Local Anesthesia for Pediatric PatientsPediatric Dentistry MCQs 0% Report a question What’s wrong with this question? You cannot submit an empty report. Please add some details. 123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960616263646566676869707172737475767778 Local Anesthesia for Pediatric Patients QB This MCQ test will show a random set of questions from the question bank each time. 1 / 78 Tags: Patient Assessment When is medical consultation indicated before local anesthesia? Never When medical clarification needed Routine cases All cases When needed information about medical condition impact on local anesthetic use is required. [Ref: AAPD Guidelines 2023] 2 / 78 Tags: Technique What anatomical knowledge is crucial for safe administration? Basic anatomy only Complete head and neck anatomy Just blood vessels Only nerve locations Knowledge of gross and neuroanatomy of head and neck for proper placement and minimizing complications. [Ref: AAPD Guidelines 2023] 3 / 78 Tags: safety What is the most important consideration in pediatric local anesthetic dosing? Surface area dosing Fixed dosing Weight-based dosing Age-based dosing Appropriate dosage must be based on body weight to minimize chance of toxicity. [Ref: AAPD Guidelines 2023] 4 / 78 Tags: Pharmacology How deep can topical anesthetics effectively penetrate tissue? 5-6mm 4-5mm 1mm 2-3mm Topical anesthetics are effective on surface tissues up to 2-3mm in depth. [Ref: AAPD Guidelines 2023] 5 / 78 Tags: Clinical Significance What is the primary importance of pain control in pediatric dentistry? Multiple benefits including trust Just behavior control Only physical comfort Treatment completion only Helps foster trusting relationship, allays fear/anxiety, promotes positive dental attitude, prevents physical/psychological consequences. [Ref: AAPD Guidelines 2023] 6 / 78 Tags: Classification What are the two general types of local anesthetic chemical formulations? Only esters Only amides Esters and amides None of above Two types are: (1) esters (procaine, benzocaine, tetracaine) and (2) amides (lidocaine, mepivicaine, prilocaine, articaine). [Ref: AAPD Guidelines 2023] 7 / 78 Tags: Basic Science What is the primary mechanism of action of local anesthetics? Potassium channel blockade Nerve destruction Calcium channel blockade Sodium channel blockade Local anesthetics act within neural fibers to inhibit rapid ionic influx of sodium necessary for neuron impulse generation and propagation. [Ref: AAPD Guidelines 2023] 8 / 78 Tags: safety What is the most important consideration in pediatric local anesthetic dosing? Weight-based dosing Fixed dosing Age-based dosing Surface area dosing Weight-based dosing crucial for safety. [AAPD Guidelines 2023] “In pediatric dentistry, appropriate dosage (based on body weight) will minimize the chance of toxicity.” 9 / 78 Tags: Pharmacology How deep can topical anesthetics effectively penetrate tissue? 5-6mm 2-3mm 1mm 4-5mm 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.” 10 / 78 Tags: Clinical Significance What is the primary importance of pain control in pediatric dentistry? Just behavior control Treatment completion only Only physical comfort Multiple benefits including trust Multiple benefits for patient experience and trust. [AAPD Guidelines 2023] “This helps prevent sensation of pain during procedures, which can foster a trusting relationship between the patient and dentist, allay fear and anxiety, and promote a positive dental attitude.” 11 / 78 Tags: Classification What are the two general types of local anesthetic chemical formulations? None of above Esters and amides Only amides Only esters Two main types: esters and amides. [AAPD Guidelines 2023] “The two general types of local anesthetic chemical formulations are: (1) esters (e.g., procaine, benzocaine, tetracaine) and (2) amides (e.g., lidocaine, mepivicaine, prilocaine, articaine).” 12 / 78 Tags: Basic Science What is the primary mechanism of action of local anesthetics? Nerve destruction Calcium channel blockade Potassium channel blockade Sodium channel blockade 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.” 13 / 78 Tags: Clinical Efficacy What is the maximum tissue penetration depth of topical anesthetics? 