From this article you will learn:
- reviews on Ultracain, release forms,
- pros and cons of the drug,
- How much does Ultracaine anesthesia cost?
The article was written by a dental surgeon with more than 19 years of experience.
The anesthetic Ultracaine is a drug in the form of an injection solution that has a very high analgesic effect when administered locally into tissues. The main active component of ultracaine is the substance “articaine hydrochloride” (Articaine), which makes it possible to classify this drug as an anesthetic of the articaine series.
Ultracaine is most often used in dentistry, which is explained by its high efficiency. There are several forms of release of this drug, which differ from each other in the concentration of the vasoconstrictor component that is also included in the composition. The latter is “epinephrine”. This component is added to articaine to locally reduce blood supply in the anesthesia zone, which will reduce the leaching of the anesthetic from the tissues (while increasing the duration and depth of anesthesia).
Anesthetic Ultracaine and carpule syringe –
For dentistry, the anesthetic is not produced in the form of ordinary injection ampoules, but in the form of special cartridges called carpules. Such a carpule is inserted inside a special carpule syringe, which has a piston in the form of a handle, and a special double-edged carpule needle is inserted from the side of the syringe nose. When pressing on the syringe piston, the latter presses on the movable rubber liner inside the carpule, which leads to an increase in pressure inside the carpule and the release of the anesthetic solution through the needle.
Ultracaine release forms –
- ultracaine DS forte (epinephrine concentration 1:100,000),
- ultracaine DS (epinephrine concentration 1:200,000),
- ultracaine D (without epinephrine).
The presence of three forms of drugs is explained by the possible side effects of epinephrine, which can increase the patient's blood pressure. For completely healthy people who do not have cardiovascular or other diseases, Ultracain DS Forte is used. For moderately high blood pressure, Ultracaine DS with a reduced concentration of epinephrine can be used. However, the instructions for use for Ultracain indicate that any of the listed forms can be used from the age of 4 years. We will tell you more about the indications for use of each form below.
How anesthesia is performed in dentistry: video
Information about the drug
Ultracaine is a combined local anesthetic drug that contains epinephrine and articaine. The first is a vasoconstrictor, the second is an amide anesthetic. When injecting the drug, loss of sensitivity occurs after the conduction of sensory impulses at the nerve endings ceases to function. The level of effectiveness is much higher than lidocaine and novocaine.
The main component of the anesthetic is articaine hydrochloride. The composition also includes sodium chloride and bisulfite, adrenaline and water.
There are 3 types of Ultracaine:
- D - does not contain epinephrine. Can be taken by allergy sufferers and those suffering from bronchial asthma.
- DS - epinephrine composition 1:200000 - is prohibited for use by asthmatics, but is acceptable for cardiovascular diseases.
- DS Forte - epinephrine 1:100000 - is not recommended for use in asthma, thyroid disease and hypertension.
The solution begins to act within one to two minutes after the injection and lasts up to an hour. Available in ampoules of 2 ml and cartridges of 1.7 ml.
Ultracaine during pregnancy and breastfeeding
The optimal form of this anesthetic during pregnancy is Ultracaine DS with an epinephrine concentration of 1:200,000. The use of anesthetics without epinephrine (or adrenaline) in pregnant and lactating women is generally not recommended. This is due to the fact that adrenaline, by constricting blood vessels at the injection site, slows down the absorption of the main component (articaine) into the blood, and accordingly this will reduce the peak concentrations of articaine in the blood, and therefore its possible side effects on the fetus.
Ultracaine during breastfeeding - after anesthesia with Ultracaine, the content of articaine in breast milk is possible, but the concentration is so low that it cannot cause any harm. Therefore, there is no need to give up breastfeeding. The epinephrine content in Ultracaine DS is also very small and cannot adversely affect either the mother or the child.
Sources:
1. Dental education of the author of the article, 2. Based on personal experience as a dentist, 3. National Library of Medicine (USA), 4. “Local anesthesia in dentistry” (Baart J.), 5. https://dental.sanofi. de/.
Main indications and dosage
An effective pain reliever Ultracaine is used for dental procedures that are accompanied by severe pain. It is administered for single and multiple tooth extractions, installation of crowns, fillings and other dental procedures.
It is used during conduction anesthesia for the following dental interventions:
- uncomplicated tooth extraction;
- preparation and grinding of teeth before prosthetics;
- performing treatment of carious cavities.
The medication is used to perform certain manipulations in the oral cavity. It is forbidden to perform an injection if there is tissue inflammation.
