What is the main goal for local anesthesia in children?
to manage the pain anticipated during dental treatment NOT to punish the kids!
How can we enforce the goal of making this necessary not easy procedure comfortable to our pediatric patients?
-proper behavior guidance techniques (TSD, distraction, positive reinforcement, Nitrous oxide
-proper topical anesthetics (leave on for correct amount of time)
-proper injection techniques (inject slowly)
-know your materials and use minimum but effective
What are the seven things you should know about the pharmacology of the local anesthetic you are using?
-mechanism of action
-type of anesthetics & metabolisms/excretion (esters vs. amides)
-duration of anesthetics (pulp vs. soft tissues0
-maximum recommended dose (MRD) calculation
-possible complications (post-op soft tissue injury, toxicity, allergy, etc.
What is the maximum dosage for lidocaine in mg/kg and mg/lb?
4.4 and 2.0
What is the maximum total dosage of lidocaine in mg?
300
How many minutes does 2% plain lidocaine last for the pulp during a maxillary infiltration?
5 minutes
How many minutes does 2% plain lidocaine last for the pulp during a mandibular infiltration?
5-10 minutes
How many minutes does 2% 1:50,000 epic lidocaine last for the pulp and soft tissue during a maxillary infiltration?
60 minutes for pulp and 170 minutes for soft tissue
How many minutes does 2% 1:50,000 epic lidocaine last for the pulp and soft tissue during a mandibular infiltration?
85 minutes for pulp and 190 minutes for soft tissue
How many minutes does 2% 1:100,000 epic lidocaine last for the pulp and soft tissue during a maxillary infiltration?
60 minutes for pulp and 170 minutes for soft tissue
How many minutes does 2% 1:100,000 epic lidocaine last for the pulp and soft tissue during a mandibular infiltration?
85 minutes for pulp and 190 minutes for soft tissue
What is the maximum dosage for Mepivocaine in mg/kg and mg/lb?
4.4 mg/kg and 2.0 mg/lbs
What is the maximum total dosage for Mepivocaine in mg?
300mg
How many minutes does 3% plain mepivocaine last for the pulp and soft tissue during a maxillary infiltration?
25 minutes for the pulp and 90 minutes for the soft tissue
How many minutes does 3% plain mepivocaine last for the pulp and soft tissue during a mandibular infiltration?
40 minutes for the pulp, and 165 for the soft tissue
How many minutes does 2% 1:100,000 epi mepivocaine last for the pulp and soft tissue during a maxillary infiltration?
60 for pulp and 170 for soft tissue
How many minutes does 2% 1:100,000 epi mepivocaine last for the pulp and soft tissue during a mandibular infiltration?
85 for pulp and 190 for soft tissue
How many minutes does 2% 1:20,000 levonordefrin mepivocaine last for the pulp and soft tissue during a maxillary infiltration?
50 for pulp and 130 for soft tissue
How many minutes does 2% 1:20,000 levonordefrin mepivocaine last for the pulp and soft tissue during a manidbular infiltration?
75 for pulp and 185 for soft tissue
What is the maximum dosage for Articaine in mg/kg and mg/lb?
7.0mg/kg and 3.2mg/lb
What is the maximum total dosage for Articaine in mg?
500mg
How many minutes does 4% 1:100,000 epi Articaine last for the pulp and soft tissue during a maxillary infiltration?
60 for pulp and 190 for soft tissue
How many minutes does 4% 1:100,000 epi Articaine last for the pulp and soft tissue during a mandibular infiltration?
90 for pulp and 230 for soft tissue
How many minutes does 4% 1:200,000 epi Articaine last for the pulp and soft tissue during a maxillary infiltration?
45 for pulp and 180 for soft tissue
How many minutes does 4% 1:200,000 epi Articaine last for the pulp and soft tissue during a mandibular infiltration?
60 for pulp and 240 for soft tissue
What is the maximum dosage for Prilocaine in mg/kg and mg/lb?
6.0mg/kg and 2.7mg/lb
What is the total maximum dosage for Prilocaine in mg?
400mg
How many minutes does 4% plain Prilocaine last for the pulp and soft tissue during a maxillary infiltration?
20 for the pulp and 105 for the soft tissue
How many minutes does 4% plain Prilocaine last for the pulp and soft tissue during a mandibular infiltration?
55 for pulp and 190 for soft tissue
How many minutes does 4% 1:200,000 epi Prilocaine last for the pulp and soft tissue during a maxillary infiltration?
40 for pulp and 140 for soft tissue
How many minutes does 4% 1:200,000 epi Prilocaine last for the pulp and soft tissue during a mandibular infiltration?
