4. LA in Children Flashcards Preview

BDS2 CDS LA Symposium > 4. LA in Children > Flashcards

Flashcards in 4. LA in Children Deck (33):
1

Functions of LA (3)

Operative pain control
Haemorrhage control
Diagnostic tool

2

Definition of surface anaesthesia

Anaesthesia of surface tissues (skin/mucous membranes)

3

Functions of surface anaesthesia (3)

Reduce pain of LA injection
Reduce discomfort of venepuncture
For superficial soft tissue manipulation

4

Methods of achieving surface anaesthesia (2)

Physical - refrigeration anaesthesia
Pharmacological - topical anaesthesia

5

Features of refrigeration anaesthesia (6)

Achieved by reducing temperature
Ethyl chloride (rarely used as LA agent in children)
Difficult to direct stream of liquid accurately
Inadvertent contact with vital teeth produces discomfort
Inflammable
Excessive use can render the patient unconscious

6

Types of pharmacological anaesthesia (4)

Intra-oral topical agents
Topical anaesthesics for skin
Controlled release devices
Jet injectors

7

Action of intra-oral topical agents

Anaesthetise 2-3mm depth of tissues

8

Uses of intra-oral topical LA (7)

Pre-injeciton
Rubber dam clamp
Placing matrix band
Suture removal
Exfoliating primary teeth
Subgingival scaling
Incision of abscess

9

Types of topical anaesthetic for skin (2)

EMLA cream
Ametop gel

10

Types of topical release devices

Patches

11

Advantages of topical jet injectors (4)

Allows anaesthesia up to 10mm
Used when bleeding diatheses/when deep injections are contra-indicated
Sole means of achieving LA
Prior to conventional techniques

12

Disadvantages of topical jet injectors (4)

Could cause soft tissue damage if used carelessly
Frightening sight and sound
Taste of solution
Expensive

13

Types of non-pharmacological pain control (2)

TENS (transcutaneous electrical nerve stimulation - GCT pain theory. Used for restorations, primary extractions, pre-LA)
Hypnosis (altered state of mind such that suggestions are accepted more readily and acted upon more powerfully. Adjunct to LA)

14

Features of lidocaine (3)

Anti-arrhyhtmic drug
Rapid onset of action
Suitable for infiltration, block and surface anaesthesia

15

Lidocaine contraindications (4)

Heart block, no pacemaker
allergy to LA/corn
Hypotension
Impaired liver function

16

Features of articaine (2)

Risk of systemic toxicity is lower than others - hydrolysed in blood quicker
Thiophene ring instead of benzene, additional ester group

17

Articaine contraindications (2)

Avoid in sickle cell patients
Avoid with haemoglobinopathies

18

Adrenaline effect (4)

Binds to a1 receptors causing vasoconstriction
Binds to b1 receptors causing tachycardia
Could increase HR
Could increase BP (HR increase and peripheral constriction)

19

LA techniques in children (3)

Infiltration
Intraligamentray
Regional block

20

Uses of LA infiltration (5)

Anaesthesia in primary teeth
Anaesthesia in maxillary permanent teeth
Anaesthesia in mandibular permanent anterior teeth
Prior to intrapapillary and then intraligamental anaesthesia in posterior permanent teeth
Prior to intrapapillary and palatal/lingual anaesthesia

21

Uses of LA intraligamentary (2)

Supplement infiltrations
Eliminate need for block

22

Intraligamentary LA can be tender due to pressure. Method to reduce discomfort (3)

Small buccal infiltration
Papillary injection
Intraligamental injection

23

Features of the LA Wand (4)

Method of intraligamentary LA
Uses computerised flow of LA
Can be used as a method of intraligamental LA for single tooth anaesthesia
Can also be used for infiltration and block anaesthesia

24

Mandibular foramen difference between adults and kids (2)

Adults - higher
Kids - lower, often below occlusal plane

25

Advantage of mental block

Very good soft tissue anaesthesia

26

Disadvantages of mental block (2)

Incisive nerve anaesthesia not as reliable as IDB
Incisors may get crossover supply across midline, so need a labial infiltration adjacent to tooth as well as this block

27

LA allergy features (3)

Very rare, especially to amide group
Metabisulphite (E223) preservative, antiseptic
Methyl parabens preservative (E218) found in blueberries

28

LA toxicity features (4)

Cardiovascular (low levels – stimulant; high levels – circulatory collapse)
CNS (depressant leading to unconsciousness and respiratory arrest)
Methaemoglobinaemia (cyanosis associated with lethargy and respiratory distress)
Prilocaine, Articaine, benzocaine (reduced ability of red blood cells to release oxygen to tissues)

29

Treatment of LA toxicity (5)

Stop dental treatment
Provide basic life support
Call for medical assistance
Protect patient from injury
Monitor vital signs

30

Early localised LA complications (5)

Pain
Intravascular injection
LA failure
Motor nerve paralysis
Haematoma formation

31

Late localised LA complications (6)

Self-inflicted trauma
Oral ulceration
Long-lasting anaesthesia
Trismus
Infection
Developmental defects

32

LA contraindications (4)

Bleeding disorders (avoid IDB)
Allergy
Acute infection
Liver disease (reduce amide dose)

33

Techniques for LA in children (7)

Positive reinforcement
Tell/show/do
Acclimatisation
Desensitisation
Voice control
Distraction
Role modelling