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Original Article
Use of Anesthesia in Pediatric Dentistry: A Cross‑sectional
Survey
A. Naurin Salma, Mahesh Ramakrishnan
Department of Pedodontics, Saveetha Dental College, Chennai, Tamil Nadu, India
Abstract
Aim: The aim of this study is to access the knowledge and use of dental anesthesia in pediatric dentistry. Objective: The purpose of this study is
to evaluate the use of dental anesthesia among pediatric dentists. Materials and Methods: The survey was conducted among pediatric dentists
who were practicing in Chennai, South India. A questionnaire was distributed which include questions relating to the use of local and topical
anesthetics. Background: Anesthetic injection is the dental procedure that produces the greatest negative response in children. Pain and anxiety
can reduce the efficacy of anesthesia in pediatric patients. This fear of anesthesia is often manifested as a behavior management problem, with a
few pediatric patients lacking good coping skills and displaying hysterical behavior in anticipation of discomfort. Anxiety is the most disturbing
experience for children, a response that sometimes can only be controlled with techniques beyond anesthesia. There are several factors that can
predispose a patient to this overdose of anesthetic. The patient factors include age, weight, other medications, sex, presence of other systemic
disorders, genetics, and mental attitude, and environment. There is a lack of studies accessing the usage and status of anesthesia in pediatric
dentistry. Results: Eighty‑eight percent used exact body weight to determine local anesthetic dosage. Only 11% of the respondents were using <10
s to inject a full cartridge. Topical anesthetics were used by most of the dentists. Most patients (98%) disliked the taste of topical anesthetics,
and adverse drug reactions were rarely seen. Conclusion: The findings of this study demonstrate that pediatric dentists are most commonly
used local anesthetics as the preferred type and shorter needle for infiltrations and blocks. Most were taking anywhere from 31 to 60 s to inject a
cartridge. Topical anesthetics were used by most and also the preferred one. However, their perception of the effectiveness of topical anesthetics
varied. There also appears to be a need to develop newer and better mode of topical anesthetic delivery system in the pediatric dental population.
Key words: Drug dosage, local anesthesia, topical anesthesia
Introduction some of the risks and unpleasantness associated with other forms
of anesthesia, such as nausea and vomiting. The anesthetic action
The administration of local anesthesia, sedation, and general
extends for longer than required and therefore provides pain relief
anesthesia is an integral part of dental practice. Local anesthesia
for several hours after the operation. Local anesthesia is associated
is the temporary loss of sensation including pain in one part
of the body produced by a topically applied or injected agent with reduced blood loss.[3] Topical anesthetics can be applied
without depressing the level of consciousness. Local anesthetics painlessly without needles and can reduce the need for physical
act within the neural fibers to inhibit the ionic influx of sodium and chemical restraints.[4] They also avoid the tissue distortion that
for neuron impulse. This helps to prevent transmission of pain occurs with infiltrated anesthetics.[5] Topical anesthetic agents are
sensation during procedures which can serve to build trust and available in gel, liquid, ointment, patch, and aerosol forms.[6] Thus,
foster the relationship of the patient and dentist, allay fear and the main purpose of this study is to evaluate the current status of
anxiety, and promote a positive dental attitude.[1] Local anesthetics dental anesthesia among dentists.
are frequently administered in dentistry and thus can be expected
to be a major source of drug‑related complications in the dental Address for correspondence: Dr. A. Naurin Salma,
office. The most frequently observed complications (dizziness, Department of Pedodontics, Saveetha Dental College, Chennai ‑ 600 077,
tachycardia, agitation, nausea, and tremor) were transient in Tamil Nadu, India.
E‑Mail: [email protected]
nature and did not require treatment.[2] Local anesthesia avoids
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DOI:
*** How to cite this article: Salma AN, Ramakrishnan M. Use of anesthesia in
pediatric dentistry: A cross-sectional survey. Int J Pedod Rehabil 2016;1:5-9.
© 2016 International Journal of Pedodontic Rehabilitation | Published by Wolters Kluwer - Medknow 5
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Salma and Ramakrishnan: Use of Anesthesia in Pediatric Dentistry
Materials and Methods Table 1: The prevalence of usage of anesthesia for
A survey was conducted among fifty pediatric dentists from treating pediatric patients
South India. The survey included consists of a questionnaire Variables and percentage
including questions relating to the use of local and topical Very often 30
anesthetics utilized among pediatric patients, length of time Often 60
used to inject a cartridge, factors deterring the dosage of Rare 10
anesthetics, form of systemic anesthetics used most commonly
in children, length of the needle used often, effectiveness of
topical anesthetics over local anesthetics, and what is his/her
patients’ most disliking factor about the topical anesthetic.
