Local Anesthesia in Dentistry: A Locoregional Approach

Cover
Title Page
Copyright Page
Contents
Preface
About the Companion Website
Chapter 1 History of Local Anesthesia in Dentistry
	The Coca Leaf
	Cocaine
	The Development of the Syringe
	The Dangers of Cocaine
	Adrenaline and the Vasoconstrictive Effect
	Novocaine or Procaine
	The Development of Local Anesthesia in Dentistry
		Local Anesthetics
		Vasoconstrictors
		Instruments
		Anesthetic Techniques
		Twenty-First Century Developments
		Frequency of Use of Local Anesthesia in Dentistry
	References
Applied Anatomy
	Chapter 2 Applied Anatomy I: Maxillary Arch
		Introduction
			The Trigeminal Nerve
			Trigeminal Ganglion
			Trigeminal Nerve: Functions
		Maxillary Nerve (V2)
			Overview of Collateral Branches
				Intracranial Zone
				Pterygopalatine Fossa Zone
				Infraorbital Zone
			Palatine Nerves
				Greater Palatine Nerve
				Nasopalatine Nerve
			Superior Alveolar Nerves
				Posterior Superior Alveolar Nerve (PSAN)
				Middle Superior Alveolar Nerve (MSAN)
				Anterior Superior Alveolar Nerve (ASAN)
			Superior Dental Plexus
		Other Structures of Interest
			Greater Palatine Canal and Foramen
				Greater Palatine Canal
				Greater Palatine Foramen
			Nasopalatine Canal and Foramen
				Nasopalatine Canal
				Nasopalatine Foramen
			Cortical Bone Thickness
			Pterygoid Venous Plexus
			Infraorbital Foramen
			Pterygopalatine Fossa
				Margins
				Content
		Glossary
		References
	Chapter 3 Applied Anatomy II: Mandibular Arch
		Mandibular Nerve (V3)
			Overview
			Buccal Nerve
				Course
				Innervation
			Auriculotemporal Nerve
				Course
				Innervation
			Lingual Nerve
				Course
				Innervation
				Remarks
			Inferior Alveolar Nerve
				Course
				Innervation
				Remarks
			Mylohyoid Nerve
				Course
				Innervation
		Body of the Mandible
			Cortical Bone Thickness
			Retromolar Zone (Trigone and Fossa)
				Retromolar Trigone
				Retromolar Fossa
			Mandibular Canal
			Mental Foramen
		Ramus of the Mandible
			Divergent Angle
			Ramus Width
			Lingula
			Mandibular Foramen
			Sulcus colli
			Coronoid Notch
			Accessory Foramina
		Pterygomandibular Space
			Anatomic Boundaries of the Pterygomandibular Space
			Open/Closed Mouth and Pterygomandibular Space
			Contents of the Pterygomandibular Space
				Sphenomandibular Ligament
			Positive Aspirations and Hematomas
		Glossary
		References
	Chapter 4 The Peripheral Nerve and Local Anesthesia
		Peripheral Nerve Microanatomy
			Neurons
			Sensory Neurons
			Axons
			Membranes
			Nerve Fibers and Myelin
				Myelinated Fibers
				Unmyelinated Fibers
			Peripheral Nerve Structure
		Basic Membrane Proteins
			Sodium–Potassium Pump
			Sodium Channels
			Potassium Channels
		Peripheral Nerve Neurophysiology
			Fundamentals
			Membrane Potentials: Membrane at Rest (Polarized)
			Action Potentials: Excited Membrane
				Phase 1: Depolarization
				Phase 2: Repolarization
				Phase 3: Hyperpolarization
			Propagation of the Action Potential
		Mechanisms of Local Anesthesia
			Mechanism
			Differential Nerve Block
			Tonic and Phase Block
			Critical Length
			Transient Receptor Potential Channel
		Nerve Block Kinetics
			Induction Stage
			Recovery Stage
			Re-Injection
			Tachyphylaxis
			Resistance to Local Anesthetics
		References
Pharmacology
	Chapter 5 Local Anesthetics
		Chemical Structure
		Physical-chemical Characteristics of Local Anesthetics
			Dissociation Constant or pKa
			Partition Coefficient or Lipid Solubility
			Protein Binding
			Vasodilation
		Assessment of Anesthesia and the Anesthetic Parameter
			Assessment of Local Anesthesia in Dentistry
			Anesthetic Parameter
		Anesthetic Concentration
			Concentration and Volume
			Concentration and Safety
			Concentration and Anesthetic Potency
			Concentration and Tissue Irritation
		Maximum Doses
		Maximum Doses for Children
		Pregnancy and Lactation
			Pregnancy
			Lactation
		Mixing Local Anesthetics
		Isomers
		References
	Chapter 6 Vasoconstrictors
		Introduction
			Advantages
			Disadvantages
			Dilutions and Concentrations
