injectionsAs we all know, it is rare for anyone to look forward to an injection. In fact, many folks dread or downright fear them. For most of us in dentistry, this is something we have to deal with on a daily basis, and what our patients don’t know is that for many of us, this can create a significant amount of stress for us as well. In this article, I will cover a couple simple tips that will help make your injections more comfortable for your patients while making their visits less stressful for you and pleasant for them.

Tips for Painless Injections

Use your topical anesthetic properly. The two big factors here are time and contact. While both of these are simple to do correctly, they are just as easy to do incorrectly; if you do not do them properly, then as one of my dental school instructors, Frans Currier, would say, “You will fail; the only question is, will you fail miserably or marginally?”

So the question is how can we ensure we are doing our injections correctly? The first step is to dry the area that you are applying the topical, and to keep that area as dry as possible throughout the process to ensure the topical gets a good contact with the tissue. I can’t stress how important this is since the saliva will otherwise prevent the topical from contacting the tissue well so it can be effective.

The other big factor is time. This is just as important as drying the tissue for good contact, however, time will not help you much if you don’t get the topical in good contact with the tissue. When it comes to time, shoot for at least several minutes. While some folks will say topical is not effective, I would bet that most that say this are not getting their contact and time right.

Inject Slowly. Our topical only works on the surface of the tissue, and we have to remember the fact that the volume of solution we are injecting has to go somewhere. This means if we slow down and take our time, the solution we are injecting will have more time to diffuse through the tissue resulting in a more comfortable and tissue-friendly injection.

Not only will this result in a more comfortable initial injection, but in many cases, it will also result in less injection site soreness post-operatively. So how slow should you go?  Shoot for at least one minute per carpule, but in general, the slower the better.

John R. Carson, DDS, PC, Spear Visiting Faculty and Contributing Author www.johncarsondds.com


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Comments

Commenter's Profile Image Scott Meuselbach
February 20th, 2015
Great points. Also, warm the anesthetic to body temp. Nothing like putting 70 degree liquid into a 98.6 degree body. Anesthetic warmers or just placing carpules in your pocket will help.
Commenter's Profile Image Everett Heringer
February 21st, 2015
This is a very important subject because it is a practice builder, a form of marketing, and the patient remembers how the "shot" felt during the injection. My goal over the last 40 years in dentistry is to some how distract them during the injection. One way is to talk about a something during the injection, with the patient being engaged in thought and maybe frustrated because they can't respond, "a distraction." Another way that has worked for me is, as you are retracting there lip for the delivery, squeeze it to a point of experiencing slight discomfort, "a distraction." While doing that, wiggle, jiggle, move or massage their lip gently, "another distraction." Adding these three things to the above comments will make you even a bigger star. This has worked wonders for me. In fact many patients ask if I just gave them a shot? I smile and tell them that some might call it that, but we like to call it our "magic wand." Hey it works, I have total control during the injection. FYI, I rarely us topical, I think it numbs everywhere else in the mouth and I personally don't like it used on me. I know, you may be wondering "what" but this does works for me. Now that my secret is out, we may have to pinky swear. lol Keep enjoying the "Art of Dentistry."
Commenter's Profile Image John Carson
February 21st, 2015
Great comments Scott and Everett! I agree getting the anesthetic closer to body temp helps. One thing I do think you have to look out for if you are warming your anesthetic is realizing that doing so would likely decrease it's shelf life so I would only do this for the amount I planned to use rather than storing it day to day heated (I know I guys who at least used to do this and I think he ran into issues as you might expect). John
Commenter's Profile Image Mike Abels
February 21st, 2015
I spend 90 seconds to two minutes per carpule. And during the first minute I inject only about one third of the carpule. In advancing the needle in a mandibular block, I spend that first minute advancing about one millimeter at a time, injecting literally only a couple drops about 5 seconds in advance of that millimeter advancement, then I spend 30 seconds to a minute injecting the rest of the capule at the site of the block. I still occasionally see patients cringe on these blocks, but they report that the pain was of very short duration. For maxillary infiltrations, pretty much 100% of the time they feel nothing in the posterior, and about two thirds of the time they feel nothing in the anterior. I often use mandibular infiltration with articaine, going really slow there. A two plus minute injection may seem awfully slow if you are not used to it, but I have patients tell me daily that my anesthesia does not hurt. I even have people ask me how I got them numb without giving them a shot.
Commenter's Profile Image John Carson
February 23rd, 2015
Thanks for sharing Mike!
Commenter's Profile Image Johanna Tesoniero
February 23rd, 2015
Something I found useful for upper anteriors is injecting just a little bit, waiting a few minutes and then injecting the rest. That area is very sensitive and this helps a lot. I can say it both as a clinician and a patient:)
Commenter's Profile Image John Carson
February 23rd, 2015
Thanks for sharing Johanna!
Commenter's Profile Image David Midkiff
March 3rd, 2015
One thing we have done to help those pesky palatial injections is to apply a slight surface pressure with a rounded instrument or cotton applicator immediately adjacent to the injection sight. This slight pressure anesthesia can help with this injection into a tight gingiva. We also will use LPT(compounded lidocaine,prilocaine and tetracaine) as a more aggressive topical ointment. You just have to be careful not to leave it on over a couple of minutes, and it should be rinsed thoroughly to avoid tissue irritation.
Commenter's Profile Image John Carson
March 3rd, 2015
Thanks for the comment David! The only thing I would add in relation to your comment is we too used to have our topical compounded (although a different combo than you are using) however new legislation (the Drug Quality and Security Act passed in Nov. 2013) has made compounding for clinical use (one jar/quantity for use on multiple patients) illegal in the eyes of the FDA. While some states, etc. have a different view on this since it is not spelled out 100% in the act, federal law trumps state and local laws and the FDA has been going into compounding pharmacies and going after them for this. For now if you want to use compounded products in your practice, each and every patient should have their own Rx. Obviously if you are outside the U.S. (I do not know where you are) then you don't have to worry about this.
Commenter's Profile Image Scott Barr
March 19th, 2015
My dental assistant taps their shoulder while I give the injection. Sure, I have been doing the wiggle thing but I can't tell you how many patients tell her how appreciative they are because of her shoulder tapping. I almost feel guilty when I give an injection without her tapping if she is busy. I don't care she gets all the glory. It's a win -win.
Commenter's Profile Image John Carson
March 19th, 2015
Thanks for sharing Scott, sounds like something to try!
Commenter's Profile Image Joshua A.
March 8th, 2019
This week I had a very anxious pt so I told her to close her eyes, take deep breaths through the nose and focus on the sound of the suction. I then go very slow and that seems to work very well.