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basic oral and dental care > la in children > Flashcards

la in children Flashcards

1
Q

What is the history of anaesthetics?

A 
1859- cocaine isolated from cocoa plant
1880- topical opthalmic anaesthetic
1884- regional anaesthesia in oral cavity
1905- procaine synthesis
1943- lidocaine
1957- bupivocaine
1959- prilocaine
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2
Q

What types of local anaesthetics are there?

A

Amides and esters
Most are amides
Amides less allergenic
Lidocaine- gold standard

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3
Q

How do anaesthetics work?

A

Chemical roadblock between source and brain
LA blocks Na channel so nerve signals can’t be transmitted
Vasoconstrictor- slows removal of anaesthetic from vicinity of nerve- prolongs anaesthetic

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4
Q

Should you use LA on children?

A 
Avoid GA- Poswillo Report, 1990
LA is mainstay of pain control during dental treatment~ GDC standards, 2005
Child- cooperation, bad experience?
Procedure- multiple quadrants?
Effects of painful experience?
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5
Q

What are possible contraindications?

A

Lidocaine- known hypersensitivity, acute porphyria syndrome, heart block

Adrenaline- cardiac arrhythmias, hyperthyroidism

Prilocaine- known allergy

Block techniques- bleeding disorders

However,
Infection at injection site- consider block techniques

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6
Q

What topical anaesthetics can be provided?

A

Xylonor gel (5% lidocaine)- hold in place for 2-5mins

Benzocaine gel (30%)- bubble gum flavoured

EMLA cream- (5% mixture lig + pril) usually for skin prior IV

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7
Q

What LA solutions are used?

A

2% (20mg/ml) lidocaine w 1:80000 adrenaline
~pulpal anaesthesia 45 mins
~soft tissue anaesthesia 2-3hrs

3% (30mg/ml) prilocaine w felypressin
~similar spectrum of activity

4% articaine w 1:1/200000 adrenaline (septanest)
~similar
~metabolised quickly
~1/2 life of 20 mins
~good lipid solubility
~not to be used <4 years or known hypersensitivity to amide LA or sodium metabisulphite
~IV strongly contraindicated

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8
Q

What are the maximum doses?

A

Prilocaine- 6mg/kg
Articaine- 7mg/kg (kids- 5mg/kg)
Lidocaine- 4.4mg/kg
Bupivocaine- 2mg/kg

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9
Q

How much does a child weigh?

A

Body weight estimation, Kg= (age+4) x2

Careful w children who are petite

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10
Q

How do you calculate the maximum cartridges for a child?

A
  1. Calculate max dose
    ~weight, kg x max dose of LA
    = ?mg
  2. Calculate mg in each cartridge
    ~use % of LA to work out parts per 1000, mg/ml
    ~1 cartridge, mg= ml x mg/ml
  3. Calculate max no of cartridges
    Max dose/cartridge mg
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11
Q

How would you figure out maximum dose in clinic?

A

Lidocaine-
1 cartridge per 10kg of body weight

Articaine-
1 cartridge per 12.5kg of body weight

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12
Q

How is anaesthesia delivered?

A

Topical- cotton pellet/roll

Syringe- ultra safety plus by septodont- single use, sterile, aspirating, prevent needle stick injuries, no recapping necessary, bevel indicator, transparent barrel

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13
Q

What needles are used?

A

Infiltration- 30 gauge 2cm

Block anaesthesia- 27 gauge 3cm
~aspirate ability

Intraligamentary- 30 gauge 1cm

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14
Q

What behaviour management can be used?

A 
Verbal/non verbal communication
TLC
Tell, show, do
Positive reinforcement 
Control
Distraction
Relaxation
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15
Q

How can you communicate w kids for LA?

A

Put magic jelly on
Wash it off with sleepy juice

It will feel hot and spicy, warm and cosy, tingly

When tooth wakes up the funny feeling will go

Distract- can you taste the juice? Take a deep breath

Reassure- that’s how it’s supposed to feel

Talk throughout procedure
Lots of feedback to their behaviour
Positive reinforcement
Dental aerobics- put feet in air

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16
Q

Should you show the syringe?

A 
Don’t lie
If child wants to see it, they can
If not, say close eyes so sleepy juice doesn’t go in their eyes
Tell, show, do vs distraction 
Identify phobia before attempt
17
Q

What is systematic desensitisation?

A

Progressively expose child to the fear inducing stimulus
Need to establish control, trust and relaxation

Eg. Visit 1- explain and teach relaxation
Visit 2- needle uncovered outside mouth
Visit 3- needle on gingiva
Visit 4- injection

18
Q

What are anatomical considerations?

A

Reduced bone density- better diffusion

So can use infiltration in mandible for younger children

19
Q

How can LA be delivered in children?

A

Apply topical for sufficient length of time
Pull mucosa taught
Establish rest for barrel
Inject v slowly esp initially (1ml/15-20s)

20
Q

How is LA performed for maxillary molars?

A

Infiltration
Apices of primary molars at muccobuccal fold
For permanent molars- 1cm bone covering roots- give above and distal to Bu-Di root and above Me-Bu root

21
Q

How is palatal anaesthesia administered?

A

Intrapapillary injections
After buccal infiltration

Penetrate buccal papilla 1-2mm
Parallel to occlusal plane and perpendicular to arch line
Inject slowly and gently advance
Observe blanching 20-30s
Repeat w other papilla until blanching joins
Can progress to palatal infiltration

22
Q

How are ID blocks administered?

A 
Topical
Foramen- more distal and inferior
Level of lower occlusal plane
1st primary molar approach
Stop signal
Finger rest
For 6-9 years
23
Q

Infiltration alone vs ID block?

A

Rule of ten
(Age of patient) + (tooth no from midline) =?
?<10 = infiltration
?>10= ID block

Eg. (4 yrs) + (LLD=4) = 8 so infiltration

W articaine- rule of 12

24
Q

When might intraligamentary techniques be required?

A

Other techniques fail

Potential damage to developing permanent teeth
Contraindicated in pts at risk from bacteraemia
Caution in acute perio inflam/perio disease

25
Q

How are intraligamentary injections administered?

A

Peripress system- high pressure, shielded barrels, protection

Interproximal perio sulcus at 50-60 degree angle to occlusal plane
Bony resistance felt
0.4-0.6ml mesial and distal
Lips and tongue not anaesthetised
Immediate analgesia
26
Q

What is computer controlled delivery?

A

Eg. The wand
Controls rate
Slow delivery via line and needle
Useful for direct palatal analgesia

27
Q

What is a jet injection?

A

Eg. Injex
‘Needleless’
Injects LA under pressure through mucosa and bone
Useful for soft tissue analgesia before traditional techniques

28
Q

What operator safety should be considered?

A

Up to 56% dentists have a needle stick per year

Important-
~disposable
~no recapping
~ultra safety plus
~good positioning
~calm approach
~hand rest
29
Q

Why might LA fail?

A
  1. Acute infection
  2. Incorrect site (muscle, IV, buccal bone)
  3. Insufficient LA
  4. Abnormal nerve supply (anastomosis from aberrant nerve)
  5. Patient immature- psychogenic pain
30
Q

What complications may arise?

A

Touch nerve- electric shock, permanent damage rare

Subperiosteal injections- v painful and unnecessary, internal surface of ramus

Inject to quickly

31
Q

What post injection problems may occur?

A

Lip, tongue, cheek trauma- self inflicted

Haematoma- lacerated vein, bruise, heals rapidly

Vasovagal syncope- anxiety, early recognition and management

Allergy/toxicity- med history and patch testing, use correct dose

basic oral and dental care (49 decks)

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