רפואת הפה והשיניים - עיתון ההסתדרות לרפואת שיניים בישראל - כרך ל"ז, גיליון מס' 3 אב תש"פ

Results Two hundred questionnaires and cartridges were collected. Only 118 (60%) were used due to missing data in 82 of them. The specialists performed 44% of the treatments, the residents 36% and the GPs 20%. Sixty five of the children were boys (54%), and the mean age was 8.13 ± 3.2 years (min 2.5 years, max 14 years). Forty nine percent of the treatments were in the maxilla and the most common treatment (70.4%) was restoration of molar teeth (Table 1).

The question is how much is effective? The answer is not clear. Insufficient anesthesia may affect the cooperation of the child and his behavior during and after treatment (6, 7, 18). The pediatric literature showed extensive documentation of toxicity following doses that were too high (3, 5, 19-26), but for the minimum amount, there are no clear guidelines or recommendations (12). The aim of the study was to establish current situation by A: analyzing prospectively the amount of local anesthetic solution injected by specialists and residents in pediatric dentistry and to compare it to general practitioners that treat children on a daily basis. B: correlating between the dental procedures performed and the amount of local anesthetic solution needed. Materials and Methods Twelve dentists that treat children on a daily basis were included in the research: 4 specialists in pediatric dentistry (SPDs), 5 residents in pediatric dentistry (RPDs) and 3 general practitioners (GPs). Each dentist filled a questionnaire containing the age of the child, the treatment performed and the post-operative symptoms. The local anesthetic cartridge was attached to each questionnaire. Only treatments of healthy children were included. 8-24 hours after treatment a dental assistant called the parents and interviewed them regarding the post-operative symptoms. The period of the research was 12 months. The amount of local anesthetic solution injected was calculated by reducing the amount that remained in the cartridge from the basic 1.8ml. Statistical analyses included uni-variate ANOVA to determine the effect of kind of local anesthesia (local infiltration Vs mandibular block), the treatment performed, gender and age of the patient, use of inhaled sedation, use of topical anesthesia, and training of the dentist on the amount of local anesthetic solution injected. The results were significantly different if P value was <0.05.

Table 1 Treatment modalities performed in 118 children

Treatment modalities

Percent 70.4% 14.4%

No . 83 17 7 4 2 2 2 1 118

Restoration Extraction Restoration+pulpotomy+SSC Restoration+extraction Restoration+SSC Restoration+pulpotomy+SSC+extraction SSC Pulpotomy Total

5.9% 3.5% 1.7% 1.7% 1.6% .8% 100%

The solution, 2% lidocaine with 1:100,000 epinephrine (64%) or 3% mepivacaine (36%) was injected using a conventional syringe with aspiration in 80% of the cases, or an intrasulcular syringe (20%). The prevalence types of needle gauge used were: 25G needle were used in 55% of the cases, 27G needle in 30% and 30G needle in 15% (Table 2). In all cases, topical anesthesia was applied

Table 2 Prevalence of needle types used

Needle diameter 25G 27G 30G Total

Distribution 62 40 16 118

% 55 30 15 100.0

40

.3 ז, גיליון ״ פ, כרך ל ״ רפואת הפה והשיניים, אב תש