		Catecholamines
			Isomers and Catecholamines
			Adrenergic Receptors
			Systemic Effects
				Heart
				Circulatory System
				Respiratory Tract
				Endocrine System and Metabolism
				Uterus
			Vasoconstrictive Effect
			Catecholamine Metabolism
			Epinephrine
			Norepinephrine
			Levonordefrin
		Phentolamine (OraVerse®)
			OraVerse®
			Advantages and Indications
			Technique and Dose
			Clinical Efficacy
			Tolerance, Toxicity, and Adverse Side Effects
		Felypressin (Octapressin®)
			Cardiovascular Effects
			Vasoconstrictive Effect
			Adverse Effects
			Contraindications
			Advantages and Disadvantages
			Maximum Doses
		Combinations of Vasoconstrictors
		References
	Chapter 7 Injectable Anesthetic Solutions Used in Dentistry
		Solution Composition
			Local Anesthetic
			Vasoconstrictor
			Antioxidants (Sulfites)
			Preservatives (Methylparaben)
			pH Adjustment
			Other Compounds
		Procaine (Novocaine)
			Metabolism
			Procaine with Epinephrine
			Remarks
		Lidocaine (Lignocaine)
			Metabolism
			Remarks
			Indications
				Standard 2% Lidocaine: L-100with 1:100 000 (10 μg/ml) Epinephrine or L-80with 1:80 000 (12.5 μg/ml) Epinephrine
				L-50,2% Lidocaine with 1:50 000 (20 μg/ml) Epinephrine
		Articaine
			Metabolism
			Remarks
				Maximum Dose and Toxicity
				Anesthetic Potency
				Anesthetic Effect
			Indications
				A-100,4% Articaine with 1:100 000 (10 μg/ml) Epinephrine
				A-200,4% Articaine with 1:200 000 (5 μg/ml) Epinephrine
		Mepivacaine
			Metabolism
			Remarks
				Maximum Doses
				Mepivacaine Solutions
			Indications
		Prilocaine (Propitocaine)
			Metabolism
			Remarks
				Toxicity and Safety
				Clinical Efficacy
				Prilocaine Solutions
			Indications and Contraindications
				Indications
				Contraindications
		Bupivacaine
			Metabolism
			Remarks
			Indications and Contraindications
				Indications
				Contraindications
		References
Contraindications
	Chapter 8 Contraindications for Local Anesthetic Techniques in Dentistry
		Lack of Cooperation from the Patient
			Predisposing Factors
			Evaluation of Risk
			Approach to Behavioral Problems
		ASA IV Physical Status
			ASA I Patients
			ASA II Patients
			ASA III Patients
			ASA IV Patients
			ASA V Patients
		Clotting Abnormalities
			High-risk Anesthetic Techniques
			Systemic Causes of the Risk of Hemorrhage
				Antiplatelet Agents
				Oral Vitamin K Antagonists: Anticoagulants
				Direct Oral Anticoagulants
				Low Platelet Counts
				Hemophilia
			Alternatives and Recommendations
		Other Contraindications
			Injection Site Infection
			Impossible Physical Access
		Summary
		References
	Chapter 9 Contraindications for Local Anesthetics
		Relevant Contraindications
			Allergy to Local Anesthetics
			Long-acting Anesthetics
			Prilocaine, Benzocaine, and Methemoglobinemia
			Cholinesterase Deficiency and Esther Anesthetics
			Myasthenia Gravis and Esters
		Minor Contraindications
			Procaine and Sulfonamides
			Lidocaine and Cimetidine
			Lidocaine and Propranolol
			Lidocaine and Succinylcholine
			Bupivacaine and Cardiotoxicity
			Amide Anesthetics and Malignant Hyperthermia
		References
	Chapter 10 Contraindications for Vasoconstrictors
		Absolute Contraindications
			Uncontrolled Insulin-dependent Diabetes Mellitus
			Intolerance to Sulfites
			Asthma Controlled with Corticosteroids
			Pheochromocytoma-induced Arterial Hypertension
			Recent Consumption of Cocaine
			Patients with Cardiovascular Diseases Who Take Amphetamines and Psychostimulants
			Allergy to Vasoconstrictors
		Relative Contraindications
			Nonselective Beta-blockers
			COMT Inhibitor-type Antiparkinson Drugs
			ASA III Patients with Cardiovascular Conditions
			Digitalis Glycosides (Digoxin)
			Amphetamines and Psychostimulants
			Tricyclic Antidepressants
			Interactions Involving Drugs that are No Longer in Use
				Older Antihypertensive Agents (Anti-adrenergicDrugs)
				General Anesthesia (Halothane and Thiopental)
		Contraindications of Little Relevance
			Uncontrolled Hyperthyroidism
			Phenothiazines and Antipsychotic Drugs