The dosage depends on the type of procedures performed, the characteristics of the body and the age of the patient. The pressure of the solution must fully correspond to the sensitivity of the tissue. When performing resection of teeth in the upper row, the calculation for each tooth is 1.7 ml. If it is necessary to increase the analgesic effect, the dose may be increased. To remove the lower premolars, 1 injection will be enough. If the effect does not appear in the first minutes, you can give a second injection at a dose of 1-1.7 ml.
When preparing a tooth for a crown, infiltration anesthesia is 0.5-1.7 Ultracaine. The maximum dosage can reach 7 microns/kg.
Ultracain: reviews from dentists
As a practicing physician, I try to use this particular anesthetic primarily, although its cost is 1.5-2 times more expensive than similar anesthetics based on articaine.
Thanks to the optimal composition, a minimum of preservatives in the composition (and the complete absence of preservatives in the form of Ultracaine D), this anesthetic can be used in all patients at risk (for cardiovascular, endocrine disorders, allergies, pregnancy and lactation). Ultracaine reviews from dentists are also as favorable as possible because this anesthetic will be a good choice if you have an allergic reaction to amide group anesthetics, for example Novocaine, Lidocaine and others. But in addition to the high safety profile, this anesthetic is also much stronger than its predecessors (see below). In addition, this anesthetic acts in inflamed tissues, but Novocain practically does not anesthetize in the presence of purulent inflammation.
The duration of action and depth of anesthesia will depend on the concentration of epinephrine in the composition of the product, for example, Ultracaine DS forte 1: 100,000 is the most powerful drug in the line. When conducting conduction anesthesia on the lower jaw, the duration of action averages from 2 to 3 hours. With infiltration anesthesia on the lower and upper jaws - a little more than an hour (24stoma.ru).
Ultracaine or lidocaine: which is better?
- Ultracaine is stronger than Novocaine - 5-6 times,
- more effective than lidocaine - 1.5-2 times.
Overdose and contraindications
In case of an overdose of Ultracaine, symptoms such as dizziness, stupor, respiratory failure, bradycardia, twitching of muscle tissue, and circulatory disorders may occur.
If such consequences occur, it is necessary to stop its administration and immediately place the patient in a horizontal position with raised lower limbs. In case of complicated symptoms, artificial respiration and endotracheal intubation should be performed.
Ultracaine DS and DS Forte contain adrenaline, which is contraindicated in cases of hypertension, glaucoma, asthma, tachyarrhythmia, anemia, tachycardia. The drug should not be used by children under 4 years of age.
Allergy tests
If you have previously experienced allergic reactions to medications, you have doubts, and you do not fully know which local anesthetics are safe for you, we strongly recommend that you undergo tests for allergic reactions at an allergy center before visiting the dentist. The addresses of such centers can be obtained from the reception of the Dentalika dental clinic. The test results can be completely trusted. This recommendation especially applies to parents of children who bring their children to the dentist for the first time. Unfortunately, from year to year the number of children susceptible to allergic reactions in our city is only growing. A visit to the allergy center will completely protect your child from possible complications.
Side effects
Most often, the body reacts to the injection under the influence of epinephrine. From the central nervous system, symptoms may appear in the form of loss of consciousness, hypoesthesia, muscle tremors, twitching and severe headache.
If we consider the cardiovascular system, Ultracaine can lead to tachycardia, heart rhythm disturbances, and heart failure.
An allergic reaction manifests itself in the form of rhinitis, difficulty breathing, urticaria, itching, and angioedema. Double vision and blurred vision may also occur.
Scandonest SVC
If the patient belongs to a risk group (with severe concomitant diseases , in particular cardiovascular pathology ), the use of an anesthetic solution with adrenaline, a vasoconstrictor, should be completely abandoned. In such cases we use Scandonest SVC . This anesthetic exhibits a vasoconstrictor effect, i.e. has vasoconstrictor properties and can therefore be used without adrenaline, which means that the drug does not contain sulfites and can also be used in patients with bronchial asthma and allergic conditions (after an allergy test). Scandonest SVC is a medium-strength anesthetic; provides anesthesia, depending on which part of the jaw the doctor disconnects from pain sensitivity, for 20 - 90 minutes, which sets it apart from the group of other non-adrenaline anesthetics.
Interaction with other drugs
Ultracaine D-S is not recommended for use with cardio-nonselective adrenergic blockers. It is also prohibited to consume alcohol while administering the solution.
Ultracaine is a local anesthetic solution that is mainly used in dentistry.
When performing various interventions, low toxicity and high efficiency allow the anesthetic to be administered to patients without much harm to their body. This article is for informational purposes only, please consult your doctor for details! Ask your doctor about contraindications and side effects.
