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Topical anesthetics

Reduce discomfort during insertion of needle

Many forms : liquid, gel, oinment

Steps : Dry the mucosa

Apply the anesthetic agent with cotton swab

Effective approximately 30seconds

tell the child : tooth is going to be put to sleep

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Management techniques

Disposable syringe preferable to stainless steel

syringe ( appeared threatening)

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Infiltration of mandibular teeth

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Infiltration of mandibular primary incisors

There maybe conjoined innervation of

mandibular incisors

Infiltration placed close to midline and also at

opposite side

Useful in :

Superficial caries excavation

Removal of partially exfoliate incisor

Adjunct to ID block

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Infiltration of mandibular primary molars

Injection at mucobuccal fold between roots of

primary molars

Useful in : most restorative procedure

Less effective in extraction and pulpotomy

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Gow-gates mandibular block technique

Anesthetize all distribution of 5th mandibular

nerve in mandibular region

Inferior dental , lingual, buccal, mental,

incisive, auriculotemporal and mylohyoid

nerve

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Landmarks : tragus of ear and corner of mouth

Insert needle medial to temporal muscle

Needle inclined upward and parallel to a linefrom corner of mouth to lower border of

tragus (intertragic notch)

Needle directed from opposite side

Gow-gates mandibular block technique

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Infiltration of maxillary teeth

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Infiltration of primary incisor and canines

Conjoined innervation from opposite side

Technique :

Place injection close to gingival margin, closeto bone, near to apex of tooth

Some prefer pull lip downwards to penetrate

tissue rather than advancing the needleupwards

Remember anesthetize palatal tissue!

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Infiltration of maxillary primary central

incisor

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Anesthetization of palatal tissues

Painful

After buccal infiltration, interdental

(interpapillary ) infiltration maybe used-

minimize pain

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Nasopalatine nerve block

Palatal tissue of 6 anterior teeth

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Infiltration of maxillary primary molars and

premolars

Middle superior alveolar nerve & posteriorsuperior alveolar nerve form plexus at primarymolar area

Both nerve must be anesthetized

Thin bone over first primary molar, but thick oversecond primary molar and first permanent molar(zygomatic process)

Supplemented injection over second primarymolar and 1st permanent molar placed at areasuperior to maxillary tuberosity

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Advances in LA techniques

Computer-controlled delivery system

Intraosseous method

Intraligamentary method Topical anaesthetic patches

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Computer-controlled delivery system

Advantages:

Excellent tactile sensation

Allows coring

penetration that

minimizes needle

deflection

Slow rate of flow reducespt discomfort

Ease of administration

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Computer-controlled delivery system

In a study that compared computer-controlled

delivery of LA with syringe delivery,

subjects reported less pain with injections

delivered using the computer-controlled device

total injection time was similar to that required for

syringe injections.

Both techniques provided adequate anesthesia.

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Computer-controlled delivery system

Computerized delivery of intrasulcular

anaesthesia (CDS-IS)

In a study that involved 193 children aged 2-13

years old, it was found that CDS-IS was effective

for anesthetizing primary molars, mainly for

amalgam, resin-based composite and stainless

steel crown restorations.

ASHKENAZI et al. 136 (10) 1418. Journal of the American Dental Association 2005

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Intraosseous method

Placement of anesthetic solution directly into thecancellous bone or marrow space adjacent to thetooth or teeth to be anesthetized, and allows for

rapid onset of profound pulpal anesthesia.

as a primary or supplemental technique

pt do not experience numb lips or tongues post-op

immediate onset of anaesthesia and reduced dosagelevels of anaesthetics

results in low perceived pain ratings, mild or no painduring and after procedure

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Intraligamentary delivery method

By inserting needle through gingival sulcus and into thePDL between tooth and alveolar bone.

The modern PDL technique involves slow injection of arelatively small volume (approximately 0.2 ml) of

anesthetic. Slow injection due to back-pressureresistance in PDL. Small volume because of confinedtissue space and design of special PDL injectiondevices.

However, researchers have recommended that PDL

injection should not be used when infection orsignificant inflammation exists at the injection site, aswell as with primary teeth.

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Topical anaesthetic patches

Bioadhesive patch impregnated with 10 or

20% lidocaine

Based on a recent study, it reduced pain

significantly better than did benzocaine gel

and placebo for all painful stimuli tested

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References

ASHKENAZI and BLUMER. Effectiveness of computerizeddelivery of intrasulcular anesthetic in primary molars. J AmDent Assoc 2005;136;1418-1425

PERRY PETER M. LOOMER and DOROTHY A. Computer-controlled delivery versus syringe delivery of localanesthetic injections for therapeutic scaling and rootplaning. J Am Dent Assoc 2004;135;358-365

CHRISTOPHER H. KLEBER. Intraosseous anesthesia:Implications, instrumentation and techniques. J Am DentAssoc 2003;134;487-491

PATRICIA L. BLANTON and ARTHUR H. JESKE. Dental localanesthetics: Alternative delivery methods. J Am DentAssoc 2003;134;228-234