			Vasoconstrictors and Osteoradionecrosis
		Contraindications of Felypressin
		References
Instruments and Topical Anesthesia
	Chapter 11 Instrument Set and Equipment
		Needles
			Parts of a Needle
				Anterior Part
				Middle Part
				Posterior Part
				Protective Sheath
			Lengths and Gauges
			Needles: Critical Aspects
				Aspiration and Gauge
				Pain and Gauge
				Deflection of the Needle and Gauge
				Lesions Caused by a Barbed Needle
				Breakage of Needles
			Criteria for the Selection of Needles
		Cartridges
			Parts of a Cartridge
				Anterior Part or Needle Adapter
				Neck
				Cylindrical Body
				Posterior Part
				Other Elements
			Storage of Cartridges
				Norms for All Cartridges
				Norms for Cartridges Containing Catecholamines
			Problems Affecting Cartridges
			Degradation of Drugs in the Cartridge
				Local Anesthesia
				Sympathomimetic Vasoconstrictors (Epinephrine)
				Sulfites
		Syringes
			Parts of a Cartridge-type Syringe
				Anterior Part or Needle Adapter
				Syringe Barrel or Body of the Syringe
				Posterior Part (Back)
				Piston
			Using the Syringe
				Set-up
				Dismantling
				Cleaning and Sterilization
			Self-aspirating Syringes
				Characteristics
				Mechanism of Action
				Advantages and Disadvantages
			Variants of Cartridge-type Syringes
				Plastic Syringes
				Uniject-typeSyringes
				Disposable Antineedle Stick Syringes
				Power-operatedSyringes
				Other Injection Devices
		Additional Instruments
			Complementary Devices
			Alkalinization System (pH Onset System®)
				Advantages
				Mechanism of Action
				Cartridges for the Device
				Mixing Pen
				Mixing
				pH
			Vibrating Devices
				Gate Control Theory
				VibraJect
				DentalVibe
			Cartridge Heaters
		References
	Chapter 12 Topical Anesthesia
		Factors Affecting Topical Anesthesia with Local Anesthetics
			Local Anesthetic
			Application Time
			Method of Application
			Amount Administered
			Types of Pain
			Area of the Mouth
		Effect of Topical Anesthesia
		Topical Anesthetics in Dentistry
			Benzocaine
				Maximum Dose
				Advantages and Disadvantages
				Specific Adverse Effects
			Lidocaine
				Maximum Dose
				Advantages and Disadvantages
				Specific Adverse Effects
			Lidocaine Adhesive Patches (DentiPatch®)
				Maximum Dose
				Advantages and Disadvantages
				Specific Adverse Effects
			EMLA Cream
				Advantages of the Structure and Composition of EMLA
				Maximum Dose
				Advantages and Disadvantages
				Specific Adverse Effects
			Tetracaine (Amethocaine)
				Maximum Dose
				Advantages and Disadvantages
				Specific Adverse Effects
			Cocaine
				Maximum Dose
				Advantages and Disadvantages
				Specific Adverse Effects
				Formulations for Use in Dentistry
			Topical Anesthetic Compounds
				Composition
				Advantages and Application
				Adverse Effects
				Clinical Efficacy
			Other Experimental Formulations
		Topical Cooling
			Cold Aerosols
			Refrigerants
			Topical Ice
		Indications for Topical Anesthetic
			For Symptomatic Relief of Pain
				Pain Resulting from Tooth Decay
				Painful Ulcers and Lesions on the Mucosa
			Indication as Anesthetic
				Minor Surgical Interventions
				Clinical Procedures
				Management of the Gag Reflex
		Periodontal Oraqix® Gel
			Oraqix System (Needle-free Anesthesia)
				Method of Application
				Efficacy
				Specific Adverse Effects
		References
Local Anesthetic Techniques in Dentistry
	Chapter 13 Basic Injection Technique
		Comment on Retraction
		Phases of the Injection
			Initial Preparation
			Preparation Phase
			Application of Topical Anesthetic
				Method of Application
				Observations on Aerosols
			Transfer of the Syringe
			Insertion of the Needle
			Aspiration
				False Positives and Negatives
				How to Interpret a Positive Aspiration
				Aspiration Technique
				Remarks
			Injection
			Final Phase
			Evaluation of Anesthesia
			Post-treatment Phase
		Causes of Pain During the Injection
			Factors That Cause Pain
			Factors That Play a Role in Pain
			Unimportant Causes (Myths)
		Terminology
		Appendix
