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+ م
LOCAL ANESTH ESIAFOR
THE CHILD
2-۵0۱0 و ذه
5 5
0
yA?
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re, ی
aspects of child behavior ای یا a’ One of the most
+ Even th ۱ 1 the dental office normally has
no co ns local anesthetic
* Injecti a ۳ 1 produces the greatest _
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>TOPICAL ANESTHETICS ARE AVAILABLE IN
>GEL
LIQUID
> OINTMENT ay © ©
»>PRESSURIZED SPRAY FORMS.
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* Ethyl amino benzoate (benzocaine) liquid, ointment, or gel preparations are probably
best suited for topical anesthesia in dentistry.
Because of:
+ More rapid onset
* longer duration of anesthesia ه00 و
“ZY في 3
~
No systemic toxicity as oral topical anesthetics
A few localized allergic reactions : prolonged or repeated use.
Reduce the slight discomfort that may be associated with the insertion of the needle
before the injection
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| نت ae
سس بت
6 * Osnprercble teste
۰ Dhe oddiicad tie required to upply thew «way tworeuse the اوه سا ری موب لاه
۳
© ها موی ع dred wi gauze, oad a sel oozunl oP the topicdd coesikelio ogeut is upped wih ماه و
sunt.
12 Doped ovesikesta shoukl be prrduved rt opprvatiraehy OO serve. (see cron Portes renvarceacksiva)
Dow
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JET INJECTION
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|
۵ ۸
یتست
ra)
۳0
تست
5 10 6 0
CONC
fared
De jet igjeciiog tostroved is based va the priaviple
that sxvoll quorctiies oP fiquids Porced though very
sw و یمه high pressure وس موی
۱ or shia wihowt cousicy
اب نا tissue trod. لودج ودج
تا
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۲ ۰ سس
©
SYRIJET MARK I ...عم
+ Holds a ‘standard.1.8-ml cartridge of local anesthetic solution.
+ Expel 0.05 to 0.2 ml of solution under 2000 psi pressure
* Produces surface anesthesia instantly:
* use instead of topical anesthetics by some
+ The method is quick and essentially 82
* The abruptness of the injection! may produce momentary
in the patient.
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ت شب
INDICATIONS
¥ Gingival anesthesia before a rubber dam clamp is placed
’ Before band adaptation of partially erupted molars
رومع“ the removal of a very loose (soft-tissue-retained) primary tooth
* Syrijet may be used instead of needle injections for:
+ Nasopalatine ۰ Y 1 2
+ Anterior palatine
* Long buccal nerve blocks
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/ م ga
Local Anesthesia
Mechanism of action:
hee ord تا با بو مه یطوط لو of ake LOB مر لوا
او
1۱ of hy ockay chou through which he ood tou wrvaly exter durtay depohartzatioa
۷ لت له مه وا و
orev? J یب«
Y Cake to wheve treshold poteurd
Y bewk of deucoyunsd oP ou uotve putvond [J blockade oP uence oP erie nephew
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— تب
لاك ۱۸
Good cere Boers are wore susceptible to the coset of اه مت he LOB تما وا مد ۲
حور وی له ساموت لاب
۰ وا رت بو موی هرا bases oad ore supped اجه ری
1۱ wt ePPevive to we wth ane hPevion oad KPkxoutza, why?
)( موی مان لمی ماه woody the meal physiology oP the tear by netecstiy مسج
pAbuinmiy (suck ao تعاطا متا oud سس
2 1 نا م0 با سا مپسا (6
* Oke تا do to cose oF مس
+ Olbebrey thes wri othe wune اتمه ote dott Pow the tiPLcked ore
- @sitbioic advivistraios
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5
ع
ze
۳4
7)
2
]- >
=a
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مسب صسر.
