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86 comments:
Know the type of anesthesia you will be using on the child and make sure to calculate the correct amount of anesthesia according to the child's weight.
Shelby Padua #166
Natalie Nguyen #159:
The control of pain and choice of words are very important in the treatment of pediatric patients. The golden standard for lidocaine is 4.4 mg/kg with an absolute maximum of 300mg. Cowhorn mandibular forceps are contraindicated for primary teeth exodontia.
To prevent damage or extraction of the developing tooth bud section primary molars prior to extraction.
Liz Miltner #150
2% lidocaine carpule has 36 mg lidocaine.
4.4mg/kg for children
Naomi NGuyen
158.
For the pediatric use of 2% Lidocaine w/ 100,000 Epi, a maximum of 4.4mg of Lido per kg weight of the pediatric pt can be used up to 300mg. A 1.8mL carpule contains 36mg of Lidocaine.
Sydon Arroyo #102
In Lido 2% 1:100,000 Epi = 36mg of Anesthestics. Know the Max dosage of LA used based on the Kg of Pedo pt.
Topical Anesthesia only works if used properly. Should place it over dried areas. Also it would work the best if leave it in for around 2 minutes.
Xiang Li #146
The "back of the hand vs elbow pinch story" is a great way to relax older kids before giving an injection.
Orly Hendizadeh, #134
Infiltration of decidous teeth should be given more close to the gingiva, directly to the apex of a tooth- unlike permanent teeth.
Sonia Lee 145
Topical anesthesia should not be used in very young pt because it can goes down in their throat and make them gag and vomit.
Heidi Gonzalez 526
We need to calculate the maximum dosage of local anesthetics before tx. A chart will be helpful. Language is very important in pedo. Use "weird" or "bother" to describe a feeling/action.
Eric Cheung #110
Maximum dosage of anesthesia (epinephrine) should be calculated prior to beginning treatment of a child (4.4mg/kg w/max 300mg). Rememeber: there are 36 mg of epi per 1.8ml 2% lidocaine cartridge.
Cristen Dismuke #118
Post-extraction, apply a 4x4 gauze, rolled-up and partially sticking out of the mouth,instead of 2x2 to avoid accidental swallowing. Also, have all your anesthetic armamentarium ready and maximum anesthetic values calculated before you start!
Emmy Le #142
When extracting a primary tooth whose roots are intimately surrounding the permanent tooth bud. We must split the primary tooth and extract in sections so as not to harm the permanent tooth bud, or cause extraction of permanent bud along with the primary tooth.
Dilshad Abtin #524
Max lidocaine dosage at 300mg for pedo patients. Cowhorn is contra-indicated for primary teeth. Use age-specific wording, sleepy juice for children who still think teeth can become sleepy and feel funny!
Jing Lee #144
Maximum local anesthetic dosage must be calculated for each pt before the procedure by pt. weight (4.4 mg lido/kg, 2.2 lbs/kg) & absolute maximum (300 mg lido) and converted into number of cartridges (36.4 mg/cartridge). Local anesthetic and needle should also be loaded beforehand.
Austin Tung 187
There is 36 mg of lidocaine per carpule (1.8 ml). MRD is 4.4 mg/kg. Best treatment to toxicity is prevention; always know pt's med hx and calculate MRD based on pt's weight.
Stacy Yu #193
It's always a good idea to calculate the maximum dosage of LA to be given to a child ahead of time because sometimes we may overdose them if no anesthesia is achieved.
Kim Pham #167
It is important to calculate the maximum local anesthesia dosage BEFORE the procedure begins. During times of stress, the operator may forget or miscalculate this very important number.
When extracting a primary molar with roots that surround a permanent tooth follicle, it is extremely important to section the tooth and extract one root at a time to avoid damaging the follicle.
Bozhena Fisher #128
The most important message from the past lecture was to take caution in administering local anesthetic with epinephrine to children in order to not overdose them.