		References
	Chapter 14 Maxillary Anesthesia I: Pulpal Anesthesia
		Introduction
			Maxilla
			Maxillary Nerve (V2)
			Buccal Anesthesia of the Upper Molars
		Buccal Infiltration
			Zones Anesthetized
			Technique
			Efficacy of this Technique
			Complications Specific to this Technique
			Factors That Lead to Success
			Modified Cotton Roll Approach
		Infraorbital Nerve Block
			Uses
			Zones Anesthetized
			Intraoral Technique
			Extraoral Technique
			Efficacy of this Technique
			Complications Specific to this Technique
			Remarks
		Posterior Superior Alveolar Nerve Block
			Zones Anesthetized
			Technique
			Efficacy of this Technique
			Complications Specific to this Technique
			Modified Adatia Technique
		High Tuberosity Approach
			Uses
			Zone Anesthetized
			Technique
			Efficacy of this Technique
			Complications Specific to this Technique
			Remarks
		Transpalatal Technique
			Uses
			Zone Anesthetized
			Technique
			Efficacy of this Technique
			Complications Specific to This Technique
			Factors That Lead to Success
		Final Remarks
		References
	Chapter 15 Maxillary Anesthesia II: Complementary Anesthesia of the Palate
		Introduction
			The Nasopalatine Nerve Innervates Less than Previously Thought
			The Potency of the Anesthetic is not Important
			Anesthesia of the Palate Without Complementary Palatal Anesthesia
		Indications
		Methods for Reducing Pain in Palatal Techniques
			Topical Anesthesia
			Pressure Techniques
			Topical Cooling
			Periodontal Ligament Technique
			Minimal Intervention Technique
		Nasopalatine Nerve Block
			Anesthetized Area
			Technique
			Specific Complications of This Technique
			Intranasal Variant
			Technique
		Greater Palatine Nerve Block
			Area Anesthetized
			Technique
			Specific Complications of This Technique
			Partial Variant of the Palate
		Transpapillary Technique in Children
			Technique
		References
	Chapter 16 Mandibular Anesthesia I: Pulpal Anesthesia
		Mandibular Block: General Remarks
			Zone Anesthetized
			Factors to Consider for the Mandibular Block
				Efficacy is Correlated to the Location of Tooth in the Mandible
				High Failure Rate
				Unreliability of Lower Lip Anesthesia
				Sequential Nature
				The Longer the Time, the More Intense the Anesthesia
				Minor Effect of the Type of Anesthetic
				Impact of the Volume Injected
				Minor Effect of the Specific Mandibular Block Technique
				Bilateral Mandibular Blocks
				Long, Caliber 25G Needles
				Slow Injection
		Mandibular Block: Conventional or Direct Technique
			Distribution of the Anesthetic Solution
			Zone Anesthetized
			Technique
			Efficacy of this Technique
			Complications Specific to this Technique
		Mandibular Block: Gow-Gates Technique
			Mechanism
			Advantages, Disadvantages, and Non-advantages
				Advantages
				Disadvantages
				Non-advantages
			Zone Anesthetized
			Technique
			Efficacy of this Technique
			Complications Specific to this Technique
			Remark on the Gow-Gates Technique
		Mandibular Block: Laguardia–Akinosi Technique
			Advantages and Disadvantages
			Use
			Distribution of the Anesthetic Solution
			Zone Anesthetized
			Technique
			Efficacy of this Technique
			Complications Specific to this Technique
		Double Infiltration in Anterior Teeth
			Keys to Success
			Zone Anesthetized
			Technique
			Efficacy of this Technique
			Complications Specific to this Technique
		References
	Chapter 17 Mandibular Anesthesia II: Complementary Anesthesia
		Introduction
		Indications
		Lingual Nerve Block
			Anesthetized Area
			Technique
			Complications of this Technique
			Partial Variant as Complementary Anesthesia
		Buccal Nerve Block
			Anesthetized Area
			Technique
			Specific Complications of this Technique
		References
	Chapter 18 Supplementary Techniques in Cases of Failure
		Introduction
		Intrapulpal Anesthesia
			Traditional Technique
				Keys to a Successful Approach
				Intrapulpal Technique
			Topical Anesthetic Technique
				Technique
		Periodontal Ligament Technique (PDL)
			Indications and Contraindications
