Local anaesthesia _pedo_

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  • 1. Various techniques of achieving LOCAL ANESTHESIA
  • 2. LOCAL ANESTHESIA Local anesthesia is defined as a loss of sensation in a circumscribed area of the body caused by a depression of excitation in nerve ending or an inhibition of the conduction process in peripheral nerves. - Malamed 1980
  • 3. Different techniques of achieving LA Local infiltration Field block Nerve block Intraligamentry Intraseptal Intrapulpal Intraosseous injection Jet injector Computer controlled local anesthetic delivery system Electronic dental anesthesia Topical anesthesia
  • 4. Local infiltration In local infiltration, small terminal nerve endings in the area of the surgery are flooded with local anesthetic solution, rendering them insensitive to pain or preventing them becoming stimulated & creating an impulse. Incision is made into the same area in which the LA has been deposited.
  • 5. Field block Method of securing regional anesthesia consisting of depositing a suitable LA solution in proximity to the large terminal nerve branches so that the area to be anesthetized is circumscribed to prevent the central passage of afferent impulses Incision is made into an area away from the site of injection
  • 6. Nerve block Method of securing regional anesthesia by depositing LA solution within close proximity to a main nerve trunk Usually at a distance from the site of operative intervention
  • 7. Periodontal ligament injection Indications 1. Pulpal anesthesia of one or two teeth in a quadrant Contraindications 1. Infection or inflammation at the site of injection 2.Treatment of isolated teeth 2. Primary teeth when the in mandibular quadrant permanent tooth bud is present 3. Patient for whom residual soft tissue anesthesia is 3. Patient who requires a undesirable “numb” sensation for psychological discomfort 4. Situations in which regional block is contraindicated
  • 8. Intraseptal injection Indications When both haemostasis & pain control are desired for soft tissue & osseous periodontal treatment Contraindications Infection or severe inflammation at the site of injection
  • 9. Intrapulpal injection Deposition of LA directly into the pulp chamber of a pulpally involved tooth provides effective anesthesia for pulpal extirpation & instrumentation where other techniques have failed.
  • 10. Intraosseous injection Indications Pain control for dental treatment on single or multiple teeth in a quadrant Contraindications Infection or severe inflammation at the site of injection
  • 11. Jet injector
  • 12. Principle- based on principle that liquid forced through very small openings, called jets, at very high pressure can penetrate intact skin or mucous membrane The primary use of jet injector is to obtain topical anesthesia before the insertion of a needle In addition it may be used to obtain mucosal anesthesia of palate.
  • 13. Advantages 1. Does not require use of needle 2. Delivers very small amount of LA 3. Used in lieu of topical anesthesia Disadvantages 1. Is inadequate for pulpal anesthesia or regional anesthesia 2. May damage periodontal tissue 3. Many patients dislike the feeling accompanying use of the jet injector 4. Post-injection soreness of soft tissue may develop
  • 14. Computer-controlled local anesthetic delivery system The system enables a dentist or hygienist to accurately manipulate needle placement with fingertip accuracy and deliver the LA with a footactivated control
  • 15. Advantages 1. Precise control of flow rate & pressure, hence a more comfortable injection 2. Increased tactile feel 3. Non-threatening 4. Automatic aspiration 5. Rotational insertion technique minimizes needle deflection Disadvantages 1. Need for additional armamentarium 2. Increased cost
  • 16. Electronic Dental Anesthesia The method of achieving local anesthesia involves the use of the principle of transcutaneous electrical nerve stimulation {TENS} which has been used for the relief of pain
  • 17. Indications 1. In patients with needle phobia 2. Ineffective LA 3. Instances where LA cannot be administered Contraindications 1. Cardiac pacemakers 2. Neurological disorders 3. Pregnancy 4. Very young pediatric patients
  • 18. Topical anesthesia Anesthesia obtained by the application of a suitable agent to an area of either the skin or mucous membrane which it penetrates to anesthetize superficial nerve endings Spray Ointments & jelly EMLA (Eutectic mixture of LA)
  • 19. References:Shobha tandon –Text book of pedodontics, 1st edition 2001, published by Divyesh a kothari, page no.464-469 Stanley F. Malamed –Handbook of local anesthesia, fifth edition, published by Elsevier, page no. 255-268 & 352-358 Goran koch & Sven poulsen –Pediatric dentistry a clinical approach, 1st edition 2001, page no. 155-159 Richard R. welbury –Paediatric dentistry, second edition, page no. 78