One of the most important and challenging aspects of child behavior management is the control of pain. Children who undergo early painful experiences during dental procedures are likely to carry negative feelings toward dentistry into adulthood. Therefore, it is important that clinicians make every effort to minimize pain and discomfort during dental treatment.
Because of the likelihood of the pediatric dental patient experiencing discomfort during restorative and surgical procedures dentists turn to the use of local anesthetics and/or analgesics to control pain. The simplest and most effective method of reducing pain during dental procedures is via an injection of local anesthetic. Unfortunately, the anticipation of receiving a “shot” tends to increase anxiety in the pediatric and adult patient and similarly in the dentist who has the task of minimizing discomfort during the injection process. Most adults are willing to subject themselves to the minor discomfort of the injection because they can envision the comfort they will experience during restorative and surgical procedures. Unfortunately, younger children do not have the ability to do this and thus may exhibit negative behavior before, during and after the injection process. Many dentists, wishing to circumvent such negative behavior, forego administering local anesthesia for restorative treatment especially in primary teeth. However, there are times when an anticipated “minor” procedure becomes a major procedure and the patient is placed in a painful situation because of the lack of dental anesthesia. Local anesthesia can prevent discomfort associated with placing a rubber dam clamp, tooth preparation, pulp therapy and extraction.
There are very few contraindications for the use of local anesthesia in children during dental procedures. However, when administering a local anesthetic to a child the clinician should be aware of the possibilities of anesthetic overdose, self-induced traumatic injuries related to prolonged duration of soft tissue anesthesia and technique variations related to the smaller skull and different anatomy in pediatric patients.
The goal of this course is to familiarize the dentist and dental auxiliaries with effective and safe techniques for the administration of local anesthesia in the pediatric dental patient. It is not intended to be the most comprehensive source of information on local anesthesia. The reader is referred to The Handbook of Local Anesthesia by Dr. Stanley Malamed for an in depth discussion of the topic.