				Indications
				Contraindications
			Diffusion of the Solution
			Factors that Determine Efficacy
				Major Factors
				Minor Factors
			Instrument Set
				Syringes
				Needles
				Cartridges
			Anesthetized Area
			Technique
			Efficacy of This Technique
			Specific Complications of the Technique
				Complications Due to Performance of the Technique
				Periodontal Abnormalities
				Pulpal Abnormalities
				Cardiovascular Abnormalities
		Intraseptal Technique
			Factors Underlying a Successful Technique
			Contraindications
			Anesthetized Area
			Technique
			Specific Complications of the Technique
		Intraosseous Technique
			Indications, Contraindications, and Disadvantages
			Instrument Set
				Stabident®
				X-Tip®
			Anesthetic Solutions
			Anesthetized Area
			Intraosseous Technique
			Efficacy
			Specific Complications
				Complications Due to Mechanical Aspects
				Postoperative Complications
				Pulpal Abnormalities
		Final Remarks
		References
	Chapter 19 Failure of Dental Local Anesthesia
		Frequency
		Consequences of Failure
		Failures: General Causes
			Highly Anxious Patients
			Patients with Drug Addiction and Alcoholism
			Teeth Affected by Irreversible Acute Pulpitis
				Reasons for Failure of Anesthesia in Acute Pulpitis
				Approach
			Resistance to Local Anesthetics
			Other Causes of Failure
		Specific Failures After Maxillary Infiltration
			Causes of Maxillary Failure
			Approach
		Specific Failures After Mandibular Block
			Reasons for Failure After Mandibular Block
				Failure Owing to Inappropriate Technique
				Failure for Anatomical Reasons
				Failure Arising from Accessory Innervation
			Approach
		References
	Chapter 20 Alternatives to Conventional Techniques
		Jet Injection
			Distribution of the Solution
			Indications
			Disadvantages
			Advantages
			Equipment
				Syrijet®
				Injex®
			Technique
			Complications of this Technique
		Electronic Anesthesia: Electronic Dental Anesthesia
			Mechanism of Action
			Indications
			Disadvantages
			Advantages
			Contraindications
			Equipment
			Technique
			Complications of this Technique
		Computer-Controlled Injection Systems (The Wand®)
			Description of the Device
				Central Processing Unit
				Foot Control
				Handpiece
				Needles
				Set-up
				Advantages and Disadvantages
			P-AMSA
				Anesthetized Area
				Technique
				Efficacy of the P-AMSATechnique
				Specific Complications of this Technique
				Advantages of the P-AMSATechnique
			P-ASA
				Anesthetized Area
				Technique
				Efficacy of P-ASA
				Specific Complications with this Technique
				Advantages of P-ASA
			The Wand and Conventional Techniques
				Periodontal Ligament Technique
				Mandibular Block
		Other Computer-controlled Injection Systems
			Comfort Control Syringe from Midwest
			Quicksleeper
				Equipment
				Anesthetized Area
				Transcortical Technique
				Efficacy of QuickSleeper
				Disadvantages
		Intranasal Maxillary Local Anesthesia (Kovanaze®)
			Composition of the Solution
			Zone Anesthetized
			Indications and Contraindications
				Indications
				Contraindications (Hersh et al. 2016b; US Food and Drug Asministration 2019)
			Equipment
				Preparation
			Technique
			Efficacy of the Technique
			Complications Specific to this Technique
			Advantages and Disadvantages
				Advantages
				Disadvantages
		References
	Chapter 21 Local Anesthesia in Children
		The Problem with Children and Adolescents
		Local Anesthetic Solutions
		Anesthetic Technique in Children
		Anesthesia of the Primary Mandibular Molars
			Needles and Mandibular Block
			Remarks on Buccal Infiltration
		References
Complications
	Chapter 22 Local Complications of Dental Local Anesthesia
		Persistent Post-injection Pain
		Self-inflicted Injury
		Facial Blanching
			Anesthetic Techniques Involved
			Clinical Manifestations
			Causes and Pathophysiology
				Proposed Causes
				Pathophysiology
		Localized Late-onset Skin Lesion
			Clinical Manifestations
			Causes and Pathophysiology
				Ischemic Necrosis Due to Vasospasm
				Type III Allergic Reaction
