Comparative analysis of the incidence of general side effects to the administration of local anaesthetics in dental practice depending on the type of anesthetic and prior allergy testing

Abstract

Actuality. Anesthetics play an important role in the practice of a dentist because they help to observe the principle of painlessness for all procedures. More than 30 million injections of local anesthetics are performed in Ukraine annually. However, due to the frequent use of local anesthetics in the treatment process, the frequency of complications and side effects associated with medications during dental interventions has also increased. In Ukraine, about 80% of dentists at least once in their clinical practice witnessed the occurrence of side effects during local anaesthesia, so it is expedient to conduct a study of such cases of complications and the possibilities of their prevention.
Purpose. Determination of the spectrum and frequency of side effects when using local anesthetics; definition of the role of general examination and allergy tests in the prevention of side effects.
Materials and methods. A survey was conducted among 14 dentists of the university dental clinic on the basis of the Faculty of Dentistry of the Uzhhorod National University and an analysis of the medical records of the dental patient form 043/0 of 650 patients. The type of local anesthetic and the nature of preliminary preparation were taken into account, on the basis of which their total number was divided into 2 groups: group 1 — patients who were exclusively interviewed about the presence of side effects to anesthetics in the past (358 people), group 2 — patients, whose detailed history was collected, a general examination was previously conducted (measurement of blood pressure, pulse, etc.) and/or an additional clinical allergy test (prick test) was conducted (292 persons).
Results. It was found that the most used local anesthetics are articaine (4%) with adrenaline 1:200,000 and articaine (4%) with adrenaline 1:100,000. The lowest frequency of side effects was observed when using articaine (4%) with adrenaline 1: 200,000 (5.49%), and the highest when using articaine (4%) with adrenaline 1: 100,000 (9.13%). Their overall frequency in the second group (3.42%) turned out to be 6.36% less than the incidence rate in the first group (9.78%).
Conclusions. The overall frequency of side effects with typical use of local anesthesia (9.78%) indicates an increase in the frequency of their occurrence. The vast majority of side effects did not pose a serious danger to patients, were temporary, and did not require medical intervention. The lower rate in the second group (3.42%) indicates the expediency and effectiveness of detailed history taking, general examination and clinical allergy testing in the prevention of side effects, in particular, this applies to such severe complications as anaphylactic shock and epileptic seizures. In order to reduce the frequency of side effects in the future, it is also worth giving preference to anesthetics with a lower concentration of adrenaline, which is one of the main reasons for the occurrence of sympathomimetic effects.