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Local Anesthesia
for children
BY:
Mennat Allah Alkaram
Under supervision of:
Professor Nagwa Khattab
Local anesthesia:
Temporary loss of sensation
including pain in one part of
the body produced by a
topically applied or injected
agent without depressing the
level of consciousness
Why?
• pain control during
procedures which can serve
to build trust and foster the
relationship of the patient
and dentist.
• Control hemorrhage.
• Diagnostic tool.
Composition:
• Local anesthetic agent.
• Vasoconstrictors.
• Preservatives.
• Fungicide.
• Vehicle.
Nerve Supply of Deciduous teeth:
Topical anesthetics:
• Topical anesthetic is effective
on surface tissues (up to two
to three mm in depth) to
reduce painful needle
penetration of the oral
mucosa.
• Topical anesthetic agents are
available in gel, liquid,
ointment, patch, and aerosol
forms.
• Compounded topical
anesthetics and the risk of
methemoglobinemia.
Topical anesthetics
The mucosa at the site of the
intended needle insertion is
dried with gauze.
A small amount of the topical
anesthetic agent is applied to
the tissue with a cotton swab.
use the smallest effective
amount to avoid anesthetizing
the pharyngeal tissues ( cause
gaging).
Different L.A. techniques
•Infiltration (maxillary and
lower anterior teeth)
•Nerve block (lower
posterior teeth)
• Intra papillary injection
•Intra ligamental injection
•Intra-osseous injection
•Intra pulpal injection
•Jet Injection
Inferior alveolar nerve block in
children should be at a lower and
posterior position than adult as
mandibular foramen is situated at
a lower level than occlusal plane
(depends on child age).
Lower primary molars in the
very young children (before
eruption of first permanent
molar) can be anesthetized by
infiltration.
Infiltration VS Nerve block
For extraction: give
first buccal
anesthesia, then give
inter-papillary
injection instead of
palatal or lingual
painful infiltration(M
& D to the tooth to be
extracted)..
Intera-ligamental injection
Indications:
• pediatric or disabled patients when
there is concern of postoperative tissue
trauma to the lip or tongue.
• bleeding disorders pt (because it is
injected in a site with limited blood
circulation).
Contraindication:
primary teeth with a developing permanent
tooth bud as there have been reports of
enamel hypoplasia in permanent teeth
following PDL injection
Technique:
• 30 degree in respect to root axis
• Single rooted tooth: 2 injections,
multirooted tooth: one injection for each
root
• Each injection: 0.2 ml
Jet injection
• principle : small quantities of
liquids forced through very
small openings under high
pressure can
penetrate mucous
membrane or skin without
causing excessive tissue
trauma.
• Indications:
• produces
surface anesthesia
(instead of topical
anesthesia).
• gingival anesthesia before
a rubber dam clamp
placement
McDonald and Avery's Dentistry for the Child and Adolescent (Tenth Edition), 2016
Recent Modalities:
•Computer-Controlled
Anesthetic delivery system
(WAND)
•Electronic dental anesthesia
Painless
insertion
of the
needle:
-
Painless
insertion
of the
needle:
• Anesthetic toxicity (overdose)
• Allergic reactions.
• Paresthesia (persistent of anesthetic sensation).
• Postoperative soft tissue injury.
Common complication
in children: Lip Injury
How to Avoid:
• Till the parents to watch the
child for at least 2 hours
• A cotton role could be placed
between teeth and lip and
secured by dental floss
Maximum recommended dose to avoid toxicity:
Maximum Recommended Doses:
4.4 mg/kg body weight with vasoconstrictor.
Dose Calculation:
2% lidocaine = 20 mg/ ml
1 carpule = 1.8ml
Amount of LA in 1 carpule = 20X 1.8 =
36mg/carpule.
