FUTURE OF PAIN MANAGEMENT IN PEDIATRIC DENTISTRY

PAIN ASSESSMENT TOOLS

METHODS OF REDCUING PAIN DURING USAGE OF ANESTHETIC AGENTS

LOCAL ANESTHESIA

CONTENTS

DEVICES USED FOR REDUCING PAIN

DISCUSSION

CONCLUSION

PAIN

REFERENCES

First text statementSecond text statementFinal text statementIt is defined as an unpleasant sensational experience initiated by noxious stimulus & transmitted over a specialized neural network to CNS where it is interpreted as such feeling

DEFINITION

PAIN

INFANTS NEONATAL INFANT PAIN SCALE(NIPS) CRIES CHILDREN >3 YEARS WONG-BAKERS FACE PAIN RATING SCALE FLACC SCALE PRE SCHOOL CHILD FACIAL CODING SYSTEM SCHOOL AGE VISUAL ANALOUG SCALE

Measurement and Assessment of Pain In Children – A Review Amit Jain*/ Ramakrishna Yeluri**/ Munshi. A K The Journal of Clinical Pediatric Dentistry Volume 37, Number 2/2012

PAIN ASSESSMENT TOOLS

NEONATAL INFANT PAIN SCALE(NIPS) CRIES Crying Requires oxygen to maintain sat > 95% Increased vital signs Expression level of sleep Level of Sleep

INFANTS

WONG-BAKER FACES PAIN RATING SCALE

WONG

FLACC SCALE

VISUAL ANALOUGE SCALE

Points to be kept in mind regarding the differences between child and adult patient

Density and calcification of maxillary and mandibular bone. Anatomic structures. Penetration of the needle. Depth of needle penetration. Emotional aspect

Transient loss of sensation in a circumscribed area of the body caused by a depression of excitation in nerve endings or an inhibition of the conduction process in peripheral nerves

LOCAL ANESTHESIA

DEFINITION

METHODS OF REDUCING PAIN DURING USAGE OF LOCAL ANESTHETIC AGENTS

1)PRECOOLING THE INJECTION SITE: Cooling the site prior to the block at injection site reduced the pain

perceived during the local anesthesia. Ice pre treatment of the soft tissue at injection site before the

procedure. According to Harbert etal precooling the injection site reduced pain

perception during palatal injections.

Effect of precooling the injectionsite on pediatric pain perception during local anesthesia.Journal of contemporary dental practice volume10,no.3 may2009

2) APPLICATION OF TOPICAL ANESTHETICS

GEL FORM SPRAY FORM LIQUID FORM

PATCH OINTMENTIntraoral topical anesthesiaJOHN G. MEECHAN Vol. 46, 2008, 56–79

Mixture of 5% lidocaine & Prilocaine. It is used more often for skin than intra orally. According toSvennson et al observed more effective results

when applied at incisve foramen region and greater palatine region.

In children under 6 months is contraindicated due to the possibility for developing methemoglobinemia due to prilocaine.

3) EMLA(EUTECTIC MIXTURE OF LA):

Oraqix contains 25 mg ⁄ g lidocaine and 25 mg ⁄ g prilocaine. Thermosetting agent. The material is liquid at room temperature but when injected

into the gingival crevice it forms an elastic gel. Fast onset in 30 seconds with duration of 20 minutes

approximately

ORAQIX

To approach the palatal mucosa via the already an anesthetised buccal inter dental papilla. This is the called “chasing” techniqueA) B) C)

D)E)

European Archives of Paediatric Dentistry // 10 (2). 2009 J. G. Meechan

CHASING TECHNIQUE:

DEVICES USED FOR REDUCING PAIN VIBROTACTILE DEVICES: Based on gate control theory VIBROJECT DENTAL VIBE ACCUPAL VIBROJECT : Small battery-operated attachment that snaps on

to the standard dental syringe.

Pain perception by vibrating needle (VibrajectTM) and conventional syringe anesthesia . International Dental & Medical Journal of Advanced Research ● Vol. 1 ● 2015

DENTAL VIBE

It is a cordless, rechargeable, hand held device that delivers soothing, pulsed, percussive micro-oscillations to the site where an injection being administered.

Stimulates the sensory receptors at the injection site, effectively closing the neural pain gate, blocking the painful sensation.