Finally, the data were analyzed by calculating the percentage
response for each question.
Use of Anesthesia in Pediatric Dentistry:
A Survey
Name: Year of study
1. How often do you use anesthesia for treating pediatric
patients?
Table 2: Commonly used anesthetic in pediatric dentistry
a. Very often b. Often c. Rare
2. What is the common age group of pediatric patients Variables and percentage
requiring anesthesia? Topical anesthesia 30
3. Which do you use commonly? Local anesthesia 70
Local or topical anesthetic
4. What form of systemic anesthetic do you use the most?
a. Nerve block b. Infiltration c. Gas
5. Do you use any topical anesthetic gel?
a. Always b. Sometimes c. Rarely d. Never
6. What is the most important factor that you consider
commonly when you decide on dosage of local anesthesia
that you will inject?
a. Exact age in years b. Exact body weight c. Others
7. What length of needle do you use most often?
a. Long b. Short c. Others
8. How much time do you take to inject a full cartridge?
Table 3: Form of systemic anesthetic used
a. <10 s b. 11–20 c. 31–60 s
9. Do you prefer topical anesthetics are effective than local Variables and percentage
anesthetics? Nerve block 34
a. Very effective b. Effective c. Poor Infiltration 66
10. What is the disliking factor about topical anesthetic? Gas 0
a. Taste b. Color c. Small d. Consistency.
Results
All the questions in the questionnaire were answered by
dental students. The data collected are represented as a
bar graph.
Sixty percent of dental students use anesthesia often for treating
pediatric patients while 30% use anesthesia very often and 10%
use it rarely [Table 1].
About 70% of dental students prefer local anesthesia whereas
30% prefer topical anesthesia [Table 2].
The response for the form of systemic anesthetic used
is about 66% in case of infiltration and 36% in case of The responses for the topical anesthetics are tabulated
infiltration [Table 3]. in Table 4. The respondents’ responses to the question
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Salma and Ramakrishnan: Use of Anesthesia in Pediatric Dentistry
regarding the use of topical anesthetics, a majority of the When questioned regarding the amount of time taken to inject
respondents (86%) always used a topical anesthetic while 8% a full cartridge of local anesthetic, 10% took < 10 s, 24% took
sometimes used a topical anesthetic. Only 4% reported that 11–20 s, and 66% took 31–60 s [Table 7].
they rarely used topical anesthetic, with 2% reporting that they
When asked about the effectiveness of topical anesthetics,
never used a topical anesthetic.
32% perceived them as effective, 36% as very effective, and
When questioned which criteria practitioners used to 8% as poor [Table 8].
determine the local anesthetic dosage, almost half of the When questioned concerning the different properties of
respondents (88%) reported using exact body weight when topical anesthetic, most patients did not like the taste (98%)
determining the dosage of local anesthetic for each pediatric and consistency was not favored by 2%, with 6% reporting
patient while 8% used the patients’ age and 4% used other complaints by patients including burning, numbness of the
methods such as number of teeth needing to be treated, length entire mouth, and inability to swallow [Table 9].
of treatment, and degree of carious involvement [Table 5].
Most of the respondents (88%) used a short needle, whereas Discussion
16% used a long needle for infiltration/nerve block [Table 6].
One of the most important and challenging aspects of child
behavior management is the control of pain. Therefore, it
Table 4: Prevalence of topical anesthetic gel
Variables and percentage Table 6: Length of the needle used often
Always 86
Variables and percentage
Sometimes 8
Long 16
Rarely 4
Short 88
Never 2
Others 0
Table 5: The most important factor that you decide on
dosage of the local anesthetic that you will inject Table 7: Time taken to inject a full cartridge
Variables and percentage Variables and percentage
Age in years 8 <10 s 10
Body weight 88 11-20 s 24
Others 4 31-60 s 66
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Salma and Ramakrishnan: Use of Anesthesia in Pediatric Dentistry
discomfort associated with tooth preparation, pulp therapy, and
Table 8: Do you prefer topical anesthetics are effective
extraction. There are very few contraindications for the use of
than local anesthetics
local anesthesia in children during dental procedures. However,
Response Percentage when administering a local anesthetic to a child, the clinician
Very effective 52 should be aware of the possibilities of anesthetic overdose,
Effective 43 self‑induced traumatic injuries related to prolonged duration
Poor 5 of soft tissue anesthesia and technique variations related to the
smaller skull and different anatomies in pediatric patients.[9]
The length of the needle should be long for all techniques
requiring penetration of significant thickness of soft tissue.[10]
Short needles may be used for injections that do not require
the penetration of significant depths of soft tissue.[11]
As for the time taken to inject a full cartridge of anesthetic, a
slow injection is important for two reasons: (1) For the safety of
the patient and (2) to prevent the solution from tearing the soft
tissue into which it is being injected. Rapid injection causes an
immediate discomfort that lasts for a few seconds, followed by a
prolonged soreness after the numbing effect of the local anesthetic
has subsided.[12] It was recommended at least 60 s for a full 1.8 ml
of cartridge as this rate of deposition will neither produce tissue
damage either during or after anesthesia nor cause a serious
reaction in an event of accidental intravascular injection.[13]
Table 9: Disliking factor about topical anesthetic
Response Percentage
Topical anesthetics are effective to a depth of 2–3 mm and are
effective in reducing the discomfort of the initial penetration
Taste 89
Color 1
of the needle into the mucosa.[12] Its disadvantages are the taste
Small 6 may be disagreeable to patient and the length of application
Consistency 4 time may increase apprehension of approaching procedure in
the pediatric patient.
