RU2290858C2 - Method for selecting anesthesia method before applying therapeutic dental intervention - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves evaluating therapeutic intervention nature as follows. 0 points are given to intervention on maxillary or mandibular teeth, filing teeth and removing dental deposit. 1 point is assigned to preparing hard tissues of vital teeth, depulping maxillary or mandibular teeth, treating the teeth in hard tissue hyperesthesia cases. 2 points are assigned to treating mandibular molars. Psychoemotional stress is evaluated in 0 points when it is low, 3 points when it is medium and 9 points when it is high. Physical state of patient: 0 points distinguish patients having no organic diseases or those having localized disease causing no systemic disorders; 3 points are assigned to patients having light or moderate disorders insignificantly disturbing normal vital activity and general physiologic state; 9 points show severe systemic disorders. The points are summed. The sum being equal to 1, local infiltration anesthesia is to be advised with articaine-containing preparations being used. The sum being equal to 2, local anesthesia is considered to be applicable. The sum being from 3 to 8 combined anesthesia is considered to be applicable. The sum being equal to 9 or higher, anesthesia is considered to be applicable only after anesthesiologist consultation.

EFFECT: enhanced effectiveness in selecting appropriate anesthesia method.

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Description

The invention relates to medicine, namely to anesthesiology in dentistry.

There is a method of choosing the method of anesthesia during the preparation of teeth in orthopedic dentistry. The method consists in the fact that the dentist, examining the patient, determines the level of psycho-emotional stress, finds out, collecting an anamnesis, the presence of concomitant somatic pathology, determines the volume and morbidity of the upcoming orthopedic intervention. Then, according to the table, each indicator is evaluated in points, summarized, and, in accordance with the sum of the points, determines the optimal method of pain management (Novikova S.G. Justification and choice of the method of pain management in the preparation of teeth in orthopedic dentistry. Author's abstract. Diss. ... k.m .n. / Moscow State Medical-Dental Institute. - M., 1992, 23 pp.).

However, the nature of the intervention and the methods of analgesia used in orthopedic dentistry are not identical to those that are effective in therapeutic dental interventions. Thus, the use of this method is limited to orthopedic dental interventions.

The objective of the invention is to provide the optimal choice of anesthesia method for therapeutic dental interventions, depending on the psycho-emotional stress of the patient, the nature of the intervention and the physical status of the patient.

This is achieved due to the fact that indicators corresponding to the nature of the intervention, psychoemotional stress and physical status of the patient are summarized and for a total score of 1, local infiltration anesthesia using articaine-containing preparations is recommended, and for a total of 2, conductive local anesthesia is recommended, with a total score of 3 to 8 is recommended combined anesthesia, and with a total score of 9 or more, they recommend anesthesia only after consultation an anesthesiologist.

A study was conducted of the effectiveness of various methods of analgesia in therapeutic dental interventions. The study was performed on 174 patients who underwent therapeutic dental interventions, and the choice of anesthesia method was carried out by the proposed method. The following set of methods was used to assess the patient's condition and determine the effectiveness of the anesthesia methods: psychological testing, measurement of blood pressure, heart rate, determination of pain sensitivity thresholds, registration of somatosensory evoked potentials, photoplethysmography. The effectiveness of anesthesia was also judged by the subjective assessment of patients, using verbal-visual scales. Research indicators were recorded: in the initial state, 40, 60 and 90 minutes after anesthesia.

In developing this method, we used methods for assessing operational risk in surgery (Gologorsky V.A., 1982, Malinovsky I.N., 1973). In determining the score for each indicator, we used the method of mathematical modeling.

The method is as follows.

The dentist examining the patient determines the nature of the upcoming therapeutic intervention and the level of psychoemotional stress; finds out, collecting an anamnesis, the physical status of the patient, and then, using the proposed table, determines the most effective way of pain relief. A point score for each indicator is determined by the table, summarized and get the most optimal way of pain relief.

With a score of 1, local infiltration anesthesia is recommended using articaine-containing drugs, with a score of 2, conductive local anesthesia is recommended, with a score of 3 to 8, combined anesthesia is recommended, and with a score of 9 or more, it is recommended that pain relief only after consultation with an anesthetist.

The proposed method is an express method, easy to use and does not require additional equipment.

Clinical example No. 1.

Patient K. And / B No. 2153.

Complaints: the presence of a deep carious cavity in the 16th tooth, periodically occurring pains on temperature stimuli (hot).