4-5mm 8-9mm 6-7mm 2-3mm Effective up to 2-3mm in tissue depth. [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.” 14 / 78 Tags: Safety Risks What is the concern with compounded topical anesthetics? stability efficacy cost toxicity risk from high concentrations Risk of toxicity due to high concentration of individual anesthetic components. [AAPD Guidelines 2023] “The FDA has issued warnings about the potential toxicity of compounded topical anesthetics due to the high concentration of individual anesthetic components.” 15 / 78 Tags: Safety Guidelines What is the FDA’s age restriction for benzocaine use? Under 1 year Under 2 years Under 3 years Under 4 years 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.” 16 / 78 Tags: Complications What is the primary risk associated with benzocaine and prilocaine? Allergic reaction Local irritation Methemoglobinemia risk Tissue damage Both agents are associated with risk of acquired methemoglobinemia. [AAPD Guidelines 2023] “Benzocaine and prilocaine both have been associated with a risk of acquired methemoglobinemia, and their use is contraindicated in patients with a history of methemoglobinemia.” 17 / 78 Tags: Pharmacology What are the drugs commonly used as topical anesthetics? 10% lidocaine and 5% tetracaine 20% benzocaine, 5% lidocaine, 4% tetracaine 30% benzocaine, 8% lidocaine, 2% tetracaine 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.” 18 / 78 Tags: Technical Considerations What size needle provides less deflection and more reliable aspiration? Higher gauge numbers Gauge is irrelevant Medium gauge only Lower gauge numbers 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.” 19 / 78 Tags: Complications What causes needle breakage? Only bending Only hub insertion Multiple factors including hub insertion, bending, movement Only movement Breakage occurs when inserted to hub, bent before insertion, or from patient movement. [AAPD Guidelines 2023] “Breakage can occur when a needle is inserted to the hub, when the needle is weakened due to bending before insertion into the soft tissues, or by patient movement after the needle is inserted.” 20 / 78 Tags: Complications Which gauge is most associated with needle breakage in inferior alveolar blocks? 30-gauge 25-gauge 23-gauge 27-gauge Most needle fractures occur during inferior alveolar nerve block with 30-gauge needles. [AAPD Guidelines 2023] “Most needle fractures occur during the administration of inferior alveolar nerve block with 30-gauge needles.” 21 / 78 Tags: Equipment What are the three available needle lengths? Only ultrashort Only short Long, short, ultrashort Only long and short Long (32mm), short (20mm), and ultrashort (10mm). [AAPD Guidelines 2023] “Dental needles are available in three lengths: long (32 mm), short (20 mm), and ultrashort (10 mm).” 22 / 78 Tags: Equipment What is the range of needle gauges used in dentistry? 18 to 25 gauge 25 to 35 gauge 20 to 28 gauge 23 to 30 gauge Needle gauges range from 23 to 30, with lower numbers having larger diameter. [AAPD Guidelines 2023] “Needle gauges range from size 23 to 30, with the lower numbers having the larger inner diameter.” 23 / 78 Tags: Medical Considerations Which patients need medical consultation for vasoconstrictor use? Multiple medical conditions Healthy patients All patients No consultation needed Patients with cardiovascular disease, thyroid dysfunction, diabetes, or on certain medications. [AAPD Guidelines 2023] “Patients with significant cardiovascular disease, thyroid dysfunction, diabetes, or sulfite sensitivity and those receiving monoamine oxidase inhibitors, tricyclic antidepressants, antipsychotic drugs, norepinephrine, or phenothiazines may require a medical consultation.” 24 / 78 Tags: Pharmacology What is the primary purpose of vasoconstrictors in local anesthetics? Reduce pain during injection Decrease absorption and prolong action Increase absorption and quicker metabolism Increase speed of onset and absorption 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.” 25 / 78 Tags: Dosage What is the maximum epinephrine dose in local anesthetic for stable patients? 