Anesthesia during dental treatment is the main achievement of modern dentistry. Without local anesthesia, only the removal of superficial caries is carried out without affecting the pulp. If the patient is terrified of medical intervention, dental procedures are performed under general anesthesia. The article will cover the question of what torus anesthesia is and in what cases it is used.
What is torusal anesthesia
Methods of pain relief during dental procedures are selected depending on the type of intervention performed and the characteristics of the clinical picture. This can be either an injection of an anesthetic into the gum (infiltration) or covering a large area of the patient’s face - conduction anesthesia. With conduction anesthesia, a bundle of nerves that transmit pain sensations to the brain is blocked.
Since there are several nerves in the oral cavity, the impact is carried out specifically on the tooth adjacent to the diseased tooth. Thus, when treating molars of the lower jaw, mandibular anesthesia is performed, a variation of which is the torus method of anesthesia. With this method of pain relief, the mandibular nerves are blocked:
- inferior alveolar;
- buccal;
- lingual.
An anesthetic solution is injected into the junction point of these nerves - the torus. As a result of infiltration of the solution, complete anesthesia of the following facial areas occurs:
- chin;
- soft tissues of the lower jaw;
- their corresponding skin.
That is, sensitivity is lost at the level of the skeletal and muscular systems, as well as the skin. The effectiveness of pain relief allows you to begin medical procedures almost immediately after instillation of the product.
The advantage of the technique is that there is a large area of the facial region that is insensitive to pain. Disadvantages are the possibility of complications after the injection and the presence of a highly qualified dentist. The doctor must have knowledge of anatomical landmarks in order to find the right point for instillation without mistakes.
Painkillers used:
- lidocaine;
- ultracaine;
- novocaine
- trimecaine.
For serious surgical interventions that require a long time, other medicinal substances with an analgesic effect are used. Trimecaine is used to remove lower molars; it effectively blocks the dental nerves. It is also used for cleaning canals and filling teeth affected by caries.
If the chewing molars remain insensitive to the action of the medicine after the injection, the dentist performs additional anesthesia: saturates the mucous membrane around the sensitive molars with the solution.
Anatomical implications
After introducing the anesthetic into the mandibular eminence, the drug immediately begins to act on the mandibular, buccal and lingual nerve endings.
The mandibular ridge is formed from 2 bone cords of the condylar and coronoid processes, they are located above and anterior to the bone uvula, along the slopes of this formation there are 3 nerve endings that lose sensitivity.
Thanks to this effect, sensitivity in the area from the 2nd premolar to the 2nd molar in the middle is turned off, which makes it possible to painlessly perform dental procedures on the dentition and operate on problem areas of the oral cavity.
When to use
The effectiveness and simplicity of torusal anesthesia allows it to be used in many cases of dental practice.
Torusal anesthesia is used for:
- opening of ulcers and abscesses in the lower jaw;
- extraction of mandibular molars;
- depulpation and other methods of intervention;
- installation of fixing splints in case of injury to the mandibular region;
- removal of molars with abnormal root locations;
- surgery for broken jaw bones;
- elimination of neoplasms;
- augmentation/removal of the jawbone.
Pain relief is also carried out in case of abnormal eruption of wisdom teeth, which is accompanied by severe swelling and pain. Incorrect growth of a wisdom tooth can cause rupture of gum tissue and cause severe complications.
The effectiveness of instillation depends on the qualifications of the dentist. To simultaneously block three nerves, you need to accurately hit the point of their connection, which is located in the torus. If the doctor cannot correctly determine the location of the torus, then it will not be possible to numb the desired area of the lower part of the face.
Incomplete pain relief can lead to discomfort during dental procedures. If the patient feels that there is insufficient blockage of the facial nerves, he should immediately inform the dentist.
Anesthetics used in this method may cause allergic reactions. Therefore, you need to warn your dentist about intolerance to certain medicinal components.
Allergic reactions to drugs are another problem with anesthesia. Since quite a large number of patients are intolerant to certain substances, pain relief can cause an unpredictable reaction in the body.
Other, not so popular methods
Among other techniques, the following are occasionally used:
- According to Leharty - used both for insufficient and free opening of the mouth, the needle tip is inserted at the anterior edge of the lower jaw, moves along its inner edge and the anesthetic is gradually released. During the manipulation, the upper part of the retromolar triangle is palpated.
