children Flashcards
what are the uses of LA?
operative pain control
haemorrhage control
diagnostic tool
what is surface anaesthesia?
anaesthesia of the surface tissues i.e. skin or mucous membranes
what is surface anaesthesia used for?
to reduce LA pain on injection
to reduce discomfort of venepuncture
for superficial soft tissue manipulation
what is physical surface anaesthesia?
refrigeration anaesthesia reduce temp ethyl chloride rarely used difficult to direct stream inadvertent contact w/ teeth discomfort highly flammable
what is topical anaesthesia?
intraoral topical agents
topical anaesthetics for skin
controlled release devices
jet injectors
how much tissue does topical anaesthetise?
2-3mm depth
describe topical technique?
dry area
apply over limited area
2 mins
what are the preparations of topical available?
lidocaine: 2% gel, 10% spray, 5% ointment
benzocaine 20% gel
what can topical be used for?
pre-injection dam clamp placing matrix suture removal exfoliating primary teeth subgingival scaling incision of abcess
what topical anaesthetics for skin are available?
ELMA crean 5% eutectic mix of prilocaine & lidocaine -45 min apply -prior to general/iv sedation ametop gel -tetracaine 4% gel (esther) faster onset
what is a topical controlled release device?
patches
incorporation of LA into materials that adhere to mucosa and allow slow release
decrease chance of anaesthetic moving away from application site
under investigation
what are advantages of topical jet injectors?
allows anaesthesia up to 1cm
bleeding diatheses where deep injections are contraindicated
sole means achieving la
prior to conventional techniques
what are disadvantages of topical jet injectors?
soft tissue damage if careless
frightening sight and sound
taste of solution
expensive
describe TENS
non-pharmalogical pain control
transcutaneous electrical nerve stimulation
blocks large myelinated nerve fibres and closes gate to central transmission of small unmyelinated
controlled by px
uses: restorations, primary extractions, pre-LA
describe hypnosis
altered state of mind such that suggestions are accepted more readily and acted upon more powerfully
adjunct to LA by decrease pulse rate
which LA is typically used in px with cardiac disease?
mepivacaine 3%
describe lidocaine
common anti-arrhythmic drug -supresses abnormal heart rhythms rapid onset half life 1.5-2 hours infiltration, block, surface anaesthesia adrenaline vasoconstrictor -delays resorption 2x duration
what are the contra-indications for lidocaine?
heart block and no pace-maker
allergy to LA or corn
hypotension
impaired liver function
what are the contra-indications for articaine?
sickle cell and other haemoglobinopathies
describe articaine
half life 20 mins thiophene ring additional ester group lower risk of systemic toxicity more effective for mandibular infiltrations than lignocaine
when should you avoid adrenaline containing local?
bp>200mgHg systolic and/or diastolic >115mmgHg
diuretics
what are the effects of adrenaline?
binds to alpha-receptors in the peripheral vasculature causing vasoconstriction
tachycardia due to binding B1-adrenergic receptors
increased HR in combination w/ peripheral constriction can lead to increased bp
which LA techniques are used in children?
infiltration
intraligamentary
regional block
what is ultra short needle used for?
infiltration
what is short needle used for?
infiltration
what is long needle used for?
ID block
what can infiltrations be used for?
anaesthesia in primary teeth, maxillary permanent teeth, mandibular permanent anterior teeth,
prior to intrapapillary and the intraligamental anaestheia in posterior permanent teeth
prior to intrapapilary and palatal/lingual anaesthesia
describe infiltration technique
dry mucosa topical anaesthetic wipe excess stretch mucosa distract px insert needle aspirate inject supraperiosteal as close as possible to apices of teeth needle 90 degrees to surface approach via anaesthetised buccal interdental papilla advance-palatal blanching
what are the uses of intraligamental?
to supplement infiltrations
may eliminate need for block
what can reduce intraligamental discomfort?
small buccal infiltration
papillary injection
describe intraligamental technique
interosseous via cancellous space via PDL
0.2ml per root
more successful w/ vasoconstrictor
32 guage needle
30 degrees to long axis of tooth in mesiobuccal gingival sulcus- advance until resistance
measured dose
what is commonly used to administer intraligamental?
the wand
computerised flow of LA
can be used as method for single tooth anaesthesia
also used for infiltration and block
describe the mandibular foramen
below occlusal plane
lower than in adults