۲ ۸۱۱۲5۲۲۱۲۱2۵۲۱۵۱ 0۴ ۱۸۵۱۱۵۱5۱۲۱۵ ۲۴۲۲۲ ۵۱۱۵ 50۴۲ ۲۱556 ۳۰
When deep operative or surgical procedures are: ken for
the mandibular pri or permanent teeth,
nerve must be bl
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0<
كت
Mandibular foramen is situated at a level lower than the occlusal
plane of the primary teeth of the pediatric patient.
m=) the injection must be made slightly lower and more
posteriorly than for an adult patient.
BELOW 6 YEARS
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د مت
* The thumb is laid on the occlusal surface of the molar, with the
tip of the thumb resting on the internal oblique ridge and the
ball of the thumb resting in the retromolar fossa.
٠ Firm support during the
injection procedure : the
ball of the middle finger
is resting 0۲ the
posterior border of the
mandible.
٠ عط[ barrel of the
syringe : between the
two primary molars on
the opposite side of the
ie eee.
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Y The needle is advanced until it contacts bone [{] aspiration [] depo:
solution
۳
The depth of insertion averages about 15 mm but varies with the size of the
mandible
Approximately 1 ml of the solution should be deposited around the inferior
alveolar nerve
Y If it was n
inserted a
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—
LINGUAL NERVE BLOCK
Inferior
alveolar
Small amounts of anesthetic
are injected during insertion
and withdrawal of the needle
for the inferior alveolar nerve
block, the lingual nerve will
invariably be anesthetized _)
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مسا
LONG BUCCAL NERVE BLOCK ۵
Y All facial mandibular gingival tissue on
the side that has been injected will be
anesthetized
¥ except tissue facial to the central and
lateral incisors
removal of mandibular عط ممعي
permanent molars or sometimes“for.the
placement of a rubber dam clamp on
these teeth.
¥ A small quantity of the solution may be
deposited in the mucobuccal fold at a
point distal and buccal to the indicated
tooth
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عل یب
Infiltration anesthesia for mandibular
primary molars
ARTICAINE (SEPTOCAINE)
Articaineis unique among local anesthetics because:
contains both ester and amide groups.
Articaine is an amide anesthetic that is metabolized in the liver.
The associated ester group also allows for plasma metabolism
via pseudocholinesterase [] increases the rate of breakdown and
reduces toxicity. ۰ ش) 0
This difference in metabolism gives ۵۲۲۱68۵106 ۲۳6 30۷۵01۵96 ۴
having a 30-minute half-life; lidocaine, for example, has a 90-
minute half-life.
Articaine has a high bone-penetrating ability, which suggests
that it may be more successful as a locally injected infiltration.
From these reports: may produce adequate anesthesia in
mandibular deciduous molars for most restorative procedures
اس
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VY
كذ
تا
INFILTRATION FOR MANDIBULAR
INCISORS
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/ شب ee
ESTHETIZATION OF MAXILLARY PRIMARY INCISORES AND CAI
SUPRAPERIOSTEAL
TECHNIQUE (LOCAL
INFILTRATION)
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UY
Ad 4
the injection should be made closer to the gingival margin than in the patient
with permanent teeth
Needle point is opposite the Position of the needle for
apex of the maxillary anesthetization of a
primary incisor. maxillary primary canine
تب 5
لا
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ANESTHETIZATION OF
7 MAXILLARY
نت PRIMARY MOLARS
MSA:
Y Innervation of primary
molars
¥ Premolars
¥ Mesiobuccal root of the
first permanent molar
How to inject:
¥The needle should
penetrate the
mucobuccal fold and
inserted to a depth
— that
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ابس« بت
ىت
تم
Maxillary bone thickness approaching 1 cm overlying the buccal roots of the
first permanent and second primary molars in the skulls of children in
primary and early-mixed dentition
This thickness of bone renders the supraperiosteal injection at the apices of
the roots of the second primary molar much less effective; the injection
should be supplemented with a Beacons injection superior to the maxillary
tuberosity area k eolar nerve
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مت سا
ANESTHETIZATION OF THE PALATAL كه
TISSUES 3
+ Innervation:
Nasopalatine and anterior palatine
* One of the more exquisitely painful procedures performed in dentistry.
