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Local Anesthesia for the Pediatric Patient


	Shan Lal DDS
	Course Director

Lidocaine 2%


	1.8 cc per Carpule
	x 2% = 36mg(lido) per Carpule
	Max Dosage: 2.2 mg/lb or 4.4mg/kg.
	Epi 1:100K or 0.018mg/carpule
	Role of epi

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Gauge of Needle


	27 Gauge Larger Than 30
	Perceptible Pain Difference?
	Better Aspiration Ability ?
	30 Ga. Slows Rate of Injection
	Long, Short, and Ultra-short
	Bevel faces bone

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Behaviour Management Techniques for L.A.


	Warm up to your patient
	(fav. Cartoons, Activity etc.)
	Tell, show, do?
	Euphemisms - “Sleepy juice” (x hurt/pain)
	Distraction and verbal communication
	Positive reinforcement
	Reward
	Breathe/count to 10
	Bathroom - micturation reflex

Local Anesthesia
techniques


	Operator and chair position
	Patient head and hand stabilization
	Topical anesthesia - technique and limitations
	Keep syringe out of patients view
	The biteblock
	Aspirate and inject very slowly
	Lip jiggling
	Mouth rinse, massage area and seat patient upright

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Assessment of Local Anesthesia


	Onset of anesthesia:
	Soft tissue vs hard tissue
	Subjective and objective testing

L.A. Techniques


	Mandibular Anesthesia - block vs infl
	Maxillary Anesthesia - palatal tissues
	Periodontal ligament injection (pdl)
	Long buccal

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Topical Anesthetics


	Use Acceptable Tasting Brand
	120 Seconds Minimum
	Effective only on Non-keratinized Areas
	Pressure Anesthesia for Keratinized Areas
			Ball Burnisher
			Increasing Pressure > Blanching

Case scenario


	A 7 yr old male presents for restorative care ( DO-RSN #T ). The patient weighs 35 kg/70 lbs.
	Discuss the mode of anesthesia (block vs infl) and maximum recommended dosage in mg and carpules for this patient.

Case Scenario


	Block
	Max dosage = 2.2 mg/lb or 4.4mg/kg
	70 x 2.2 = 154mg (lido)
	36 mg of lido and 0.018mg of epi = 1 carpule
	154 div 36 = 4.2 carpules ( 0.0756mg of epi )

L A Overdose


	Causes - intravascular injection, excess dosage
	CNS depression
		drowsiness
		seizures
		disorientation
		Loss of consciousness
	CVS - ¯HR, ¯CO, CV collapse

OVERDOSE PREVENTION


	Know pt. Hx, Wt.
	Calculate max dosage and use the smallest qty to achieve adequate anesthesia
	ASPIRATE and inject slowly

	MANAGEMENT - BLS, transport to medical facility

DOCUMENTATION


	1. L.A. contains lidocaine and epinephrine.
	THESE ARE DRUGS
	2. Chart entries must include dosage(in mg), site,
	route of administration.
	Example:
	36mg of lido(2%) with 0.018mg of epi was
	administered as an IAN block for a pulpotomy on
	#T using RD isolation. PICPF

AHA guidelines


	Posted on courseworks.
	Excerpts……
	Pre-medication needed for ortho bands placement and pdl injections.
	Pre-medication not needed for pulpotomy or LA

Pediatric Exodontia


	Dr. S Lal

Indications


	Gross decay/unrestorable teeth
	Tooth abscess/infection
	Over retained primary teeth
	Orthodontic reasons
	Root tips

Pre-op workup


	Obtain X-ray on the day of ext
	Explain and obtain consent from the parent before you start the procedure
	Explain to the child that he/she has a “Sugar bug in his tooth that needs to be wiggled”
	Topical anesthesia
	Know max recommended dosage
	Med hx

Pathology



	Furcation involvement with internal root resorption.
	Tx : Ext #T, Sp.mgmt?

Pathology



	Internal resorption with furcation involvement.
	Tx- Sp.mgmt impressions followed by ext# T

Anomalies



	Over-retained primary 2nd molar due to unfavorable pattern of root resorption
	Tx- Ext #T

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Armamentarium

Getting Started

Taking the Proper Precautions

Don’t Forget the Finger Rest

Grasping the Instruments

Wafer Thin Roots

Making Room for the Permanent Dentition

Root Close-up

Gross Caries

Baby Cowhorns

Post-op care


	Check for any root breakage vs(x-ray)
	Compression of bony socket
	Hemostasis - positive pressure-5min
	Gauze pack
	Post-op instructions

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Pediatric Rubber Dam Application


	Isolation
	Prevents:
		Aspiration
		Materials Contamination
	Behavior Management Aid
		Excessive Talking
		Tongue Interference

Area of Isolation


	Clamp tooth distal to treatment tooth
	Isolate one tooth either side of treatment site

Rubber Dam Clamp


	Seat Well Via Finger Pressure
	Breakage
		Occurs at Bow
		Lingual Aspect: Aspiration Danger
	Retrieval:
		Floss Tied through Lingual Forcep Hole
		Peds clamps- 27, 27N, 14, 14A

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Maxillary Anterior Isolation


	Avoid 227 Clamp...Traumatic
	2 “Large” Contiguous Holes
	Stretch from Canine to Canine
	Ligate if Necessary

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"Thank you !!"




	Thank you !!