Chapter 19 - Pediatric Patients Flashcards
- Why is it generally more critical to consider toxicity of LA n pediatric pts than in adults?
a. Children react differently to local anesthetic agents than adults.
b. LA doses are based on body weight
c. Appropriate LA agents are different than for adults.
d. Crying and screaming may allow more rapid anesthetic uptake.
b. LA doses are based on body weight
(a, c, d “may be true, but the greatly reduced body weight is the key issue”)
- How does excellent anesthesia serve as a management tool for children?
a. Restorative procedures become tolerable, if not pain-free
b. Clamp placement for rubber dam is simplified
c. Quadrant (or half-mouth) treatment can be completed in one visit
d. All of the above
d. All of the above
- In which of the following ways do anatomical variations affect the choice of injection techniques for children?
a. Roots of primary teeth are generally shorter than permanent tooth roots
b. The cortical plate is thicker and less porous in children vs. adults
c. The IA foramen is often more superior in children than adults
d. All of the above
a. Roots of primary teeth are generally shorter than permanent tooth roots
- Which of the following describe ways in which an assistant can play a vital role in the successful administration of LA to children?
a. Showing the pt the needle to prepare them
b. Calming the parent during the injection by explaining what is happening
a. Roots of primary teeth are generally shorter than permanent tooth roots
d. None of the above
a. Roots of primary teeth are generally shorter than permanent tooth roots
- Which of the following are benefits of using age-appropriate terminology and specific positive feedback during the successful anesthetic administration in pediatric patients?
a. Using understandable terms to demystify the child’s experiences
b. Using specific positive feedback teaches children what is expected and going well
c. Avoiding frightening “trigger” words to reduce the chance of resistance
d. All of the above
d. All of the above
- Which of the following is TRUE when considering injections techniques in children?
a. Mandibular infiltrations rarely work for children
b. Deposition of LA solutions for mandibular blocks are more inferior compared with adults
c. Long needles are usually necessary
d. All of the above
b. Deposition of LA solutions for mandibular blocks are more inferior compared with adults
- When children traumatize soft tissues immediately following injections, what is the best management?
a. Place a cold pack immediately
b. Place a warm pack immediately
c. Always put the child on an antibiotic for infection
d. a and c
a. Place a cold pack immediately
to minimize circulation and decrease initial swelling
after 8-12 hrs, warm packs are appropriate to increase circulation and promote healing
Q19-3: What are the most important considerations when treating pediatric patients related to a child’s body weight and the immaturity of their organs?
A19-3: The potential for drug toxicity due to the relatively low body weight of small children and the immaturity of their organs.
Q19-4: Explain why mepivacaine without a vasoconstrictor seems to be associated with a higher number of local anesthetic toxicity reports compared with other agents.
Q19-5: Discuss why dose-dependent toxicity reactions in dentistry are most frequently reported in children.
A19-5: Several possible theories include:
- disproportion of orofacial anatomy to a child’s body weight (larger head compared with body) that may require larger volumes of anesthetic to achieve effect
- failed anesthesia leading to multiple injections
- inadequacy of pain assessment scales due to some patients perceiving the numb feeling as pain
- lack of or improper calculation of MRDs
Q19-6: Discuss special consideration for maximum doses of anesthesia for morbidly obese children.
A19-6:
- When a young child has the body weight of an adult, the usual dosing guidelines likely do not apply
- advisable to use the ideal body weight (IBW) when calculating doses
- remaining alert to the development of adverse events and dosing below the MRD is paramount whenever local anesthetic drugs are administered to these children
Q19-7: What is the treatment for postoperative trauma caused by lip/cheek biting?
A19-7:
- cold pack if notified of self-injury soon after apptmt to reduce swelling
- warm pack can be recommended to stimulate circulation and promote healing on day following tx
- Antibiotics usually not indicated; prescribed only in the unlikely event of infection
Q19-8: Discuss the efficacy of articaine for pediatric patients.
A19-8: Articaine is believed by some to be more effective in its ability to diffuse through bone compared to other amide anesthetic solutions, thus having improved efficacy, especially as it relates to mandibular infiltration.
Q19-9: Provide examples of the use of topical anesthetics for children.
A19-9: Topical anesthetics are useful for pre-anesthesia for injections, for comfortable rubber dam clamp placement, and to anesthetize the tissues retaining extremely mobile primary teeth to allow children to remove their teeth atraumatically at home.
Q19-10: What is the primary focus of an assistant during injection procedures?
A19-10: The primary focus of an assistant during injection procedures is to provide passive restraint.
- DA places one hand over the child’s hands (which should be placed on their stomach)
- The other hand is placed on the child’s forehead to guard against sudden or unexpected movements.
