Part 9

LOCAL ANESTHESIA FOR

DENTAL CHILD PATIENT

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LOCAL ANESTHESIA FOR DENTAL
CHILD PATIENT
One of the most important factors in successful
dental service for children is the control of pain during
the treatment. The procedure should be accomplished
with a minimum degree of discomfort.
Local anesthesia is the most common method of
pain control. Effective local anesthesia allows dental
procedures to be carried out painlessly. This method of
eliminating pain is painful itself and can be very
distressing to the child. Most cavity preparations, vital
pulp therapy, extraction of teeth and surgical procedure
require administration of local anesthesia. In children
dentistry, special techniques are required. The
procedure should be prepared and given properly.
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General principle:-
1.Explain to the child in terms of his language what you are
going to do for example the child will be told that to treat
his tooth properly and comfortably, this tooth is going to
be “put to sleep”.

2.The parents, if present in the operating room, should be

informed not to interfere or comment or ask their child to
open, or close his mouth or even try to help by
encouraging words.
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3.Use topical anesthesia:- An acceptable
topical anesthesia for oral use should be:
a- of pleasant taste
b- fast acting and effective
c- cause no irritation
d- topical anesthesia can be provided as paste (ointment, cream, gel)
or solution (spray) or cotton pellets or even adhesive disk.

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e- the use of past (ointment or cream) is better than the use of spray.
4. Use warm anesthesia solution.
5. Use fine-gauge (gage 30 for infiltration, gauge 27 for
block) and short 2-2.5 cm for infiltration and 3 cm for block.
6. Always try to have a dental nurse to assist.
7. Hold mucosa.
8. Inject slowly

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9. Warn about postoperative numbness (particularly in
block).
10. Pass the syringe below the child‘s chin and out of the field
of his vision.

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11. All maxillary and lower anterior teeth can be anesthetized
by filtration anesthesia.

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12. Lower primary molars can be anesthetized by infiltration or inferior
dental block, but in the very young (under 6 years) infiltration is
preferred.

13. In the case of extraction in upper jaw is to wait for the buccal
infiltration to have its effect and then to inject into the palatal aspect
of the intredental papillae from the buccal side distal and mesial to the
tooth to be extracted. This called intrapapillary injection. Now inject
into the blanched area on the palate for a nearly painless palatal
anesthesia.
14. When the buccal infiltration anesthesia is used in the lower jaw,
lingual anesthesia will be necessary for any extraction. An
intrapapillary injection as mention with maxillary teeth. 8
Types and Techniques
1. Infiltration injection.
2. Block injection.
3. Intra papillary.
4. Intra ligamentory.
5. Jet injection.

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1. INFILTRATION INJECTION
a- Fellow the general principle before.
b- Pull the cheek (lip) outwards so that the mucosa membrane
is made taut.
c- Position the tip of the needle, at the mucobuccal fold with the
long axis of the tooth, just above the tooth.
d- Inject few drops, then pause for few seconds, then advance the
needle carefully, and inject slowly.

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2. INFERIOR DENTAL NERVE BLOCK
a- A little topical anesthesia paste at the end of a cotton roll in contact
with the dried retromolar area is acceptable.
b- The mandibular foramen is situated at a lower level than the
occlusal plane of primary teeth. Therefore the injection must be made
slightly lower and more posteriorly than for adult.
c- The needle directed towards the injection site from the opposite
side over lower |D| area or (4)
d- If contact bone withdraws slightly and inject ½ the cartridge
slowly then withdraw ½ way and inject few drops slowly for analgesia
of lingual tissue.

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3. INFRA PAPILLARY INJECTION
a- for analgesia of palatal or lingual tissue.
b- when analgesia of soft tissue buccally obtained
by infiltration, pass the needle horizontally
through the papilla from buccal.

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4. INFRA LIGAMENT INJECTION
a- If given into the periodontal ligament using special syring.
b- Tooth should be free of calculus.
c- Introduce the needle into the gingival cervice down the
mesial or distal surface.
d- Inject few drops then move the needle apically about 2 cm,
and inject slowly.
e- For posterior teeth give a round each root.

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 5. JET INJECTION
a- A special designed jet syring (syrijet) is used.
b- Explain to the child that a spray is to be used to
make the gum or tooth go to sleep.
c- Clean the injection site with antiseptic solution.
d- Direct the long axis of the nozzle at right angle
to the undrelying bone, on attached gingiva near the
root apex do not exert pressure to the tissue
e- Warn the child that “the spray is coming”

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 Vasoconstrictors
• Constrict vessels and decrease blood flow to the site of
injection.
• Absorption of LA into bloodstream is slowed, producing
lower levels in the blood.
• Lower blood levels lead to decreased risk of overdose
(toxic) reaction.
• Higher LA concentration remains around the nerve
increasing the LA's duration of action.
• Minimize bleeding at the site of administration.
Improve quality of pain control and decrease the
potential toxicity of the LA.

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 POST-ANESTHESIA
TRAUMA
• The number one postoperative complication of
local anesthesia in children.

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POST-ANESTHESIA
TRAUMA

Minor to major. Always painful.

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Other Post-Anesthesia
Conditions

Blanching due to
vasoconstrictor

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Other Post-Anesthesia
Conditions

Hematoma due to local anesthesia

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 POST-ANESTHESIA
TRAUMA
Prevention:
• Remind both parent and child that area will
remain numb after the appointment.
• Caution that child should not to chew, bite or
pick at area. Extremely important for young
children and "first timers".
• Sometimes placing a cotton roll between the
teeth will help remind patient not to chew.

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 Local Anesthesia Allergy

RARE!
• If suspected have patient tested by allergist.

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Use minimum amount needed

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