Local Anesthesia in childs , dentistry for adoleclsence

injection is the dental procedure that produces the greatest negative response in children.
Topical anesthetics are available in gel, liquid, ointment, and pressurized spray forms. However, the pleasant-tasting and quick-acting liquid, gel, or ointment preparations seem to be preferred by most dentists.
Ethyl aminobenzoate (benzocaine) liquid, ointment, or gel preparations are probably best suited for topical anesthesia in dentistry.
The mucosa at the site of the intended needle insertion is dried with gauze, and a small amount of the topical anesthetic agent is applied to the tissue with a cotton swab. Topical anesthesia usually produces an effect within 30 seconds, although keeping it in place between 2 and 3 minutes may provide the best results �
The jet injection instrument is based on the principle that small quantities of liquids forced through very small openings under high pressure can penetrate the mucous membrane or skin without causing excessive tissue trauma.
Jet injection produces surface anesthesia instantly and is used instead of topical anesthetics by some dentists.
The method is quick and essentially painless; however the abruptness of the injection may produce momentary anxiety in the patient. This technique is also useful for obtaining gingival anesthesia before a rubber dam clamp is placed for isolation procedures ��
INFERIOR ALVEOLAR NERVE BLOCK (CONVENTIONAL MANDIBULAR BLOCK)
the mandibular foramen is situated at a level lower than the occlusal plane of the primary teeth of the pediatric patient. Therefore the injection must be made slightly lower and more posteriorly than for an adult patient.
An accepted technique is one in which the thumb is laid on the occlusal surface of the molar, with the tip of the thumb resting on the internal oblique ridge and the ball of the thumb resting in the retromolar fossa.
The barrel of the syringe should be directed on a plane between the two primary molars on the opposite side of the arch.
The depth of insertion averages about 15 mm but varies with the size of the mandible
Approximately 1 mL of the solution should be deposited around the inferior alveolar ne
Lingual nerve block
One can block the lingual nerve by bringing the syringe to the opposite side with the injection of a small quantity of the solution as the needle is withdrawn. If small amounts of anesthetic are injected during insertion and withdrawal of the needle for the inferior alveolar nerve block, the lingual nerve will invariably be anesthetized as well.
Long buccal nerve block
A small quantity of the solution may be deposited in the mucobuccal fold at a point distal and buccal to the last tooth
All facial mandibular gingival tissue on the side that has been injected will be anesthetized for operative procedures, with the possible exception of the tissue facial to the central and lateral incisors, which may receive innervation from ove
SUPRAPERIOSTEAL TECHNIQUE (LOCAL INFILTRATION) �The injection sho

1. Anesthesia in child Hani mortezaee

2. Topical Anesthetics injection is the dental procedure that produces the greatest negative response in children. Topical anesthetics are available in gel , liquid , ointment , and pressurized spray forms . However, the pleasant-tasting and quick-acting liquid, gel, or ointment preparations seem to be preferred by most dentists. Ethyl aminobenzoate ( benzocaine ) liquid, ointment, or gel preparations are probably best suited for topical anesthesia in dentistry. The mucosa at the site of the intended needle insertion is dried with gauze , and a small amount of the topical anesthetic agent is applied to the tissue with a cotton swab. Topical anesthesia usually produces an effect within 30 seconds , although keeping it in place between 2 and 3 minutes may provide the best results

3. Jet Injection The jet injection instrument is based on the principle that small quantities of liquids forced through very small openings under high pressure can penetrate the mucous membrane or skin without causing excessive tissue trauma. Jet injection produces surface anesthesia instantly and is used instead of topical anesthetics by some dentists. The method is quick and essentially painless; however the abruptness of the injection may produce momentary anxiety in the patient. This technique is also useful for obtaining gingival anesthesia before a rubber dam clamp is placed for isolation procedures

4. Anesthetization of Mandibular Teeth and Soft Tissue INFERIOR ALVEOLAR NERVE BLOCK (CONVENTIONAL MANDIBULAR BLOCK) the mandibular foramen is situated at a level lower than the occlusal plane of the primary teeth of the pediatric patient. Therefore the injection must be made slightly lower and more posteriorly than for an adult patient. An accepted technique is one in which the thumb is laid on the occlusal surface of the molar, with the tip of the thumb resting on the internal oblique ridge and the ball of the thumb resting in the retromolar fossa. The barrel of the syringe should be directed on a plane between the two primary molars on the opposite side of the arch . The depth of insertion averages about 15 mm but varies with the size of the mandible Approximately 1 mL of the solution should be deposited around the inferior alveolar nerve