0.08mg (4 cartridges) No limit 0.06mg (3 cartridges) 0.04mg (2 cartridges) Maximum 0.04mg epinephrine (2 cartridges 1:100,000) per appointment. [AAPD Guidelines 2023, Table] “Maximum 0.04mg epinephrine (2 cartridges with 1:100,000) per appointment.” 26 / 78 Tags: Clinical Considerations What effect does infection have on local anesthetic efficacy? Better efficacy Delayed onset or ineffective No effect Faster onset May delay onset or make anesthesia ineffective due to low pH. [AAPD Guidelines 2023] “If a local anesthetic is injected into an area of infection, its time to onset may be prolonged or anesthesia may be ineffective.” 27 / 78 Tags: Anatomy What is different about mandibular bone in children? Less dense Less blood supply Larger growth centers No difference Less dense than adult bone, allowing more rapid anesthetic diffusion. [AAPD Guidelines 2023] “The mandibular cortical bone of a child is less dense than that of an adult, permitting more rapid and complete diffusion of the injected anesthetic.” 28 / 78 Tags: Chemistry What is the pH of anesthetics containing epinephrine and why? pH 4.5 to prolong shelflife pH 3 to match blood acidity pH 7 to maintain a neutral state pH 6 to match the oral tissues pH of approximately 4.5 to prolong vasoconstrictor shelf life. [AAPD Guidelines 2023] “Agents that include epinephrine are formulated to an approximate pH of 4.5 in order to prolong the shelf life of the vasoconstrictor.” 29 / 78 Tags: Pharmacology All are amide local anesthetics available for dental use, except Procaine Mepivacaine Articaine Lidocaine Five main amides are available. [AAPD Guidelines 2023] “Amide local anesthetics available for dental usage include lidocaine, mepivacaine, articaine, prilocaine, and bupivacaine.” 30 / 78 Tags: Anatomical Considerations Which os the following is true about buccal infiltration in children? Are not effective Maybe as effective as block anesthesia Not recommended Have low efficacy compared to block anesthesia May be as effective as blocks due to less dense mandibular bone. [AAPD Guidelines 2023] “Because of this increased permeability, mandibular buccal supraperiosteal infiltration with local anesthetic may be as effective as an inferior alveolar nerve block for dental procedures.” 31 / 78 Tags: Clinical Factors What affects local anesthetic efficacy in infected areas? Low pH affects diffusion Blood flow only Inflammation only Temperature Low pH of infected tissue inhibits anesthetic action. [AAPD Guidelines 2023] “Infection lowers the pH of the extracellular tissue, inhibiting diffusion of the active free base form of the anesthetic across the neural membrane, thereby stopping nerve impulse conduction.” 32 / 78 Tags: Infection Prevention When is endocarditis prophylaxis needed for local anesthetic injection? Sometimes needed Case dependent Always needed Not needed for routine injections Not recommended for routine injections through noninfected tissue in at-risk patients. [AAPD Guidelines 2023] “Endocarditis prophylaxis (antibiotics) is not recommended for routine local anesthetic injections through noninfected tissue in patients considered at risk.” 33 / 78 Tags: Dosage Guidelines What is the lidocaine maximum dose for pediatric patients? 4.4 mg/kg 2.2 mg/kg 3.3 mg/kg 6.6 mg/kg 4.4 mg/kg (AAPD recommendation) vs manufacturer’s 7 mg/kg. [AAPD Guidelines 2023] “The table lists the long-established pediatric dental maximum dose of lidocaine as 4.4 mg/kg; however, the MRD is 7 mg/kg.” 34 / 78 Tags: Dosage Modifications How should dose be adjusted for young infants? 30% reduction No adjustment 20% reduction 50% reduction Reduce amide local anesthetic doses by 30% in infants younger than 6 months. [AAPD Guidelines 2023] “The calculated maximum total dose of amide local anesthetics should be reduced by 30 percent in infants younger than six months.” 35 / 78 Tags: Age Limitations What age restriction exists for articaine? Under 8 years Under 6 years Under 2 years Under 4 years Not recommended for patients under 4 years old. [AAPD Guidelines 2023, Table] “Use in pediatric patients under four years of age is not recommended.” 