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Pediatric Dentistry > Local Anesthesia & Surgery in Children > Flashcards

Local Anesthesia & Surgery in Children Flashcards

1
Q

an unpleasant sensory and emotional experience associated
with actual or potential tissue damage ,or described in terms
of such damage

A

pain

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2
Q

most fundamental and important component (of pain), sound principles of behavior management

A

pain control

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3
Q

pain control is achieved by:

A
  1. psychological preparation
  2. skilled and sensible local anesthetic delivery technique
  3. sound knowledge of anatomical landmarks
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4
Q

when patient management problems occur

A
  • painful injection experience
  • no anesthesia during dental extraction
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5
Q

a loss of sensation in a circumscribed area of the body
caused by a depression of excitation in nerve endings or an
inhibition of the conduction process in peripheral nerves

A

local anesthesia

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6
Q

local anesthesia: ideal properties

A
  • reversible
  • non-irritating to tissue; produce no secondary local reaction
  • no or minimal systemic toxicity
  • sufficient potency
  • rapid onset of action
  • adequate shelf life
  • provide complete regional anesthesia
  • relatively free from producing allergic reaction
  • stable in solution
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7
Q

amide vs ester: which and why?

A
  • amide type
  • rare adverse effects
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8
Q

most often used LA for pedo px

A

2% Lidocaine 1:100,000 epi

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9
Q

seldom used LA for pedo px

A

4% Articaine 1:100,000 epi

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10
Q

why Articaine is not used for pedo px

A
  • more potent
  • causes prolonged numbness, which can lead to soft tissue injury
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11
Q

T or F: LA agents are vasodilators and the use of vasoconstrictor is recommended

A

true

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12
Q

advantages of using a vasoconstrictor

A
  • decrease probability of high plasma levels (avoid overdose)
  • slowing LA agent into cardiovascular system (avoid toxicity)
  • prolong effect of anesthesia
  • decrease bleeding at the site of administration
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13
Q

contents of LA

A
  1. LA agent (amide, ester)
  2. vasoconstrictor (adrenaline)
  3. reducing agents (sodium metabisulphite)
  4. preservatives (methylparaben)
  5. fungicide (thymol)
  6. vehicle (modified ringer’s solution, distilled water)
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14
Q

2% Lidocaine: common concentration

A

20 mg/mL

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15
Q

1 carpule = ?

A

1.8 mL

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16
Q

amount of LA in 1 carpule

A

20 mg/mL x 1.8 mL = 36 mg/carpule

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17
Q

MSD/MAD

A
  • 4.0 mg/kg body weight without epinephrine
  • 7.0 mg/kg with epinephrine
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18
Q

MSD equation

A

patient kg x MAD/concentration of LA agent in carpule

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19
Q

applied before injecting LA solution

A

topical anesthesia

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20
Q

topical anesthesia: types

A
  • gel
  • liquid
  • spray
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21
Q

advantage of using benzocaine-based topical anesthesia

A
  • slowly absorbed
  • less likely to cause any overdose complications
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22
Q

advantage of using gel-type topical anesthesia

A

more controlled regional application at a proposed injection site

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23
Q

method of applying aerosol formulation (sprays) topical anesthesia

A

using cotton tip on mucosa

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24
Q

depth where topical anesthesia is effective

A

2-3 mm

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25
Q

primary use of topical anesthesia

A

reducing discomfort of initial penetration of needle into the mucosa

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26
Q

disadvantage of using topical anesthesia

A

taste may be disagreeable

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27
Q

amount to use for topical anesthesia

A

pea size amount (0.1 ml = 20 mg)

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28
Q

points to note when using intraoral topical anesthesia

A
  • area of application should be dried
  • applied over limited area
  • applied for sufficient time
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29
Q

topical anesthesia: drying methods

A
  • 3 way syringe
  • cotton
  • suction
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30
Q

topical anesthesia: area efficacy

A

more effective on mucosa than attached gingiva

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31
Q

topical anesthesia: sufficient time for anesthetic effect to occur

A

1.5 - 5 mins

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32
Q

why is it not advisable to use topical anesthesia for 2.5 mins in practice?

A

cooperation of child might not be stable; if px is not cooperative, 1 min is enough

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33
Q

LA mechanism of action

A

because LA are weak bases, they are commonly combined with a strong acid (i.e. HCl) to improve water solubility, tissue diffusion, etc.