Most practitioners responded that the current topical anesthetics
they were using in their offices were very effective (36%). The
fact that 2% of them perceived topical anesthetics to be ineffective.
Most practitioners responded that their patients disliked taste,
consistency, and warm/burning sensation of the topical anesthetic.
Conclusion
The findings of this study demonstrate that pediatric dentists
are most commonly using local anesthetic as the preferred
type of using short needle for infiltrations and blocks. Most
were taking anywhere from 31 to 60 s to inject a cartridge.
Topical anesthetic was used by most and also the preferred
one. However, their perception of the effectiveness of topical
anesthetics varied. There also appears to be a need to develop
is important that clinicians make every effort to minimize
pain and discomfort during dental treatment. Because of newer and better mode of topical anesthetic delivery system
the likelihood of the pediatric dental patient experiencing in the pediatric dental population.
discomfort during restorative and surgical procedures, Financial support and sponsorship
dentists turn to the use of local anesthetics and/or analgesics Nil.
to control pain. The simplest and most effective method of
reducing pain during dental procedures is via an injection of Conflicts of interest
local anesthetic.[7] Unfortunately, the anticipation of receiving There are no conflicts of interest.
a “shot” tends to increase anxiety in the pediatric and adult
patients.[8] Younger children do not have the ability to do References
this and thus may exhibit negative behavior before, during, 1. Malamed SF. Basic injection technique. In: Handbook of Local
and after the injection process. Local anesthesia can prevent Anesthesia. 6th ed. St. Louis, Mo: Mosby; 2013. p. 157‑68.
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Salma and Ramakrishnan: Use of Anesthesia in Pediatric Dentistry
2. Kravitz ND. The use of compound topical anesthetics: A review. J Am anesthesia considerations during sedation. Pediatr Dent 1999;20:49.
Dent Assoc 2007;138:1333‑9. 9. Malamed SF. Pharmacology of vasoconstrictors. In: Handbook of Local
3. Steward DJ. Manual of Pediatric Anesthesia. New York: Churchill Anesthesia. 6th ed. St. Louis, Mo: Mosby; 2013. p. 25‑38.
Livingstone; 1979. p. 5‑13. 10. Hersh EV. Local anesthetics in dentistry: Clinical considerations, drug
4. Hollander JE, Singer AJ. Laceration management. Ann Emerg Med interactions, and novel formulations. Compend Contin Educ Dent
1999;34:356‑67. 1993;8:1020‑30.
5. Berde CB. Toxicity of local anesthetics in infants and children. J Pediatr
11. McDonald RE, Avery D, editors. Local anesthesia for the child and
1993;122 (5 Pt 2):S14‑20.
adolescent. In: Dentistry for the Child and Adolescent. 7th ed. St. Louis:
6. Rosivack RG, Koenigsberg SR, Maxwell KC. An analysis
of the effectiveness of two topical anesthetics. Anesth Prog CV Mosby Co.; 2000. p. 283‑4.
1990;37:290‑2. 12. McGrath PJ, McAlpine L. Psychologic perspectives on pediatric pain.
7. Corssen G. Intravenous Anesthesia and Analgesia. Philadelphia: Lea J Pediatr 1993;122 (5 Pt 2):S2‑8.
and Febiger; 1988. p. 99‑174. 13. Malamed SF, editor. Drug overdose reactions. In: Medical Emergencies
8. American Academy of Pediatric Dentistry: Guidelines. Local in the Dental Office. 4th ed. St. Louis: Mosby Co.; 1993. p. 230.
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