The local anaesthesia in pediatric dentistry: intraligamentary and intraosseous anaesthesia

Описание: The local anaesthesia in pediatric dentistry: intraligamentary and intraosseous anaesthesia

Local anesthesia is the temporary loss of sensation including pain in one part of the body produced by a topically-applied or injected agent without depressing the level of conscious- ness. Local anesthetics act within the neural fibers to inhibit the rapid ionic influx of sodium necessary for neuron impulse generation.4,5 This helps to prevent transmission of pain sensa- tion during procedures, which can serve to build trust and foster the relationship of the patient and dentist, allay fear and anxiety, and promote a positive dental attitude. The technique of local anesthetic administration is an important considera- tion in pediatric patient behavior guidance. In pediatric dentistry, the dental professional should be aware of proper dosage (based on body weight) to minimize the chance of toxicity and the prolonged duration of anesthesia, which can lead to self-inflicted tongue or soft tissue trauma.8 Knowledge of gross and neuroanatomy of the head and neck allows for proper placement of the anesthetic solution and helps minimize complications (e.g., hematoma, trismus, intravascular injection).8,9 Familiarity with
the patient’s medical history is essential to decrease the risk of aggravating a medical condition while rendering dental care. Medical consultation should be obtained as needed.
Many local anesthetic agents are available to facilitate man- agement of pain in the dental patient. There are two general types of local anesthetic chemical formulations: (1) esters (e.g., procaine, benzocaine, tetracaine); and (2) amides (e.g., lido- caine, mepivacaine, prilocaine, articaine).10
Vasoconstrictors epinephrine are added to local anesthetics to constrict blood vessels in the area of injection. This lowers the rate of absorption of the local anesthetic into the blood stream, thereby lowering the risk of toxicity and prolonging the anesthetic action in the area.Epinephrine is a relative contraindication in patients with hyperthyroidism, and dose of local anesthetics with epi- nephrine should be limited.Patients with significant cardio- vascular disease, thyroid dysfunction, diabetes, or sulfite sensitivity and those receiving monoamine oxidase inhibitors, tricyclic antidepressants, antipsychotic drugs, norepinephrine, or phenothiazines may require a medical consultation to determine the need for a local anesthetic without vasoconstric- tor.When halogenated gases are used for general anesthesia, the myocardium is sensitized to epinephrine, and such situations dictate caution with use of a local anesthetic.
Amide-type local anesthetics no longer are contraindicated in patients with a family history of malignant hyperthermia, an abnormal elevation in body temperature during general anesthesia with inhalation anesthetics or succinylcholine.13
If a local anesthetic is injected into an area of infection, its onset will be delayed or even prevented. The inflammatory process in an area of infection lowers the pH of the extra- cellular tissue, inhibiting anesthetic action as little of the active free base form of the anesthetic is allowed to cross into the nerve sheath to prevent conduction of nerve impulses.8 Additionally, endocarditis prophylaxis is not recommended for routine local anesthetic injections through noninfected tissue in patients considered at risk.
Alternative techniques for delivery of local anesthesia
Most local anesthesia procedures in pediatric dentistry involve traditional methods of infiltration or nerve block techniques with a dental syringe, disposable cartridges, and needles as described so far. Several alternative techniques, however, are available. These include computer-controlled local anesthetic delivery, periodontal injection techniques, needleless systems, and intraseptal or intrapulpal injection. Such techniques may improve comfort of injection by better control of the adminis- tration rate, pressure, and location of anesthetic solutions and result in more successful and controlled anesthesia.38,39
The mandibular bone of a child usually is less dense than that of an adult, permitting more rapid and complete diffusion of the anesthetic.8 Mandibular buccal infiltration anesthesia is as effective as inferior nerve block anesthesia for some oper- ative procedures.8 In patients with bleeding disorders, the periodontal ligament (PDL) injection minimizes the potential for postoperative bleeding of soft tissue vessels.13 The use of the PDL injection or intraosseous methods is contraindicated in the presence of inflammation or infection at the injection site.

Local anaesthesia in dentistry: The calculations of the toxicity and toxic dose. Lidocaine articaine

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