The patient 2 months ago suffered an extensive myocardial infarction, expresses concern about the results of treatment, is wary, very afraid of possible pain during the treatment.

Objectively: there is a deep carious cavity on the chewing surface of the 16 tooth, the sounding of the bottom is painful.

Radiological: 16 tooth - the carious cavity communicates with the tooth cavity, there are no changes in the periapical tissues.

Diagnosis: chronic pulpitis of 16 teeth.

The physical status of the patient according to the proposed table (the presence of severe systemic disorders) is 9 points, the degree of psychoemotional stress (average) is 3 points and the nature of the intervention (depulpation of the upper jaw tooth) is 1 point, the total score is 13, therefore, the patient is recommended to undergo a therapeutic dental interventions only after consultation with an anesthetist.

Clinical example No. 2.

Patient N. And / B No. 1497.

Complaints: acute, spontaneous, night-intensifying pain in the region of 37 teeth.

The patient considers himself practically healthy, however, he experiences a strong fear of dental treatment, blood pressure - 135/80 mm Hg, heart rate - 86 beats per minute. Previously preferred tooth extraction before treatment.

Objectively: 37 tooth - on the contact distal surface of the seal, around which secondary caries is noted.

Radiological: 37 tooth - around the fillings, the area of softened dentin, which communicates with the cavity of the tooth, is absent in the periapical tissues.

Diagnosis: acute pulpitis of 37 teeth.

According to the proposed table, the physical status of the patient is determined (there are no organic diseases) - 0 points, the degree of psychoemotional stress (average) - 3 points, the nature of the intervention (treatment of molars of the lower jaw) - 2 points. The total score is 5, therefore, the patient is given combined analgesia (premedication - 1 tablet of phenazepam 0.001 g + mandibular anesthesia Sol. Uitracaini 1: 100000).

37 teeth are depulpated, a temporary filling of oil dentin is placed. According to the subjective assessment of the patient, the intervention was painless.

Table.
A method for a comprehensive assessment of the patient's condition when choosing an anesthesia method in therapeutic dentistry. The nature of the therapeutic intervention Interventions on the devital teeth of the upper or lower jaw, preparation of hard tissues of teeth, mechanical and drug treatment of tooth canals. Grinding teeth. Removal of dental plaque. 0 points Preparation of hard tissues of vital teeth, depulpation of teeth of the upper or lower jaw (except molars of the lower jaw). Surgical interventions on periodontal tissues of the upper or lower jaw. Dental treatment for hyperesthesia of hard tissues. 1 point Treatment of molars of the lower jaw. 2 points Power
psychoemotional
voltage low 0 points average 3 points high 9 points

Patient Physical Status Patients who do not have organic diseases, or the disease is localized and does not cause systemic disorders
Patients with mild or moderate systemic disorders that slightly affect normal functioning and general physiological condition (stage 1 hypertension, ANS, etc.)
Patients with severe systemic disorders that seriously impair normal functioning (e.g. GB, stages 2–3, chronic insufficiency with angina pectoris of tension and rest, post-infarction cardiosclerosis, chronic chronic cerebrovascular insufficiency with residual cerebrovascular accident, severe diabetes mellitus, allergic reactions, etc.) 0 points
3 points
9 points

Claims (1)

The method of choosing anesthesia method before therapeutic dental surgery, depending on the nature of the intervention, psychoemotional stress and the physical status of the patient through a scoring, characterized in that the nature of the therapeutic intervention is evaluated as follows - interventions on the devital teeth of the upper or lower jaw, grinding of teeth, removal of dental plaque - 0 points; preparation of hard tissues of vital teeth, depulpation of teeth of the upper or lower jaw with the exception of molars of the lower jaw, surgical interventions on periodontal tissues of the upper or lower jaw, dental treatment for hyperesthesia of hard tissues - 1 point; treatment of molars of the lower jaw - 2 points; degree of psychoemotional stress: low - 0 points, medium - 3 points, high - 9 points, physical status of the patient: patients who do not have organic diseases, or the disease is localized and does not cause systemic disorders - 0 points, patients with mild or moderate systemic disorders , which slightly violate normal life activity and the general physiological state - 3 points, patients with severe systemic disorders - 9 points, then the points obtained are summed up and with a total score of 1, I think the local anesthesia using articaine-containing preparations is indicated; with a total score of 2, conduction local anesthesia is indicated, with a total score of 3 to 8 combined anesthesia is considered indicated, and with a total score of 9 or more, anesthesia is indicated only after consultation of an anesthetist.