Local Anesthesia for Pediatric Patients

Not recommended for patients under 3 years or less than 15 kg. [AAPD Guidelines 2023] “Use of phentolamine mesylate is not recommended for patients who are younger than three years of age or weigh less than 15 kg (33 pounds).”

Local anesthetic systemic toxicity, can result from high blood levels from single intravascular injection or repeated injections. [AAPD Guidelines 2023] “LAST can result from high blood levels caused by a single inadvertent intravascular injection or repeated injections.”

Limited to surface penetration. [AAPD Guidelines 2023] “Topical anesthetics are effective on surface tissues (up to two to three millimeters [mm] in depth) to reduce pain from needle penetration of the oral mucosa.”

Common single drug topicals include benzocaine 20%, lidocaine 5%, and tetracaine 4%. [AAPD Guidelines 2023] “Single drugs which are often used as topical anesthetics in dentistry include 20 percent benzocaine, five percent lidocaine, and four percent tetracaine.”

When needed information about medical condition impact on local anesthetic use is required. [Ref: AAPD Guidelines 2023]

Lower gauge numbers (larger diameter) provide less deflection and more reliable aspiration. [AAPD Guidelines 2023] “Needles with lower gauge number (larger diameter) provide for less deflection as the needle passes through soft tissues and for more reliable aspiration.”

Local anesthetics act within neural fibers to inhibit sodium influx for neuron impulse generation. [AAPD Guidelines 2023] “Local anesthetics act within neural fibers to inhibit the rapid ionic influx of sodium necessary for neuron impulse generation and propagation.”

FDA warns against use for children younger than two years. [AAPD Guidelines 2023] “FDA warns against use of topical anesthetics (including over-the-counter teething products) containing benzocaine for children younger than two years.”

Evidence is equivocal for post-operative pain reduction. [AAPD Guidelines 2023] “In patients undergoing general anesthesia for dental treatment including restorations and extractions, however, the evidence for administration of local anesthesia intraoperatively to reduce postoperative pain is equivocal.”

In presence of inflammation or infection at injection site. [AAPD Guidelines 2023] “The use of the PDL injection or intraosseous methods is contraindicated in the presence of inflammation or infection at the injection site.”

In patients with bleeding disorders to minimize post-operative bleeding. [AAPD Guidelines 2023] “In patients with bleeding disorders, the periodontal ligament (PDL) injection minimizes the potential for postoperative bleeding of soft tissue vessels.”

Computer-controlled delivery, periodontal injection, needleless systems, intraseptal/intrapulpal injection. [AAPD Guidelines 2023] “Several alternative techniques, including computer-controlled local anesthetic delivery, periodontal injection techniques, needleless systems, and intraseptal or intrapulpal injection, are available.”

Concerns for increased future pain sensitivity and reduction in postoperative pain. [AAPD Guidelines 2023] “Reasons to use local anesthesia for dental procedures under general anesthesia include concerns for increased future pain sensitivity due to CNS priming and reduction in postoperative pain.”

Not recommended for patients under 4 years old. [AAPD Guidelines 2023, Table] “Use in pediatric patients under four years of age is not recommended.”

Time-based record of all agents when using local anesthetic with sedatives. [AAPD Guidelines 2023] “recording doses of all agents on a time-based record can help ensure patient safety.”

Constrict blood vessels to lower absorption rate and prolong action. [AAPD Guidelines 2023] “Vasoconstrictors are added to local anesthetics to constrict blood vessels in the area of injection. This lowers the rate of absorption of the local anesthetic into the blood stream, thereby lowering the risk of toxicity and prolonging the anesthetic action in the area.”

Body weight and maximum recommended total dose calculations. [AAPD Guidelines 2023] “documenting the body weight and calculating the maximum recommended total dose preoperatively can help prevent overdosage.”

While LAs are safe in pregnancy, second trimester is optimal for non-urgent care. [AAPD Guidelines 2023] “The second trimester of pregnancy… may be the optimal time to complete non-urgent dental treatment.”

These are early signs of LAST requiring immediate cessation of LA administration. [AAPD Guidelines 2023] “Early subjective indications of toxicity involve the CNS and include dizziness, anxiety, and confusion… followed by muscle twitching.”

Infants younger than 6 months require 30% reduction in amide local anesthetic doses. [AAPD Guidelines 2023] “The calculated maximum total dose of amide local anesthetics should be reduced by 30 percent in infants younger than six months.”