36 / 78 Tags: Patient Selection Which patients should avoid bupivacaine? Elderly patients Hypertensive patients Children Women Contraindicated in children and intellectually disabled patients due to prolonged numbness risk. [AAPD Guidelines 2023] “While the prolonged effect of a long-acting local anesthetic (i.e., bupivacaine) can be beneficial for postoperative pain in adults, the concomitant increased risk of self-inflicted injury infers that it is contraindicated for children or intellectually disabled patients.” 37 / 78 Tags: Multiple Agents When using multiple agents, what documentation is required? Time-based comprehensive record Basic list of agents used A succinct summary The total amount 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.” 38 / 78 Tags: Weight-Based Records For weight-based dosing documentation, what should be included? Weight and max dose Patient weight Final dose calculations No documentation needed, just consent 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.” 39 / 78 Tags: Post-Treatment Records What post-procedure documentation is required? Post-injection instruction review Just follow-up No requirements Only complications Must include statement that post-injection instructions were reviewed. [AAPD Guidelines 2023] “Local anesthesia documentation also includes a statement that post-injection instructions were reviewed with the patient and parent.” 40 / 78 Tags: Special Populations What special documentation is needed for young or sedated patients? No special notes Weight and max dose calculations Just weight Just calculations Document body weight and calculate maximum recommended dose preoperatively. [AAPD Guidelines 2023] “With patients for whom the maximum dosage of local anesthetic may be a concern (e.g., young patients, those undergoing sedation), documenting the body weight and calculating the maximum recommended total dose preoperatively can help prevent overdosage.” 41 / 78 Tags: Documentation Format What example format is recommended for documenting local anesthetic use? Basic details only Just drug name Complete details with injection type, amount, location Drug amount only Should include specific details like injection type, needle size, amount, location. [AAPD Guidelines 2023] “For example, local anesthetic administration might be recorded as: mandibular block with 27-short; 34 milligrams (mg) two percent lidocaine with 0.017 mg epinephrine (or 1/100,000 epinephrine); tolerated procedure well.” 42 / 78 Tags: Sedation Records What additional documentation is needed when using sedation? Time-based record of all agents Basic notes only Just total doses No extra documentation Must document doses of all agents on a time-based record. [AAPD Guidelines 2023] “Because there may be enhanced sedative effects when local anesthetics are administered in conjunction with sedative drugs, recording doses of all agents on a time-based record can help ensure patient safety.” 43 / 78 Tags: Record Keeping What are the minimum documentation requirements for local anesthesia? Patient response only Only dosage Only type Type and dosage Must include type and dosage of local anesthetic administered. [AAPD Guidelines 2023] “This would include, at a minimum, the type and dosage of local anesthetic administered.” 44 / 78 Tags: Emergency Treatment What is the treatment for serious LAST? Basic life support Close monitoring IV lipid emulsion therapy Early treatment with intravenous lipid emulsion therapy. [AAPD Guidelines 2023] “Early treatment with intravenous lipid emulsion therapy is a priority in potentially serious cases of LAST.” 45 / 78 Tags: Technique What is the recommended protocol for injections? Minimize pain by fast injection Aspiration and slow injection No aspiration unless needed No aspiration for small needle sizes Aspirate before injection, inject slowly. [AAPD Guidelines 2023] “This would include aspirating after needle placement before agent delivery during every injection and injecting slowly.” Local anesthetic systemic toxicity (LAST) is a life-threatening reaction to local anesthetic drugs that can cause severe central nervous system (CNS) depression, seizures, and cardiac arrhythmias. 