The local anesthetic drugs presently available and used in dentistry represent the safest and most effective drugs in all of medicine for the prevention and management of pain. The dental profession purchased in excess of 300 million local anesthetic cartridges in the United States in 2006, making local anesthetics the most-used drugs in the dental profession. One drawback associated with intraoral local anesthesia is patients’ fear of injections and the perception that these are painful. Recent advances have resulted in the use of computer-controlled local anesthetic delivery vehicles to regulate the delivery and rate of flow of local anesthetics at the injection site, lessening potential discomfort associated with injections. New injection techniques that provide reliable anesthesia have also been introduced, and depending on the technique used and area of anesthesia necessary, they do not result in undesired extraoral soft tissue anesthesia. These new injection techniques have been aided by the use of computercontrolled local anesthetic delivery systems.

Modern general anesthesia and conscious sedation procedures are predictable, effective, and safe with appropriate patient selection, drugs and techniques. The use of conscious sedation in dentistry in office-based settings continues to increase. Nitrous oxide is the most commonly used inhalation anesthetic (sedative) used in dentistry, and has withstood the test of time with an excellent safety record. It reduces anxiety, pain, and memory of the treatment experienced, and is a valuable component of the armamentarium available to clinicians.

Oral irritations and ulcerations occur frequently in the general population. Recurrent aphthous ulcers (RAU) are the most common. There are three types of RAU -- minor, major and herpetiform, the most common being minor aphthae. The exact etiology of RAU is not known. Systemic and local factors, as well as infectious agents, have been proposed. Certain medications and foods are associated with oral ulcerations, and chemicals such as sodium lauryl sulfate (SLS) contained in dentifrices have also been implicated. RAU also occur in more serious systemic diseases and where appropriate patients should be referred for screening and medical care. Treatment of recurrent aphthous ulcers is palliative, based on the severity of the lesions. Both topical and systemic medications are available. Nutritional and oral hygiene advice should also be given, and if patients are sensitive to SLS, a low-dose SLS or SLS-free dentifrice should be recommended.

Nitrous oxide was discovered and first prepared in 1793 by an English scientist and clergyman named Joseph Priestley. Since then nitrous oxide has proven to be a safe and popular agent utilized by many dental practices. In this setting, its use is usually as a mild sedative and analgesic. It helps to allay anxiety many patients may have toward dental treatment, and it offers some degree of analgesia. As such, its use for phobic patients has been well established and remains its primary indication. Relative contraindications to the use of nitrous oxide include patients with psychiatric disorders, blocked eustachian tubes, bowel obstruction, colostomy bags, gas in the ocular orbit, and large tubercular lesions in the lung. When administered appropriately, nitrous oxide is a safe and valuable asset in decreasing the pain and anxiety experienced by dental patients.

Many studies show that prilocaine is as effective as any amide local anesthetic in the marketplace for adults and children. The choice of which local anesthetic to use might be decided upon by considering the duration of pulpal anesthesia required. Prilocaine can produce maximum pulpal anesthesia with minimal vasoconstrictor use, or it can provide short duration pulpal anesthesia with no vasoconstrictor use. As well, there are advantages to limiting or even completely eliminating vasoconstrictor from the local anesthetic solution. The patient’s medical history, acidification of tissues and pulpal insult are some of the factors to consider. Prilocaine is an effective drug to add to your local anesthesia armamentarium.

Caries remains an endemic problem worldwide. A number of primary and contributory factors determine whether or not caries develops as well as a patient’s risk, while risk modifiers mitigate caries risk. Fluoride has played a central role for several decades in caries prevention, with in-office and home-care options available. Performing an individual risk assessment enables the dental professional to determine the level and type of preventive care appropriate for a particular patient.

Science has identified three factors involved in decay: pathogenic bacteria, poor dietary habits and xerostomia. The Caries Balance Theory states that caries is the outcome of the complex interaction of pathologic and protective factors. The caries process involves demineralization and remineralization of teeth. Caries management requires risk assessment. For patients at risk, preventive therapies available include the use of antimicrobials, fluorides, xylitol, calcium and phosphate products, baking soda products and glass ionomers.