Ultracaine: price of anesthesia
The cost of 1 carpule of Ultracaine is from 90 rubles (this is the price at which dental clinics purchase it). But in a dental clinic using Ultracain, the price for anesthesia will be approximately 400 to 500 rubles. Unfortunately, you won’t be able to buy a carpule of anesthetic at a pharmacy and bring it with you. This is strictly prohibited by law, because... In this case, the dentist cannot guarantee that the anesthetic is not counterfeit or that it was stored correctly. As a result, the dentist will in any case be to blame for the complications and will be held responsible for it.
Children
It should be noted separately the features of local anesthesia in children. The technique of local anesthesia in children must be planned so that 100% pain relief is achieved at all stages of treatment, otherwise it will be impossible to carry out the necessary manipulations.
As mentioned above, children under 5 years of age are given an anesthetic without adrenaline (3% scandonest SVC, or septanest 4% SVC).
Children over 5 years old can use an anesthetic with low concentration adrenaline (1:200,000 - Ultracaine DS). The dose of drugs is selected depending on age. Pain relief is performed in children in 3 stages:
- First, a superficial anesthetic gel is applied
- then a small dose (0.1-0.2 ml) of anesthetic is administered;
- after which, after 60-90 seconds (time sufficient for effective anesthesia of the needle path in the soft tissues), the remaining amount of the planned dose of anesthetic is administered.
We wait 5-10 minutes until complete anesthesia occurs. The child, feeling a complete absence of pain, gains confidence in the doctor and gives the opportunity to carry out the necessary intervention.
Anesthesia “Ultracaine”
There are times when it is impossible to do without anesthesia. Until recently, dentists used arsenic, which has a detrimental effect on the nerves. A new approach to dental pain relief has become possible thanks to ultracaine.
Advantages
Ultracaine is characterized by high efficiency and minimal side effects. It is twice as effective as lidocaine, and six times more effective than novocaine. Quickly passes into the tissue without affecting cardiovascular activity.
The active ingredients do not penetrate the placental barrier and do not enter breast milk, so the drug can be used during pregnancy and lactation.
Composition of the medicine
The active ingredients of the drug are hydrochlorides of artacaine and adrenaline (epinephrine).
Types of anesthetic
Ultracaine is available in three forms:
- DS Forte - due to its increased duration of action, it is ideal for operations and dental depulpation. Contraindicated in asthma, thyroid pathologies, hypertension, pregnancy and breastfeeding.
- DS - can be used during pregnancy, lactation, heart and vascular diseases. Contraindicated in asthma and thyroid pathologies.
- D - does not contain epinephrine, the duration of action is short - no more than half an hour. The drug is recommended for diseases of the thyroid gland, allergies, hypertension, asthma, and heart pathologies.
Mechanism of action
Ultracaine is used for local and regional anesthesia. It has a vasoconstrictor effect, thereby reducing pain.
The anesthetic effect appears almost instantly (in half a minute) and lasts for 1-5 hours. The drug blocks the transmission of nerve impulses, causing the patient to temporarily lose sensation.
It is eliminated from the body naturally within 6-12 hours.
The doctor selects the dosage and form of the medicine individually for each patient, taking into account age, weight, type of manipulations performed, and degree of complexity.
Indications and contraindications
Anesthetic is recommended for:
- filling, depulping and extraction of teeth;
- preparing the tooth for prosthetics;
- opening abscesses;
- inflammation of the maxillofacial area;
- surgical interventions.
Ultracaine is contraindicated for:
- individual intolerance to ingredients;
- anemia;
- heart failure;
- arterial hypertension;
- alcohol intoxication;
- less than 4 years of age.
Use with caution in case of bronchial asthma, arrhythmia, diabetes mellitus, hyperthyroidism.
Ultracaine should not be administered intravenously or injected into inflamed areas, or used simultaneously with inhibitors, beta-blockers and anticoagulants.
Failed anesthesia
I would also like to touch upon the topic of unsuccessful local anesthesia. Almost every dentist has encountered this in their practice. The reasons for this phenomenon can be classified into 2 groups:
- depending on the doctor (poor choice of anesthesia technique and anesthetic solution; errors in the technique);
- depending on the anatomical and psychological characteristics of the patient.
To eliminate psychological causes in patients with a labile psyche (with increased emotionality, sensitivity, excitability), premedication is used: sedatives and sedatives.
In all other cases, the doctor must approach the choice of anesthetic and local anesthesia technique with even greater responsibility and professionalism, starting from the very first minutes of communication with the patient (history collection).
You should always remember that there are NO teeth that cannot be anesthetized, it’s just sometimes more difficult to achieve this.
High-quality pain relief minimizes patient discomfort and allows dentists to perform the necessary interventions.
Natalya Lvovna Mayorova doctor - therapist - dentist October 2009
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