		Facial Hematomas
			Technical Factors Contributing to Hematomas
			Clinical Manifestations
			Management by the Dentist
		Nerve Lesions
			Anatomical Lesions
			General Causes
			Immediate Electric Shock Sensation
				Electric Shock Sensation After the Transpalatal Approach
			Long-Term Paresthesia
				Causes of Long-termLesions
				Clinical Manifestations
				Management by the Dentist
			Alterations of the Sense of Taste
			Hoarseness
		Trismus
			Local Anesthetic Techniques Implicated in the Development of Trismus
			Causes of Trismus
			Clinical Types of Trismus
				Acute Early-onsetTrismus
				Chronic Late-onsetTrismus Due to Fibrous Band Formation
				Chronic Late-onsetTrismus Due to Infection
			Treatment of Trismus
				Conservative Treatment (Mechanical Therapy)
				Forced Opening Under General Anesthesia
				Surgical Drainage
		Facial Palsy
			Clinical Manifestations
			Facial Palsy Associated with Mandibular Block
				Immediate Onset and Short Duration
				Late Onset and Long Duration
			Facial Palsy Associated with Maxillary Infiltration
		Ocular Complications
			Anesthetic Techniques Involved
			Clinical Manifestations
			Other Clinical Aspects of Interest
			Onset and Duration
			Predictors of Sequelae
			Management by the Dentist
			Pathophysiology of Complications
				Retrograde Arterial Flow
				Retrograde Venous Flow
				Passive Diffusion to the Orbit
				Irritation of the Sympathetic System
				Sympathetic System Block (Horner-likeSyndrome)
				Other Proposed Causes
		Needle-induced Infection
			Clinical Manifestations
			Management by the Dentist
		Post-injection Mucosal Ulceration
			Clinical Manifestations
			Proposed Causes
			Management by the Dentist
		Breakage of the Needle
			Anesthetic Techniques Involved
			Causes of Needle Breakage
			Associated Factors of Interest
			Clinical Manifestations
			Decision to Retrieve (or Not)
			Management by the Dentist
			Preventive Measures
		Breakage of the Cartridge in the Mouth
		Aural Complications
			Techniques Responsible
			Clinical Manifestations
			Management by the Dentist
		References
	Chapter 23 General Complications of Dental Local Anesthesia
		Preventive Measures
		Basic Management of Complications
			Initial Measures
			Unconscious Patient
				P: Posture
				A: Airway
				B: Breathing
				C: Circulation
			Routes of Administration of Drugs
			Calling the Emergency Services
		Psychogenic Reactions
			General Causes
			Vasovagal Syncope
				Pathophysiology
				Predisposing Factors
				Clinical Manifestations
				Management by the Dentist
				Prevention
			Hyperventilation Syndrome
				Pathophysiology
				Clinical Manifestations
				Differential Diagnosis
				Management by the Dentist
			Allergic-like Reactions
		Toxicity Induced by Sympathomimetic Vasoconstrictors
			Pathophysiology
			Symptoms of Reaction to Epinephrine
			Symptoms of Reaction to Norepinephrine
			Management by the Dentist
		Systemic Toxicity Induced by Local Anesthetics
			Pathophysiology
			Causes of Local Anesthetic-induced Toxicity
				Inadvertent Intravascular Injection
				Overdose
				Rapid Absorption
			Clinical Manifestations
				First Phase: Initial
				Second Phase: Advanced
				Third Phase: Convulsions
				Fourth Phase: Final
			Clinical Variations
			Management by the Dentist
			Recovery and Discharge
			Prevention
		Toxic Methemoglobinemia
			Local Anesthetics Involved
				Benzocaine
				Prilocaine
				Other Anesthetics
			Aggravating Factors
			Clinical Manifestations
			Management by the Dentist
		Allergy
			Allergy to the Components of Local Anesthetic Solution
				Local Anesthetic
				Esters
				Amides
				Vasoconstrictor
				Antioxidants (Sulfites)
				Preservative (Methylparaben)
			Confusion with Other Reactions
			Clinical Manifestations
				Minor Manifestations
				Major Manifestations
			Diagnosis
			Management by the Dentist
				Treatment of Minor Manifestations
				Treatment of Major Manifestations
				Support Measures for Major Manifestations
				Recovery and Discharge
			Prevention
		References
Index
EULA