How to Give a Painless Injection [Part III]
Continuing the series on painless injections, the palatal injection is one of the more difficult processes. No one likes giving them, and patients sure don’t like getting them; it’s a necessary evil. So how do we make them as comfortable as possible?
Topical anesthetics don’t work very well due to the thicker keratinized tissue on the palate. So to get the tissue to not respond to the initial stick of the needle there are a couple of tricks.
A quick application of ice will numb the surface allowing the needle to enter with little to no pain. You can use endo ice for this, but make sure to be careful not to get it so cold that it causes tissue damage.
Once the tissue is numb from the ice and you have the needle in place, gently squeeze out one to two drops of anesthetic. You should give the anesthetic enough time to soak in. This will anesthetize the area and allow you to administer more local without pain. If you rush this step, your patient’s tissue won’t be numb and when you inject it will be painful because of the amount of pressure you’ll need to apply.
The palatal tissue is tight to the underlying bone and has very little room for anesthetic. You’ll have to place some mild anesthetic in the area before trying to pump in more.
The other technique that can be used takes a little more time but is very effective—especially with the very anxious patient or children. First you start with an infiltration. Allow the anesthetic to take effect for a minute or so; this will give enough time for the soft tissue on the buccal to become numb. Once this has occurred, administer a small amount of local anesthetic to the facial papillae.
Make certain to apply enough pressure that you start to see the tissue change on the palatal papillae. This will cause the palatal papillae to become anesthetized. Once this has occurred you can slowly creep your way from the papillae to the palatal tissue administering more local along the way.
I have used both techniques and prefer the ice technique most of the time. It has good results without taking a long time to administer and limits the number of needle insertions necessary. The papillae technique is great when you need a lot of anesthetic or hemostasis, since you will have epinephrine placed directly in the soft tissue in numerous areas.
Darin O’Bryan, DDS [ www.onemorereasontosmile.com ]