Pharmacological Pain Control and LA Flashcards
Name some factors that influence perception of going to dentist
- Stage of development
- Parental dental fear
- General emotional status
- Peers
- Media
- MH
- Past dental experience
Name forms of pain control and describe difference
Anaesthetic
-Loss of all forms of sensation (pain, touch, temperature, pressure +/- motor function)
Analgesia:
-Loss of pain sensation unaccompanied by loss of other forms of sensibility
Common methods of pain control in the dental chair for kids
Analgesics
LA
LA and inhalation sedation
GA
How to estimate an approx weight for child between 1-10
(Age +4) * 2 is body weight in kg
so a 6yo should way approx 20kg
best analgesics for dental pain
- paracetamol and ibuprofen
- available in sweetened versions but ensure sugar free versions are prescribed
indications for paracetamol, doses for u18s and regime
-Pain and pyrexia
3-12 months: 60-125mg
1-5 ys: 125-250mg
5-12 ys: 250-500mg
12-18 ys: 500mg-1g
Regime:
-4-6 hourly max 4 doses in 24 hours
at what mg/kg can paracetamol cause serious affects
- 150mg/kg for most adults
- levels higher for young children
ibuprofen indications nd contraindications
- pyrexia, inflammation, pain
- asthma, liver disease, renal failure, bleeding disorders
doses for ibuprofen for u18s and regime
- 3-12 months 50 mg (mx 30mg/kg)
- 1-4 years 100 mg (max 30mg/kg)
- 4-7 years 150 mg (max 30mg/kg)
- 7-10 years 200 mg (mx 2/4g per day)
- 10-12 years 300 mg (max 2.4 g per day)
- 12-18 years 300-400 mg
regime 8 hourly
Common LA solutions %
2% lidocaine with 1:80,000 adrenaline
4% articaine with 1:100,000 adrenaline
3% prilocaine with felypressin (octapressin)
Storage and contras for lidocaine
- Protected from light
- Below 25 degrees c, do not freeze
Contras:
- those who have exhibited sensitivity to amide-type analgesic agents
- severe liver disease
- allergy (extremely rare)
dosage of lidocaine
2% lidocaine= 20mg/ml
2.2ml cartridge is 44mg
max dose I 4.4 mg/kg
dosage of articaine
articaine 4%
- 7mg/kg
- recommended 5mg/kg in children
methods of anaesthetic administration
- topical
- infiltration
- block
- interpapillary
- intraligamentary
how to use topical successfully, how much does it anaesthetise and how long for
- 2-3mm depth of soft tissue can be anaesthetised
- area of application should be dried
- applied over a limited area
- around 5 minutes of application time
when should u use topical agents
- pre injedtion
- rubber dam clamp
- matrix band placement
- suture removal
- exfoliating primary teeth
- subgingival debridement
- incision of abscess
procedure of giving la
- dry mucosa
- topical
- wipe off excess topical
- stretch mucosa
- distract pt (gentle pressure on lip)
- insert needle
- aspirate
- inject supraperiosteal
Intra-papillary injection indications and technique
-avoids painful palatal/lingual infiltrations
- after buccal infiltration inject the interdental papilla medial/distal to the tooth
- pass needle buccally to lingually through papilla
when would u do an intraligamentary
- can be tender in child due to pressure
- consider papillary or small buccal instead
- good to supplement infiltrations
- may eliminate need for a block
what syringe should u use, how much should be given and where should intraligamental la be given
- 0.2ml per root
- interosseous via cancellous space via pdl
- more successful with vasoconstrictor
- ultra short 30 gauge (30 degrees to long axis of tooth in mesiobuccal gingival sulcus- advance until resistance)
- specialised syringe measured dose
- conventional syringe- 0.2ml is width of bung
what needle should you use for young children in an id block
- 25mm needle satisfactory for young children
- older may require 35mm needles
difference in mental foramen location between kids and adults
-more anterior in children
where would you place your needle for a mental block in children
-between d and e in buccal sulcus between apices
advantages nd disadvantages of mental block
-very good soft tissue anaesthesia
- not as reliable as idb
- incisors may get x-over supply across midline so need a buccal infiltration adjacent to the tooth
