NARCOTIC ANALGESICS AND ANTIPYRETICS

Analgesics are drugs that relieve pain without producing unconsciousness or impairing mental capacities. Many of these drugs also have an antipyretic and/or an anti-inflammatory effect. Antipyretics are drugs that lower increased body temperatures. Analgesics can be used to relieve pain from toothache, or can be prescribed for dental postoperative pain relief.

Aspirin

Aspirin is an economical analgesic, antipyretic, and anti-inflammatory agent used for mild to moderate pain. It is contraindicated in peptic ulcer disease. It acts as a gastric mucosal irritant and has an anticoagulant (inhibits blood clotting) effect.

Acetaminophen

This drug is similar to aspirin, but has no anti-inflammatory action. It is available as tablets, elixir, drops, or capsules and is useful for patients who are sensitive to aspirin.

Ibuprofen

Ibuprofen is indicated for the relief of mild to moderate pain. It is used as an anti-inflammatory agent for dental pain associated from post surgical or operative procedures. It is not to be given to patients in the third trimester of pregnancy or anyone with a history of gastrointestinal bleeding.

OPIUM AND ALKALOIDS

Alkaloid-based compound names end in -ine. Examples include atropine, caffeine, and nicotine. The most important alkaloids of opium are morphine and codeine. All of the opiate derivative drugs are very addictive and require strict control.

Morphine Sulfate

Morphine sulfate is a drug indicated for the relief of severe pain and used preoperatively to sedate patients, treat myocardial infarctions, and is used in casualty care. It is contraindicated in patients with head injuries, acute alcoholism, or convulsive disorders.

Codeine Sulfate

Codeine sulfate is like morphine, but has one-sixth of the analgesic power and one-fourth of the respiratory depressant of morphine. It is used as a pain reliever in dentistry for moderate to severe dental pain.

Meperidine Hydrochloride (Demerol)

This is a synthetic analgesic similar to morphine. In dentistry it is used for moderate to severe pain and as a preoperative medication.

VASODILATORS

These drugs produce vasodilation by relaxing and enlarging the diameter of the blood vessels and smooth muscle of the arteries, thereby lowering the blood pressure.

Amyl Nitrite

Amy1 nitrite is primarily used in casualty care to treat blood agents. This will be discussed in chapter

13. Other uses are for urological conditions.

Nitroglycerin

Nitroglycerin is indicated for the treatment and management of acute and chronic angina pectoris. Administration of this drug will be discussed in Dental Technician, Volume 2, NAVEDTRA 12.573, chapter 9.

VASOCONSTRICTORS

Vacoconstrictors are the opposite of vasodilators; these drugs produce constriction of the blood vessels with consequent rise in blood pressure. In dentistry, epinephrine is used in some dental anesthetics, rarely in gingival retraction cord processes, to help control diffuse bleeding, and can be used to treat severe allergic reactions, such as anaphylactic shock. In local anesthetics, small amounts of epinephrine are added in dental carpules, with ratios ranging from: 1:50,000, 1:100,000, or 1:200,000 parts of epinephrine to anesthetic solutions.

HEMOSTATICS

Hemostatics are any agents, mechanical or chemical, that arrest bleeding. They are used to control hemorrhage from minute vessels or tissues by stopping bleeding or by forming of a clot. Examples of mechanical and chemical agents will be discussed in Dental Technician, Volume 2, NAVEDTRA 12573, chapter 5, "Oral Surgery Assistance."

ANTICOAGULANTS

This group of drugs delays or prevents blood coagulation. A common anticoagulant used in dental I.V. sedation is heparin sodium.

ANESTHETICS

The word anesthesia means a partial or total absence of sensation to stimuli, such as cold, heat, or painful irritation. In dentistry the words numb, frozen, or asleep are examples of how the mouth can feel when the anesthetic is administered. Dental anesthesia comes in many forms such as gas, local, and topical to control pain and relax patients.

Nitrous Oxide

Control of anxiety and pain associated with dental care can be accomplished by administering local anesthesia and sedation. The most commonly used gas in dentistry is nitrous oxide sedation. It may produce a condition where the patient may laugh and become quite talkative. Nitrous oxide is supplied in blue steel tanks. Inhalation sedation with a mixture of 40% nitrous oxide and 60% oxygen (N20-02), delivered through a gas machine produces a conscious sedation that is a safe and effective means to manage the behavior, anxiety, and pain of many dental patients before and during a dental procedure. The advantages of N2O-O2 sedation are:

Rapid onset of action.

Good control of the depth of the sedation.

Rapid and complete recovery.

Guidance to dental treatment facilities for the administration of nitrous oxide-oxygen (N2O-O2) inhalation conscious sedation for dental outpatient services can be found in BUMEDINST 6710.68.

Local Anesthetics

Most dental procedures require cutting or painful manipulation of living tissue. To make these procedures comfortable for the patient, the dental officer will inject local anesthetic agents for pain control. Local anesthetics temporarily prevent the conduction of sensory impulses such as pain, touch, and thermal change from a body part along nerve pathways to the brain. The dental officer can select regions of the mouth he would like to lose sensation to complete the dental procedure. About 15 different local anesthetics are available for dental use. These anesthetic solutions can be chemically classified into two different categories: amides and esters.

Amides\An organic compound that comes from ammonia. Examples of amide solutions are lidocaine, bupivacaine, and mepivacaine.

Esters \Are compounds formed from alcohols and acids by the removal of water. Ester compounds are rarely used in dentistry today. Examples of ester solutions are procaine and propoxycaine.

The two most common local anesthetics used in dentistry today are 2% lidocaine hydrochloride and 2% mepivacaine. Both solutions take effect quickly, and provide a complete anesthetic effect of the dental pulp, tissues, and surrounding bone for up to 90 minutes. The use of vasoconstrictors with local anesthetics has been discussed earlier. Both lidocaine and mepivacaine are available with or without epinephrine.

Topical Anesthetics

In dentistry topical anesthetic agents are used to temporarily anesthetize (numb) the tiny nerve endings located on the surfaces of the oral mucosa. This can reduce the discomfort of dental injections and eliminate the gag reflex when performing radiographic, periodontal, and prosthetic impression procedures. You must be aware that the concentration of topical anesthetic solutions are much higher than injectable anesthetics. Also topical anesthetics take longer for the full effect compared to injectable anesthetics. One to five minutes after application is the recommended time for topical anesthetics to reach their full effectiveness. Whenever you are using topical anesthetics, you must have permission from the dental officer. Follow all safety precautions and manufacturer's instructions. The three most commonly used topical anesthetics in dentistry are ointments, sprays, and liquids.