**4. Common agents delivered by oral mesotherapy**

## **4.1 Local anesthesia**

*Periodontal Disease - Diagnostic and Adjunctive Non-surgical Considerations*

in place (being far more powerful and efficient) [6].

and collagenase are not approved by the FDA [9].

**3. Benefits and uses of mesotherapy**

tors that are activated [4].

**2. FDA and mesotherapy**

using mesogun [1]*.*

systemically [1].

the general practitioner [11].

layers and structures of the oral cavity.

ing tissues [2, 5, 6].

agent. The wider the mesointerface is, the greater the number of the dermal recep-

The technique depends on the skin characteristics and components. It determines the type of drug injected, the technique of injection, and the drug dosage. The skin has a natural sustained releasing property. Therefore, the nature of the skin determines the layers that are suitable for injection. The injection process must be in the superficial layers (intradermal) for the drug to remain as long as possible and for its clearance to become slower. If the drug is injected deeper, its clearance becomes faster. So the more superficial the injection is, the longer the drug remains

The FDA is the association concerning about the assurance of the food and drug

All the drugs used in mesotherapy are considered by the FDA as off-label used drugs. The off-label approval includes the approved drug and the approved route of administration of this drug. The local anesthetic agents calcitonin, hyaluronidase,

The local treatment in mesotherapy has superior advantages over the systemic one either oral or parental. Firstly, it avoids the side effects resulted from drug metabolism and excretion in the stomach, intestine, liver, and kidneys. Secondly, the effectiveness of the local drug is directly administrated into the area of interest. Finally, it minimizes the dosage used into 1% of the dosage used

Improvement of blood flow, removal of fibrotic tissue, an increase in the connective tissue quality and amount, hair loss (mesohair), skin rejuvenation (mesoglow), excessive fat and cellulite removal, improvement of the lymphatic drainage, osteoarthritis, and pain relief are the main medical indications of mesotherapy [10]. On the financial point of view, it is a cost-effective modality that provides successful drug delivery using inexpensive equipment with short-term practice needed for

Oral mesotherapy is an old technique which was commonly applied in order to introduce various agents. Infiltration, intraligamentary, intramucosal, intralesional, and intraepidermic injection are common names for oral mesotherapy technique that have been used previously. The different names were more related to different

safety. Although FDA did not approve the mesotherapy technique, it approved many drugs that have been used in mesotherapy as aminophylline, yohimbine, procaine, lidocaine, and marcaine [7]. Other drugs do not have the FDA approval for any purpose of usage as it is beyond the scope of FDA because they do not consider drugs as vitamins and minerals [8]. It also approved the delivery method

On the other hand, the vertical component depends on the depth of penetration. Mesotherapy could be injected in the epidermis, dermis, or subcutaneous [1]. The more superficial injection is, the longer the drug remains in the tissue. It permits sustained release of the drug with slow and progressive diffusion into the surround-

**70**

Local anesthesia is a reversible blockage of nerve conduction in a defined area that resulted in loss of sensation [12]. It can be performed using various techniques which differ according to the width of the area needed to be anesthetized as well as tissue depth and its relation to target nerve.

Local infiltration is one of the techniques in which the local anesthetic solution is administrated submucosal, intradermal, or intraligamentary in order to anesthetize the nerve endings that innervate the target region. The submucosal injection involves the drug administration in the deep dermis layer reaching the lipid layer with 45 angulation and thicker needle, while the intradermal injection involves introduction of anesthetic agent into the superficial dermis (papillary dermis) with 10 to 15 degrees using fine needle [13, 14]. Intraligamentary (or periodontal) anesthesia is a type of the locally delivered anesthetic technique in which the needle is introduced in the mesiobuccal and distobuccal directions delivering the anesthetic agent in an apical direction. Its accuracy, easiness, minimal administration of anesthetic solution, efficiency, and the lack of harmful effects to the adjacent periodontal apparatus are the main advantages of this technique [15, 16]. The pressure needed for such technique is necessary, and it remains the main cause behind the development of local inflammation and pain which may last up to 7 days as well as bone and root resorption in relation to the injection site [17]. Defective enamel disorders were also detected following intraligamentary injection of local anesthesia. In hemophilic patients, intraligamentary injections are usually not recommended to avoid hematoma formation. It was also avoided in deciduous teeth [18] (**Figure 1**).

On the other hand, the field block technique involves the introduction of the anesthetic agent in a circular configuration around the operative site [19].

The interseptal technique is a simple technique which provides adequate control of pain and bleeding especially during emergency conditions. During infection and inflammatory conditions, interseptal technique is usually preferred. A 27 gauge needle is inserted at 45° at the center of the interdental papilla. Minimal amount (0.2–0.4 ml) of the anesthetic agent is injected. It was found that interseptal technique showed higher anesthetic efficiency than the intraligamentary and intraosseous injection [18, 19].

The intrapulpal technique is one of the most common techniques that are used during endodontic treatment especially in acute phases of pulpal inflammation.

**Figure 1.** *Intraligamentary injection [18].*

**Figure 2.** *Corticosteroids and chronic gingival inflammation.*

Despite its rapid onset, effectiveness, and safeness, its action has shorter duration than other techniques [18]. Finally, the intraosseous technique provides rapid introduction, which is commonly used following failure of the field or nerve block technique. It depends on the direct introduction of the anesthetic agent to the interdental bone resulting in rapid delivery of the anesthetic agent to the blood circulation which should be avoided in cardiovascular patients [19] (**Figure 2**).
