Local Anesthesia for Pediatric Patients

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Local Anesthesia for Pediatric Patients

• Barbara Sheller DDS, MSD

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Pediatric Dental Triangle
DENTIST
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Pediatric Dental Triangle
Wants child to be comfortable
DENTIST
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Pediatric Dental Triangle
Needles
Wants child to be comfortable
DENTIST
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Pediatric Dental Triangle
Needles
Wants child to be comfortable, safe happy
Wants child to be comfortable
DENTIST
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Local Anesthesia Paradox

• Profound anesthesia improves patient
  cooperation !

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Local Anesthetic

• Is a CNS depressant
• With small children it is easy to exceed
  the limits !

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Local Anesthetic

• Is a CNS depressant
• With small children it is easy to exceed
  the limits !
• Weigh all your patients
• Use 2 lidocaine with epinephrine
• Maximum dose 4.4 mg / kg

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Child Weight
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Set Up Topical

• Use good tasting topical
• Choice of flavor
• Dry tissue with 2 x 2 gauze
• Apply topical with cotton - tipped swab
• Place topical for at least 30 seconds

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Set Up Needles

• Infiltration
• Extra short 30 gauge (10 mm)
• Short 30 gauge (20 mm)

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Set Up Needles

• Infiltration
• Extra short 30 gauge (10 mm)
• Short 30 gauge (20 mm)
• Mandibular blocks
• Short 30 gauge
• Short 27 gauge
• Long 27 gauge (32 mm)

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Set Up The Handoff...

• Childs eyes follow dentists eyes
• Focus on childs face !
• Ask the child to keep their eyes open
• Assistant passes syringe out of childs
  line of vision
• Use peripheral vision to smoothly and
  slowly bring syringe to the mouth

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Set Up Assistant Position

• Have assistant lean across chair to control
  patients hands

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Set Up Assistant Position

• Have assistant lean across chair to control
  patients hands
• Once youre in - stay in !
• Continuous reinforcement and distraction

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Local Anesthesia Maxilla

• Primary incisors and canines
• Innervated by ASA branch of the maxillary
  nerve

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Local Anesthesia Maxilla

• Primary incisors and canines
• Innervated by ASA branch of the maxillary
  nerve
• Place needle into vestibule to a depth of
  the tooth apex

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Local Anesthesia Maxilla

• Primary incisors and canines
• Innervated by ASA branch of the maxillary
  nerve
• Place needle into vestibule to a depth of
  the tooth apex
• Obtain palatal anesthesia by papillary
  infiltration

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Local Anesthesia Maxilla

• Primary molars
• Innervated by MSA nerve

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Local Anesthesia Maxilla

• Primary molars
• Innervated by MSA nerve
• Place needle into vestibule to the depth
  of tooth apex
• Obtain palatal anesthesia by papillary
  infiltration

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Local Anesthesia Mandible

• Teeth innervated by inferior alveolar nerve
• Two options for anesthesia depending on
  treatment planned
• Infiltration at the mental foramen
• IA block

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Infiltration at Mental Foramen

• More comfortable than IA block
• Patients behave better than with IA block

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Infiltration at Mental Foramen

• More comfortable than IA block
• Patients behave better than with IA block
• Not effective for pulp tx on 2nd primary
  molars
• Inter - papillary injections needed for
  extractions

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Inferior Alveolar Block

• Place thumb pad on anterior ramus
• Wrap fingers around external posterior ramus

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Inferior Alveolar Block

• Insert needle at level of occlusal plane
• Advance slowly to bone, back up and
  aspirate
• Inject slowly

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Inferior Alveolar Block

• No contraindication to bilateral IA blocks

Trauma higher in children with unilateral
IA blocks
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Communication

• Self confidence of the dentist is critical
  to success
• Words
• Facial expression

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Communication

• Self confidence of the dentist is critical
  to success
• Words
• Facial expression
• Kids and dogs can sense hesitation, fear,
  and uncertainty

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Communication Plan

• Confident approach
• Age appropriate language
• State expectations
• Keep talking !
• Specific verbal reinforcement
• Distraction
• Praise patient for progress
• Keep

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Communication

• This is easy
• You will be my helper

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Communication

• This is easy
• You will be my helper
• Your tooth will take a rest
• Do you have a blanket and pillow on your
  bed at home ?
• I have a tiny blanket and pillow for your
  tooth ...

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Communication

• Lets cuddle the blanket next to your
  tooth
• Now the yummy tooth cream...
• The tooth will rest for a little while

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Distraction

• My finger is still awake - it likes to
  dance

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Distraction

• My finger is still awake - it likes to
  dance
• Wiggle your tongue !

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Communication

• You may feel a tiny sparkle
• Did the sugar bug bite you ?
• Is that bothering you ? Ill fix it

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Assessing Anesthesia

• Ask child to point where it feels funny
• Touch un - anesthetized area then
  anesthetized area
• Is it sleepy here ? How about over here ?

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Assessing Anesthesia

• Ask child to point where it feels funny
• Touch un - anesthetized area then
  anesthetized area
• Is it sleepy here ? How about over here ?
• Watch child
• Sucking on lip
• Rubbing face
• Reaction to rubber dam

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Pitfalls

• Delaying injection
• Giving the child inappropriate control
• Focusing on injection rather than on child

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Pitfalls

• Delaying injection
• Giving the child inappropriate control
• Focusing on injection rather than on child
• Remaining silent
• Saying " okay ? "
• Lying

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Complications

• Drooling
• Speech difficulty
• Child upset by numb sensation
• Soft tissue trauma
• Needle breakage
• Hematoma

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I Did It !!!
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Click Here to Take Test

• Pediatric Oral Health Access Program
• Behavior Management Post Test