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34
Q

innervations: maxillary

A
  • greater palatine n.
  • anterior superior alveolar n.
  • middle superior alveolar n.
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35
Q

innervations: mandibular

A
  • inferior alveolar n.
  • mental and incisive n.
  • long buccal n.
  • lingual n.
  • mylohyoid n.
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36
Q

points to be kept in mind regarding the difference between child and adult px

A
  1. density and calcification of max. and mand. bone
  2. anatomic structure
  3. depth of needle penetration
  4. emotional aspect
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37
Q

special considerations in anesthesizing

A
  1. acceptable behavior
  2. position of mandibular foramen
  3. needle scare
  4. computation for maximum safe dosage
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38
Q

special considerations: acceptable behavior

A
  • crying is okay
  • head should be still
  • hands on the side
  • legs should be lying straight
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39
Q

anatomic structure - mandibular canal: below 6 yrs old

A

below plane of occlusion

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40
Q

anatomic structure - mandibular canal: 6-12 yrs old

A

about even with plane of occlusion

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41
Q

anatomic structure - mandibular canal: 12 yrs old and above

A

palpate deepest curvature on the anterior border of ramus with thumb and bisect

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42
Q

needle scare: management

A
  • learn proper handling of instruments
  • use auxiliary or chairside assistant
  • prepare patient emotionally and psychologically
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43
Q

commonly used needle in pedo px

A

short needle (22 mm); 27 gauge

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44
Q

goals of anesthesia

A
  • minimize sensation of needle penetration in mucosa
  • minimize sensation on pressure created during delivery of anesthetic solution
45
Q

how to minimize sensation of pressure during delivery of anesthetic solution

A
  • slow delivery (deliver 1 ml/min)
  • distract the px (let them count)
46
Q

best topical used before anesthesizing

A

Benzocaine 20% for 2 mins

47
Q

anesthetic technique: mandibular teeth

A
  • inferior alveolar nb
  • lingual nb
  • long buccal nb
48
Q

IAN block: amount of LA

A

1/2 carpule

49
Q

IAN block: needle used

A

30G (common), 27G for children over 12

50
Q

Lingual NB: when used

A

injecting small amounts during IAN block and withdrawal of needle during IAN block

51
Q

Lingual NB: amount of LA

A

1/4 carpule

52
Q

Long Buccal NB: nerve supply anesthesized

A
  • buccal gingiva
  • accessory innervation
53
Q

Long Buccal NB: amount of LA

A

1/4 carpule

54
Q

Long Buccal NB: landmark

A

distal of 1st molar

55
Q

anesthetic techniques: maxillary teeth

A
  • infiltration technique
  • palatal anesthesia
56
Q

best and effective technique in maxillary anesthesizing

A

infiltration technique

57
Q

infiltration technique: landmark

A

apices of max. molars

58
Q

infiltration technique: amount of LA

A

1/2 carpule on buccal

59
Q

more painful maxillary anesthetic technique

A

palatal anesthesia

60
Q

why palatal anesthesia is more painful

A
  • dense bone
  • penetration of solution is difficult
61
Q

technique used for palatal anesthesia

A

CHASE technique

62
Q

interdental infiltration with slow injection to palatal aspect

A

CHASE technique

63
Q

pulpotomy: techniques used

A
  • buccal/labial infiltration
  • block
64
Q

pulpectomy: techniques used

A
  • buccal/labial infiltration
  • block
65
Q

extraction: techniques used

A
  • labial/palatal infiltration
  • block
66
Q

placement of clamps: techniques used

A
  • buccal/interdental infiltration
  • block
67
Q

evaluation of anesthesia

A
  • explorer test (before placing of clamps)
  • run handpiece outside of mouth
  • run handpiece inside mouth but not touching the tooth
  • observe reaction
68
Q

general techniques in anesthetic administration

A
  • use of dental assistant
  • use of topical anesthesia
  • use of euphemisms
  • distraction
69
Q

euphemisms used in anesthetic administrations

A
  • topical anesthesia: tooth jelly/sleepy juice
  • needle prick: mosquito bite/pinch
  • numbness: tooth will take a nap, feel fat
70
Q

post op instructions after anes

A
  • tell the child what to expect after anes
  • assure px sensation will come back soon
71
Q

complications of LA: general

A
  • psychogenic (fainting/syncope)
  • allergy
  • toxicity
  • cardiovascular effects
  • CNS effects
  • methemoglobinemia
  • drug interactions
  • infections (disposable needles)
72
Q

complications of LA: early localized

A
  • pain
  • intravascular injections
  • failure of LA
  • motor nerve paralysis
  • hematoma formation
73
Q

complications of LA: early localized - pain

A
  • needle penetration
  • too rapid injection
  • injection at inappropriate site
74
Q

when motor nerve paralysis occurs

A

when deposition of LA solution is within parotid gland

75
Q

complications of LA: late localized

A
  • self-inflicted trauma
  • oral ulceration
  • long-lasting anesthesia
  • trismus
  • infection
76
Q

T or F: Extraction of primary teeth is an integral part of any dental practice that includes children

A

true

77
Q

main deterrent for a child to anticipate in any form of oral surgery

A

fear

78
Q

suggested method for avoiding adverse psychological reactions to tooth extractions of children

A

child should be informed several days in advance of the appointment for tooth extraction

