Local Anesthesia in Pediatric Patients – a Review of Current and Alternative Methods, Devices and Techniques

• Published in: Folia Medica Vol. 60; no. 3; pp. 381 - 388
• Main Authors: Veneva, Elitsa R, Belcheva, Ani B
• Format: Journal Article
• Language: English
• Published: Plovdiv MEDICAL UNIVERSITY- PLOVDIV 01.09.2018; Pensoft Publishers
• Subjects: Anesthesia; Anxiety; children analgesia; Clinical trials; Control theory; Dental care; Dentistry; Fear & phobias; Lasers; Local anesthesia; local anesthesia children; Methods; pain control pedodontics; Pain management; Patients; pediatric dental patients; pediatric dentistry anesthesia; Pediatrics; Studies; Teeth; Virtual reality
• DOI: 10.2478/folmed-2018-0015
• ISSN: 0204-8043

Besides its anesthetic properties, it also reduces the risk of bleeding due to the shrinkage of regional blood vessels without causing significant cardiovascular disturbance in healthy patients.11 The method allows dental clinicians to perform conservative dental manipulations requiring pulpal anesthesia of maxillary frontal teeth, canines and premolars in adults and children weighing more than 40 kg.12,13 More studies on the effectiveness and safety of administration of the method for pediatric patients are necessary. 1.2. Safety precautions should be considered when intraligamentary anesthesia is applied on primary teeth close to developing permanent teeth, as some researchers report risk of enamel hypoplasia occurrence.26 An increasing number of clinical trials demonstrate measurable benefits of the technology.25,27 The effectiveness of the system in comparison to conventional syringe infiltration, in reducing dental anxiety and injection pain in pediatric patients, is a subject of clinical research with controversial results.24,28-30 b. Computer-assisted intraosseous anesthesia (CAIO) Intraosseous anesthesia is considered to be a successful alternative to conventional anesthetic infiltration by some authors, as the anesthetic agent is injected directly into the cancellous bone adjacent to the tooth required to be anesthetized.31 Computercontrolled intraosseous anesthesia delivered with constant velocity and pressure of the anesthetic solution, is found to reduce the injection pain and the time of onset of the anesthetic effect (Fig. 5). Virtual reality may also have analgesic potential47, leading to new term creation - "virtual anesthesia". [...]suggests that VR distraction may be a useful tool for dental clinicians and extensive research in this field is required to validate any efficacy of the method. Phentolamine mesylate (OraVerse) is a short-acting alpha-adrenergic antagonist, leading to an increased clearance of local anesthetic solution from the injection site, reducing the duration of action. Since it is an antagonist to the vasoconstrictor and not to the anesthetic agent compound, it is mainly recommended for use in non-surgical treatment.48 Controlled research reports high level of satisfaction of patients and dental practitioners.48-50 Despite its limitations, phentolamine mesylate is described as safe and effective means for reducing the duration of soft-tissue anesthesia induced by local anesthetic infiltration, and its associated functional deficits in adults and children after 6 years of age.50 CONCLUSION The safety and efficacy of the aforementioned products and techniques is a subject of current research studies.