Use of Local Anesthesia for Pediatric Dental Patients

Abstract

This best practice presents recommendations regarding use of local anesthesia to control pain during pediatric dental procedures. Considerations in the use of topical and local anesthetics include: the patient’s medical history, developmental status, age, and weight; planned procedures; risk for methemoglobinemia; formulations of injectable anesthetic agents with and without vasoconstrictor as well as contraindications for their use; and selection of syringes and needle length and gauge. Guidance for documentation of local anesthesia addresses anesthetic selection and dose administered in addition to injection type and location and postoperative instructions. Potential complications such as toxicity, paresthesia, allergy, and post-operative self-induced soft tissue injury are discussed. Recommendations also are provided for alternative delivery methods, use with sedation or general anesthesia, and use during pregnancy. Safety precautions emphasize calculating maximum dosage based on the patient’s weight, adjusting local anesthetic dosage when additional analgesic or sedative agents are used, considering systemic absorption and the possibility of methemoglobinemia from topical anesthetic use, and bending of needles at the hub increases risk for breakage. Management of pain is an important component of oral health care and can result in a more positive patient experience.

This document was developed through a collaborative effort of the American Academy of Pediatric Dentistry Councils on Clinical Affairs and Scientific Affairs to offer updated information and recommendations on using local anesthetics in the management of dental pain for pediatric patients and persons with special health care needs.

^{KEYWORDS: ANALGESICS; ANESTHESIA, GENERAL; ANESTHESIA, LOCAL; DELIVERY OF HEALTH CARE, METHEMOGLOBINEMIA, PAIN MANAGEMENT, PEDIATRIC DENTISTRY}