Pediatric anesthesia and rubber dam

by Dr. Gregory Psaltis

Not 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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