Example:
20 Kg child can tolerate a maximum dose of 2%
lidocaine with
vasoconstrictor of LA ----------
4.4 X 20= 88 mg = 2.4carpules.
Local Anesthetic techniques for child dental patient.pptx

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Local Anesthetic techniques for child dental patient.pptx

  • 1. Local Anesthesia for children BY: Mennat Allah Alkaram Under supervision of: Professor Nagwa Khattab
  • 2. Local anesthesia: Temporary loss of sensation including pain in one part of the body produced by a topically applied or injected agent without depressing the level of consciousness
  • 3. Why? • pain control during procedures which can serve to build trust and foster the relationship of the patient and dentist. • Control hemorrhage. • Diagnostic tool.
  • 4. Composition: • Local anesthetic agent. • Vasoconstrictors. • Preservatives. • Fungicide. • Vehicle.
  • 5. Nerve Supply of Deciduous teeth:
  • 6. Topical anesthetics: • Topical anesthetic is effective on surface tissues (up to two to three mm in depth) to reduce painful needle penetration of the oral mucosa. • Topical anesthetic agents are available in gel, liquid, ointment, patch, and aerosol forms. • Compounded topical anesthetics and the risk of methemoglobinemia.
  • 7. Topical anesthetics The mucosa at the site of the intended needle insertion is dried with gauze. A small amount of the topical anesthetic agent is applied to the tissue with a cotton swab. use the smallest effective amount to avoid anesthetizing the pharyngeal tissues ( cause gaging).
  • 8. Different L.A. techniques •Infiltration (maxillary and lower anterior teeth) •Nerve block (lower posterior teeth) • Intra papillary injection •Intra ligamental injection •Intra-osseous injection •Intra pulpal injection •Jet Injection
  • 9. Inferior alveolar nerve block in children should be at a lower and posterior position than adult as mandibular foramen is situated at a lower level than occlusal plane (depends on child age).
  • 10. Lower primary molars in the very young children (before eruption of first permanent molar) can be anesthetized by infiltration. Infiltration VS Nerve block
  • 11. For extraction: give first buccal anesthesia, then give inter-papillary injection instead of palatal or lingual painful infiltration(M & D to the tooth to be extracted)..
  • 12. Intera-ligamental injection Indications: • pediatric or disabled patients when there is concern of postoperative tissue trauma to the lip or tongue. • bleeding disorders pt (because it is injected in a site with limited blood circulation). Contraindication: primary teeth with a developing permanent tooth bud as there have been reports of enamel hypoplasia in permanent teeth following PDL injection Technique: • 30 degree in respect to root axis • Single rooted tooth: 2 injections, multirooted tooth: one injection for each root • Each injection: 0.2 ml
  • 13. Jet injection • principle : small quantities of liquids forced through very small openings under high pressure can penetrate mucous membrane or skin without causing excessive tissue trauma. • Indications: • produces surface anesthesia (instead of topical anesthesia). • gingival anesthesia before a rubber dam clamp placement McDonald and Avery's Dentistry for the Child and Adolescent (Tenth Edition), 2016
  • 14. Recent Modalities: •Computer-Controlled Anesthetic delivery system (WAND) •Electronic dental anesthesia
  • 17. • Anesthetic toxicity (overdose) • Allergic reactions. • Paresthesia (persistent of anesthetic sensation). • Postoperative soft tissue injury.
  • 18. Common complication in children: Lip Injury How to Avoid: • Till the parents to watch the child for at least 2 hours • A cotton role could be placed between teeth and lip and secured by dental floss
  • 19. Maximum recommended dose to avoid toxicity: Maximum Recommended Doses: 4.4 mg/kg body weight with vasoconstrictor. Dose Calculation: 2% lidocaine = 20 mg/ ml 1 carpule = 1.8ml Amount of LA in 1 carpule = 20X 1.8 = 36mg/carpule. Example: 20 Kg child can tolerate a maximum dose of 2% lidocaine with vasoconstrictor of LA ---------- 4.4 X 20= 88 mg = 2.4carpules.