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Le#er

 To  The  Parents  


Topical  Anaesthesia  
•  10%  lidocaine,  10%  prilocaine,  4%  tetracaine  in  an    aqueous  base  

•  compounding  pharmacy  

•  CAN  BE  SQUEEZED  ONTO  A  GAUZE  PAD  THEN  APPLIED  TO  SITE  FOR  
APPROXIMATELY  2  MINUTES-­‐  PROVIDES  ANESTHESIA  FOR  APPROXIMATE  
DURATION  OF  30  MINUTES.  

•  DOES  NOT  CAUSE  TISSUE  BURNING  AS  BENZOCAINE  REPORTEDLY  DOES.  

•  AFTER  APPLYING,  RINSE  OFF  AFTER  3  MINUTES  TO  PREVENT  SLOUGHING.  

•  CONTRAINDICATIONS:  any  paWent  with  a  known  sensiWvity  to  local  anestheWcs  of  
the  amide  type.  (Allergic  reacWons  of  the  amide  type  are  very  rare)  or  pera-­‐
aminobenzoic  acid.  Use  with  cauWon  in  paWents  with  hepaWc  disease  since  
metabolism  takes  place  in  the  liver.  
LOCAL  ANAESTHESIA    
•  Maxillary  anaesthesia  
 —supraperiosteal  infiltraWon  in  the  mucobuccal  fold  —
intrapapillary  injecWon  for  palatal  anesthesia  

•  Mandibular  anesthesia    
—supraperiosteal  infiltraWon  (effecWve  for  incisors  and  
canines  and  occasionally  effecWve  for  minor  operaWve  
procedures  on  primary  molars)  
 —inferior  alveolar  nerve  block  (effecWve  for  extensive  
operaWve  procedures  or  oral  surgical  procedures  on  
primary  (or  permanent)  molars.    
MAXIMUM  RECOMMENDED  DOSAGES  
COMMON  L.A.  

DRUG   MG/KG   MG/LB   ABSOLUTE  


MAXIMUM  DOSE  
AriWcane   7.0   3.2   500  
Lidocaine   4.4   2.0   300  
Mepivicaine   4.4   2.0   300  
Prilocaine   6.0   2.7   400  
Bupivacaine   2.0   0.9   90  
MAXIMUM  DOSE  EPINEPHRINE  
PATIENT  WEIGHT  (KG/LB)   MG   NO.  CARTRIDGES  
10/23   44   1.2  
15/34.5   66   1.8  
20/46   88   2.4  
25/57.5   100   2.7  
30/69   132   3.6  
40/92   176   4.8  
50/115   220   6.1  
60/138   264   7.3  
70/161   300   8.3  
COMPLICATIONS  OF  LOCAL  
ANESTHESIA  
—accidental  lip,  cheek  or  tongue  biWng  or  
scratching  from  prolonged  soj  Wssue  
anesthesia    
—more  common  in  very  young  or  
developmentally  disabled  child    
—warn  paWent  and  parent  of  possible  injury;  
advise  parent  to  watch  paWent  to  prevent  
injury  
Analgesics  
ANALGESIC   RECOMMENDED   ADVANTAGES   DISADVANTAGES   HOW  SUPPLIED  
DOSAGE  -­‐  ORAL  

Acetaminophen   10-­‐15mg/kgq4h   AnWpyreWc;  rare  side   No  anW-­‐  inflammatory   Drops:80mg/0.8ml  


(Tylenol,  Tempra,   effects   acWon   calibrated  dropper  
Panadol)   Mild  pain  relief   Suspension:160mg/5ml  
Chewable  tabs:  80mg  
tabs  
Tablets:  325  and  
500mg  tabs  
Ibuprofen  (Advil,   2-­‐8mg/kg,q6-­‐8  h   AnW-­‐  inflammatory,   Gastric  irritant,  may   Suspension:100mg/5ml    
Motrin)   good  relief  for   impair  clomng   Tablets:  200mg  
moderate  to  severe  
pain,  anWpyreWc  
Frankl’s  Scale  

•  The  gold  standard  of  behaviour  raWng  


scales  modified  by  Gerry  Wright.  
1)  definitely  negaWve  (  -­‐  -­‐  )  
2)  negaWve  (  -­‐  )  
3)  posiWve  (  +  )  
4)  definitely  posiWve  (  +  +  )  
Frankl  S  et  al,  Should  the  parent  remain  with  the  child  in  the  dental  operatory?  J  Dent  Chil,  2nd  
Quarter  1962;  29:  150  –  63.