Pharmacological Pain Control and LA

Question 1

Name some factors that influence perception of going to dentist

Answer 1

• Stage of development
• Parental dental fear
• General emotional status
• Peers
• Media
• MH
• Past dental experience

Question 2

Name forms of pain control and describe difference

Answer 2

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

Question 3

Common methods of pain control in the dental chair for kids

Answer 3

Analgesics

LA

LA and inhalation sedation

GA

Question 4

How to estimate an approx weight for child between 1-10

Answer 4

(Age +4) * 2 is body weight in kg

so a 6yo should way approx 20kg

Question 5

best analgesics for dental pain

Answer 5

• paracetamol and ibuprofen

- available in sweetened versions but ensure sugar free versions are prescribed

Question 6

indications for paracetamol, doses for u18s and regime

Answer 6

-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

Question 7

at what mg/kg can paracetamol cause serious affects

Answer 7

• 150mg/kg for most adults

- levels higher for young children

Question 8

ibuprofen indications nd contraindications

Answer 8

• pyrexia, inflammation, pain

- asthma, liver disease, renal failure, bleeding disorders

Question 9

doses for ibuprofen for u18s and regime

Answer 9

• 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

Question 10

Common LA solutions %

Answer 10

2% lidocaine with 1:80,000 adrenaline
4% articaine with 1:100,000 adrenaline
3% prilocaine with felypressin (octapressin)

Question 11

Storage and contras for lidocaine

Answer 11

• 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)

Question 12

dosage of lidocaine

Answer 12

2% lidocaine= 20mg/ml

2.2ml cartridge is 44mg

max dose I 4.4 mg/kg

Question 13

dosage of articaine

Answer 13

articaine 4%

• 7mg/kg
• recommended 5mg/kg in children

Question 14

methods of anaesthetic administration

Answer 14

• topical
• infiltration
• block
• interpapillary
• intraligamentary

Question 15

how to use topical successfully, how much does it anaesthetise and how long for

Answer 15

• 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

Question 16

when should u use topical agents

Answer 16

• pre injedtion
• rubber dam clamp
• matrix band placement
• suture removal
• exfoliating primary teeth
• subgingival debridement
• incision of abscess

Question 17

procedure of giving la

Answer 17

• dry mucosa
• topical
• wipe off excess topical
• stretch mucosa
• distract pt (gentle pressure on lip)
• insert needle
• aspirate
• inject supraperiosteal

Question 18

Intra-papillary injection indications and technique

Answer 18

-avoids painful palatal/lingual infiltrations

• after buccal infiltration inject the interdental papilla medial/distal to the tooth
• pass needle buccally to lingually through papilla

Question 19

when would u do an intraligamentary

Answer 19

• can be tender in child due to pressure
• consider papillary or small buccal instead
• good to supplement infiltrations
• may eliminate need for a block

Question 20

what syringe should u use, how much should be given and where should intraligamental la be given

Answer 20

• 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

Question 21

what needle should you use for young children in an id block

Answer 21

• 25mm needle satisfactory for young children

- older may require 35mm needles

Question 22

difference in mental foramen location between kids and adults

Answer 22

-more anterior in children

Question 23

where would you place your needle for a mental block in children

Answer 23

-between d and e in buccal sulcus between apices

Question 24

advantages nd disadvantages of mental block

Answer 24

-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

Question 25

what technology is available for more comfortable injections in kids

advantages and disadvantages

Answer 25

• the wand
• computer controlled dental injection
• flow rate of la is controlled by a computer
• injection is guaranteed to be slow and steady and therefore comfy

+

• non-threatening
• less anxiety
• precise control of flow rate and pressure means more comfy

-

• cost
• takes time
• lots of hazardous waste because holder, tube and handpick are disposable
• extra space

Question 26

Complications of LA

Answer 26

• psychogenic (emotional distress)
• lip biting/soft tissue trauma
• needle stick injury
• toxic (od, low tolerance)
• allergy but v rare
• drug interaction v rare also

cns depressance
cardiovascular issues