- Apodactyl variant - the landmark in this variant is the pterygomandibular fold, which can be of different widths and is located to the inside of the oral cavity from the temporal crest.
- Extraoral access is used when there is no access inside the mouth; during its use, the projection of the mandibular slot on the skin is specified. The anesthetic is injected in doses in two doses.
Technique
Since the technique was developed by the Soviet dentist Weisbrem, it bears his name. In addition to Weisbrem’s technique, there are several more proven methods of torusal anesthesia developed by other experienced dentists - Legardi, Akinosi, etc.
According to Weisbrem
For the instillation of the medicine to be successful, the patient must throw back his head and open his mouth wide. During instillation, the syringe needle reaches the jawbone, so it should be held strictly perpendicular to the patient’s cheek. The success of pain relief depends on the correct location of the torus point.
The syringe needle is inserted into the soft tissues quite deeply and is located at the level of the first or second chewing molar. After inserting the needle, the medicinal composition is instilled in a volume of 1.5-2 cubes. To check that the needle has entered the blood vessel, the doctor draws a small amount of medication back into the syringe. The presence of blood in the syringe body indicates deformation of the blood vessel during instillation.
If everything went well, the doctor performs a block of the lingual nerve. No more than 0.5 ml of the medicinal composition is consumed to relieve pain. After 5 minutes, the patient should feel numbness in the mandibular region, and only after this can treatment procedures begin.
According to Akinozi
Using the technique, two nerves are blocked - the lingual and alveolar. The patient does not need to open his mouth wide; all manipulations are carried out with closed teeth. The doctor inserts the syringe needle into the point between the tubercle and the recess of the lower jaw. The volume of the drug is the same and is 1.5-2 ml. However, Akinosi anesthesia is used only in cases of ineffective blocking of nerve endings by other methods.
Despite the high effectiveness of pain relief, the method has the following risks:
- injury to the facial nerve;
- deformation of the periosteum;
- injury to the pterygoid and temporal muscles.
The Askinosi method requires a highly qualified dentist, as it is unsafe and traumatic. However, it is the Askinosie method that brings high-quality pain relief to patients who have two or more nerve endings in their molars.
According to Go-Gates
The anesthesia method was developed by Australian dentist Gou-Gates. It differs in that instillation is carried out in the corner of the patient’s lips. The syringe is inserted into the tendon of the pterygoid and temporal muscles and touches the jaw bone. After taking an aspiration sample (checking for the presence of blood in the solution), the dentist administers the medicinal composition in a volume of 1.5 -2 ml. Next, the patient should remain with his mouth open until the nerve endings are completely blocked. This takes no more than five minutes, although it is inconvenient.
Despite the inconvenience, using the Go-Gates method, several nerve roots are blocked at once:
- maxillohyoid;
- reed;
- temporal;
- buccal;
- lower lunula.
Complete blocking of the nerve roots occurs somewhat later than with other methods.
Improper instillation can cause spasm of the respiratory tract and hematoma formation. The method is one of the safest.
Injection equipment
For local anesthesia in children, carpule syringes of various designs are used. Preference should be given to injectors intended for carrying out an aspiration test (Rabinovich S. A., Vasilyev Yu. L., Sokhov S. T., 2013; Tarasenko S. V., Kuzin A. V., Belyaeva E. A., Kurtyshov A. A., 2013). Local injection anesthesia in children carries the risk of intravascular injection of local anesthetic. This fact is explained by the high degree of vascularization of the tissues of the maxillofacial region of children. Thus, the frequency of intravascular administration of an anesthetic during mandibular anesthesia in adults is 10-15%, and in children - 20-25%. Syringes with a plunger in the form of an anchor and a corkscrew have the best technical characteristics. The choice of injection needle depends on the method of anesthesia. For conductive methods, needles with a diameter of at least 0.4 mm (27G) should be used. When conducting conduction anesthesia, 0.3 mm (30G) needles bend excessively in the tissues (deflection), which leads to the deposition of the anesthetic away from the intended end point of pain relief (Rabinovich S. A., Vasiliev Yu. L., 2011).
Needles 0.3 mm (30G) are advisable to use for infiltration anesthesia and periodontal methods of pain relief.
Do not forget that when performing local anesthesia, the needle may break off. This complication, as a rule, occurs when the child makes sudden movements: withdrawing the head, abruptly closing the mouth. In most cases, these severe complications occur when using 30G needles when performing mandibular anesthesia in children.