5. LONG BUCCAL NERVE BLOCK AND LINGUAL NERVE BLOCK Lingual nerve block One can block the lingual nerve by bringing the syringe to the opposite side with the injection of a small quantity of the solution as the needle is withdrawn. If small amounts of anesthetic are injected during insertion and withdrawal of the needle for the inferior alveolar nerve block, the lingual nerve will invariably be anesthetized as well. Long buccal nerve block A small quantity of the solution may be deposited in the mucobuccal fold at a point distal and buccal to the last tooth All facial mandibular gingival tissue on the side that has been injected will be anesthetized for operative procedures, with the possible exception of the tissue facial to the central and lateral incisors, which may receive innervation from overlapping nerve fibers from the opposite side. 

6. INFILTRATION ANESTHESIA FOR MANDIBEL Articaine behavior in young children can be adversely affected by the painful mandibular block. It is well known that articaine has a high bone-penetrating ability, which suggests that it may be more successful as a locally injected infiltration. From these reports, one may infer that mandibular infiltration anesthesia may produce adequate anesthesia in mandibular deciduous molars for most restorative procedures. INFILTRATION FOR MANDIBULAR INCISORS The terminal ends of the inferior alveolar nerves cross over the mandibular midline slightly and provide conjoined innervation of the mandibular incisors. A single inferior alveolar nerve block may not be adequate for operative or surgical procedures on the incisors .

7. MANDIBULAR CONDUCTION ANESTHESIA (GOW-GATES MANDIBULAR BLOCK TECHNIQUE) This approach uses external anatomic landmarks to align the needle so that anesthetic solution is deposited at the base of the neck of the mandibular condyle. This technique is a nerve block procedure that anesthetizes virtually the entire distribution of the fifth cranial nerve in the mandibular area, including the inferior alveolar, lingual, buccal , mental, incisive, auriculotemporal , and mylohyoid nerves. The external landmarks to help align the needle for this injection are the tragus of the ear and the corner of the mouth . The needle is inserted just medial to the tendon of the temporal muscle and considerably superior to the insertion point for conventional mandibular block anesthesia. The needle is also inclined upward and parallel to a line from the corner of the patient’s mouth to the lower border of the tragus ( intertragic notch). The needle and the barrel of the syringe should be directed toward the injection site from the corner of the mouth on the opposite side Gow-Gates16 suggested that, once the technique is learned properly, it rarely fails to produce good mandibular anesthesia.

8. Anesthetization of Maxillary Primary and Permanent Incisors and Canines SUPRAPERIOSTEAL TECHNIQUE (LOCAL INFILTRATION ) The injection should be made closer to the gingival margin than in the patient with permanent teeth, and the solution should be deposited close to the bone. After the needle tip has penetrated the soft tissue at the mucobuccal fold, it needs little advancement before the solution is deposited (2 mm at most) because the apices of the maxillary primary anterior teeth are essentially at the level of the mucobuccal fold. Before extraction of the incisors or canines in either the primary or permanent dentition, it is necessary for the palatal soft tissues to be anesthetized. The nasopalatine injection provides adequate anesthesia for the palatal tissues of all four incisors and at least partial anesthesia of the canine areas.

9. Anesthetization of Maxillary Primary Molars and Premolars The bone overlying the first primary molar is thin, and this tooth can be adequately anesthetized by injection of anesthetic solution opposite the apices of the roots For anesthetization of the maxillary first or second premolar, a single injection is made at the mucobuccal fold to allow the solution to be deposited slightly above the apex of the tooth.

