Local anaesthesia for children

Success relies on co-operation

DHT can administer LA to a child for:

  • cavity prep that involves cutting into dentine

  • extraction of primary teeth


Topical agents:

  • Physical

    • ethyl chloride

    • rarely used in children

  • Pharmacological

    • topical sprays or gels

    • 5% lidocaine or 18-20% benzocaine (not under age 2)


Use of topical gel

  • success depends on technique

  • anaesthetises 2-3mm depth

  • area must be dry

  • gel should be applied over a limited area

  • applied for sufficient time

  • limit the amount used

  • cotton bud/cotton wool roll


Equipment

  • syringe

  • needle

  • cartridge


LA solutions

  • lidocaine 2% 1:80,000 adrenaline - gold standard

  • articaine 4%, 1:100 000 or 1:200,000 adrenaline - effective alternative to IDB, not under 4yrs, infiltrate only

  • mepivacaine 3% plain - when adrenaline contra-indicated

  • prilocaine 3% octapressin - caution, for known latex allergy

  • at room temp


Max doses

Max dose: 3 x (age) + 7 = weight in kg



Basic technique

  • same for adults

  • assemble equipment and hide

    • check expiry date and integrity

  • check MH, consent, prescription

  • ensure

    • correct pt positioning, ideally 30 degrees to the vertical

    • good lighting

    • correct operator positioning

  • dry mucosa

  • apply topical gel

  • stretch mucosa

  • distract the pt

  • insert the needle

  • aspirate

  • inject very slowly

  • confirm anaesthesia




Infiltration

Buccal:

  • method of choice for maxilla and anterior mandible

  • effective alternative to IDB with articaine

  • sufficient for restorative work

Palatal:

  • painful

Intrapapillary

  • reduces discomfort of palatal

short (blue) or extra short needle (purple)


Maxillary buccal infiltration

  • pull the cheek outwards so mucosa is taut

  • insert needle into muco-buccal fold

  • aspirate

  • advance upwards towards the apex

  • inject slowly


Upper anteriors

  • more uncomfortable

  • initially inject into buccal sulcus and “chase” anaesthesia across

  • extra short needle (purple)

Intrapapillary

  • for extraction of primary teeth following buccal infiltration

  • extra short needle (purple)

  • insert into base of interdental papilla at 90 degrees

  • advance palatally while injecting

  • performed mesially and distally

  • look for blanching palatally/lingually

  • supplement with painless palatal infiltration

Palatal

  • supplements the intrapapillary for extractions

  • extra short needle (purple)

  • check that the palate has blanched when giving intrapapillary

  • insert at right angles to the mucosa approx ½ cm away from gingival margin


Regional block

  • inferior alveolar and lingual nerve

  • long (yellow) needle

  • childs mouth must be open wide

  • insert 5mm above occlusal plane

  • advance to bone

  • aspirate

  • inject slowly ¾ cartridge

  • withdraw and deposit rest of cartridge for lingual nerve


Post op instructions

  • numb feeling will last for a few hours

  • avoid eating on the anaesthetised side

  • avoid anything very hot or cold

  • do not bite/chew soft tissues


Complications

  • generalised

  • localised

    • early onset

    • late onset


Generalised:

  • psychogenic

  • allergy

  • toxicity

  • cardiovascular effects

  • CNS effects

  • methaemoglobinaemia

  • drug interactions

  • infection

Localised complications - early onset

  • pain

  • intravascular injections

  • failure of LA

  • facial paralysis

  • sensory interference

  • haematoma

Localised complications - late onset

  • self inflicted trauma

  • oral ulceration

  • prolonged anaesthesia

  • trismus

  • infection


Contra-indications

  • maturity

  • intellectual or physical disability

  • acute infection

  • allergy

  • medical conditions

  • poor blood supply


wouldn’t rlly do IDB in a child under 7? do articaine infiltrations


Scenarios

  • restoration of URD

  • extraction of LLE

  • restoration of LR6



active recall qs

  1. what does success rely on

  2. what are the reasons a DHT can administer LA to a child

  3. what are the two types of topical agents that can be used

  4. describe how topical gel should be used

  5. what equipment is needed

  6. what LA solutions are available for use

  7. how is max dose calculated

  8. what is the basic technique for LA

  9. what are the different infiltrations

  10. maxillary buccal infiltration method

  11. upper anteriors method

  12. intrapapillary method

  13. palatal method

  14. regional block method

  15. what are the post op instructions

  16. what complications can occur

  17. what generalised complications can occur

  18. what are the early onset localised complications

  19. what are the late onset localised complications

  20. what are the contraindications