46 / 78 Tags: Prevention How can LAST be prevented? Keep an emergency kit nearby Ensuring close patient observation Correct LA technique, observation, proper dosing Proper dosing and a fast injection Careful injection technique, patient observation, weight-based dosing. [AAPD Guidelines 2023] “LAST can be prevented by careful injection technique, watchful observation of the patient, and knowledge of the maximum dosage based on body weight.” Local anesthetic systemic toxicity (LAST) is a life-threatening reaction to local anesthetic drugs that can cause severe central nervous system (CNS) depression, seizures, and cardiac arrhythmias. 47 / 78 Tags: Systemic Effects How does LAST affect the cardiovascular system? Biphasic response Minimal Cardiovascular impact Hypotension followed by ketosis Myocardial infarction Initial increase in heart rate/BP, then vasodilatation and myocardial depression. [AAPD Guidelines 2023] “The cardiovascular system response to local anesthetic toxicity also is biphasic. Initially, heart rate and blood pressure may increase due to the injected epinephrine. As plasma levels of the anesthetic increase, however, vasodilatation occurs followed by depression of the myocardium.” 48 / 78 Tags: Toxicity Signs What is the classic overdose reaction? Tonic-clonic convulsion Dizziness Nausea Fainting Generalized tonic-clonic convulsion. [AAPD Guidelines 2023] “The classic overdose reaction to local anesthetic is generalized tonic-clinic convulsion.” 49 / 78 Tags: Early Recognition What are early signs of LA toxicity? Dizziness and swelling Numbness, heightened awareness and cyanosis Dizziness, anxiety, and confusion Dizziness, anxiety, confusion, followed by diplopia, tinnitus, drowsiness, circumoral numbness. [AAPD Guidelines 2023] “Early subjective indications of toxicity involve the CNS and include dizziness, anxiety, and confusion. This may be followed by diplopia, tinnitus, drowsiness, and circumoral numbness or tingling.” 50 / 78 Tags: Emergency Recognition What is the LA CNS toxicity sequence? Severe depression Excitation then depression Depression then excitation Excitation Biphasic reaction: excitation followed by depression. [AAPD Guidelines 2023] “Local anesthetic causes a biphasic reaction (excitation followed by depression) in the central nervous system (CNS).” 51 / 78 Tags: Complications What is the underlying cause of LAST or Local anesthetic systemic toxicity? Local tissue reaction Trauma at the Injection site High blood levels Allergic response 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.” 52 / 78 Tags: Post-Op Management What is phentolamine mesylate’s role? Reduces anesthetic duration Increases anesthetic duration Prevents high blood levels of anesthetic Reduces duration of local anesthetic effects by reversing vasoconstrictor. [AAPD Guidelines 2023] “Use of phentolamine mesylate injections in patients over age six years or at least 15 kilograms (kg) has been shown to reduce the duration of effects of local anesthetic.” 53 / 78 Tags: Patient Selection What age/weight restrictions exist for phentolamine mesylate? No restrictions Under 3 years or <15 kg Under 4 years Under 5 years or <25 kg Phentolamine mesylate is a non-selective α-adrenergic antagonist that causes vasodilation. This increases blood flow and is reported to halve the reversal time of anaesthesia which is particularly desirable following dental surgery. It is 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).” 54 / 78 Tags: Technical Considerations Which nerve block technique increases soft tissue trauma risk? Unilateral mandibular blocks Long buccal block Infiltration technique Bilateral mandibular blocks Bilateral mandibular blocks increase risk compared to unilateral blocks. [AAPD Guidelines 2023] “The use of bilateral mandibular blocks may increase the risk of soft tissue trauma when compared to unilateral mandibular blocks or ipsilateral maxillary infiltration.” 55 / 78 Tags: Post-Op Complications What is the treatment for soft tissue injury risk, post-local anesthesia? Antibiotics to prevent spread of infections Local anesthesia to prevent permanent damage No treatment, its self-limiting Self-induced trauma (lip/cheek biting) is common, usually self-limiting. [AAPD Guidelines 2023] “Self-induced soft tissue trauma (e.g., lip and cheek biting) is an unfortunate clinical complication of local anesthetic use in the oral cavity. Most lesions of this nature are self-limiting.” 