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Nasopalatine
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سب رسب
NASOPALATINE NERVE BLOCK و
Y Path of insertion of the needle
alongside the incisive papilla, just
posterior to the central incisors.
۷ ۱۲ the needle is carried into the canal, it
is possible to anesthetize the six
anterior teeth completely.
¥ this technique is painful and is not
routinely used before operative
procedures.
۷ ۱۲ the patient experiences incomplete
anesthesia after supraperiosteal
injection above the apices of the
anterior teeth on the labial side, it may
be necessary to resort to the
nasopalatine injection.
Y For canine : it may be necessary to
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57 مب
7 GREATER (ANTERIOR) PALATINE كا
INJECTION
The innervation of the soft tissues of the
posterior two thirds of the
palate :greater and lesser palatine
Incisive 2 3 Extraoral
عست soft tissue
nerves.
Anesthetizes the mucoperiosteum of the : Alveolar
palate from the tuberosity to the canine / G Lil
region and from the median line to the
indi ini ۲ Greater | | ffe 4 Palatal sof
gingival crest on the injected side ی 1 lee
1 1 3 / 010
It is not necessary to enter the greater 55 0
palatine foramen.
injected slowly at the point where the
A few drops of the solution should be
nerve emerges from the foramen. كن Ww o 7 )
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| ZH a
كسا The needle is inserted approximately 10 mm 4
8 posterior to the distal surface of the second
primary molar.
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| ZH SZ
7 COMPLICATIONS AFTER A LOCAL 3
ANESTHETIC
1) ANESTHETIC TOXICITY
+ Rarely observed in adults
٠ Young children are more likely to experience toxic reactions because of their
lower body weight
* Cardiovascular and CNS dysfunction
* CNS responses is complex and depend on the plasma concentration:
dizziness, blurred vision, anxiety tremors, convulsions, CNS depression and ©
death
* Cardiovascular dysfunction: the primary effect on heart is myocardial
۳ 1
ات ا depresssion
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_- مت
Maximum RECOMMENDED DOSES OF —
LOCAL ANESTHETICS
Proprietary Percent of Local Maximum
Dose Name Anesthetic Vasoconstrictor Duration of Anesthetic Recommended Dose
Lidocaine ——_-Xylocaine 2 Epinephrine 1:100,000 Pulpal: 60 min 4.4 mg/kg
Soft tissue: 3-5 h
Mepivacaine Carbocaine 3 Pulpal: 20-40 min 4.4 mg/kg.
Soft tissue: 2-3 h
Prilocaine —_Citanest 4 Hplapheins 7200,000; Pulpal 60:20 in 6.0 mg/kg
Forte
Articaine Septocaine 4 Epinephrine 1:100,000 7 mg/kg
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1۵0۵ ?
م96 ع و 0۵۵۵ :0 ۰ 000-۷۵ ©
096 بط و بط Dantwany dose?
.9 6/۵9
“The rule of 25”
1 cartridge of anesthetic for every 25 pounds of patient weight
)2 @ مب
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ey 7
~ 2) TRAUMA TO SOFT TISSUE
Parents should be warned that the soft tissue in the area will be without لأ
sensation for 1 hour or more.
Children who receive an inferior alveolar injection for routine operative
procedures may bite the lip, tongue, or inner surface of the cheek
The result 24 hours later is an ulceration
Awarm saline mouthrinse is helpful in keeping the area clean. *
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A —
REVERSAL OF DENTAL ANESTHESIA ۳ به
+ ORGBOERGE : كانت
+ Dhesicknene: wana htee (PO) : ای اجه موی مورا مومت موی
+ Pantha he cbarcace oP ihe bord oeesthear 2 ricki oP GG-B0% te the tere oP من سح ات
۰ Oo serine uberse eves
+ Dhe const coerxonn adverse reat UAB Insist Rip ste pat.
* Quredl), orwerse ool و موی fa chides your fron © pears of age or ta hose
who werd bos thas IS by (89 b). 0
