Checking for Cavities in Toddlers

1) Parent sits in dental chair and cradles child in their arms to restrain them
-dentist examines child w/ hands on both sides of head while assistant sits on opposite side to restrain legs
2) Parent and dentist sit knee to knee and childs head rests on dentists thighs
Attention Deficit Hyperactivity Disorder (ADHD)
-involves two sets of symptoms:
1) inattentive behavior
2) combo of hyperactive and impulsive behaviors
-arises btw ages of 2-5 usually and affects 2-9% of school-age children worldwide
-can persist into adulthood
-cause unknown
-common meds:
a) methylphenidate (Ritalin, Concerta)
b) atomoxetine (Strattera)
c) amphetamine/dextroamphetamine (Adderal)
-side effects of all types of meds are HTN, nausea, and dry mouth
-txt modifications include shorter appts and verbal reinforcement
Management of Angry and Fearful Children
1) Angry
a) separate child and parent
b) place child inc hair and be firm
c) use hand-over-mouth technique (GET PARENTS PERMISSION)
d) display authority and command respect
e) comfort and compliment pt at end of visit
2) Fearful
a) have parent stand quietly behind chair
b) be consistent in voice tone
c) permit child to express their fears
d) change childs focus off of fear
e) if nothing else works, use sedation
Part 3: Local Anesthesia and Nitrous Oxide Sedation for Children
Local Anesthetics and Max Recommended Doses
1) 2% lido w/ 1:100,000 epi: 4.4mg/kg
-safest LA to use in pediatrics
2) 3% mepivicaine: 4.4 mg/kg
3) 4% prilocaine w/ 1:200,000 epi: 4.4 mg/kg
Calculation of Max Dose and Cartridges
1) Obtain pts weight in pounds and convert to kilograms
-1kg=2.2 lbs (divide weight in lbs by 2.2)
-ex. 44lb child: 44/2.2=20 kg
2) Multiply weight in kg by max dose to obtain max mg dosage
-20 kg x 4.4 mg/kg lidocaine= 88 mg
3) Calculate number of mg/cartridge by multiplying % of local anesthetic times 10 then multiply by size of cartridge
-2% x 10= 20 x 1.8= 36 mg/cartridge
4) Divide max mg dose by number of mg per cartridge to get max allowable cartridges
-88 mg/ 36 mg/cartridge= 2.44 cartridges
Topical Anesthetics
-a good, long-lasting benzocaine topical is recommended
-benzocaine has rapid onset
-dry the mucosa w/ gauze first, then apply topical for minimum of 30 seconds