How to Give a Painless Injection [Part I]
I once heard someone say at a continuing education seminar that, “Patients only know three things: Did it hurt? Does it look good? Did they treat me nice?” There is certainly some truth to this. Patients don’t understand if your margins are impeccable or if you have put them in the most stable occlussal scheme possible. But if you make them jump when you give them an injection, they sure as heck remember that.
So what can we do to help ease one of the most unpleasant parts of our practice?
It’s important to address the topical. There are two topical anesthetics I would use. The first is Profound from Steven’s Pharmaceutical. It’s a mixture of 10% prilocaine, 10% lidocaine and 4% tetracaine. It comes in both a regular and a light. The regular is very viscous and the light is runnier.
The second is The Best Topical Ever. It’s a mix of 10% lidocaine, 10% tetracaine, 2.5% prilocaine and 2% phenylephrine. Both of these topical anesthetics seem to work magic; however, making their magic work takes more than just swabbing some on.
One of the keys to make the topical work is to dry the gingiva before applying the topical. This removes the saliva and salivary proteins that can act as a barrier to the medications within the topical. Thoroughly dry the area with gauze and apply topical. Let the topical sit for 30-60 seconds or until the tissue gets a corrugated look to it.
This lets you know that the topical has penetrated the outer mucosa and affected the subepithelial nerve fibers. At this time you can penetrate the tissue with the needle with little to no sensation. If you give the tissue a little jiggle when inserting the needle, it also distracts the patient and helps stimulate the nerves so they don’t register the needle poke.
There are devices, like the Vibrajet that aid you in shaking or jiggling the tissue, but personally I can do it myself. After giving the injection be sure to thoroughly rinse the tissue as the topical can cause some sloughing of the mucosa if left on too long.
Darin O’Bryan, DDS [ www.onemorereasontosmile.com ]