56 / 78 Tags: Risk Factors Which anesthetic concentration is most associated with paresthesia? 1% solutions 2% solutions 4% solutions 3% solutions 4% solutions (articaine and prilocaine) compared to lower concentrations. [AAPD Guidelines 2023] “Paresthesia has been reported to be more common with four percent solutions such as articaine and prilocaine compared to those of lower concentrations.” 57 / 78 Tags: Allergic Reactions What is the cross-allergy pattern between amides and esters? There are no cross-reactions All amides and esters are cross-reactive Allergy to one ester does not rule out the use of another ester, but allergy to one amide rules out use of another amide Allergy to one amide does not rule out the use of another amide, but allergy to one ester rules out use of another ester Allergy to one amide doesn’t rule out others, but allergy to one ester rules out all esters. [AAPD Guidelines 2023] “Allergy to one amide does not rule out the use of another amide, but allergy to one ester rules out use of another ester.” 58 / 78 Tags: Allergic Reactions How common are true allergic reactions to local anesthetics? Rare occurrence Moderate frequency Common finding High prevalence True allergy is a rare finding and is absolute contraindication for use. [AAPD Guidelines 2023] “Allergy to a local anesthetic, a rare finding, is an absolute contraindication for its use.” 59 / 78 Tags: Evidence Base What is the evidence for LA use under GA to reduce postoperative pain? No evidence Equivocal evidence Strong evidence against its use Strong evidence for its use 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.” 60 / 78 Tags: Combined Techniques What adjustments are needed when using local anesthesia with opioid sedation in pediatric patients? Change technique No adjustment Reduce LA dose Increase LA dose Reduce local anesthetic dose when using with opioid sedation. [AAPD Guidelines 2023] “Therefore, it is recommended that the dose of local anesthetic be adjusted downward when sedating children with opioids.” 61 / 78 Tags: Contraindications When is PDL injection contraindicated? Presence of an infection Young patients Complex procedures Elderly patients 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.” 62 / 78 Tags: Special Indications When is PDL LA injection specifically indicated? Patients with cardiovascular conditions Pediatric patients Anxious patients Patients with bleeding disorders 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.” 63 / 78 Tags: Risk Assessment Which pregnant patients need extra caution with vasoconstrictors? Patients with preeclamsia Diabetec patients Patients in the First trimester Patients in the Second trimester Pregnant patients with hypertensive conditions like preeclampsia. [AAPD Guidelines 2023] “Therefore, caution is indicated in the use of local anesthetics with vasoconstrictor for pregnant women, particularly those with hypertensive conditions (e.g., preeclampsia).” 64 / 78 Tags: Lactation Safety Is lidocaine safe during breastfeeding? Unknown Conditional use Unsafe Safe Lidocaine is considered safe during breastfeeding. [AAPD Guidelines 2023] “Lidocaine is considered safe for use during breastfeeding.” 65 / 78 Tags: High-Risk Pregnancy What special consideration exists for complicated pregnancies? No special care Normal protocols Avoid treatment Extra caution with placental crossing Additional caution needed as local anesthetics can cross placental barrier. [AAPD Guidelines 2023] “Because local anesthetics can pass through the placental barrier, additional caution is indicated when the fetus has known medical complications.” 66 / 78 Tags: timing When is the optimal time for dental treatment in pregnancy? Third trimester Any time First trimester Second trimester Second trimester, after organogenesis and before positioning difficulties. [AAPD Guidelines 2023] “The second trimester of pregnancy, when organogenesis of the fetus is complete and comfortable positioning in the dental chair may still be possible, may be the optimal time to complete non-urgent dental treatment.” 