Çocuk Hastalarda Lokal Anestezi Uygulamasında Kullanılan Güncel Teknikler

Diş hekimliği pratiğinde çürük temizleme, restoratif işlemler, pulpal veya periodontal işlemler, çekimler veya küçük cerrahi işlemlerde kullanılan lokal anestezi ile belirli bir bölgenin innervasyonunu sağlayan sinir dallarının anestezisi amaçlanır. Lokal anestezikler, sinir ağları boyunca hareket ederek buradaki sodyum akışını inhibe ederler. İşlemler sırasında ağrı hissinin oluşmasını önlemek hasta ve diş hekimi arasında güven hissini oluşturmak ve korku, kaygı gibi olumsuz duyguları hafifletmekte yardımcı olmaktadırlar. Diş hekimi tedavinin gerekliliklerine göre en güvenli, en minimal invaziv ve en ön görülebilir anestezi tekniğini seçebilmelidir. Çocuk diş hekimliğinde en çok kullanılan anestezi uygulamaları; bölgesel sinir bloğu uygulamaları (inferior alveolar sinir bloğu, infraorbital sinir bloğu gibi…), lokal infiltrasyon (bukkal infiltrasyon gibi…), periodontal ligament enjeksiyonu, intraosseöz anestezi ve değişik tekniklerin kombinasyonudur. Enjeksiyonun ağrılı doğasını önlemenin ve dental işlemlerden önce lokal anestezi yapılmasının daha konforlu ve keyifli bir yolunu bulmak için sürekli araştırmalar yapılmaktadır. Son zamanlarda geleneksel yöntemlere ek olarak; bilgisayar kontrollü lokal anestezi uygulamaları, elektronik dental anestezi, titreşimle lokal anestezi uygulamaları, intraoral lidokain bandı ve jet enjeksiyon yöntemi kullanılmaya başlanmıştır. Bu derlemede çocuk diş hekimliğinde lokal anestezi uygulamalarında kullanılan güncel teknikler değerlendirilip, geleneksel yöntemlere göre avantajları ve dezavantajları tartışılacaktır. Son zamanlarda elde edilen yeniliklere rağmen, geleneksel yöntemlerle uygulanan enjeksiyonlar lokal anestezi sağlamada ilk sıradaki yerini korumayı sürdürmektedir.

Current Approaches of Local Anesthesia in Pediatric Patients

Daily practice in dentistry; using local anesthetics for carving, restorations, pulpal and periodontal treatments, extractions and minor surgical treatments, provide inhibition of neural fibers in that area. Local anesthetics are essential in dentistry practice in providing comfortable working for patients and dentists. The most used anesthesia applications in pediatric dentistry; regional nerve block applications (such as inferior alveolar nerve block, infraorbital nerve block…), local infiltration (such as buccal infiltration…), periodontal ligament injection, intraosseous anesthesia and a combination of different techniques. Many new methods have been developed to provide local anesthesia. A dentist should choose the most reliable and most predictable technique for her/his patient. To find more comfortable technique is challenge because of nature of the injection. Recently, in addition to traditional methods; Computer controlled local anesthesia applications, electronic dental anesthesia, local anesthesia with vibration, intraoral lidocaine tape and jet injection method have been used. In this review, current techniques used in local anesthesia in pediatric dentistry will be evaluated and their advantages and disadvantages compared to traditional methods will be discussed. In spite of the recent innovations in injection, it is still the most preferred method in local anesthesia.

PDF

___

1. The American Academy of Pediatric Dentistry. Use Of Local Anesthesia For Pediatric Dental Patients. Reference Manual. 2015; 40(6): 18-19.

2. Dean JA, Avery DR, McDonald RE. Local anesthesia and pain control for the child and adolescent. In: Dentistry for the Child and Adolescent. 9th ed. St Louis, Mo.: Mosby. 2011; 241-52.

3. Malamed SF. Basic injection technique. In: Handbook of Local Anesthesia. 6th ed. St. Louis, Mo.: Mosby. 2013; 157-68.

4. Tandon S, Mathur R, Sharma M, Gandhi M, Kalia G, Rathore K. Comparative Evaluation of Mucosal Vibrator with Topical Anesthetic Gel to reduce Pain during Administration of Local Anesthesia in Pediatric Patients: An in vivo Study. Int. J. Clin. Pediatr. Dent., 2018; 11(4): 261–265.

5. Hegde KM, Srinivasan NRI, Melwani A, Radhakrishna S. Effect of vibration during local anesthesia administration on pain, anxiety, and behavior of pediatric patients aged 6–11 years: A crossover split-mouth study. J. Dent. Anesth. Pain Med. 2019; 19(3): 143.

