Local Anesthesia Overview in Pediatric Dentistry

Local Anesthesia in Pediatric Dentistry

• Primary Purpose: To minimize pain and anxiety during dental procedures.

  Topical Anesthesia:

  • Availability: Most topical anesthetics are available, but benzocaine, which is often found in over-the-counter products, is not commonly used in the dental setting.
  • Rapid Onset and Longer Duration: Lidocaine is noted for its rapid onset and extended duration of action when applied topically.
  • Concentrations: While lidocaine is available in various concentrations, 4% is not mentioned as being available in topical form.
  • Total Dosage Calculation: It's crucial to consider the total amount of anesthetic administered both topically and injectably.
  • Drying the Mucosa: The ideal duration for topical anesthetic to remain on dry mucosa for optimal results is at least one minute.

• Lidocaine and Injected Amide Local Anesthetics: There is a potential risk of hypersensitivity to lidocaine when using injected amide local anesthetics.

• Mucosa Drying: Drying the mucosa is essential in preparing the injection site, not just before applying topical anesthetics, as it helps with needle penetration and anesthetic efficacy.

• Documentation: Following local anesthesia administration, it's essential to document the specific anesthetic type, dosage, and injection sites.

• Counterirritation: Applying pressure or coldness during local anesthesia administration is known as counterirritation, which helps distract the child from the injection's discomfort.

• Local Anesthesia with Sedatives: When local anesthesia is used alongside sedative drugs, this information must be included in the patient's documentation.

• Deposition Rate: The recommended rate for depositing a single carpule of local anesthetic is approximately 100 mg per minute.

• Dosage Concerns: Preoperatively, document any patient concerns related to local anesthetic dosage.

• Communication with Child: During injection, communicate with the child about the process in a calm and reassuring way, using simple language and incorporating positive reinforcement.

• Dental Assistant Role: The dental assistant plays a crucial role in assisting with the administration of local anesthesia, ensuring proper positioning, providing comfort, and assisting with aspiration.

• Needle Penetration: After needle penetration, avoid applying pressure or moving the needle abruptly, as this can cause discomfort and potential trauma.

Local Anesthesia Complications

• Paresthesia Risk: The risk of permanent paresthesia (numbness) with 4% local anesthetics is low.
• Paresthesia Commonality: Articaine and bupivacaine are more commonly associated with reports of paresthesia.
• Duration of Paresthesia: Most cases of paresthesia usually resolve within 24-48 hours.
• Bilateral Mandibular Blocks: Bilateral mandibular blocks are commonly reported to carry a** higher risk of soft tissue trauma** compared to unilateral blocks.
• Inferior Alveolar Nerve Foramen: The average position of the inferior alveolar nerve foramen in adults is approximately 3-4 mm below the occlusal plane.
• Postoperative Soft Tissue Injuries: Postoperative self-induced soft tissue injuries are more likely related to the patient's behavior or habitsrather than the anesthetic procedure itself.
• Caregiver Supervision: Postoperative supervision for children after local anesthesia is highly recommended, especially when feeding or chewing is involved, to prevent potential injuries.

Local Anesthetic Techniques

• Infiltration vs. Block: Infiltration and block anesthesia often have similar duration and efficacy, so one isn't generally considered more effective.
• Posterior Mandible: Inferior alveolar nerve blocks are considered the most dependable technique for anesthetizing the posterior mandible.
• Inadequate Block: A single inferior alveolar nerve block may be inadequate for some procedures due to the variability of nerve distribution and the presence of accessory canals.
• Middle Superior Alveolar Nerve: Traditionally, the middle superior alveolar nerve was considered independent, but recent studies suggest it may not be a distinct nerve.
• First Primary Molar Anesthesia: The first primary molar can be adequately anesthetized using a combination of supraperiosteal and infiltration techniques.
• Second Primary Molar: The presence of the tuberosity overlying the second primary molar can sometimes hinder the effectiveness of supraperiosteal injections.
• Bone Thickness Compensation: When bone thickness is an issue during maxillary anesthesia, the use of a long needle or supplementing with infiltration techniques can improve anesthetic effectiveness.
• Premolar Injection Site: The recommended injection site for the maxillary first or second premolar is in the buccal sulcus, directly over the root of the involved tooth.
• Premolar Buccal Cortical Bone: The buccal cortical bone over the roots of the premolars is often thinner than other regions, making anesthesia easier to achieve.
• Injection Technique: Supraperiosteal injections are preferred for infiltration and block anesthesia.
• Extraction When extracting maxillary primary molars or premolars, infiltration anesthesia is typically more effective and safer than block anesthesia.
• Palatal Tissues: Administering anesthesia to palatal tissues often presents unique challenges due to the thick palatal mucosa and underlying bone.
• Interdental Infiltration: The interdental infiltration technique is used to anesthetize the pulp of a specific tooth.
• Superficial Soft Tissue Anesthesia: Tingling or numbness in the superficial soft tissue, especially those surrounding the injection site, signifies that the anesthesia is taking effect.
• Nasopalatine Nerve Block: The nasopalatine nerve block is a technique that is uniquely administered through the incisive foramen.
• Needle Insertion: For the nasopalatine nerve block, the needle is inserted in the palatal mucosa, between the central incisors and the lateral incisors.
• Nasopalatine Nerve Block Discomfort: Applying pressure on the soft tissue before inserting the needle can minimize discomfort during the nasopalatine nerve block.