In the field of oral medicine, wisdom tooth extraction is a common and important treatment procedure. Many people have experienced the pain caused by wisdom teeth, and the safety and effectiveness of medication during tooth extraction directly affect the patient’s treatment experience and postoperative recovery. Next, let’s take a detailed look at what medications dentists use when extracting wisdom teeth.
Anesthetic drugs: Making the tooth extraction process “painless”
Before extracting wisdom teeth, the primary task is to ensure that the patient does not feel pain during the operation, which requires the use of anesthetic drugs. The principle of action of anesthetic drugs is to block the conduction of nerve signals, causing a temporary loss of sensation in the local area. At present, the anesthetic drugs commonly used by dentists when extracting wisdom teeth are mainly divided into two categories: local infiltration anesthetics and block anesthetics.
Local infiltration anesthetics
Local infiltration anesthetics inject drugs into the tissues near the surgical area, temporarily depriving the nerve endings in that area of their ability to conduct pain. The commonly used drug is lidocaine, which has the characteristics of rapid onset, definite anesthetic effect and moderate maintenance time. Generally speaking, lidocaine takes effect within 1 to 3 minutes after injection, and the anesthetic effect can last for 1 to 2 hours. This medicine is suitable for some relatively simple wisdom tooth extraction surgeries, such as when the wisdom tooth is located relatively shallowly, the root is short and there is no obvious adhesion.
When using lidocaine, dentists will adjust the drug concentration and dosage according to the specific condition of the patient. The commonly used concentration is 1% – 2%, and the maximum dose for adults at one time should not exceed 400mg. In addition to lidocaine, procaine was also a widely used local invasive anesthetic in the past. However, due to its tendency to cause allergic reactions, its usage frequency has gradually decreased now.
Block anesthetics
Block anesthetics work by injecting the drug near the nerve trunk to block the conduction of nerve impulses, thereby exerting an anesthetic effect in the area innervated by that nerve. Commonly used block anesthetics include lidocaine, atecaine, etc. Tetracaine, commercially known as Bilanma, is increasingly widely used in clinical practice due to its advantages such as good anesthetic effect, low toxicity and strong penetration.
The onset time of atecaine is faster than that of docaine. It usually takes effect within 30 seconds to 1 minute after injection, and the duration of anesthesia can reach 2 to 3 hours. It is particularly suitable for some complex wisdom tooth extraction surgeries, such as when the wisdom tooth is located deep, the root is curved, and it is closely related to important anatomical structures. When using tetracaine, the commonly used concentration is 4%, and the general injection dose for adults does not exceed 7mg/kg of body weight.
When performing block anesthesia, dentists need to accurately grasp the injection site and method to ensure that the drug can precisely act on the target nerve. At the same time, due to the relatively large range of block anesthesia, patients may experience numbness in the face and lips after injection. These are all normal anesthetic reactions and will gradually return to normal as the effect of the drug wears off.
Postoperative analgesic drugs: Relieve pain after tooth extraction
After wisdom teeth are extracted, the wound can cause pain. To alleviate the patient’s suffering, analgesic drugs are usually used after the operation. The function of postoperative analgesic drugs is to relieve pain symptoms by inhibiting the generation or conduction of pain signals in the body. Common postoperative analgesic drugs include non-steroidal anti-inflammatory drugs and opioid analgesics.
Non-steroidal anti-inflammatory drugs
Non-steroidal anti-inflammatory drugs are the most commonly used analgesics after wisdom tooth extraction surgery. The mechanism of action of this type of drug is to inhibit the synthesis of prostaglandins in the body, thereby reducing inflammatory responses and pain perception. Common drugs include ibuprofen, acetaminophen, etc.
Ibuprofen has antipyretic, analgesic and anti-inflammatory effects, and can effectively relieve mild to moderate pain. Its analgesic effect is relatively mild and has few side effects. The common side effects mainly include gastrointestinal discomfort, such as nausea, vomiting, and stomach pain. It is generally recommended that adults take 0.3 to 0.6 grams each time, once every 4 to 6 hours, and the maximum dose within 24 hours should not exceed 2.4 grams.
