4 Anesthesia: Essays and Researches Editor‑in‑Chief : Mohamad Said Maani Takrouri (KSA) Open Access HTML Format For entire Editorial Board visit : http://www.aeronline.org/editorialboard.asp A E R Review Article An update on local anesthesia for pediatric dental patients Faizal C. Peedikayil, Ajoy Vijayan 1 Departments of Pedodontics and Preventive Dentistry, 1 Oral and Maxillofacial Surgery, Kannur Dental College, Kannur, Kerala State,India Corresponding author: Dr. Faizal C. Peedikayil, Department of Pedodontics and Preventive Dentistry, Kannur Dental College, Kannur, Kerala State, India. E‑mail: drfaizalcp@gmail.com Access this article online Website DOI Quick Response Code www.aeronline.org 10.4103/0259-1162.113977 Abstract Pain control is an important part of dentistry, particularly in the management of children. Behavior guidance, and dose and technique of administration of the local anesthetic are important considerations in the successful treatment of a pediatric patient. The purpose of the present review is to discuss the relevant data on topics involved, and on the current methods available in the administration of local anesthesia used for pediatric dental patients. Key words: Local anesthesia, pain control, pedodontics INTRODUCTION Fear-related behaviors have long been recognized as the most difficult aspect of patient management and can be a barrier to good care. [1] Administering local anesthesia by injection is still the most common method used in dentistry. However, there is a constant search for ways to avoid the invasive and often painful nature of the injection, and find a more comfortable and pleasant means of achieving local anesthesia before dental procedures. [2,3] Chemically, the local anesthetic agents in common clinical use today may be divided into two broad groups: (A) agents containing an ester linking and (B) agents containing an amide. The most commonly used local anesthetics for pediatric dentistry are the amide type agents. Lidocaine hydrochloride (HCl) 2% with 1:100,000 epinephrine is preferred because of their low allergenic characteristics and their greater potency at lower concentrations. [4] Table 1 shows the dosage per 1.8 mL cartridge of lidocaine. Local anesthetic carpules also contain organic salts and may contain vasoconstrictors. Vasoconstrictors are used to constrict blood vessels, counteract the vasodilatory effects of the local anesthetic, prolong its duration, reduce systemic absorption and toxicity, and provide a bloodless field for surgical procedures. [4,5] The use of the vasoconstrictor will allow the maximum total dose of the anesthetic agent to be increased by nearly 40%. [6,7] Many agents have been employed as vasoconstrictors with local anesthetics. But none has proved to be as clinically effective as epinephrine. [6] Table 1: Dosage per dental cartridge Lidocaine mg/1.7 mL or 1.8 mL cartridge Vasoconstrictor/1.7 mL or 1.8 mL cartridge 2% plain 34 or 36 N/A 2%+1:50,000 epinephrine 34 or 36 34 μg or 0.034 mg or36 μg or 0.036 mg 2%+1:100,000 epinephrine 34 or 36 17 μg or 0.017 mg or18 μg or 0.018 mg