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History, chemistry, types

of dental analgesia
Dr. Tatiana Shkolnik MD, DDS

Department of Oral and Maxillofacial Surgery


SEMMELWEIS UNIVERSITY
FACULTY OF DENTISTRY
2015
What people are afraid of?

Agras et al. Milgrom et al.


1970 1988

Ranking: Ranking:
Height 1 Height 1
Storm 2
Dentistry 2
Flying 3

Dentistry 4
History of the
anaesthesia,
analgesia
The oldest sedative
known to man is alcohol.

Was used in ancient


Mesopotamia
Statuette of
moon-godess
with poppy seeds
on her crown
/13th century B.C. Crete/
Opium has been cultivated and used
Assirians, Sumerians, Babilonians,
Egyptians.

In China and India cannabis was used.

Bian Que ( 300 BCE ) – Chinese internist


and surgeon used cannabis in a form of a
drink for general anesthesia
Hua Tuo ( 145-220CE ) - surgeon
Oral surgical
intervention on
a solder
/IV. century B.C./
Arabic and Persian physicians were the
first to utilize oral and
Inhaled anesthetics ( 940-1020 )
Saint Apollonia was one of the virgin martyrs, who suffered in
Alexandria during the uprising against christians./294/
According to the legend, all of her teeth were violently pulled out
or shattered.
For this reason,she is populary regarded
as the patroness of dentistry, and of those
suffering from toothache or other dental problems

/Wikipedia, the free encyklopedia/

/Jean Fouquet 1455./


Saint Apollonia
/1470./
The cult of Saint
Apollonia
/09. February/
Patron saints of toothache

• Saint Apollonia
• Saint Lawrence – burning pain of teeth
• Saint Lúcia – problems with
wisdom teeth
Discovery of diethyl ether

Alchemist Ramon Lull 1275

Paraselsus - discovered analgesic


properties 1525

Valerius Cordus - synthesis 1540


A man is
escorted to the
extracteur by
his wife
/Landesbibliothek Stuttgart
1467./
Tooth removal
/Jan Victors 1654./
Pierre
Fauchard
The father of
modern dentistry
„Le chirurgien dentiste
ou traité des dents”
1728
L. Koecker: Grundsätzen der
Zahn-Chirurgie 1828.
• proper psychological preparation
• quick extraction
• high technical skill
with the goal, to keep the
pain tolerable
1772 Joseph Priestly
discovered the
„laughing gas” /N2O/, nitric
oxide, hydrogen chloride, oxygen

1800 Humphry Davy


discovered the
anaesthetic and analgesic effect of
N2O
In the first half of the 19th century the "laughing
gas" was used to entertaint.
Fredrich Serturner first isolated morphine
from opium 1804

Henry Hill Hickman experimented with


carbon dioxide 1824

1830s Davy’s work is publicized, public


lectures.

Edward William Clarke, Crawford Long,


Horace Wells,
William T. Morton
1844. Horace Wells, dentist.
tooth extraction with N2O
1846. William
Morton
dentist
the first ether anaesthesia
First surgery in ether anaestesia
Boston /U.S.A./ 1846.
Painted by Robert Hinckley in 1882
Analgesia with ether before tooth
extraction by Morton in 1846
painted by Ernest Board
History of the anaesthesia,
analgesia

1860. isolation of cocaine /Niemann/


1865. Charles Hunter – hypodermic
syringe
History of the anaesthesia, analgesia
1884. Carl Koller ophtalmologist, Jellinek
laryngologist
topical analgesia with cocaine
1885. William S. Halsted surgeon
nerve block analgesia
1897. metal-glass syringes
1905. Alfred Einhorn - Invention of Procain
/Novocain/
1943. N.Löfgren - synthesis of the lidocaine
1905. Invention of Procain /Novocain/
Alfred Einhorn

Cocain Procain

1905. Procain + Adrenalin local analgesia


Heinrich Braun surgeon
History of the anaesthesia, analgesia

1943 N. Löfgren
synthesis of the lidocaine

1946 introduced into clinical


practice
Olga Lenz, the first female
dentist in the U.S.A.
/photograph 1910./
History of the anaesthesia, analgesia

1957. Introduction of Mepivacain


1960. Introduction of Prilocain
1963. Introduction of Bupivacain
into clinical practice
History of the anaesthesia, analgesia

1969. Invention of Articain


/Muscheweck/
1975. Introduction of Articain
into clinical practice
What is the
pain?
PAIN
•is an unpleasant sensory and emotional experience
•can be in connection with an actual or potential
tissue damage
•can not be accurately measured. From a clinical and
practical standpoint we must rely on subjective
responses and accept the patient’s definition
COMPONENTS OF PAIN

Physiological -> pain-perception

Psychological -> pain-reaction


Gate Control theory /Melzack, Wall 1965/
Thalamus

„T” cells

Fibers A + B,
descending Substantia Stimulation by C-
inhibitor system gelatinosa fibers

First neuron

Periphery
Factors influencing the reaction
of the pain
Personal: age, gender, cultural
background, physical
and emotional state

Situation: attention, fear and


anxiety
Types of analgesia

1. General anesthesia

2. Local anaesthesia
TYPE OF LOCAL ANALGESIA

a. superficial mucosal anesthesia

b. submucosus infiltration

c. subperiostal infiltration

d. intraligamental infiltration
Thank you for your attention!