Local Anesth in Pediatric Px

• Pain control

a critical component of a child behavior guidance.

• Local anesthetics

the primary pharmacologic methods used to control pain before and during dental procedures.

Local Anesthesia - Jet Injection

a needle free method of delivering local anesthetic using a high-pressure, narrow stream of liquid that penetrates the mucosa and deposits the anesthetic solution into the underlying tissue.

• Needle gauge - smaller gauge needles (23-30 gauge)

this can successfully aspirate blood; gauge alone does not prevent aspiration.

• 25-gauge needle

often recommended for highly vascular areas or where soft-tissue needle deflection may be a concern.

• SLOWLY

Regardless of needle size, the anesthetic solution should be administered?

• Patient monitoring

this is when a dentist closely observe the child for any unexpected or adverse reaction during injection.

• conventional injections

it remain an important method for achieving adequate anesthesia in children.

• an inferior alveolar nerve block (IANB)

this is generally required For deep operative or surgical procedures involving primary or permanent mandibular teeth

Conventional Mandibular Block

IANB is also known as?

Supra-periosteal infiltration

this may work for primary incisors, but it is less reliable for complete anesthesia of mandibular molars.

lower relative to the occlusal plane than in adults.

In children, the mandibular foramen is positioned where?

Lingual Nerve Block *

It is providing anesthesia to the lingual soft tissues associated with the mandibular area.

• Important point for Lingual Nerve Block

A separate lingual nerve injection is often not necessary when performing an IANB. Because as the anesthetic solution is deposited during needle insertion and withdrawal, the lingual nerve is commonly anesthetized as well.

Long Buccal Nerve Block

it is needed when treating mandibular permanent molars

• Extraction, procedures involving the buccal gingiva
• Placement of a rubber dam clamp when the area is sensitive

Long Buccal Nerve Block is particularly needed for this procedure

A small amount of anesthetic is deposited in the mucobuccal fold distal and buccal to the tooth being treated.

Where is Long Buccal Nerve Block anesthetize

Primarily the buccal/facial gingival and mucosal tissues in the mandibular molar region.

What does the Long Buccal Nerve anesthetize?

• Answer: IANB can be uncomfortable and may produce significant anxiety in children. Therefore, clinicians have investigated whether less invasive infiltration techniques can provide adequate pain control for certain procedures involving primary mandibular molars.

Can infiltration anesthesia work for mandibular molars instead of an IANB?

• Type and depth of treatment
• Required depth of anesthesia
• Local anesth used
• tooth involve
• Child age
• Extent of inflammation/infection

For some procedures involving primary mandibular molars, infiltration may be an alternative depending on:

• IANB

this is a Tooth Pulp Anesthesia

• Lingual

it anesthetizes the Lingual Soft tissue

• Long Buccal

it anesthetizes the Buccal Soft Tissue

• Infiltration

a localized alternative in selected pediatric cases.

• Articaine

a local anesthetic with both amide and ester characteristics.

thiophene ring

Articane contains ______, which contributes to its ability to penetrate bone well.

plasma pseudocholinesterase ; 4%

• It is rapidly metabolized, partly by __________, giving it a relatively short half-life. Because of its good bone penetration buccal infiltration with ___ articaine can be effective for mandibular teeth, esp. in children.

• Articaine infiltration

may provide adequate anesthesia for extraction without always requiring a conventional nerve block.

articaine

• Pain perception was reported to be lower with _______ in cited study.

• Buccal articaine infiltration

it can sometime replace a mandibular block for primary molar procedures.

• The inferior alveolar nerve branches can cross the mandibular midline.
• Therefore, a single inferior alveolar nerve block may not completely anesthetize mandibular incisors.

• Supraperiosteal infiltration
• For treatment involving both sides, infiltration may need to be given near the midline. Infiltration of Mandibular Incisors

• SUPRAPERIOSTEAL infiltration

this can be effective because the bone in the anterior mandible is relatively thin.