79
Q

clinical exam and diagnosis for extraction

A
  • mobility
  • sensitivity to percussion
  • lymphadenopathy
  • soft tissue swelling
  • reddening around affected area
80
Q

important to put emphasis that no surgical procedure should be done without permission of guardian or parent

A

consent

81
Q

questions answered for the basic understanding of consent

A
  • what is to be done?
  • why is it being done?
  • what complications can occur?
82
Q

T or F: use of antibiotics in pediatric oral surgery is mandatory

A

false

83
Q

conditions where antibiotics is not needed

A
  • abscess well resorbed
  • px is asymptomatic and in good general health
84
Q

conditions where antibiotics can be considered

A
  • fever
  • periapical swelling
  • adenopathy
  • lymphadenitis
85
Q

antibiotics is used as a prophylactic therapy for…

A

child with chronic debilitation (i.e. chronic heart disease)

86
Q

T or F: radiographs are not important in pediatric tooth extractions

A

false

87
Q

most frequent oral surgical procedure in children

A

extraction of 1 or more carious teeth

88
Q

a good radiograph can determine:

A
  • size and contour with primary roots
  • presence of developing permanent tooth bud
  • pathological root resorption and potential areas of root fracture during extraction
  • extent of disease
89
Q

indications for extraction

A
  • unrestorable carious lesion
  • necrotic pulp
  • apical or furcation disease
  • fractures of crown or roots
  • acute and chronic pathologic involvement
  • prolonged retention of primary teeth
  • abnormal root resorption
  • ankylosis
  • impacted teeth
  • supernumerary teeth
  • iatrogenic reasons
  • natal/neonatal primary tooth
  • medically compromised children in w/c pulp therapy is contraindicated
90
Q

reasons for removal of neonatal/natal teeth

A
  • aspiration
  • irritation (affects ventral part of tongue)
  • pain during breastfeeding
91
Q

importance of vitamin K in neonatal/natal tooth extractions

A

…

92
Q

contraindications for extraction

A
  • acute systemic infections
  • acute oral infection
93
Q

contraindications for extraction: acute systemic infections

A
  • chronic heart disease
  • congenital heart disease
  • kidney disease
94
Q

contraindications for extraction: acute oral infection

A
  • cellulitis
  • dentoalveolar abscess
  • herpetic stomatitis
  • bleeding disorders
  • irradiated jaws
  • malignancy
95
Q

factors to consider during extraction

A
  • age of child
  • arch development
  • amount of resorption of roots of primary teeth
  • development of underlying permanent teeth
  • presence or absence of successors
  • behavior management
96
Q

factors to consider during extraction: arch development

A
  • preservation of primary canines
  • serial extraction in interceptive orthodontics
97
Q

factors to consider during extraction: amount of resorption of roots of primary teeth

A
  • significant 2nd to 3rd degree mobility regardless of presence of succedaneous clinically
  • less than 2/3 of succedaneous formed
98
Q

cornerstones of the oral cavity

A

canines

99
Q

primary tooth usually extracted last to give space for permanent teeth

A

first premolar

100
Q

pediatric tooth extraction: armamentarium

A
  • forceps (150, 151)
101
Q

why forceps 16 is not used in primary molars

A
  • cowhorn; beak is adapted on the bifurcation and this can affect succedaneous teeth of a primary molar
102
Q

when do we suture in pediatric oral surgery?

A

when doing multiple exo (preserve interdental)

103
Q

optimal movements for surgical procedure in pediatric dentistry

A

slow, smooth, graceful

104
Q

important matters in facilitating good patient management in oral surgery

A

make sure that your px will:
- not feel any discomfort
- will not have murdered soft tissue

105
Q

if a root is fractured

A
  • be cautious in removing root tips so permanent tooth bud will not be jeopardized
  • sometimes root tip is better left embedded; allow it to be exfoliated or resorbed
  • parents should be advised that root tip remains; record properly in px notes and monitor periodically
106
Q

pre-operative preparation: for parents

A
  • parental consent before procedure
  • instruct parent not to discuss with child what dentist will do
107
Q

pre-operative preparation: for patients

A
  • armamentarium should be kept behind chair
  • never hold needle in front of child; always hide behind fingers/hand
  • before giving LA, explain to child sensation of pinching or bite that can be felt
  • explain to child the diff. between pressure and pain and sensation of numbness
108
Q

patient position for administration of LA:

A
  • max. occlusal plane at an angle between 60-90 degrees to the floor
  • mandibular occlusal plane is parallel to floor
  • supine position
109
Q

post operative care

A
  • bite on gauze for 30 mins
  • do not use straw to drink for 24 hours
  • do not spit
  • use ice packs after surgery for the next 24 hours; keep on for 10 mins and off for 10 mins
  • soft diet for 1st day
  • appropriate warning to prevent trauma to cheeks and lips
  • take pain medication as directed

Pediatric Dentistry (10 decks)

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