Marc Thomas 182
In primary maxillary molar extractions, first apply pressure to the palatal. The tooth may need to be sectioned in a "Y" shape, but don't separate through the furcation
Brandon Seto
#173
A cowhorn forcep is contraindicated for the extraction of primary teeth due to the risk of damage to the underlying developing follicle
Amy Dixon #120
When anethetizing the pts oral cavity: remember to dry area before applying topical, and the MRD of 2% lidocaine w/ 1:100k epi is 4.4mg/kg. (40lb kid~2 carpules)
Morris Poole #169
The most important thing this lecture was definitely knowing the maximum amount of anesthetic to give a child. Know the child's weight in pounds, divide it by 2.2 to convert to kg, then multiply by 4.4mg/kg to get the maximum dosage in mg. Then divide by 36mg per carpule to get the number of carpules.
Joshua Cardwell #108
It's important to look at the radiographs to see the development of primary rooth before to extraction to prevent potential damage to secondary teeth.
Tina Duong 125
Make sure you know the pts. weight and figure out the absolute maximum amount of local anesthetic that can be used before the pt sits in the chair. Also, use blocks instead of infiltrations if you need to anesthetize a large area and think the max will be reached. Ex) infraorbital vs. infiltrations.
Broc Mushet
#156
Check the radiographs before extracting a tooth, you may need to section the primary tooth in order to avoid damaging the tooth bud.
[Colby Smith #178]
Don't forget to dry the area before applying topical and anesthetic. A 1.8ml cartridge of Xylocaine is 36 mg. For pediatric pts 4.4mg per kg is the max. Cowhorn forceps will damage permanent teeth.
Chris Claus 113
While in adults one can usually feel safe about giving up to 7 carpules of lido w/ epi, in children, one must take into account how many kilos the child weighs, and give no more than 4.4mg/kg, up to 300mg.
I learned that using any type of word such as "stinging, biting, pinching" are deleterious to your patient management protocol whereas the word "weird" is a preferred way to communicate an upcoming injection experience.
#165
Neilesh Patel
The elbow pinch demo may help introduce the syringe into the mouth of the pediatric pt. Additionally, the palatal root should be luxated first for maxillary teeth extractions, since its bulk can expand the bone.
Christine Chung #112
Cowhorn forceps are contraindicated for use in extraction of primary mandibular molars because of the possibility of damaging the developing tooth buds located just below the furcation area.
Paul Hoang #135
use only 4mg/kg lido for a pedo patient. Infiltration of primary teeth should be delivered closer to the apices of the teeth, unlike adults.
Farshid Siami #177
When giving anesthetic use the rule 4mg/kg for a child. Also, when using topical make sure the field is dry.
Mihir Shah
175
Before administering local anesthesia, be prepared: Know the maximum dosage you can give the child, and have the carpule in the syringe, ready to go.
Joanne Kim #140
1) Local anesthesia dose for kid: 4.4mg/kg, 36mg per carpule.
2) IA is 5mm above occul plane.
3) Cow hon is contraindicated for primary teeth.
Tiffany Hsu #529
i didn't know that you could pinch really hard on your elbow and feel no pain. that would be good for explaining the reduced sensitivity of oral injections vs. IM injections.
Catheirne Do #122
It is important to know how much anesthetic that can be administered to children by calculating the maximum recommended dose before tx. It is also important to know that there is 36 mg of Lidocaine in per carpule.
-Shelton Chow #111
Never say that local will not hurt. You don't want to lose your patients' trust in you. Use other phrases instead.
Dave Tajima #181
I learned that proper patient management and use of "safe" words can almost be as effective in reducing perceived pain vs. local anesthesia.
Sean Nguyen #160
Topical anesthesia has to be applied for at least 2 min for the greatest effect. rita chen 109
You can be more effective if you dry the mucosa before applying topical anesthetic. For children, the max recommended dosage of 2% lidocaine with 1:100,000 epinephrine is 4.4mg/kg. (300mg absolute max)
J.Oka #162
1. The primary molars need to be sectioned before extraction in order not to damage the follicle of the permanent premolar.
2. Dry the area before placing the topical anesthetic so the child wouldn't taste the anesthetic.
3. The doze of lidocaine for children:4.4mg/kg
Cornel Crasnean #525
Don't use topical anesthesia in very young kids due to gag reflexes and unpleasant tastes when they swallow. Calculate max local anesthetic dose for a kid before appointment according to the weight in kg.
Alina Tiraspolskaya (#183)
You should instruct parents not to warn the kids about local anesthesia, because when they tell them, they can be aprehensive during the appointment. Also it's important to use distraction techniques when applying the anesthesia.
