Local anesthesia

for
children
 Local anesthesia
 Surface anesthesia
 Non-pharmacological method
 Infiltration anesthesia
 Regional block anesthesia
 Intraligamentary anesthesia
 Surface anesthesia

 Physical method

 Intra-oral topical agents

 Topical anesthetic that will anesthetize skin

 Controlled release devices

 Jet injectors
 Intra-oral topical anesthesia

 Depth 2-3mm of surface tissue

 Lidocaine and benzocaine

 Available as sprays, solns, creams, or

ointments

 Application time is around 5 min

Surface anesthesia...

 For effective anesthesia, ensure:

 The area of application should be dried


Limited area

 Sufficient time
 Controlled release devices

 Active agents
incorporated into
materials that will
adhere to mucosa
and allow the slow
release of the agent

Bio-adhesive delivery system

of lidocaine
 Jet injectors

 A jet of soln under hi

pressure
 Over 1 cm depth
 In children with bleeding
diathesis
 For primary teeth
extractions
Jet injector...


Disadvantages

 Expensive equipment

 Soft tissue damage

 Frightening to children

 The unpleasant taste

Jet injector
Non pharmacological pain control

 Electrical stimulation

 Radio wave

 Hypnosis

Transcutaneous electrical
nerve stimulation (TENS)
 Infiltration anesthesia

 The method of choice in the maxilla

 0.5-1.0 ml is sufficient for pupal anesthesia in
children
 Deposited close to the apex of the tooth
 Buccal approach is employed
 The needle is directed towards the apex of the
tooth
 The soln is deposited supraperiosteally
Infiltration anesthesia...

Lip position yl and needle direction yn

recommended
 Intra-ligamentary anesthesia

 Very effective in children

 Intra-osseous injection with the local anesthetic
reaching the cancellous bone
 Small amount of soln about 0.2ml
 2% lidocaine with 1:80,000 epinephrine
 Rapid entry into circulation
Intra-ligamentry injection...


30 g needle at 30 deg with the
long axis of the tooth

 Gingival sulcus at the MB

aspect of each root
Intra-ligamentary anesthesia...


The needle is advanced until firm
resistance is met
 0.2ml under firm controlled
pressure
 Specialized syringes

Pistol grip intraligamentry

syringe
 Regional block

 Inferior alveolar nerve block

 In children the mandibular
foramen is low in relation to
the occlusal plane
Regional block...


Approach is from opposite side


Parallel to the occlusal plane


Mandibular retromolar region lateral
to the pterygomandibular raphe


About 5mm above occlusal plane


Medial border of mandible is
touched
Regional block...

 Mental nerve
 Mental foramen faces forward in children

 Thus it is easier for the soln to diffuse through the

foramen

 The needle is advanced in the buccal sulcus and directed

towards the region between the first and second primary
molars
Regional block...


Long buccal buccal infiltration

 Permanent lower incisors buccal and lingual

infiltrations
 Pain-free local anesthesia
 Depends on a number of
factors
 Equipment

Sharp and narrow needles

Speed of injection
 Materials
 Vasoconstrictors lower the
pH of local anesthetic soln

Techniques

The Wand computerized

injection system, which permits
slow delivery of soln
Pain-free local anesthesia...

 Techniques

Posterior maxillary buccal infiltration
 Dry the mucosa and apply a topical anesthetic for 5 min
 Wipe off excess topical anesthetic
 Stretch the mucosa
 Distract the patient
 Insert the needle—if bone is contacted withdraw slightly
 Aspirate

Inject 0.5—1.0 ml supraperiosteally over 15—30 s
Pain-free local anesthesia...

 Anterior max buccal infiltration

 Is very uncomfortable

Some preparatory steps are to be taken
 The area is anesthetized gradually
 0.2 ml is deposited in the first primary molar buccal
sulcus using the method described above
 Anterior to this a minute later and so on until the tooth of
interest is reached
 0.5—1.0 ml can now be delivered painlessly
Pain-free local anesthesia...

 Palatal anesthesia
 Direct injection is painful

 Cotton—wool bud with topical anesthetic


The use of computerized delivery system

 Approach to the palatal mucosa via already

anesthetized buccal interdental pappillae
Pain-free local anesthesia...

 Mandibular anesthesia

 IANB can be uncomfortable


For incisors, infiltration is the method of choice
 Infiltration is not successful in the posterior
permanent dentition.
Pain-free local anesthesia...

 Intraligamental injection may be employed by

the following technique for posterior teeth
 Initially a small dose buccal infiltration is given apical to
the tooth
 Then papillary injection is given
 Finally the intraligamental injection is given
 Lingual gingival anesthesia is obtained via the pdl by
directing the needle through the interdental space
Complications of local anesthesia
 Classified as:
 Generalized

 Localized

 Early

 Late
Complications of local anesthesia...


Generalized complications

Psychogenic

Allergy

Toxicity

Cardiovascular effects

Central nervous system effects

Methemoglobinemia

Drug interactions

Infection
Complications of local anesthesia...


Early localized complications
 Pain
 Intravascular injection
 Failure of local anesthesia
 Motor nerve paralysis
 Interference with special senses
 Hematoma formations
Complications of local anesthesia..


Late localized complications
 Self inflicted trauma
 Oral ulceration
 Long lasting anesthesia
 Trismus
 Infection
 Developmental defects
 Contraindications to local
anesthesia
 In some children local anesthetic material is
contraindicated, in others specific technique is
not advised

General
 Immaturity
 Mental or physical handicap
 Treatment factors
 Acute infection
Contraindications to local anesthesia...


Specific agents

 Allergy


Medical condition

 Poor blood supply

 Specific techniques
 Bleeding diathesis

 Susceptibility to endocarditis

 Incomplete root formation

 Trismus

 Epilepsy
Thanks