The injectable local anaesthetics in the prevention of intraoperative pain in paediatric dentistry – practical remarks on agent choice and methods. Possible complications of local anaesthetic administration in paedodontics

Abstract

In paedodontics, as in general dentistry, causal treatment plays a fundamental role in the management of pain present before the appointment, but the therapeutic procedures performed are often associated with the occurrence of acute pain. It is currently being accepted, that effective dental treatment of children is possible after obtaining the appropriate level of local anaesthesia. Local anaesthesia is one of the most delicate and difficult procedures in paediatric dentistry. Fear of anaesthesia and the accompanying pain is clearly marked in paediatric patients; therefore, the right attitude of a dentist plays a crucial role, while psychological strategies and pharmacological approach may be a valuable help. In the case of intraoperative pain prevention in paedodontics, injectable aminoamide derivatives-mainly lidocaine, articaine and mepivacaine in Polish conditions – are of fundamental importance. The success of the procedure is the result of the precision of the injection and administration of the solution, dependent on the practitioner, the reaction of the tissues into which the drug is deposited, their anatomical structure and the patient's stress level. The article discusses the clinically significant features distinguishing paediatric patient population and the impact of this specificity on the choice of methods of effective dental local anaesthesia. The agents used have been characterized, taking into account the dosage, the latency period and the resulting anaesthesia time for the dental pulp and soft tissues. Pulp anaesthesia allows for painless intervention within the tooth tissues, while soft tissue anaesthesia is necessary to undertake a therapeutic action requiring soft tissue disruption in dental surgery. Soft tissue anaesthesia, especially in the inferior alveolar nerve block, with long-acting local anaesthetics, is associated with a higher risk of self-injury in children with loss of sensation and proprioception in mucosa of the cheeks, lips and tongue. Local and general complications of dental anaesthesia in children were presented, along with their prevention and management.