Acetaminophen mainly exerts antipyretic and analgesic effects by inhibiting the synthesis of prostaglandins in the central nervous system. Its analgesic effect is similar to that of ibuprofen, but its anti-inflammatory effect is relatively weak. Acetaminophen has relatively high safety and rarely causes adverse reactions in the gastrointestinal tract, making it suitable for patients with weak gastrointestinal function. The commonly used dose for adults is 0.5g each time, once every 4 to 6 hours, and the maximum daily dose should not exceed 2g.
Opioid analgesics
Opioid analgesics are mainly used to relieve moderate to severe pain. This type of drug exerts a powerful analgesic effect by binding to opioid receptors in the central nervous system and inhibiting the conduction of pain signals. Common drugs include codeine, tramadol, etc.
Codeine is a weak opioid analgesic, and its analgesic effect is stronger than that of non-steroidal anti-inflammatory drugs. It has a certain effect in relieving pain after tooth extraction, but codeine is addictive and long-term use may lead to drug dependence. Therefore, it is generally not recommended for routine use. It should only be considered when the patient’s pain is severe and non-steroidal anti-inflammatory drugs cannot effectively relieve it. The common dosage for adults is 15-30 mg each time, once every 4-6 hours.
Tramadol is also a weak opioid analgesic. Its analgesic mechanism is rather complex. Besides acting on opioid receptors, it can also inhibit the reuptake of norepinephrine and serotonin and enhance the regulatory effect of the central nervous system on pain. The analgesic effect of tramadol is similar to that of codeine, but its addictive nature is relatively low. The commonly used dose for adults is 50-100 mg each time, once every 4-6 hours, with a maximum daily dose not exceeding 400mg.
It should be noted that opioid analgesics have relatively more side effects. Besides addiction, they may also cause adverse reactions such as nausea, vomiting, dizziness, drowsiness and respiratory depression. Therefore, when using such drugs, dentists will strictly control the indications and dosage, and closely observe the patient’s response.
Anti-inflammatory drugs: To prevent and control postoperative infections
Extracting wisdom teeth can cause wounds in the mouth. To prevent and control wound infection and promote wound healing, dentists usually prescribe anti-inflammatory drugs to patients. Anti-inflammatory drugs are mainly divided into antibiotics and antibacterial mouthwashes.
Antibiotics
Antibiotics are drugs that exert an anti-infection effect by inhibiting or killing bacteria. After wisdom tooth extraction surgery, commonly used antibiotics include amoxicillin, cephalosporin antibiotics, metronidazole, etc.
Amoxicillin belongs to the β -lactam class of antibiotics. It exerts its bactericidal effect by inhibiting the synthesis of bacterial cell walls. Amoxicillin has good antibacterial activity against most common oral bacteria and is suitable for preventing infection after general wisdom tooth extraction. The common dosage for adults is 0.5g each time, once every 8 hours. It is generally recommended to take it continuously for 3 to 5 days. However, it should be noted that patients allergic to penicillin drugs are prohibited from using amoxicillin.
Cephalosporin antibiotics are also a widely used type of antibiotic. Their mechanism of action is similar to that of amoxicillin, killing bacteria by inhibiting the synthesis of bacterial cell walls. Cephalosporin antibiotics are classified into first-generation, second-generation, third-generation, etc. based on their different antibacterial spectra and antibacterial activities. After wisdom tooth extraction surgery, commonly used drugs include cefradine and cefaclor, etc. The common adult dose of cefradine is 0.25-0.5g each time, once every 6 hours. The common adult dose of cefaclor is 0.25g each time, once every 8 hours. Similarly, patients allergic to cephalosporin drugs are prohibited from using it.
Metronidazole belongs to the nitroimidazole class of antibiotics and has a powerful antibacterial effect on anaerobic bacteria. The wound environment in the oral cavity is suitable for the growth of anaerobic bacteria. Therefore, after wisdom tooth extraction surgery, metronidazole is often used in combination with amoxicillin or cephalosporin antibiotics to enhance the anti-infection effect. The commonly used dose for adults is 0.4g each time, once every 8 hours. Common side effects of metronidazole include nausea, vomiting, and a metallic taste in the mouth. A few patients may experience neurological symptoms such as headache and dizziness.
