רפואת הפה והשיניים - עיתון ההסתדרות לרפואת שיניים בישראל - כרך ל"ח, גיליון מס' 1 שבט תשפ"א - ינואר 2021

Local anesthesia in pediatric dentistry - How much is enough?

Introduction Pain prevention in pediatric dentistry is crucial for achieving positive experience of a child during dental treatment, building trust and cooperation and establishing a compliant dental adult. One of the main methods to prevent pain is local anesthesia (1-3). Local anesthesia is achieved by injecting a chemical that diffuses in tissue, reaches nerve cells, binds to receptors located on thecellmembraneandcauses a temporary blockage of the sensory nerve conduction at the injection site (3, 4, 5). The amount of injected material can influence the onset, duration, manifestations of toxicity and side effects of anesthesia during and after treatment. The time before the onset and the duration of anesthesia are influenced by the specific tissue reaction to the injected

solution (3, 5), the amount injected (6, 7), the type of the local anesthetic solution (8), the individual reaction of the patient, the anatomical variations and the injection technique (3, 9). Toxicity of local anesthetic substance develops when the level of the substance in the blood is higher than permitted. The causes of toxicity include: injecting into blood vessels, injecting too quickly, or injecting a larger amount of solution than allowed (3, 4, 10, 11). The toxicity is diagnosed by the suppression of the central and cardiovascular nervous system, with a range of symptoms including mild tremor, dizziness and paralysis until tonic-clonic contractions and a slight decrease in blood pressure and cardiac output (3, 9). Postoperative side effects include injury of soft oral tissues due to biting post

Dr. Mass E., Dr. Palmon Y., Dr. Zilberman U. Pediatric Dental Unit, Barzilai Medical University Center, Ashkelon, Israel

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.1 רפואת הפה והשיניים, שבט תשפ״א, כרך ל״ח, גיליון