LA for Children

• DHT can administer LA to a child for:– Cavity prep that involves cutting in to dentine– Extraction of primary teeth
• Physical Topical agents – ethyl chloride– rarely used in children
• Pharmacological topical agent

  – topical sprays or gels

  – 5% lidocaine or 18-20% benzocaine

  (not under age 2)
• Describe the use of topical gel in paediatric dentistry

  Success is technique sensitive, anaesthetises 2-3mm depth, area must be dry, gel should be applied in limited area for a sufficient time using a cotton bud or a cotton wool roll.
• What equipment is required for LA on a child?

  syringe, needle and cartridge.
• What LA solutions are used?

  Lidocaine 2%, 1:80,000 adrenaline – gold standard. Articaine 4%, 1:100,000 or 1:200,000 adrenaline – effective alternative to IDB, not under 4yrs, infiltrate only. Mepivacaine 3% plain – when adrenaline contra-indicated. Prilocaine 3%, octapressin – caution, for known latex allergy. At room temp.
• What is the max dose of LA in children?

  3 x (age) + 7 = weight in kg
• What is the max dose for LA solution in Children?

  Lidocaine = 4.4mg/kg, 44mg/2.2ml cartridge Articaine = 7mg/kg, 88mg/2.2ml cartridge

  Meprivocaine = 4.4mg/kg, 66mg/2.2ml Priolocaine = 6mg/kg, 66mg/2.2ml cartridge
• Describe the technique for giving LA in children

  Same as for an adult, assemble equipment and hide. Check expiry and integrity. Check MH, consent, prescription. Ensure pt in correct position, good lighting and correct operator positioning. Dry mucosa, apply topical, stretch mucosa, distract pt, insert needle, aspirate. inject very slowly and confirm anaesthesia.
• What needles do we use for LA for paeds?

  Short (blue) and extra short (purple)
• why might we use intra-papillary instead of palatal?

  Reduced palatal discomfort
• When might we use an extra short needle?

  For upper anteriors as more uncomfortable for buccal infiltration. Technique involves 'chasing' anaesthesia across.
• Describe the process of giving intra-papillary injections?

  For xla of primary teeth following buccal infiltration. Use an extra short needle. Insert into base of interdental papilla at 90O. Advance palatally while injecting and perform mesially and distally. Look for blanching. Supplement with painless palatal infiltration.
• Describe the process of giving palatal injections?

  supplements the intrapapillary for xla, using an extra short needle, check that the palate has blanched when giving intrapapillary. Insert at a right angles to the mucosa approx 1/2 cm away from gingival margin
• Describe a regional block with a paeds pt

  Inferior alveolar and lingual nerve, long needle, childs mouth must be open wide, insert 5mm above occlusal plane, advance to bone, aspirate and inject 3/4 cartridge, withdraw and deposit rest of cartridge for lingual nerve
• Post-op instructions?

  Numb feeling will last a few hrs, avoid eating on the anaesthetised side, avoid anything hot or cold, do not bite/chew soft tissues.
• List some generalised complications: psychogenic, allergy, toxicity, cardiovascular effects, CNS effects, Methaemoglobinaemia, drug interactions, infection
• What are some early onset localised LA complications?

  Pain, intravascular injection, failure of LA, facial paralysis, sensory interference, haematoma
• what are some late onset LA complications?

  self inflicted trauma, oral ulcerations, prolonged anaesthesia, trismus, infection
• What are some contraindications of LA in children?

  Maturity, intellectual or physical disability, acute infection, allergy, medical conditions, poor blood supply.
• how would you work out a max dose for a child when giving LA?

  3 x (age) + 7 = weight in kg