LOCAL ANESTHESIA

IN PEADIATRIC
DENTISTRY

Presented By: Dr.Walija Ansari & Dr. Yousuf Ahmed Khan

Objectives

•Definition of local anesthesia

•Classification
•Topical Anesthesia
•Contents of L.A solution
•Dose Calculation
•Anesthesia of Mandibular teeth and Soft Tissues
•Anethesia on Maxillary teeth and Soft Tissues
•Supplemental Injection Techniques
•Post op instructions after LA administration
•Complications of L.A
Local Anesthesia
 Transient 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.
Classification
Based on composition:
1. Ester group
Cocain
Benzocaine
Tetracaine
2. Amide group
Bupivacaine
Lidocaine
Articaine
Based on mode of administration:
3. Topical- it can be supplied in solution, gel or spray form
4. Injectables
Based on mode of administration:
1. Topical- it can be supplied in solution, gel or
spray form
Benzocaine
Lignocaine
2. Injectables
Lignocaine
Procaine
Topical Anesthesia
 Available in different forms:
1.Gel (most effective type)
2.Liquid
3.Spray
Technique:
• The mucosa at the site of the intended needle insertion is dried with gauze

• A small amount of the topical anesthetic agent is applied to the tissue with

a cotton swab
• Topical anesthesia should be produced in 30 seconds

• The dentist should prepare the child for the injection (tell the patient the

tooth is going to sleep so that the treatment can proceed without

discomfort)
 Effective to depth of 2-3mm
 Effective in reducing the discomfort of the initial penetration
of the needle into the mucosa
 Its disadvantages are the taste that may be disagreebale to
patient and the length of application time may increase
apprehension in the pediatric patient.
 When applying topical anesthetics to the soft tissue use the
smallest effective amount to avoid anesthetizing the
pharyngeal tissues (cause gagging)
 Not known to produce any systemic toxicity in adults but can
produce local allergic reaction
Contents of L.A Solution
 Local anesthetic agent: Lignocaine HCL- 2%
(20mg/ml)
 Vasoconstrictors: Adrenaline- 1:80,000 (0.012mg)
 Preservatives
 Fungicide
 Vehicle
Points to be kept in mind regarding the difference
between child and adult patient

 Density and calcification of maxillary and

mandibular bone
 Anatomic structures
 Penetration of the needle
 Depth of the needle penetration
 Emotional aspect
Types of Injection Procedures
 Nerve Block: Depositing the L.A solution within
close proximity to a main nerve trunk.
 Field Block: Depositing in proximity to the larger
nerve branches.
 Local Infiltration: Small terminal nerve endings
are anesthetized.
Dose calculation
 Maximum recommended doses:
4.4mg/kg body weight with vasoconstrictor
 Dose calculation:

2% lidocaine= 20mg/mL
1 catridge= 1.8mL
Amount of LA in 1 cartridge= 20x1.8= 36mg/cartridge
 Example:

20kg child can tolerate a maximum dose of 2% lidocaine with

vasoconstrictor of LA
4.4x20=88mg=2.4 cartridges
Anesthesia of Mandibular Teeth and Soft Tissue

1. Inferior alveolar nerve block + Lingual nerve

block:
 The mandibular foramen is situated at the level lower than the
occlusal plane of the primary teeth of the pediatric patient.
 The injection must be made slightly lower and more posterior than
for an adult patient
 Landmarks:
1) Coronoid notch
2) Pterygomandibular raphe
3) Occlusal plane of the mandibular teeth
 Areas anesthetized
 Mandibular teeth of the injected side
 Body of the mandible, inferior
portion of the ramus
 Buccal mucoperiosteum, mucous
membrane anterior to the mandibular
1st molar.
 Anterior 2/3rd of the tongue anf the
floor of the mouth
 Lingual soft tissue and periosteum
 Used for more then 1 tooth filling,
extraction, pulp therapy and if can’t
apply mental block due to infection
2. Mental nerve block (lower d
and e fillings)
3. Long buccal nerve block
 Site of injection:
Mucous membrane distal and
buccal to the most distal
molar tooth in the arch

 Area anesthetized:
Soft tissue and periosteum
buccal to the mandibular
molar teeth
4. Infiltration for Mandibular Incisors:
The terminal ends of the inferior alveolar nerves cross over the
mandibular midline slightly and provide conjoined
innervation of the mandibular incisors.
The labial bone overlying the mandibular incisors is usually thin
enough for supraperiosteal anesthesia techniques to be
effective.
Anesthesia of Maxillary Teeth and Soft Tissue

1) Supraperiosteal Technique (Local Infiltration)

Most frequently used for obtaining pulpal
anesthesia in maxillary teeth.
Indicated whenever dental procedures are
confined to only one or two teeth.
 Landmarks: Insertion 45 to long
access of the teeth
1. Mucobuccal fold
2. Crown of the tooth
3. Root contour of the teeth
 Areas Anesthetized:
1. Pulp and root area of the
tooth
2. Buccal periosteum
3. Connective tissue
4. Mucous membrane
2. Palatal anesthesia:
a) Nasopalatine Nerve Block
Blocking the nasopalatine nerve anesthetizes the palatal
tissues of the six anterior teeth.
This technique is painful and is not routinely used
before operative procedures
b) Greater Paltaine Nerve Block
Anesthetizes the mucoperiosteum of the palate
from the tuberosity to the canine region and from
the median line to the gingival crest on the injected
side
Supplemental Injection Technique
 Periodontal Ligament Injection:
The needle is placed in the gingival sulcus and advanced along
the root surface until resistance is met.
The approximately 0.2mL of anesthetic is deposited into the
periodontal ligament.
Pressure is necessary (by the injection) to express the anesthetic
solution.
Post op instructions given after LA administration

 Keep a close eye on your child for atleast two hours after
treatment.
 Remind your child that their face is numb and that they
should avoid chewing, scratching or sucking on the area as
this could cause irritation or abrasions.
 Limit your child to liquids and soft foods until the numbness
has subsided.
Complications of LA
 Systemic complications
1. Toxicity
2. Syncope
3. Allergic reaction

 Local complications
1. Broken needle
2. Hematoma
3. Trauma of nerve causing paresthesia
4. Trismus
5. Soft tissue injury
THANKYO
U