67 / 78 Tags: Vasoconstrictor Effects Why use caution with epinephrine in pregnancy? Uterine vessel effects Fetal toxicity Maternal toxicity No effect May cause uterine vessel contraction and limit placental blood flow. [AAPD Guidelines 2023] “Epinephrine may cause contraction of uterine blood vessels and limit blood flow to the placenta.” 68 / 78 Tags: patient management Pregnant patient in first trimester needs emergency treatment. Which statement is MOST accurate? Must get physician consent Treat emergency only, defer elective Avoid all LA Use only 3% mepivacaine 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.” 69 / 78 Tags: Dosing Calculation Calculate maximum lidocaine (2%) with epi for 15kg child. 1 cartridge 3 cartridges 2 cartridges 4 cartridges Using 4.4mg/kg guideline, 15kg x 4.4 = 66mg max dose. Each cartridge contains 34mg. [AAPD Guidelines 2023] “The long-established pediatric dental maximum dose of lidocaine as 4.4 mg/kg… 34mg per cartridge.” 70 / 78 Tags: Emergency Management During LA administration, patient exhibits circumoral numbness, confusion, and twitching. What is your FIRST action? Continue slowly Call emergency Stop LA administration immediately Give oxygen 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.” 71 / 78 Tags: Clinical Decision Making A 4-year-old patient requires mandibular treatment. Which LA is absolutely contraindicated? Prilocaine Mepivacaine Bupivacaine Lidocaine Bupivacaine is contraindicated in young children due to prolonged numbness and risk of self-injury. Articaine also not recommended under age 4. [AAPD Guidelines 2023] “Use in pediatric patients under four years of age is not recommended… bupivacaine is contraindicated for children.” 72 / 78 Tags: Drug Safety Why are high-concentration compounded topicals contraindicated? Cost concerns Taste concerns Stability issues Toxicity risk Risk of toxicity due to unknown concentrations. [AAPD Guidelines 2023] “Use of compounded topical anesthetics with unknown concentrations of local anesthetics carries a risk of complications associated with overdose, including seizures, arrhythmias, and death.” 73 / 78 Tags: Pregnancy Considerations Which trimester is contraindicated for elective dental treatment? Third trimester Second trimester No contraindication First trimester First trimester should be avoided for elective treatment. [AAPD Guidelines 2023] “The second trimester of pregnancy… may be the optimal time to complete non-urgent dental treatment.” 74 / 78 Tags: Local Conditions When is PDL injection contraindicated? Local infection/inflammation Anticoagulation Young age Controlled diabetes PDL injection is contraindicated with 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.” 75 / 78 Tags: Disease-Specific Contraindications Which anesthetic is contraindicated in patients with a history of methemoglobinemia? Articaine Prilocaine Lidocaine Mepivacaine Both benzocaine and prilocaine are contraindicated in patients with history of methemoglobinemia. [AAPD Guidelines 2023] “Benzocaine and prilocaine both have been associated with a risk of acquired methemoglobinemia, and their use is contraindicated in patients with a history of methemoglobinemia.” 76 / 78 Tags: Dose Modifications Which factor requires a 30% dose reduction? If there is an infection Children under 5 years Infants under 6 months 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.” 77 / 78 Tags: Age Restrictions Which age/drug combination is explicitly contraindicated? Mepivacaine under 5 years Prilocaine under 3 years Bupivacaine under 12 years Lidocaine under 6 years Bupivacaine in patients under 12 years and articaine under 4 years are contraindicated. [AAPD Guidelines 2023] “Use in patients under 12 years of age is not recommended” (for bupivacaine) 78 / 78 Tags: Major Contraindications Which is a true contraindication for local anesthesia? Documented allergy Diabetes Hypertension Pregnancy True allergy to the specific anesthetic agent is an absolute contraindication. [AAPD Guidelines 2023] “Allergy to a local anesthetic, a rare finding, is an absolute contraindication for its use.” Your score is 0% Restart quiz References: American Academy of Pediatric Dentistry. Use of local anesthesia for pediatric dental patients. The Reference Manual of Pediatric Dentistry. Chicago, Ill.: American Academy of Pediatric Dentistry; 2024:386-93.
