Thursday, November 22, 2007

Local Anesthesia in Pediatric Dentistry

Novocaine, that's the stuff that makes it possible to complete complex dentistry without discomfort. It's the stuff that "numbs" the tooth. Now really we don't use basic novocaine. I would guess the main drugs used these days are Lidocaine, Mepivicain, and Articaine. All these drugs are various derivatives in the same chemical family. They all do basically the same thing: make the area where we are working "numb".

It comes in little 1.8cc carpules that we put into the syringes. Yup, we still have to "squirt" the medication into the tissues, usually after placing some topical anesthetic. The numb feeling usually lasts a few hours. With kids you really worry about them biting their lip once they have left the office. I think the advent of local anesthesia is one of the the most significant advances in modern dentistry.

41 comments:

Enkhee said...

Hello Doctor.My daughter is 3 and she 's getting her teeth fixed under local anesthesia.She has a slight cough here in there and I'm worry if it's safe ? What if cold get worse ? Thank you !

Dr. Dean Brandon said...

Consult your doctor.

The Dew's said...

My Daughter had a tooth pulled today (one of those funky grow in the middle ones) and when they gave her the novacane where it was injected was white. It looked like a blister. It took several hours for the white to go away from her top lip. What is this? i googled and found nothing?

The Dew's said...

Hi there.
My daughter had one of those funky growing in the middle of her two front teeth removed today and when they gave her the novacaine it turned her gums and lip white. It almost looked like a blister and took a long time for her lip in that spot to return to the normal color? What is this? i googled and couldnt find anything.

THANKS AN LOOOOOOVE YOUR BLOG!

Dr. Dean Brandon said...

I can't say in your case, but I do see sometimes tissue "blanch" due to either compression of the tissues from the fluid or vasoconstriction from the epinephrine in the anesthetic-(shrinks the blood vessels). If I see that it is no big deal.

sardar said...

I ts graet reading you blog dedicated intotality to the pediatric dentistry.Great job congratulation ,and all the best

DAELYN24 said...

My 5 year old daughter had a tooth pulled today due to decay. It is a back moler. I was reading your blog (about putting in a spacer) however my daughters dentist did not do that. Is that something that should have been done or is on a case by case basis?

mgantner said...

Hi I tried to post on another blog but it was disabled. Hopefully you can help me with my question.

My son is 6 and he had a pulpotomy on his lower molar three months ago. The dentist initially placed a temporary filling in there for two months to be sure it would not be abscess. We went back on November 18th to remove the temp and place the permanent filling in. Well yesterday we discovered a bump on his gum next to this tooth. I called the doc and the doctor in the office prescribed penicillin. Then I called again today to speak with the doc that actually did the work and he told me the tooth needs to be pulled.

My question is- Is there an alternative we can try before extraction?

Dr. Dean Brandon said...

I cannot speak directly to your specific situation, but it kind of depends on which tooth it is--a permanent one, dentists often try a root canal--on a baby one (the most likely), extraction is the preferred method. Only rarely will you do a root canal in a baby tooth, and they are not very successful. Removal of an abscessed baby tooth is done 99.9% of the time.

Anonymous said...

You are amazing, I love this site, I am a general dentist and my question is that when I do pulpotomies, I use lidocaine and one carp only, but I have been noticing that its not enough, can u recommend what other local combination would give the optimum result and at the same time avoiding the use of more carps? thanks

Dr. Dean Brandon said...

Sometimes there is no magic solution. Lower Es are the hardest to numb I think. Sometimes I use septocaine, but not usually for mandibular blocks. I have also used carbocaine. Like I said sometimes it is just difficlut not to mention even harder with anxious kids. Good luck.

Kate said...

Hello Doctor - my eight month old baby's first two bottom teeth just erupted and they are severely crooked - literally in an upside down 'V' - is there orthopedic straightening for babies teeth - I am concerned this may affect his self esteem as he has quite a number of years before they fall off and permanent teeth appear. As a parent I need to explore what alternatives there are to straighten babies teeth.

Dr. Dean Brandon said...

Well, that's sort of an orthodontic question--basically from what you have described, I see teeth coming in that way all the time, and it is not a problem. You really can't put braces on a two year old--have a pediatric dentist follow it and he will let you know when it is reasonable to do anything. Sometimes teeth just come in that way. The lower central incisors (in the middle) come out around 5 or six years of age. Speaking as a father, kids do not care about peer pressure at that age. See my other posts on orthodontics and when to start--over there on the sidebar--kind of hard to find since there are so many now.

Anonymous said...