Claudia Rodriguez #531
A 2% lidocaine carpule contains 36 mg of lidocaine.
The maximum recommended dose is 4.4mg/kg for children.
The absolute maximum is 300mg.
Topical anesthetic should be applied for 2 minutes to get the maximum effect.
steph morphis #154
Lidocaine 2% 1:100,000 epi contains
36 mg of Lidocaine per carpule.
Maximum Recommended Dose (MRD) is 4.4 mg/kg.
Absolute Maximum is 300 mg.
Soheil Yashari #191
A carpule of 2% Lidocaine w/ 1:100,000 epinephrine contains 36 mg of Lidocaine. For pediatric patients, the maximum recommended dose is 4.4 mg/kg and the absolute maximum is 300 mg.
Kevin Omoto
#163
It is best to calculate the maximum dose of local anesthetic before you start working on a kid- also you may need to section a primary tooth before extraction to avoid damaging the developing tooth bud, so you should look at the radiograph!
Cynthia Morford #153
Do NOT overdose a child receiving local anesthetic. Always know that there are 36 mg of lidocaine in one carpule and you should only give 4.4 mg/kg.
Sanam Soroudi
#180
Jonathan Do #121
Know what anesthetic you are using. and when giving a description to young kids, keep explanations simple (ex: sleepy juice ). Do not give examples that may infer about pain and scare kids such as pinching, sting,..etc.
When a child is in pain, the child is unable to cooperate. It's better to use anesthetic to avoid pain and have their cooperation. When giving the anesthetic injection, don't lie to the child by saying that 'it won't hurt'. The child will lose trust in you and not believe you again. It's better if you tell them that 'it will feel weird'.
-Raquel Ulma #188
Topical anesthesia should not be use on very young children except for anterior maxilla because of bitter taste.
The height of needle insertion for IA block in children is slightly lower and more posterior than in adult pts.
Edvin, #100
When using topical anaesthetic, the area of application should be dried, the gel should be used sparingly, but should be applied for at least 2 minutes.
Matthew Moadel #151
Making sure that the dosage of anesthetic is calculated prior to starting tratment and while delivering it, being careful not to make any mention of unpleasant sensations like'pain' 'stinging' etc, but rather referring to all unpleasant sensations as being 'wierd' feelings.
Asha Sethu-Madhavan #532
It is important to keep in mind the childs weight and age prior to deliverying anesthetic.
Ernest Lai #141
Know that a child’s maximum recommended dosage for local anesthesia is 4.4 mg/kg and the absolute maximum dose is 300mg.
- Jeanne Wong, #195
It is not a good idea to use topical anesthetic in very young children due to the bad taste and smell.
Pedram Sooferi
#179
For Pediatric use ,the maximium dosage of lidocaine that can be used safely is 4.4mg/kg of body weight upto a maximum of 300mg.Also I learnt the imporatnce of language in treating kids.Words like "weird" evoke a better response than words like"pinching or stinging".
Amandeep Iqbal
#527.
Pain control is one of the most important aspects of pediatric pt. management. Make sure you calculate the max. dose of whatever anasthetic you are using before you begin. For 2% lido use the formula 4.4mg/kg weight with one carpule containing 36mg lidocaine.
Diana Craft 115
I learned that the topical needs to be in the mouth for minimum of 2 mins for it to be effective.
Jeff Kim
139
Couple of key things:
1- Pain management is very important in a pediatric setting, language is key.
2- Max dose of 2% lido w/ 1:100,000 epi is 4.4mg/kg.
3-If you have to make a slot, it's important not to extend the slot to the furcation when trying to extract difficult max and mand primary molars.
Sanaz Hamzehpour #132
When giving the IA block to a child, you need to place the needle slightly higher and more posteriorly based on the usual landmarks.
William Traynor #186
You should calculate the maximum amount of anesthetic that can be given to a child by their weight. Use 4.4mg/kg as a guide. Management of children are age specific and one should not forget to manage the parent. Make sure not to damage developing tooth bud when extracting teeth
Jun Flores #130
For kids the maximum recommended dose (MRD)4.4 mg/kg and the maximum dose is 300 mg.
