6 Local analgesia

6

Local Analgesia

Philosophy

Many dentists are reluctant to administer an “injection” to children for dental treatment and feel that they can undertake restorative treatment in children without the use of local analgesia. This is a myth, and in the authors’ view it is not possible to achieve good quality restorative dentistry in children without local analgesia. It is incumbent on all those who treat children to do so with adequate pain control.

Explanation

The full procedure should be explained to the child in simple terms, such as “putting the tooth to sleep” or putting “jungle juice” around the tooth. A signal should be agreed with the child whereby they can indicate when they are feeling uncomfortable, such as putting their hand up to indicate discomfort.

Topical/Surface Analgesia

A flavoured topical analgesic should always be used. The most commonly used is topical 20% benzocaine, which is available in various flavours.

1. Apply in small quantity on cotton roll or cotton bud.
2. Ensure that area of application is dry to avoid it leecing into saliva as the taste might then upset some children.
3. Apply for at least 1 minute for best effect.

Commonly Used Local Anaesthetics

  • Lignocaine 2% with 1:80 000 epinephrine.
  • Prilocaine 3% with felypressin 0.54 µg/ml.
  • Articaine 4% with 1:100 000 epinephrine.

Lignocaine 2% with epinephrine remains the most commonly used anaesthetic solution in dentistry. However, in the last few years the use of articaine has increased. There is some limited evidence that in young children infiltration with 4% articaine with 1:100 000 epinephrine gives as profound an analgesia as inferior dental block (IDB) with lignocaine for the restoration of mandibular posterior teeth, including for pulp therapy in primary molars. In the authors’ opinion it certainly seems to give profound analgesia with mandibular infiltration and with careful case selection can be used instead of an IDB in many cases.

Infiltration Analgesia

  • Most frequently used for restorative procedures in maxillary teeth and for minor soft tissue surgical procedures such as removal of mucocoele, epulis etc.
  • Lignocaine used as infiltration does not reliably provide profound analgesia for mandibular />
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Jan 20, 2015 | Posted by in Pedodontics | Comments Off on 6 Local analgesia
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