Hello Doctor, my 3 year old granddaughter injured her 2 top front teeth 3 weeks ago. They are still mobile and changing color. She is scheduled to have a pulpotomy and caps on the 2 teeth tomorrow morning. We were told that she would be given versed and nitrous oxide, but that an injection of lidocaine will probably not be needed?????? If they see she feels it, they will give it to her. I am mortified by the thought of her feeling a jolt. Please advise. Thank you so much. Maureen

Anonymous said...

Dear Doctor, Thank you for your help. My 3 y/o granddaughter injured top 2 front teeth in fall. Tomorrow a.m. she is scheduled for pulpotomy and capping; will give her versed and nitrous oxide. Dentist stated that lidocaine will not be given because she will probably not need it. If she feels pain, they will give it to her. I am worried; don't want her to feel a "jolt". Please adivse. Thanks, maureen

Dr. Dean Brandon said...

Sounds like she will be somewhat sedated. Sometimes you can get away with no anesthesia under certain circumstances with small procedures . I usually numb up if the work is extensive or just to be sure. Still it is up to the dentist as each case is different.

Dr. Dean Brandon said...

Just as a followup. I always numb for a pulpotomy.

cowman1a said...

my grandson is suppose to have 6 metal caps after the 6 baby root canals. After watching the 20/20 report on all the unnecessary caps on children, how can we be sure these are really necessary? I'm very concerned and would like a 2nd opinion but the dentist's say we have to pay for the xrays to take them somewhere else. ... is that a normal practice?

Dr. Dean Brandon said...

Sometimes caps are necessary (read my post on white crowns for baby teeth). Obviously, I do not agree with doing unnecessary crowns, but they are often indicated especially in back baby teeth that have multiple surfaces involved or are deeply decayed. In the front there is sometimes the option of removal of tooth or white crowns.

aliisha said...

Hello-
I am a dental student and I would like to know if you have ever used a local anesthesia reversal agent, like oraverse. I think it would be very beneficial for pedo patients (to avoid biting cheek, etc.) I have not used it, and haven't yet met a dentist that has.
thanks! and I love your blog.

Dr. Dean Brandon said...

Nope I have not.

Anonymous said...

Hello Dr.

My 3 year old daughter is scheduled to have a cavity filled (molar). The doctor prescribed Atarax 10 mg the night before (1 tsp) and then 2tsp 2 hours before appt and then 2 tsp. 1 hour before appt. My question is-Is this drug safe for her and are those appropriate doses? It seems like a lot to me. Thanks.
KatesMom

Dr. Dean Brandon said...

Atarax is a fairly mild medication. You might want to read my post on sedative drugs used in pediatric dentistry. I cannot say if it is right or wrong for your child (sedative drugs can be right for one child and incorrect for another for various reasons), but one or two teaspoons for a three year old does not sound too unusual. -Depends on weight, the procedure, other medications, health conditions, behavior, etc.

Shared Decision Making said...

It really helps to get rid of a tooth or even while the root canal process is on.

Medical Billing Software said...

Dentistry has become pretty advanced with the patient having to just get rid of the tooth and have it back too through a root canal.

Anonymous said...

Hi Doctor, my 7 year old daughter had a filling yesterday and she must have bit her lip when it was still numb. Its big and the inside is white like a big blister. Can I treta this at home with mouth washes like proxigel and glyoxide?

Dr. Dean Brandon said...

See my post on "don't bite your numb lip". If it is that, you just have to do what you are doing, it will get better in a few days. Consult your dentist.

Chris said...

Thanks for your informative blog. Two days ago, I was injected with additional Novocaine while my dentist was drilling to prepare my lower left maim molar for a cap. During administration of this second dose (I was still feeling a little pain during drilling), he moved the needle around inside my gum just below the tooth. My jaw is now swollen...has a lump and I am wondering if it will go away...I have never had this kind of lump after previous injections of Novocaine. What is happening and will it go away? Thanks so much for answering. Chris

Dr. Dean Brandon said...

Chris, don't know what it is, but when an infilltation injection a "carpule" of anesthetic puts about 1.8cc of fluid in there which distends the tissues a little. Most of the time it is no concern, but could be residual from injection. A hematoma can form as well (bleeding/clot there). Either way should go away in a few days. If it continues or concerns you, I would get it checked out.

Jill said...

It seems as though "happy gas" is the only thing doctors use in the city we recently moved to. My daughter gets a little anxious prior to her cavities and I have asked several doctors to prescribe what her previous dentist did which was a small dose of atarax (she is 7) at a cost of $3.00. When I proposed this in alternative to the $55 gas he suggested he told me that atarax has been the cause of death of many children. This was a very alarming statement and I have been trying to find any articles that would support this claim. Do you have any information on this?

Dr. Dean Brandon said...

I do not usually use atarax with children. I do sometimes use it with adult special needs patients. See my other posts on sedation. There is a lot of stuff there especially on particular medications. Most meds are safe if used properly. However if used safely---they might not be effective. So you try and find the safe drug or combination of drugs that works.