Antibacterial Mouthwash
Antibacterial mouthwash can directly act on the surface of oral wounds, inhibit the growth and reproduction of bacteria in the mouth, keep the mouth clean and prevent wound infection. Common antibacterial mouthwashes include chlorhexidine mouthwash and siderylammonium chloride mouthwash, etc.
Chlorhexidine mouthwash is a broad-spectrum antibacterial agent. It can adhere to the surface of bacteria and destroy their cell membranes, thereby achieving the purpose of sterilization. Chlorhexidine mouthwash has a good inhibitory effect on common Gram-positive bacteria, Gram-negative bacteria and anaerobic bacteria in the oral cavity. When in use, it is generally recommended to take 10-15 ml each time, gargle for 1-2 minutes, and use it 3-4 times a day. Long-term use of chlorhexidine mouthwash may cause side effects such as discoloration of teeth and tongue surface and changes in taste, but these side effects usually disappear gradually after stopping the use.
Sypyridium chloride mouthwash is also a commonly used antibacterial mouthwash. It exerts its antibacterial effect by reducing the surface tension of bacteria and altering the permeability of bacterial cell membranes. Sypyridinium chloride mouthwash has an inhibitory effect on various bacteria in the oral cavity, and its usage method is similar to that of chlorhexidine mouthwash. Its side effects are relatively few and generally do not cause problems such as tooth discoloration.
Other auxiliary drugs
In addition to the main drugs mentioned above, some auxiliary drugs are sometimes used during the process of wisdom tooth extraction. For instance, during an operation, if there is a significant amount of bleeding, hemostatic drugs such as epinephrine may be used. Adrenaline can constrict blood vessels and reduce bleeding, but the dosage and concentration need to be strictly controlled when used to avoid adverse reactions such as elevated blood pressure and arrhythmia.
In addition, for some patients who are nervous or fearful about the surgery, dentists may prescribe some sedative drugs based on the situation to help them relax and better cooperate with the surgery. However, the use of sedative drugs requires extreme caution. The decision on whether to use them and the dosage must be made by a professional doctor after evaluating the patient’s physical condition.
Precautions for Drug Use
Allergy history notice: Before undergoing wisdom tooth extraction treatment, patients must provide the dentist with detailed information about their drug allergy history. Whether it is anesthetic drugs, analgesic drugs or anti-inflammatory drugs, they all may cause allergic reactions. Severe allergic reactions can even be life-threatening. Therefore, truthfully informing the history of allergies is an important prerequisite for ensuring the safety of medication.
Drug interactions: If the patient is taking other medications, they also need to inform the dentist. Because different drugs may interact with each other, affecting their efficacy or increasing the risk of adverse reactions. For example, when non-steroidal anti-inflammatory drugs are used in combination with anticoagulants, the risk of bleeding may increase. When certain antibiotics are used in combination with hypoglycemic drugs, it may affect the control of blood sugar.
Take medicine as prescribed: After the operation, patients must strictly follow the dentist’s instructions to use the medicine, including the dosage, time of administration and course of treatment, etc. Do not increase or decrease the dosage of the medicine or stop taking it by yourself, as this may affect the treatment effect or cause the disease to recur.
Observe drug reactions: During the medication process, patients should closely observe their own physical reactions. If any discomfort symptoms occur, such as rashes, itching, breathing difficulties, dizziness, nausea, etc., you should contact a dentist or seek medical attention promptly.
Conclusion
All kinds of drugs used by dentists during the process of extracting wisdom teeth have their specific functions and application methods. Understanding the relevant knowledge of these drugs can help patients better cooperate with the treatment, alleviate pain and promote postoperative recovery. Meanwhile, patients should strictly follow the doctor’s advice during the treatment process to ensure the safety and effectiveness of the medication.
Related topics:
Can wisdom teeth be removed? Will there be any sequelae?
What should I do if my wisdom teeth don’t grow out and it hurts?
What is the success rate of Osstem dental implants?