Effect of the DentalVibe Injection System on Pain During Local Anesthesia Injections InAdolescent PatientsDavid Ching, DMD' • Matthew Finkelman, PhD^ • PEDIATRIC DENTISTRY V 36 ; NO 1 JAN / EEB 14

Cordless device that uses both vibration and pressure to precondition the oral mucosa.

Accupal provides pressure and vibrates the injection site 360° proximal to the needle penetration, which shuts the “pain gate.”

. Murray P, Terrett K, Lynch E, Hussey DL. Efficacy of a vibrating dental syringe attachment on pain levels. Paper presented at: 81st General Session of the International Association for Dental Research; June 26, 2003; Göteborg, Sweden.

ACCUPAL:

COMPUTER CONTROLLED LOCAL ANESTHETIC DELIVERY SYSTEM (CCLAD)

Advanced Techniques and Armamentarium for Dental Local Anesthesia Taylor M. Clark, DDS, DCNA October 2010Volume 54, Issue 4, Pages 757-768

• WAND/COMPUDENT SYSTEM:• The light weight hand piece is held in a pen-like grasp that

provides the user with greater tactile sensation.• The available flow rates of LA delivery are controlled by a

computer

• COMFORT CONTROL SYRINGE:• It has two main components: A base unit and a syringe.• functions of the unit- most importantly injection and aspiration-

can be controlled directly from the syringe.

JET INJECTORS

SYRIJET:

Features of the device is that it accepts the

standard 1.8 mL cartridges of LA solution (thereby ensuring sterility of the

solution).

Completely autoclavable

MED-JET H III:

Extremely small stream of liquid under pressure pierces and then the

remainder of the dose will be dispersed into the

desired layer of tissue.

Ability to utilize low pressure delivery methods without

compromising accuracy, convenience and ease of

use - while ensuring patient comfort.

PREVENTS NEEDLE STICK INJURY1) Ultra Safety Plus XL syringe

2) Ultra Safe Syringe

3) Hypo Safety Syringe

4) RevVac safety syringe

SAFETY DENTAL SYRINGES

ELECTRONIC DENTAL ANESTHESIA

Uses the principle of Transcutaneous Electrical Nerve Stimulation (TENS).

It increases salivary blood flow. Requires good patient co-operation

DISCUSSION The use of topical application to obtain anesthesia for intraoral operative procedures is appealing.

The patch was applied for 15 minutes and the gel for 30 seconds.

When the different jaws were compared the lidocaine patch was more effective than the benzocaine gel.

Effectiveness of EMLA when applied apical to deciduous teeth showed significant results.

Significant reduction of pain was observed when using topical anesthetic and reduced anxiety in children.

Devices used while during the procedures results shown that there is decrease in Pain and more comfort compared to conventional syringes.

CONCLUSION

Sight of large syringe being injected into tender gums can bring tears to the eyes of most of the children.

Achievement of successful local anesthesia is a continual challenge in dentistry.

Adjuvant techniques and devices can effectively reduce the pain in children during dental treatment.

MALAMED SF. HANDBOOK OF Local anesthesia.5th edition. St.Louis, Mo:CV Mosby;2004:274-2754TH .

Measurement and Assessment of Pain In Children – A Review Amit Jain*/ Ramakrishna Yeluri**/ Munshi. A K The Journal of Clinical Pediatric Dentistry Volume 37, Number 2/2012.

Effect of precooling the injectionsite on pediatric pain perception during local anesthesia.Journal of contemporary dental practice volume10,no.3 may2009.

Intraoral topical anesthesia, JOHN G. MEECHAN Vol. 46, 2008, 56–79 Pain perception by vibrating needle (VibrajectTM) and conventional syringe

anesthesia . International Dental & Medical Journal of Advanced Research ● Vol. 1 ● 2015.

Effect of the DentalVibe Injection System on Pain During Local Anesthesia Injections InAdolescent PatientsDavid Ching, DMD' Matthew Finkelman, PhD^ • PEDIATRIC DENTISTRY V 36 ; NO 1 JAN / EEB 14.

REFERENCES

Murray P, Terrett K, Lynch E, Hussey DL. Efficacy of a vibrating dental syringe attachment on pain levels. Paper presented at: 81st General Session of the International Association for Dental Research; June 26, 2003; Göteborg, Sweden.

Advanced Techniques and Armamentarium for Dental Local Anesthesia Taylor M. Clark, DDS, DCNA October 2010Volume 54, Issue 4, Pages 757-768

European Archives of Paediatric Dentistry // 10 (2). 2009 J. G. Meechan