Local Anesthetic Techniques in Children

It has been repeatedly emphasized throughout this book that local anesthesia in conjunction with non-pharmacological behavior guidance techniques is integral for successful outcomes with midazolam. But the administration of local anesthesia in children is a double-edged sword. Its careful and gentle administration will improve child cooperation by enhancing the anxiolytic effect of midazolam. But an unpleasant experience can negatively impact child’s behavior possibly leading to an undesired paradoxical reaction. This chapter will streamline a process for the administration of local anesthetic injections in children. It will also describe specific techniques to administer some common intraoral injections like supraperiosteal injections, palatal injections, and the inferior alveolar nerve block with minimal discomfort. Some important clinical considerations related to local anesthesia in children will also be discussed. This will include injection in the maxillary second primary/first permanent molar region, maximum recommended dosage of the anesthetic solution, effectiveness of mandibular molar supraperiosteal injections, and the role of buffering to enhance the effectiveness of the local anesthetic solution.