A child’s future perceptions and expectations are likely to be conditioned by early experiences of dental treatment. Just under half of all children report low to moderate general dental anxiety, and 10–20% report high levels of dental anxiety. Montiero et al. (2014) indicate that the prevalence of needle phobia may be as high as 19% in 4- to 6-year-olds. Davidovich et al. (2015) reflected that, for general practitioners and specialists alike, Local anaesthetic (LA) injection for an anxious child was the most stressful procedure regardless of the operator’s age, gender, or years of professional experience. Despite impressive reductions in caries in children in recent years, there still exists a social gradient with inequalities in experience of dental disease, and there remains a significant cohort of children for whom extractions and restoration of teeth are necessary. Aside from emerging restorative strategies that do not require LA (e.g. atraumatic restorative technique or placement of preformed metal crowns using the Hall technique), effective and acceptable delivery of LA remains an important tool to enable successful operative dental treatment to be carried out comfortably for child patients. Effective surface anaesthesia prior to injection is very important as a child’s initial experience of LA techniques may influence their future perceptions and help in establishing trust. Cooling tissues prior to injection has been described but is rarely used, and surface anaesthesia is generally achieved with intra-oral topical agents. Although the main use of topical agents is as a pre-injection treatment, they have been used as the sole means of anaesthesia for some procedures including the extraction of mobile primary teeth. It is possible to achieve a depth of 2–3mm of anaesthesia if topical agents are used correctly: • the area of application should be dried • topical anaesthetic agent should be applied over a limited area • the anaesthetic agent should be applied for sufficient time. In the UK 5% lidocaine (lignocaine) and 18–20% (17.9%) benzocaine gels are the most commonly used agents. Benzocaine topical anaesthetic gel is not recommended for use on children under 2 years old because of an increased risk of methaemoglobinaemia.
Inflation perceptions and expectations in Sweden - Are media reports the missing link?