Prior to administrating anesthesia, you should not let the child look at the syringe, or use scary words such as hurt, pinch, sting. Instead use words such as "this will bother".
Regina Espinoza #126
An effective way to do a less painful palatal injection to do a buccal infiltration, followed by infiltration through the papilla, and a palatal infiltration once the mucosa blanches.
Robert Busan #107
Don't forget that in some situations when infiltration of the upper anterior teeth is difficult to acomplished do to trauma,infection,etc. We can deliver infraorbital anesthetic.
The use of topical anesthetic is contraindicated for very young children. And for those kids that topical is used on, be sure to dry the area prior to application.
Michelle Duong #123
Maximum local anesthetic should be calculated prior to every patient; 4.4mg/kg with max 300mg. Cowhorn is contraindicated in primary teeth extraction.
Max dose for kids is 2% of lido - 4.4 mg/kg. up to 300 mg/kg. 1 carpule has 36 mg.
#176
Majic moment: Maximum Recommended Dose (MRD) is 4.4 mg/kg
(2.2 lb=1kg)and absolute maximum is 300 mg.
poonam rai #530
It is critical to calculate the maximum dosage of local anesthesia based on weight to be used on a child prior to the commencement of treatment. The maximum lidocaine dosage is 300 mg for pediatric patients.
Richard Duong #124
Children have the unique ability to thoroughly test the psychological foundation of dentists. Because of this, we need to communicate on their level for their comfort (ex: local anseth= sleepy juice.
The local dose of anesthetic for a child is 4.4mg/kg, with a standard carp volume of 36mg/carp. Also definately avoid dosing above 300mg unless you want the exorcist to show up for another sequel.
jeff flores
#129 above
Do not use topical anesthetic with very young children. Know the type of anesthetic you will use and always calculate the right amount (4/4 mg/Kg of Lido with a maximum of 300mg).
Paredes #164
When doing an IA block, use a more rigid needle than a 30, at least a 27 or 25. Also, A carpule of 2% Lidocaine has 36 mg of Lidocaine. For kids, the maximum recommended dose is 4.4 mg/kg and the absolute maximum is 300 mg.
Jake Cragun #117
It is crucial to calculate the maximal amount of anesthetic for the pt prior to the appt and to remember that it takes about 7-10 minutes for the anesthetic to take effect.
Amy Tran #184
When extracting the primary molars with long and curby roots, to avoid hurting the permanent tooth underneath,section the tooth first.
Lei Zeng, #535
Prior to injecting any anesthetic in a pediatric patient, make sure that you are familiar with the maximum dose for the patient. For example, no more than 4.4mg lidocaine/kg weight with an absolute maximum dose of 300mg should ever be administered. IA injections in children are given slightly inferior and posterior to where you should inject on an adult.
Jared Martin #147
Azadeh Ahmadi-Ardakani
student 101
make sure you know the difference between the mandibular structures between pediatric population and adudlts. in pediatric the postrior IA block is give more inferiorly than in the adult population. also the weight is the factor to consider when you're calculating the dosage not the age.
The amount of anesthetic that is given to a pediatric patient should be calculated BEFORE treatment begins. The maximum is 4.4 mg/kg with a maximum of 300 mg total of 2% lidocaine with 1:100,000 epi. To calculate this, one needs to know that each carpule of lidocaine has 36 mg of lidocaine.
Also, it is probably better not to give topical anesthetic to really young children because it can go down their throats and make them gag or vomit.
-Enayat Astani
#308
4.4 miligrams/kilogram of lidocaine for children. 300 mg is the maximum.
Nick Quach #170
Magical Minute:
The most interesting thing I learned is that the first force that you should apply when extracting a tooth is an apical force. This will ensure that the instrument is fully seated around the tooth so that it won't slip off when trying to extract it.
Paul Field #127
Need to calculate the dosage before the procedure. The best treatment is PREVENTION.
Varo Boyajyan #106
Extraction of primary teeth takes planning ahead of time.
1) you must look at the position of both the primary and developing permanent tooth to make sure that the permanent tooth is not damaged in the proceedure
2) You must plan the dosage of local anesthesia to make sure you do not over medicate for the child's mass.
The above blog was Jonathan Miller #149.
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