6. Alanazi KJ, Pani S, AlGhanim N. Efficacy of external cold and a vibrating device in reducing discomfort of dental injections in children: A split mouth randomised crossover study. Eur. Arch. Paediatr. Dent. 2019; 20(2): 79–84.

7. Bilsin E, Güngörmüş Z, Güngörmüş M. The Effıcacy of External Cooling and Vibration on Decreasing the Pain of Local Anesthesia Injections During Dental Treatment in Children: A Randomized Controlled Study. J. Perianesthesia Nurs. 2020; 35(1): 44–47.

8. Gümüş H, Aydınbelge M. Evaluation of effect of warm local anesthetics on pain perception during dental injections in children: a split-mouth randomized clinical trial. Clin. Oral Investig. 2020; 24(7): 2315–2319.

9. Kuhnisch J, Daublander M, Klinberg G, Dougall A, Spyridonos Loizides M, Stratigaki E, Amar JL, Anttonen V, Duggal M, Gizani S. Best Clinical Practice Guidance For Local Analgesia In Paediatric Dentistry: An Eapd Policy Document, Eur Arch Paediatr Dent. 2017; 18: 313-321.

10.Milam SB, Giovannitti JA Jr. Local anesthetics in dental practice. Dent Clin North Am. 1984; 28(3): 493-508.

11.Farmasötik hesaplamalar. Anadolu Üniversitesi Eczacılık Teknolojisi Bölümü Ders Notları. 2015.

12.Koch G, Poulsen S, Çocuk Diş Hekimliğine Klinik Yaklaşım, İstanbul: Rotatif Yayınevi.

13.Tüloğlu D, Bayrak Y. Çocuk Diş Hekimliğinde Kullanılan Lokal Anestezi Teknikleri Ve Güncel Yaklaşımlar. Ata Diş Hek Fak Derg. 2010; 53-61.

14.Peedikayil FC, Vijayan A. An Update On Local Anesthesia For Pediatric Dental Patients. Anesth Essays Res. 2013; 7.

15.Singh C, Kour G, Masih U, Srivastava M, Yadav P, Kushwah J, Insulin Syringe: A Gimmick in Pediatric Dentistry. Int. J. Clin. Pediatr. Dent. 2017; 10(4): 319–323.

16.Kandiah P, Tahmassebi JF. Comparing The Onset Of Maxillary Infiltration Local Anaesthesia And Pain Experience Using The Conventional Technique Vs. The Wand In Children. Br Dent J. 2012; 9: 213.

17.Jälevik B, Klingberg G, Pain Sensation And Injection Techniques In Maxillary Dento-Alveolar Surgery Procedures In Children--A Comparison Between Conventional And Computerized Injection Techniques (The Wand). Swed Dent J. 2014; 38(2): 67-75.

18.Alamoudi NM, Baghlaf KK, Elashiry EA, Farsi NM, El Derwi DA, Bayoumi AM. The effectiveness of computerized anesthesia in primary mandibular molar pulpotomy: A randomized controlled trial. Quintessence Int. (Berl). 2016; 47(3): 217–224.

19.Garret-Bernardin A, Cantille T, Galeotti A. Pain experience and behavior management in pediatric dentistry: A comparison between traditional local anesthesia and the wand computerized delivery system. Pain Res. Manag. 2017.

20.Giannetti L, Forabosco E, Spinas E, Re D, Murri Dello Diago A. Single tooth anaesthesia: A new approach to the paediatric patient. A clinical experimental study. Eur. J. Paediatr. Dent. 2017; 19(1): 40–43.

21.Li C, Shi Z, Glenny AM. Electronic Dental Anaesthesia For Managing Pain During Dental Procedures. Cochrane Database Of Systematic Reviews. 2018; 2018(5).

22.Libonati A, Nardi R, Gallusi G, Angotti V, Caruso S, Coniglione F, Marzo G, Mattei A, Tecco A, Paglia L. Pain and anxiety associated with Computer-Controlled Local Anaesthesia: Systematic review and meta-analysis of crossover studies. Eur. J. Paediatr. Dent. 2018; 19(4): 324–332.

23.Al-Obaida MI, Haider M, Hashim R, AlGheriri W, Celur SL, Almadi E, Alsaleh S. Comparison of perceived pain and patients’ satisfaction with traditional local anesthesia and single tooth anesthesia: A randomized clinical trial. World J. Clin. Cases. 2019; 7(19): 2986–2994.

24.El Hachem C, Kaloustian MK, Cerutti F, Chedid NR. Metallic syringe versus electronically assisted injection system: A comparative clinical study in children. Eur. J. Paediatr. Dent. 2019; 20(4): 320–324.

