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

Discussion Local anesthesia for dental treatment in children is one of the most important steps for achieving cooperative behavior during treatment and for positive reaction after treatment. There are no specific guidelines regarding the minimal amount of local anesthesia solution to be injected in children. We know the maximal amount to be injected by weight and we know that the success rate of good anesthesia differs with regards to the jaw to be treated and the injection technique used (18, 27). The maximal amount of injected solution is well established by weight and the success rate of good anesthesia differs with regards to the jaw to be treated and the injection technique used (18, 27). The amount of local anesthetic solution injected has to be suitable to complete the treatment in a positive way and to reduce the time of post-treatment numbness, in order to minimize the possibility of self-inducted trauma (27). For local anesthesia in adults some recommendations were published: 1-1.5ml for mandibular block (28, 29) and 0.5- 2.0ml for local infiltration (3). In young children the bone density is reduced and the diffusion rate is higher (3) and the amount of local anesthetic solution can be reduced. SPDs and RDPs injected less than half of the amount of local anesthetic solution than GPs that treated children on a daily basis. The maximum recommended dose for 2% lidocaine with 1:100,000 epinephrine to be injected is 7.0mg/kg, and for 3% mepivacaineis 6.6 mg/kg. One cartridge of 2% lidocaine contains 36 mg and should be used for children with weight of more than 5.2kg, while for mepivacaine 1 cartridge contains 54 mg and the minimum weight for 1 cartridge is 8.2kg (28). The weight of the children was not reported but the youngest child was 2.5 years old and treated by a specialist using only 0.72ml of 2% lidocaine, so the maximum recommended dose was never reached. The use of 2% lidocaine with epinephrine in pediatric dentistry is more common for better and longer anesthesia (11, 17 ,29). The use of inhalation sedation reduced the amount of local anesthetic solution injected.

and inhalation sedation (N 2 O/O 2 ) was used in 58% of the treatments. In 54% of the children two teeth were treated during the treatment session; in 31% only one tooth, in 20% three teeth and in 5% four teeth were treated. Thirty seven children- reported of post-operative pain but only 15 (12.7%) needed analgesic treatment (Table 3). More boys reported post-operative pain-16% Vs 4% of girls. Table 3 Post-operative reports of pain and use of analgesics of 118 children

Reports of post-operative pain Analgesics taken No analgesics taken Report of no pain Missing value Total

Frequencies 15 22 39 42 118

Percent 12.7% 18.6% 33.0% 35.7% 100%

SPDs and RPDs injected significantly reduced amount of local anesthetic solution compared to GPs – (0.786/0.746±0.4ml Vs 1.65±0.3ml) (P<0.001) (Table 4). Table 4 Use of solutions volumes characterized by different factors

Volume 0.90±0.57ml 1.34±0.46ml 0.8±0.5ml 1.06±0.5ml 0.58±0.48ml 0.98±0.54ml

P

Local infiltration Block

P>0.05

With N 2 O W/O N 2 O

P<0.001

Anterior segment Posterior segment

p<0.005.

The amount of solution injected in the upper jaw was significantly less than that injected in the mandible 0.90±0.57ml Vs 1.34±0.46ml (P<0.05). When inhalation sedation was used less anesthetic solution was injected (0.8±0.5ml with N 2 O/O 2 V s 1.09±0.5ml without). The use of 3% mepivacaine solution was significantly higher in the SPDs/ RPDs group compared to GPs group - 22% of the treatments Vs 2% (P<0.001).

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The Journal of the Israel Dental Association, vol. 37, No. 3, July 2020.