There is an opinion that the thinner the needle, the less painful the patient perceives the stage of puncturing the mucous membrane and advancing the needle into the tissues. This opinion can be classified as a misconception. There are studies confirming that the diameter of the needle does not affect the reduction in the degree of pain of the anesthesia (Malamed SF, 2002).
Danger and risks
Pain-relieving procedures require highly qualified dentists and a certain amount of caution when performing them. Improper administration of torus anesthesia can lead to the following complications:
- fracture of a syringe needle followed by surgery;
- injury to blood vessels with subsequent bleeding and hematomas;
- paralysis of facial muscles, partial loss of facial mobility;
- injury to the fibers of the pterygoid muscles;
- loss of sensitivity of the oral mucosa;
- ischemia of the chin due to penetration of the drug into the bloodstream;
- infection of tissues with subsequent development of inflammation;
- neuritis of the mandibular nerves.
However, the patient must be careful after the dentist’s manipulations:
- sanitize the oral cavity in a timely manner;
- exclude rough foods until the mucous membranes are completely healed;
- take care of liver restoration.
Any anesthesia negatively affects the health of the liver, so the patient is obliged to independently take care of his own health and take prescribed medications or use other methods of restorative procedures.
Feel
After direct administration of the drug, a person gradually begins to feel heaviness in the legs or a slight tingling sensation. This indicates that the administered drug is beginning to work. After a few minutes, sensitivity completely disappears. Before surgery, the doctor must test for loss of sensitivity. If suddenly a person feels an unpleasant sensation, more like an electric shock, you should immediately tell a doctor about it.
In some situations, longer spinal anesthesia may be required. In this case, a special instrument, a catheter, is placed in place of the previous puncture for additional administration of the medicine.
Contraindications for carrying out
In what cases is local anesthesia of the oral cavity contraindicated or has partial contraindications? Anesthesia is prohibited for any liver pathologies, as it directly affects liver cells. Due to the high dose of novocaine, this method is excluded from the permissible method, and general anesthesia is recommended instead.
Also, torusal anesthesia is contraindicated for:
- intolerance to the components of the medicinal substance;
- pathologies of the circulatory system;
- mental disorders;
- bronchial asthma;
- cardiovascular pathologies;
- epileptic seizures.
Also, local anesthesia of this method is not carried out in case of anatomical disorders in the structure of the jaw and gums, as well as when the point of connection of the nerves is shifted.
Can this anesthesia be used during pregnancy? Permission must be given by the treating gynecologist, since the method may pose a certain danger to the fetus.
Negative consequences of spinal anesthesia
In order for the patient to decide to undergo spinal anesthesia, he needs to familiarize himself in advance with information about the disadvantages of this method of pain relief.
- During the medication administration process, the patient's blood pressure may drop sharply. Therefore, hypotensive patients are given drugs that increase blood pressure in advance - of course, if necessary. For hypertensive patients, this consequence can only have a positive effect.
- The time of loss of sensitivity is directly related to the dose of the drug. If sensitivity returns before the required time, and there is not enough time to complete the operation, the patient is immediately placed under general anesthesia. The spinal anesthesia method does not involve constant support of the anesthetic in the body; most often it is administered once. However, do not worry, since modern medicine uses medications that last up to six hours, which in most cases allows the surgeon to carry out all the manipulations on time.
- Headaches are a frequent companion of the patient after recovery from anesthesia.
Bottom line
Torusal anesthesia is an effective means for quickly numbing a large area of the facial area. It is performed during complex dental procedures, when it is necessary to numb a large area of the facial region for a long time. With one injection, it is possible to immediately block three facial nerves that react acutely to pain.
However, performing the manipulation requires high medical qualifications, knowledge of the anatomy of the location of nerve endings, and careful handling of instruments. Improper administration of a drug can lead to various complications and injure the patient. The technique is used when other methods of blocking nerve endings are ineffective.
Sources used:
- Basic methods of pain relief at an outpatient dental appointment / Samedov Timur Islamovich. - M.: SpetsLit, 2011.
- Local anesthesia in dentistry / E.A. Bazikyan. - M.: GEOTAR-Media, 2012.
- Therapeutic dentistry. Anesthesia. Bleaching. Filling. Endodontics / Edited by E.V. Borovsky. - M.: Dentistry, 2005.