60 for pulp and 220 for soft tissue
What is the maximum dosage for Bupivacaine in mg/kg and mg/lb?
1.3mg/kg and .6mg/lb
What is the maximum total dosage for Bupivacaine in mg?
90mg
How many minutes does .5% 1:200,000 epi Bupivicane last for the pulp and soft tissue during a maxillary infiltration?
40 for pulp and 340 for soft tissue
How many minutes does .5% 1:200,000 epi Bupivicane last for the pulp and soft tissue during a mandibular infiltration?
240 for pulp and 440 for soft tissue
How much lidocaine is in 1.7ml cartridge and 1.8ml cartridge?
34 or 36mg respectively
How much 3% plain mepivacaine is in 1.7ml cartridge and 1.8ml cartridge?
51 or 54mg respectively
How much 2% 1:100,000 epi mepivacaine and 2% 1:20,000 levonordefrin is in 1.7ml cartridge and 1.8ml cartridge?
34 or 36 respectively
How much articaine is in 1.7ml cartridge and 1.8ml cartridge?
68 or 72mg respectively
How much prilocaine is in 1.7ml cartridge and 1.8ml cartridge?
68 or 72 mg respectively
How much bupivacaine is in 1.7ml cartridge and 1.8ml cartridge?
8.5 or 9mg respectively
Why is knowing the MRD important?
you can actually kill your patient , you need to know the dosage you can give to your patient
What are five things to consider for behavior guidance during anesthesia?
- use age appropriate and non-threatening terminology
-basic behavior guidance
-communication % communicative guidance
- partental presence/abscence
-use of nitrous oxide/oxygen inhalation
What techniques does video 1 demonstrate?
Shows dentist giving LA to PEDS patient. Gives the patient a lot of encouragement. Always talk to the patient and kind of give them an idea of what to expect. Make sure to hide the needle.
What techniques does video 2 demonstrate?
Another example. Assistant and provider have to be in communication
What techniques does video 3 demonstrate?
Another example of LA to PEDS patient. The younger the patient the more behavior management you need. You want to encourage the good behavior you want.
T/F The timing of initial radiographs should be based on the patients age instead of each individual's cirumstances (needs)
F. The timing of initial radiographs should NOT be based on the patients age but on each individual's cirumstances (needs)
T/F dental radiographs should be taken ONLY when there is an expectation that the diagnostic yield will affect patient care
TRUE
What are four ways that we can minimize the patient's exposure due to the accumulated effects of radiation exposure over time?
#NAME?
know guidelines for prescribing dental radiographs
The recommendations in this charter subject to clinical judgement and may not apply to every patient.
When determining what radiographs to take for a patient what are the two main things to consider?
1) History & Clinical Findings 2)CARIES RISK
A 6 year-old boy has returned for a 6-month recall. At the previous appointment, the child had bitewing radiographs, taken, revealing no dental caries and you concluded him to be low caries risk. What would your choice of radiographs at this appt?
A) two
didn't go over the answer but I would have assumed no x-rays would be taken?
What are three radiography techniques used to take bitewings?
1) X-cps, 2) bite tab, 3)snap-a-ray
Bitewing radiographs are taken to ?
a) Detect incipient interproximal caries
b) Determine pulp chamber configuration and depth of caries lesions
c) Record the width of spaces created by premature loss of primary teeth
d) Determine the relation of occlusal
A? didn't go over answer
You are about to take a maxillary occlusal film on a 5 year-old patient, what would be the normally directed angulation of the central X-ray beam?
(A)+60� (B)+30� (C)+40� (D)+50�
A? again did not go over
What is the most efficient way to interpret a Panorex in pediatric patients?
Systemic approach (outside inside)
TMJs, ramus & cervical spine, hyoid bone, etc.
Teeth & alveolar ridges
Task & area of interest
Identify findings related to growth/development
we are dealing with the growing patients
chronological development & dental
Here is the panoramic film of your 12-year- old patient. Please summarize your radiographic findings. picture is in answer.
Upper canines erupting
-
Expect to see 2nd molar erupting
-
Canines rotated
-
Mandibular 3rd molars may be impacted
-
Caries
Here is the panoramic film of your 10- year-old patient. Please summarize your radiographic findings. (pic is in answer)
Area of interest: the caries
Here is the panoramic film of your 8-year- old patient. Please summarize your radiographic finding. pic in answer
Peg lateral
-
Maxillary canine is high
-
2nd molars are developing, normal for an 8 year old
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Is the patient missing teeth or have an extra tooth?