Local Anaesthesia in Children

Question 1

what is surface anaesthesia

Answer 1

anaesthesia of surface tissues

Question 2

when do you use surface anaesthesia

Answer 2

to reduce pain of local anaesthesia injection, reduce discomfort of venepuncture, superficial soft tissue manipulation

Question 3

what depth do intraoral topicals anaesthetise?

Answer 3

2-3mm

Question 4

how do you apply topical

Answer 4

dry area, apply over limited area for 2 mins

Question 5

what are the uses of topical

Answer 5

pre-injection, rubber dam clamp, placing matrix band, suture removal, exfoliating primary teeth, subgingival scaling, incision of abscess

Question 6

what non-pharmacological pain control is used?

Answer 6

transcutaneous electrical nerve stimulation, hypnosis

Question 7

how long does lignocaine last?

Answer 7

3hrs

Question 8

what does the addition of adrenaline do to lignocaine?

Answer 8

vasoconstricts arteries, reduces bleeding, delays reabsorption of lidocaine, doubles duration of anaesthesia

Question 9

what are the contraindications of lignocaine

Answer 9

heart block and no pace-maker, allergy to LA, hypotension, impaired liver function

Question 10

how long does articaine last for?

Answer 10

40mins

Question 11

when would you avoid articaine

Answer 11

sickle cell patients and other haemoglobinopathies

Question 12

what is the effect of adrenaline on the systemic circulation

Answer 12

binds to alpha receptors causing vasoconstriction, binds to beta 1 receptors causing tachycardia, increases heart rate

Question 13

what are infiltrations used for?

Answer 13

primary teeth, maxillary permanent teeth, mandibular permanent anterior teeth, prior to intrapapillary and intraligamental and palatal/lingual

Question 14

what is the process of infiltraion

Answer 14

dry mucosa, topical anaesthetic, wipe excess topical, stretch mucosa, distract patient, insert needle, aspirate, inject supraperiosteal

Question 15

how do you reduce discomfort of intraligamental

Answer 15

small buccal infiltration, papillary injection

Question 16

where do you aim for intraligamental?

Answer 16

intraosseous space via cancellous space via PDL

Question 17

what are the disadvantages of a mental block

Answer 17

not as reliable as IDB, incisors cross over with nerve supply so need a labial infiltration too

Question 18

what is max safe dose of lignocaine

Answer 18

4.4mg/kg (1 cartridge per 10kg)

Question 19

what is max safe dose of prilocaine

Answer 19

6mg/kg (1 cartridge per 11kg)

Question 20

what is max safe dose of mepivacaine

Answer 20

4.4mg/kg

Question 21

what is max safe does of articaine

Answer 21

7mg/kg

Question 22

how do you prevent complications

Answer 22

aspiration, slow injection, dose limitation

Question 23

how do you treat toxicity

Answer 23

stop treatment, BLS, call for medical assistance, protect patient from injury, monitor vitals

Question 24

what are the late localised complications

Answer 24

inflicted trauma, oral ulceration, prolonged anaesthesia, trismus, infection, developmental defects

Question 25

what are the early localised complications

Answer 25

pain, intravascular injection, failure of LA, motor nerve paralysis, haematoma formation

Question 26

what are the contradindications to LA

Answer 26

bleeding disorders, allergy, acute infection, care in liver disease

Question 27

what do you not do with behaviour management

Answer 27

bribe, coax, shout, bully, threaten humiliate, lose patience, allow child their own way

Question 28

what do you do for behaviour management

Answer 28

empathetic, safe environment, allow control, ask how they feel

Question 29

what are good techniques for LA in children

Answer 29

positive reinforcement, tell show do, acclimatisation, desensitisation, voice control, distraction, role modelling