Why does anesthesia not work during dental treatment?

What is anesthesia?

The procedure for injecting special drugs aimed at eliminating local sensitivity is called anesthesia. The active substance of the anesthetic blocks the conduction of impulses from nerve endings to the brain, preventing the occurrence of pain in response to manipulations. After the anesthetic wears off, sensitivity is completely restored.

Today in dentistry there are several types of local anesthesia. The most commonly used anesthesia is an injection into the area of one tooth. Other methods are aimed at “switching off” the nerves of several teeth at once.

The anesthesia procedure allows you to avoid discomfort during dental procedures, which is why anesthesia is used everywhere during the treatment and extraction of teeth.

They're looking in the wrong place

“For such patients there are special pain clinics, where treatment is individually selected,” says Emil Isagulyan, a neurosurgeon-algologist at the Institute of Neurosurgery named after. N. N. Burdenko, Ph.D. “They deal only with pain and consider pain as an independent disease.
Unfortunately, we have few such clinics, and doctors are aimed at eliminating the cause of pain. They often perform multiple operations, looking for formations that can put pressure on the nerve and cause pain - scars, adhesions, hernias, fragments of intervertebral discs, consequences of injuries. This anatomical cause is eliminated, but the pain remains. For such patients there is even a special diagnosis - “operated spine syndrome.” In such cases, the matter is not in anatomy, not in eliminating the cause of nerve compression, but in physiology - in the improper functioning of the nervous system. The body's anti-pain system, which normally works well, is depleted, and the pain system is activated. We don’t know why this happens, but we know how to help.” An article on the topic of exercise therapy and the gym. Pain syndromes can be treated without pills. How not to bring things to such agony? The cause may be the painkillers themselves. After watching enough advertising, we ourselves treat headaches without a doctor and get hooked on pills. As a result, the so-called Overuse headache - it is caused by medications. You cannot treat migraines and other pain that appear periodically on your own. This increases the risk of developing severe pain syndrome. “Advertised” medications can be taken for moderate and rare pain. All others should be treated by a doctor.

“If he can’t help either,” continues Emil Isagulyan, “you need to go to a pain clinic. Over the past year they were opened at the Institute. Sklifosovsky and at the First Moscow State Medical University. They are mainly treated with therapeutic methods. We are engaged in pain surgery; people come to us who cannot be helped there. The main method of treatment is electrical stimulation. We implant a special device under the skin with electrodes that are connected to the nerves, spinal cord or brain. Using the remote control, we turn on the stimulator, which sends signals that modulate the functioning of the nerves. As a result, the pain weakens or disappears. First, we install a test stimulator to check whether it helps a particular patient. If all is well, we install a permanent one. The operation is simple, and the device does not limit life.

Reasons for the lack of effect of anesthesia

Individual features of anatomy. The effect of the local anesthetic is ensured by its injection into a specific location near the nerves. However, there are people who have a non-standard structure and arrangement of nerves. In such situations, additional injections of anesthetic solution are required in other areas.
Local inflammatory process. In the presence of infectious inflammation in the tissues, the pH level decreases, which indicates an increase in the acidity of the environment. Under such conditions, the chemical structure of anesthetics is destroyed and their effect is neutralized. There are several solutions to this problem: preliminary therapy with antibacterial drugs or the use of alternative methods of pain relief that do not affect the area of inflammation (Gow-Gates anesthesia, intraosseous anesthesia, etc.).
Ehlers-Danlos syndrome. This is a genetic disease that affects the condition of the skin, bone tissue and muscles. With this pathology, conventional anesthesia is not effective, and it is necessary to resort to the use of stronger drugs. In some cases, for high-quality pain relief, several injections are required at once.
Psychological state of the patient. With dental phobia (panic fear of dental treatment), the production of anxiety hormones that interfere with the action of anesthetics increases. People with this condition are advised to take sedatives before visiting the dentist.
Red hair color. It is known that red hair is a consequence of a mutation in the melanocortin-1 gene, a change in which also reduces the effectiveness of local anesthesia.
Poor quality anesthetic. If the storage rules for the drug are not followed and its expiration date expires, you may not expect any effect from the administration of the anesthetic. Therefore, you should be responsible when choosing a doctor and a clinic where treatment will be carried out.
Insufficient amount of administered drug. If the dosage is incorrectly selected, the anesthetic will not be able to work effectively.
Wrong choice of drug for pain relief. The anesthetic should be selected by the dentist depending on the method of anesthesia and the desired result.
Violation of the integrity of the mucous membrane at the site of injection of the anesthetic. The solution will simply flow out of the tissue without having the desired effect. This can happen if you select an injection needle incorrectly, which will injure the mucous membrane, forming a wide channel behind it.

If pain relief is repeatedly unsuccessful during treatment or tooth extraction, the dentist will be able to determine the cause of the problem and select an alternative method of anesthesia.

What to do when regular painkillers stop helping?

Palliative care specialist* Andrei Ivanov answered questions from TV viewers about pain syndrome in seriously ill patients.

— What to do if a previously prescribed painkiller does not help, and the person is in pain?

— The regulatory framework states that any attending physician, including a local therapist, can prescribe narcotic painkillers without restrictions if persistent pain occurs. The therapist can do this even without any consultation with an oncologist or other specialist. This is now provided for by law.

Unfortunately, our therapists very often play it safe and try to send the patient to the oncology clinic so that they can write there what additional drugs can be prescribed. We take this calmly, we write recommendations, but according to the law, therapists must do this themselves without any restrictions or delays.

That is, if the patient’s pain intensifies, then the therapist must immediately either increase the dosage, or the shorter duration of taking the drug, or prescribe a stronger drug.

