Sign In Local Analgesia (LA) should be routinely used in all age groups. Age of the patient should not be a contraindication for its use, even for mandibular blocks.
The full procedure should be explained in simple terms to the child using terms such as ‘putting the tooth to sleep’. An agreed signal whereby the child can indicate when they feel discomfort can help to enhance control. Signals such as putting their hand up can be used.
Topical Analgesia should always be used. One of the most commonly used topical is 20% benzocaine and this is the topical of choice in the Paediatric Dental department. Other agents such Xylonor (5% lidociane) are also available.
1. Apply in small quantity on cotton roll or cotton bed.
2. Ensure that area of application is dry.
3. Apply for at least 3 minutes for best effect.
- Lignocaine 2% with 1:80000 epinephrine
- Prilocaine 2% with fellypressin 0.54μg/ml
- Articaine 4% with 1:100 000 epinephrine
Ligocaine 2% with epinephrine remains the most commonly used anaesthetic solution in dentistry. However, in the last few years the use of articiane has increased. There is some limited evidence that the use if infiltration with 4% articiane with 1:100000 epinephrine gives profound analgesia. Articaine should not be used for Inferior Dental Blocks (IDB) as it is neurotoxic.
Infiltration is frequently used for procedures in the maxillary arch and for soft tissue surgery. In order to secure palatal analgesia for placement of rubber dam clamps or for extractions, an indirect palatal injection can be given. This technique is administered through the buccal papilla after administering buccal infiltration. The needle is advanced through to the palatal mucosa where solution is deposited slowly. The palatal mucosa will appear to blanch when local analgesia is deposited. This can produce sufficient analgesia for clamp placement however, an additional direct infiltration maybe required for extractions.
The Wand is a computerised LA system that is able to deliver local anaesthetic solution slowly, at a fixed speed. The system is made up of a microprocessor control unit, disposable hand piece and foot control (activation switch).
The Wand delivers LA at a slow fixed rate which is thought to provide ‘pain free local analgesia’. This technique can be useful in providing LA in children who are anxious or ‘needle phobic’.
Berde, C.B. Toxicity of local anesthetics in infants and children. J Pediatr. 1993;122:14–20
Dalens, B. Regional Anesthesia in Infants, Children, and Adolescents. in: Williams & Wilkins Waverly Europe, London; 1995:550
Serour, F., Mandelberg, A., Mori, J. Slow injection of local anaesthetic will decrease pain during dorsal penile nerve block. Acta Anaesthesiol Scand. 1998;42:926–928
Haas Daniel A. An update on local anesthetics in dentistry. J Can Dent Assoc. 2002 Oct;68(9):546–551
Preshaw PM, Rowson JE. The use of lignocaine local anaesthetic. Br Dent J. 1996 Oct 5;181(7):240–240
See also Restorative Dentistry