25.Smolarek PC, Wambier LM, Siqueira Silva L, Chibinski ACR. Does computerized anaesthesia reduce pain during local anaesthesia in paediatric patients for dental treatment? A systematic review and meta-analysis. Int. J. Paediatr. Dent. 2020; 30(2): 118–135.

26.Bansal N. Pain Elimination during Injection with Newer Electronic Devices: A Comparative Evaluation in Children. International Journal of Clinical Pediatric Dentistry. 2014; 7(2): 71–76.

27.Langthasa M, Yeluri R, Jain AA, Munshi AK. Comparison of the pain perception in children using comfort control syringe and a conventional injection technique during pediatric dental procedures. Journal of Indian Society of Pedodontics and Preventive Dentistry. 2012; 30(4): 323–328.

28.Sixou JL, Barbosa-Rogier ME. Efficacy of intraosseous injections of anesthetic in children and adolescents. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008; 106(2): 173-8.

29.Smaïl-Faugeron V, Muller-Bolla M, Sixou JL, Courson F. Evaluation of intraosseous computerized injection system (QuickSleeperTM) vs conventional infiltration anaesthesia in paediatric oral health care: A multicentre, single-blind, combined split-mouth and parallel-arm randomized controlled trial. Int. J. Paediatr. Dent. 2019; 29(5): 573–584.

30.Li C, Shi Z, Glenny AM. Electronic Dental Anaesthesia For Managing Pain During Dental Procedures. Cochrane Database Of Systematic Reviews. 2018; 2018(5).

31.Second YLK, Neelakantan P. Local Anesthetics in Dentistry: Newer Methods of Delivery. IJPCR. 2014; 6(1): 4-6.

32.Şermet Elbay Ü, Elbay M, Kaya C, Uğurluel C, Baydemir C. The Efficacy of DentalVibe Injection Comfort System Producing Vibration Impuls to Reduce Injection Pain of Palatal Local Infiltration Anesthesia in Children. Turkiye Klin. J. Dent. Sci. 2015; 21(3): 207–215.

33.Veneva E, Cholakova R, Raycheva R, Belcheva A. Efficacy of vibrotactile device DentalVibe in reducing injection pain and anxiety during local anaesthesia in paediatric dental patients: A study protocol for a randomised controlled clinical trial. BMJ Open. 2019; 9(7): 1–7.

34.Raslan N, Masri R. A randomized clinical trial to compare pain levels during three types of oral anesthetic injections and the effect of Dentalvibe® on injection pain in children. Int. J. Paediatr. Dent. 2018; 28(1): 102–110.

35.Tung J, Carillo C, Udin R, Wilson M, Tanbonliong T. Clinical Performance of the DentalVibe® Injection System on Pain Perception During Local Anesthesia in Children. J Dent Child (Chic). 2018; 85(2): 51-57.

36.Hassanein PH, Khalil A, Talat DM. Pain assessment during mandibular nerve block injection with the aid of dental vibe tool in pediatric dental patients: a randomized clinical trial. Quintessence Int. 2020; 51(4): 310-317.

37.Sanghi DK, Tiwle R. An Update: On Needle Free Injections. Int J Pharm ChemBiol Sci. 2014; 4(1): 129-138.

38.Kale TR, Momin M. Needle Free Injection Technology - An Overview. Inov Pharm. 2014; 5(1): Article 148.

39.Munshi AK, Hegde A, Bashir N. Clinical Evaluation Of The Efficacy Of Anesthesia And Patient Preference Using The Needle-Less Jet Syringe In Pediatric Dental Practice. J Clin Pediatr Dent. 2001; 25(2): 131-136.

40.Makade SC, Shenoi PR, Gunwal MK. Comparison Of Acceptance, Preference And Efficacy Between Pressure Anesthesia And Classical Needle Infiltration Anesthesia For Dental Restorative Procedures In Adult Patients. J Conserv Dent. 2014; 17(2): 169-174.

41.Arapostathis KN, Dabarakis NN, Coolidge T, Tsirlis A, Kotsanos N. Comparison Of Acceptance, Preference, And Efficacy Between Jet Injection Injex And Local Infiltration Anesthesia In 6 To 11 Year Old Dental Patients. Anesth Prog. 2010; 57(1): 3-12.

42.Zarzecka J, Gończowski K, Kesek B, Darczuk D, Zapała J. Comparison Of The Systems Used For Providing Local Anesthesia In Dentistry--The Wand (Milestone Scientific) And Injex (Rosch). Przegl Lek. 2010; 63(12): 1304-1309.