1. Pediatric Behavior Management, Nitrous Oxide & Local Anesthesia
Dr. Ha T. Jacklynn Thai
Board Certified Pediatric Dentist
Associate Professor, University of California, San Francisco
Department of Pediatric Dentistry
HRSA Program: Pediatric Dentistry in Hygiene Dentistry
24700 Calaroga Ave. Suite 104 ~ Hayward, CA ~

2. Pediatric Behavior Management Modalities

3. Communication based guidance
No intervention
Communication based guidance
Positive pre-visit imagery
Direct observation/modeling
Tell show do (TSD)
Ask Tell Ask
Voice control
Positive reinforcement
Parent presence/absence
Pharmacological/advanced based guidance
Local anesthesia
Nitrous oxide
Protective stabilization
Oral conscious sedation
IV/General/Deep sedation

4. Permission
CONSENT

5. Background
Recognition of the type of behavior/personality your patient has
Recognition of parental expectations
Presence or absence of dental pain
Previous experience
Medical
Dental
Grooming

6. Goal
Behavior management techniques are used to alleviate anxiety, nurture a positive dental attitude, and perform quality oral health care safely and efficiently for infants, children, adolescents, and persons with special needs
Preservation of a positive experience and positive psyche
Source: American Academy of Pediatric Dentistry – Clinical Practice Guidelines Publication

7. Nitrous Oxide Also known as laughing gas Colorless, virtually odorless
Analgesic properties
Anxiolytic properties
CNS depression
Euphoric induction
Little effect on respiratory system
Rapid intake, rapid recovery
Extremely soluble to lung tissue  diffusion hypoxia
Minimal impairment to reflexes therefore protects gag/cough reflex
No recorded fatalities or morbidity if used in proper concentrations
Always given concurrent with oxygen – fail safe

8. Indications/Contraindications
Fearful, anxious patient
Special health care needs
Strong gag reflex
Lengthy, extensive treatment
Contraindications
Chronic pulmonary obstructive disease
Severe emotional disturbances
First trimester of pregnancy
Treatment with bleomycin sulfate (chemo agent)
Methylenetetrahydrofolate reductase deficiency
Cobalamin (B12) deficiency

9. Other Considerations Monitoring Side effects Other uses
Considered to be a mild sedation
Clinical observation
Side effects
N + V
Diffusion hypoxia
Other uses
Medical
Food processing propellant
Semiconductor manufacturing
Chemical manufacturing
Auto racing engine injection
Abuse

11. Local Anesthesia Types Added vasoconstriction (epinephrine)
Procaine  Novacain
Mepivacaine (Carbocain)
Lidocaine (Xylocaine)
Articaine (Septocaine)
Benzocaine
Added vasoconstriction (epinephrine)

12. Things to Consider Proper administration Overdose amounts Pregnancy
First trimester  no vasoconstrictor
No Prilocaine  leads to methhemoglobinemia
Lactation effects
Lidocaine is considered the safest

13. Maximum Dose Calculation
____ lbs x kg x mg x carp
lbs kg mg
40 lbs x 1 kg x 4.4 mg x 1 carpule = 2.35 carp
2.2 lbs 1 kg mg

14. Side Effects Biphasic reaction Toxicity Allergies
Excitation followed by depression
Toxicity
Dizziness
Anxiety
Confusion
Blurred vision
Drowsiness
Ringing in ears
Muscle twitching
Heart palpitations followed by bradycardia
Seizure activity
Unconsciousness
Respiratory arrest
Allergies
Itchy
Swelling
Paresthesia (partial or full)
Post-operative maintenance and care

15. Safety & Handling