Jill said...

Thank you for your response. You have some fantastic resources available.

Anonymous said...

Hi! I am the mom of 3 kids. My 10 yr old has fluorosis..brown spots. I have been taking my kids to the dentist since they were 10 months old. I switched dentist and found out that the old dentist had never done xrays on my 10, 6, and 4 yr old. Now my 6 yr old need a 2 pulpotomies and has a couple of small cavities in between the teeth. I am wondering if he can handle it in the office and should I do it at the hospital? Also from his six yr molars...it looks like he will also have fluorosis. I feel like crying. Teeth are very important to me and I feel like I did everything right, I brushed their teeth, took them early, my 10 yr old has had braces, and he does not like his teeth because of the color. What can I do any advice would be great. Thanks LOVE the site!!!

Dr. Dean Brandon said...

Thanks of the compliment on the blog. I hope you can find more info on behavior management in the dental office and preventive and restorative strategies. Don't feel too bad, I see some kids who are the best brushers and flossers that still get cavities, and others that don't know the right end of the brush that never have a problem. Things happen fast in children. Sounds like you are on the path to get things in good shape.

Nita said...

Hello Doctor. I took my 2 year old son to pediatric dentist today and he says extensive dental work is required. No xrays were taken but from visual assessment he came up with the following:
1. 4 Prefab stainless steel crown
2. 3 Prefab resin crown
3. 2 Extractions
4. 2 Therapeutic pulpotomy.

I had taken him coz I was worried about dental caries in his front 4 teeth (out of which 2 need to be extracted). I was not expecting such extensive work. I'm not sure if his 4 backmolars need stainless steel crowns, if there are cavities, can they not be filled. I'm so confused and will be going in for a second opinion. My question is can we just deal with the first 4 tooth infected by dental caries and leave the rest with fillings instead of crowns?

Nita said...

Also if the second opinion we get indicates extensive dental work, I'm not thrilled about getting his procedure done with oral sedation and restraining board and am leaning towards surgery with anesthesia. Any thoughts on this? Thanks a lot for your advise.

Dr. Dean Brandon said...

Nita,

You sound like many parents of young children with extensive cavities. I encourage you to read more on this blog about fillings crowns sedation, general anesthesia, etc. Short answer, basically, if a cavity forms it will get worse. A small cavity needs a filling a large cavity often needs a crown. I saw a three year old earlier today with almost the same thing. The combination of multiple cavities, thus multiple dental needs on such a young child makes things more difficult than a small cavity on an adult. There are a lot of things to consider. Again read more here if you find it useful.

If there is a lot of treatment on a two year old, the option of general anesthesia is often discussed. If you do get a second opinion, make sure it is from a Pediatric Dentist.

Haywood Jablome said...

Do you place mandibular blocks?... Or are you a Septo infiltration guy?

Dr. Dean Brandon said...

We do mandibular Lidocaine blocks all the time--of course a lot of infiltrations too. I do not use Septocaine for blocks, but It is pretty useful for infiltrations.

KS said...

My son is almost 3 years old. Shortly after he turned one, he fell and damaged his two top front teeth. His pediatric dentist and I have been trying to save his teeth since then, but they're gradually crumbing. My son is due to have those two top teeth extracted in two weeks. His dentist is said to be the best pediatric dentist in the area, and since I've started taking my son to him, I've been 100% satisfied, however I do have some serious misgivings with how my son's teeth will be pulled. My first concern is, the dentist said that only a topical (Lidocaine, I believe) will be used on the gums for any pain killer before and during the extraction, while I hold him still. Does that sound right to you? I can't see how that will make it not hurt terribly, especially since my son fights like the devil and needs to be restrained just to open his mouth for the dentist, but my son's dentist is confident that it will be no problem. My insurance does not cover GA or any other pediatric dentists in the area and my son's dentist does not give novacaine shots to children this young. In your opinion, is Lidocaine sufficient for pulling out baby teeth on a three year old?

Dr. Dean Brandon said...

Topical anesthesia is often all that is needed if you have a very loose baby tooth or coronal remnants just hanging on. It can be pretty effective. I suspect though that they meant local anesthesia, which is injecting something like Lidocaine (lidocaine is what is used most of the time for this). Though I often suggest sedation or general anesthesia, we do often remove teeth with local anesthesia only (not general anesthesia or sedation). There are two issues, behavior management (i.e. relaxation, cooperation and general comfort) and there is the numbing the specific area (local anesthesia). I numb with an injection unless there is some severe health problems or safety issues. Cooperation/resistance does make it a little difficult though. By the way, actual removal of teeth, especially int he front is very quick... So quick the kids sometimes don't even realize we have already finished.