4. LA in Children

Question 1

Functions of LA (3)

Answer 1

Operative pain control
Haemorrhage control
Diagnostic tool

Question 2

Definition of surface anaesthesia

Answer 2

Anaesthesia of surface tissues (skin/mucous membranes)

Question 3

Functions of surface anaesthesia (3)

Answer 3

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

Question 4

Methods of achieving surface anaesthesia (2)

Answer 4

Physical - refrigeration anaesthesia

Pharmacological - topical anaesthesia

Question 5

Features of refrigeration anaesthesia (6)

Answer 5

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

Question 6

Types of pharmacological anaesthesia (4)

Answer 6

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

Question 7

Action of intra-oral topical agents

Answer 7

Anaesthetise 2-3mm depth of tissues

Question 8

Uses of intra-oral topical LA (7)

Answer 8

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

Question 9

Types of topical anaesthetic for skin (2)

Answer 9

EMLA cream

Ametop gel

Question 10

Types of topical release devices

Answer 10

Patches

Question 11

Advantages of topical jet injectors (4)

Answer 11

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

Question 12

Disadvantages of topical jet injectors (4)

Answer 12

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

Question 13

Types of non-pharmacological pain control (2)

Answer 13

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)

Question 14

Features of lidocaine (3)

Answer 14

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

Question 15

Lidocaine contraindications (4)

Answer 15

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

Question 16

Features of articaine (2)

Answer 16

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

Question 17

Articaine contraindications (2)

Answer 17

Avoid in sickle cell patients

Avoid with haemoglobinopathies

Question 18

Adrenaline effect (4)

Answer 18

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

Question 19

LA techniques in children (3)

Answer 19

Infiltration
Intraligamentray
Regional block

Question 20

Uses of LA infiltration (5)

Answer 20

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

Question 21

Uses of LA intraligamentary (2)

Answer 21

Supplement infiltrations

Eliminate need for block

Question 22

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

Answer 22

Small buccal infiltration
Papillary injection
Intraligamental injection

Question 23

Features of the LA Wand (4)

Answer 23

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

Question 24

Mandibular foramen difference between adults and kids (2)

Answer 24

Adults - higher

Kids - lower, often below occlusal plane

Question 25

Advantage of mental block

Answer 25

Very good soft tissue anaesthesia

Question 26

Disadvantages of mental block (2)

Answer 26

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

Question 27

LA allergy features (3)

Answer 27

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

Question 28

LA toxicity features (4)

Answer 28

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)

Question 29

Treatment of LA toxicity (5)

Answer 29

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

Question 30

Early localised LA complications (5)

Answer 30

``` Pain Intravascular injection LA failure Motor nerve paralysis Haematoma formation ```

Question 31

Late localised LA complications (6)

Answer 31

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

Question 32

LA contraindications (4)

Answer 32

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

Question 33

Techniques for LA in children (7)

Answer 33

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