— Where to complain if medications are no longer effective, but they refuse to prescribe a stronger drug to a cancer patient?

- We need to complain to higher authorities. If your therapist refuses to help, then complain to the head of the clinic. Contact the chief physician, the chief freelance specialist, or the regional ministry of health.

Remember: if the drug does not help, the therapist must change it!

— When are potent drugs prescribed?

-. If the pain is severe and prevents a person from sleeping, actively participating in life, or caring for himself, then it is necessary to prescribe narcotic analgesics.

And if a person was previously helped by non-steroidal anti-inflammatory drugs or antispasmodics, but recently they have not helped even in maximum doses, then one must switch to narcotic drugs.

There are weak drugs and stronger ones. There are drugs in the form of tablets, patches, injections. The doctor can select the minimum dose of narcotic analgesics that will not even cause addiction. In this case, the person will be completely anesthetized.

But if, for example, a person says that he wakes up from pain once or twice, and during the day he experiences discomfort with some movements, then in this case narcotic drugs should not be prescribed yet. First you need to try regular painkillers, non-steroidal anti-inflammatory drugs, antispasmodics. Perhaps a person will be able to do without drugs for a long time.

* Andrey Ivanov – head of the palliative care department of the Novgorod Regional Oncology Center, chief specialist in palliative care in the Novgorod region.

More questions and answers - in the NT program “Tell me, Doctor” (host Svetlana Sterligova):
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Recommendations before visiting the dentist:

The night before your appointment, drink lemon balm or chamomile tea before bed. These natural remedies have excellent calming effects.
If you have constant strong feelings, before each dentist appointment, it is recommended to take a course of light sedatives a week before visiting the doctor. For example, “Afobazol” and “Tenoten”, they calm the nervous system, improving well-being and relieving anxiety before dental surgery. Drugs such as valerian and motherwort are best taken in tablets: tinctures are alcohol-based, which impairs the quality of pain relief.
For the same reason, you should not drink alcoholic beverages at least 24 hours before your dentist appointment. Alcohol is eliminated from the body within 72 hours, but the products of its metabolism remain in the body for another week. To speed up the cleansing of the body from toxic substances, it is recommended to take sorbent preparations.
Get a good night's sleep and eat before your appointment. This way you will save yourself from additional stress, and, consequently, from unnecessary problems during dental procedures.
Be sure to tell your dentist about any medical conditions you have and the medications you are taking! This will help the doctor choose the right method of pain relief and anesthetic. In addition, taking certain medications can greatly reduce the quality of pain relief.

The main recommendation would be a careful approach to choosing a dental clinic and doctor. After all, a competent dentist, even if difficulties arise with administering anesthesia, will be able to find the right way out of the current situation.

Case histories

Question answer

In what cases should patients be given pain medication? “For 12 years I was tormented by pain in my hip, in the last 2 years it has intensified, nothing helped, I could hardly walk,” says a man in his sixties, walking along the corridor of the department. — The Ministry of Health gave me a referral to the Research Institute of Neurosurgery. First they put in a temporary neurostimulator, and I immediately felt better. The pressure dropped to normal, before it was 180/120. The pain has eased significantly. Now the stimulator is constant, I turn it on when necessary. I take medications much less often.”

In addition to pain, the method can also help with delicate problems. “Three years ago I was diagnosed with an overactive bladder,” says the young woman. — Every 30-40 minutes I had to go to the toilet. I couldn’t leave home for a long time, I couldn’t go to the movies, and riding public transport was a problem. I tried everything - medications, homeopathy, acupuncture, psychotherapy - nothing helped. A year ago they installed a stimulator and life got better.”

Pain is a signal that there is a problem in some organ, as well as evidence that some part of the body or skin has been damaged. It is thanks to pain that we can correctly respond to aggressive external factors and maintain our health and body. There are people who have a congenital lack of sensitivity to pain, and they can become disabled because their body cannot properly respond to aggressive environmental factors.

If pain occurs, especially if it intensifies, you need to be examined at a good medical center in Strogino, visit a surgeon, neurologist, therapist and other specialists who will help identify the causes of the anxiety and eliminate the pain. People who suffer from chronic pain experience depression and an imbalance of serotonin and norepinephrine in the brain.

Experiments have shown that pessimistic people are the least resistant to cold and, conversely, optimism helps improve mood and better tolerance of cold. The difference in susceptibility is due to perception, which is why optimistic people live longer and get sick less.

Chronic pain and depression are rarely treated with conventional painkillers; unfortunately, they turn out to be ineffective, and only specialists in a good medical center in Strogino can help the patient eliminate the pain by identifying the causes.

Patients who have undergone surgery are very worried about their health and suffer from chronic pain because they are focused on it. Depression and anxiety should be treated by a psychotherapist and related physicians. Antidepressants can be quite effective here; cognitive behavioral therapy is also used, when the patient learns to control the emerging feeling of anxiety and analyze his fears.

Psychological factors and the family situation influence the chronic pain of each of them: a family where all its members are accustomed to suffering is doomed to constant discomfort, both physical and mental. Psychotherapeutic treatment for such pain syndromes is quite lengthy and requires serious medical intervention. Scientists have proven that people who tend to be secretive, gloomy, pessimistic, and who keep all negative feelings inside themselves most often suffer from depression and pain.

Of course, it is necessary to separate pain that has psychological causes from pain that is caused by physical factors: bruises, blows or chronic diseases - to eliminate it, appropriate medication, physiotherapy or surgical treatment is prescribed in a good clinic in Strogino.