CROSS-MIDLINE INNERVATION

MANDIBULAR INCISORS MAY NEED INFILTRATION BECAUSE OF?

• Gow-Gates technique

a high mandibular nerve block.

• neck of the mandibular condyle

For the Gow-Gates Technique, it is deposited near the ?

• It can anesthetize almost the entire distribution of CN V3
• Including the inferior alveolar nerve, lingual nerve, buccal Nerve, mylohyoid nerve and auriculotemporal nerve.

Gow-Gates Mandibular Block

Gow-Gates Mandibular Block

It can anesthetize an entire side of mandible with one Injection.

Gow-Gates

it is a high block, a Broad V3 anesthesia

• Tragus of the ear
• Corner of the mouth
• Needle directed toward the neck of the mandibular condyle
• Syringe is positioned from the opposite corner of the mouth.

The main landmarks of Gow Gates are:

Injection is placed close to the gingival margin/ mucobuccal fold.

Deposit a small amount of solution near the apical region.

The needle should penetrate only slightly because the apices of maxillary anterior teeth are close to the mucobuccal fold.

Location For anesthetization of maxillary anterior teeth

Palatal anesthesia

For extraction of maxillary incisors/canines,

Nasopalatine nerve

• supplies the palatal tissues of the anterior teeth.

Middle superior alveolar nerve

Nerve that supplies the primary maxi. Premolar and molar

Superior Alveolar Nerve Plexus

important innervation of primary molars.

Nasopalatine Nerve Block

• Anesthetizes the palatal tissues of the six anterior maxillary teeth.

• Injection is directed toward the incisive canal through/near the incisive papilla.

• It can provide extensive anterior palatal anesthesia but may be painful, so it is not routinely used unless needed.
  Topical anesthesia and slow injection help reduce discomfort.

• For the canine region, additional infiltration may be necessary because of overlapping nerve supply.

Nasopalatine Nerve Block. Infss.

Greater Palatine Nerve Block

• Anesthetizes palatal mucoperiosteum from the tuberosity to the canine region.

• Primarily covers the posterior two-thirds of the palate.

Greater Palatine Nerve Block

• Often used together with a middle/posterior superior alveolar nerve block for maxillary molar procedures.

• Locate the greater palatine foramen and deposit a small amount slowly.

Infraorbital Nerve Block

Anesthetizes the anterior and middle superior alveolar nerves and associated soft tissues.

Upper lip, side of the nose, and under the eye area

The infraorbital nerve block produces numbness to these areas

Infraorbital Nerve Block

Useful for impacted canines/large extractions, infection where infiltration is less effective, or when a larger area needs anesthesia.

Mental Nerve Block

• Produces numbness of the lower lip and chin.

• Anesthetizes mandibular teeth in the quadrant except permanent molars.

• Can facilitate treatment or primary teeth.
  .

IANB

It is generally preferred when pulpal anesthesia is specifically required

Periodontal Ligament Injection

• Intraligamentary injection

• Used as supplemental technique when infiltration or nerve block does not provide adequate anesthesia.

• Requires only a small amount of anesthetic.

• Solution is injected into the gingival sulcus along the root surfaces into the PDL.

• Multirooted teeth require injections on both mesial and distal aspects.

• Requires considerable pressure.

Intraseptal/intrapulpal/intraosseous

Supplemental techniques when regular anesthesia fails.

Intrapulpal Injection

For a profound anesthesia for direct pulp treatment; rapid but initially painful.

Intraosseous/interseptal Injection

anesthetic cancellous bone for rapid effect.

• Dose must be calculated according to the child's body weight. Never exceed the maximum recommended dose

• Consider the total amount from all injections.

Maximum Recommended Local Anesthetic Dose

warn parents about lip/cheek/tongue biting while numb. Monitor children until protective sensation returns.

Post anesthetic care for pediatric pxs

Analgesia

may be used to control postoperative dental pain after the anesthetic solution wears