10. the thick zygomatic process overlies the buccal roots of the second primary and first permanent molars in the primary and early-mixed dentition. This thickness of bone renders the supraperiosteal injection at the apices of the roots of the second primary molar much less effective; the injection should be supplemented with a second injection superior to the maxillary tuberosity area to block the posterior superior alveolar nerve

11. Anesthetization of Maxillary Permanent Molars PSA Block The puncture point is in the mucobuccal fold above and distal to the distobuccal root of the first permanent molar. If the second molar has erupted, the injection should be made above the second molar. The needle is advanced upward and distally, depositing the solution over the apices of the teeth. The needle is inserted for a distance of approximately 2 cm in a posterior and upward direction; it should be positioned close to the bone, with the bevel toward the bone For complete anesthesia of the first permanent molar for operative procedures, the supraperiosteal injection is made

12. Anesthetization of the Palatal Tissues Anesthesia of the palatal tissues can be one of the more exquisitely painful procedures performed in dentistry. for achieving profound anesthesia with minimal pain in the palatal and lingual aspects. After buccal infiltration, they suggest interdental ( interpapillary ) infiltration NASOPALATINE NERVE BLOCK Blocking the nasopalatine nerve anesthetizes the palatal tissues of the six anterior teeth . this technique is painful and is not routinely used before operative procedures.

13. GREATER (ANTERIOR) PALATINE INJECTION The greater palatine injection anesthetizes the mucoperiosteum of the palate from the tuberosity to the canine region and from the median line to the gingival crest on the injected side. bisect an imaginary line drawn from the gingival border of the most posterior molar that has erupted to the midline. In the child in whom only the primary dentition has erupted, the injection should be made approximately 10 mm posterior to the distal surface of the second primary molar.

14. Supplemental Injection Techniques INFRAORBITAL NERVE BLOCK AND MENTAL NERVE BLOCK The infraorbital nerve block anesthetizes the branches of the anterior and middle superior alveolar nerves. It also affects innervation of the soft tissues below the eye, half of the nose , and the oral musculature of the upper lip on the injected side of the face. The infraorbital block technique is preferred when impacted teeth (especially canines or first premolars) or large cysts are to be removed, when moderate inflammation or infection contraindicates use of the supraperiosteal injection site, or when longer duration or a greater area of anesthesia is needed

15. Supplemental Injection Techniques Mental nerve block Blocking the mental nerve anesthetizes all mandibular teeth in the quadrant except the permanent molars. the technique puts the syringe in clear view of the patient, whereas the inferior alveolar nerve block may be performed with the syringe out of the child’s direct vision . PERIODONTAL LIGAMENT INECTION (INTRALIGAMENTARY INJECTION) The needle is placed in the gingival sulcus, usually on the mesial surface, and is advanced along the root surface until resistance is met. Approximately 0.2 mL of anesthetic is then deposited into the periodontal ligament.

16. ANESTHETIC TOXICITY young children are more likely to experience toxic reactions because of their lower body weight . Young children are also often sedated with pharmacologic agents before the treatment. The potential for toxic reactions increases when local anesthetics are used in conjunction with sedation medications. For example, the toxic dose of lidocaine would be attained if hardly more than 1.5 cartridges (3 mL) of 2% lidocaine with 1:100,000 epinephrine were injected at one time in a patient weighing 14 kg (30 lb ). The rule of 25 for healthy patients, a dentist can safely use 1 cartridge of anesthetic for every 25 pounds of patient weight;

17. TRAUMA TO SOFT TISSUE children should be observed carefully so that they will not purposely or inadvertently bite the tissue Children who receive an inferior alveolar injection for routine operative procedures may bite the lip, tongue, or inner surface of the cheek. Sometimes a parent calls the dentist’s office an hour or two after a dental appointment to report an injury to the child’s oral mucous membrane. The parent may wonder if the accident occurred during the dental appointment;

18. Reversal of Dental Anesthesia OraVerse ( phentolamine mesylate ) became the first pharmaceutical agent indicated for the reversal of soft tissue anesthesia The most common adverse reaction was transient injection site pain . Although tachycardia and cardiac arrhythmia may occur with the parenteral use of alpha-adrenergic blocking agents The recommended maximum dose for OraVerse is as follows: □ Two cartridges for adults and adolescents 12 years and older □ One cartridge for patients aged 6–11 years and weighing over 66 lbs □ ½ cartridge for children aged 6–11 years and weighing 33–66 lbs □ In pediatric patients weighing at least 10 kg (22 lbs ), the maximum dose of OraVerse recommended is ¼ cartridge. 

19. Analgesics