by
Dr. Gregory PsaltisNot every
dentist who treats children would agree with the necessity of local
anesthesia and/or rubber dam for restorative care. We routinely use both
in my practice, largely because we believe they enable us to provide
better restorations painlessly, particularly in this age of bonded
restorations. The materials and products we routinely use include the
following:
Topical anesthetics — One Touch produced by Hager. This product contains
18% benzocaine and 2% Tetracaine HCl. We use this routinely for our
pre-injection topical anesthetic and have begun using it as an all-purpose
topical anesthetic for multiple tasks. It is slightly objectionable to
taste, but very effective and profound in use. Other topical anesthetics
are used for narrowly defined tasks, but One Touch is now our standard.
Local anesthetics — 2% Lidocaine HCl with 1:100,000 epinephrine produced
by Cook Waite. This is our routine local anesthetic, used in most
restorative cases that require reliable anesthesia for any extended period
of time. We like its reliability, safety, and duration. 3% Carbocaine (Mepivacaine
HCl) produced by Cook Waite. This is our first alternative for patients
allergic to lidocaine. 4% Articaine HCl (Septocaine) distributed by
Septodont. We use this when patients have a history of lidocaine not being
effective. We have found that it is particularly effective in
anesthetizing second molars in teenage patients. I have spoken with some
dentists who are using this routinely for all local anesthesia.
Local anesthetic techniques — For most routine procedures, we use classic
infiltration and mandibular block techniques. When the procedure is
limited to a single primary tooth in the mandible, we have excellent
success with mandibular infiltration anesthesia. We often use 30 gauge
extra short needles made by Acuject, which we find to provide adequate
depth of penetration and nearly painless initiation. Others have enjoyed
excellent results with intraligamentary injections. A variety of syringes
are available for this technique.
Rubber dam — Medium latex 5"x 5" rubber dam (Ivory) distributed by Heraeus
Kulzer. This is our usual choice. We find it to be very pliable, yet
strong. Flexi-dam 150mm x 150mm produced by Roeko. This is a non-latex
rubber dam that is in nearly every way as effective as the latex, other
than a slightly lower degree of stretchability.
Rubber dam clamps — Ivory 8A, 14A, 2, 3, 12 and 13. For most of our
primary tooth care, we find 8A clamps to be very effective. The 14A is
extremely effective on partially erupted permanent teeth. The 2 and 3 are
good for fully erupted permanent biscuspids and molars, and the 12 and 13
(which have one fluted wing) are less invasive to the gingival tissues and
often adequate to stay on partially erupted teeth.
About the author: Dr. Gregory Psaltis has been in private
pediatric dental practice in Olympia, Wash., since 1981. In addition, he
has lectured nationally and internationally on a variety of topics, both
clinical and business. He is actively involved in consulting with other
offices to create more enjoyment and profit in the workplace. His Web site
is www.psaltis.info or he can be
reached by phone at (360) 413-5760 or e-mail at
drpsaltis@orcalink.com.
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