The document discusses techniques for providing local anesthesia to children during dental procedures, including using topical anesthetics to numb the injection site, distracting the child during needle insertion, slowly injecting small amounts of local anesthetic, and advising the child on what numbness to expect. It also recommends infiltration over nerve block anesthesia for young children's lower molars and intrapapillary over palatal injections in the upper jaw.

1. Local Anesthesia for
Dental Child Patient
Presented by
Dr. Rasha Hatem
Lecturer of Pediatric Dentistry and
Public Health
Faculty of Oral and Dental Medicine
Cairo University

2. Local Anesthesia for Dental Child
Patient
* Local anesthesia is the most common method of
pain control in dentistry.
* This method of eliminating pain is painful itself
and can be very distressing to the child patient.

3. Topical anesthesia or surface anesthesia:
Applied to injection site to make needle insertion painless.
Forms of topical anesthesia:
- Paste (ointment, cream, gel).
- Solution (spray in pressurized container).
- Cotton pellets.
- Adhesive discs.

4. Requirements of an acceptable topical anesthesia:
1- Of pleasant taste.
2- Fast acting and effective.
3- Causes no irritation.
Use of topical paste is better than spray because
the spray splatters and reaches the soft palate
causing gagging sensation.

5. Local anesthesia:
1- Preparation of the child patient:
- He is told that his tooth is going to be "put to sleep".
- At first "a paste" will be applied to put the gum to sleep,
and then it will be "washed away".
- Parents should not interfere or comment.
2- Application of topical anesthesia:
- Should be applied to dried mucous
membrane.
- Use one end of cotton wool roll to dry site
of insertion and other end to apply the
paste. In nerve block injection the child
may hold the cotton wool roll between
teeth to localize topical anesthetic paste.
- Wait for about 2 minutes before giving the
injection to allow topical anesthesia to
work.

6. - Warm local anesthetic carpule between hands before use.
- Apply pressure to injection site using your finger before injection.
- Stretch the tissues before insertion of needle to facilitate penetration.
- Concealment of the syringe from the child.
The assistant gives you the syringe in working position before
injection and receives it when injection is complete.
Pass the syringe below the child's chin and out of his field of vision.
3- Injecting local anesthetic solution:

7.  Distract child's attention at moment of needle insertion.
 Inject the first drop on penetration wait for a moment, then
inject slowly.
 After completing the local anesthetic injection tell the child what
he is going to feel (numbness, feels big or fat…….).
 About 1 ml of the 1.8 ml carpule produces profound anesthesia
in children under 10 years of age.
 Allow enough time before starting any procedure.
 Use fine gauge needle (gauge 27 for aspirating and gauge 30 for
non aspirating).

8. Local Anesthetic techniques
Upper jaw and lower anterior teeth
(Infiltration anesthesia)
- All the maxillary and lower anterior teeth can be
anesthetized by infiltration anesthesia using a
short needle.

9. - In case of extraction in upper jaw avoid palatal injection
(very painful).
- As an alternative give intrapapillary injection.

10. Lower Posterior Teeth
(Nerve block anesthesia)
- Used for all mandibular molars.
- Used to anesthetize large area with fewer injections.
- Used when there is localized infection in area of infiltration
site.

11. Some points to be followed to deliver a
painless local anesthetic injection:
1- Apply topical anesthetic paste to dried mucous
membrane and give sufficient time for topical
anesthesia to work.
2- Warm local anesthetic carpule between hands.
3- Apply pressure to injection site.
4- Stretch tissues.
5- Concealment of syringe.
6- Distract child's attention.

12. 7- Inject first drop, then wait, inject slowly.
8- Use only 1ml of solution.
9- Use fine gauge needle.
10-Tell the child what he is going to feel.
11- Use infiltration anesthesia instead of nerve
block anesthesia for lower molars in very
young children.
12- Use intrapapillary injection instead of
palatal injection for extraction in upper jaw.