Local anaesthetic adverse effects and other emergency problems in general dental practice.

This paper has three parts: local anaesthetic adverse effects, haemorrhage control and altered immune response. Primary emphasis is placed on the problems with anaesthetics since their use is widespread. Every day, nearly 2 million injections of local anaesthetic are given in dental practice. From 2.5 to 10 per cent of patients experience adverse reactions. This adverse effect rate is 10 times higher than that in medicine for the same drugs. Allergic, toxic, idiosyncratic and psychogenic effects are discussed. New data on the role of local anaesthetic agents, vasoconstrictors and preservatives is presented. In addition, the problem of anaesthetic failure (occurring in over 10 per cent of patients) is explained. Treatment (drug and psychological) for anaesthetic related emergencies such as panic attacks, shortness of breath, palpitations and nausea is recommended. Prevention and treatment of haemorrhage is explained. Medical and dental conditions may increase clotting time (e.g., systemic disease or local factors such as granulation tissue). Preventive strategies are outlined and laboratory tests discussed. Emphasis should be placed on the use of local anaesthetics with vasoconstrictors, haemostatic agents and pressure. The final aspect of the paper discussed new data on problems for dentists arising with patients who have altered immune function. In particular AIDS is discussed from the point of view of protection of the dentist and dental treatment for the patient.