With predictability when I hear a group of dentists discussing the use of topical anesthetic the conversation revolves around how it doesn’t work, has no impact on the feeling of the injection and is a waste of time. A review of the dental literature supports that the use of topical anesthetics do reduce the patient’s rating of how painful an injection is. The results are statistically relevant in comparison to the use of a plain gel, which the patient was told was a topical, so as to evaluate the placebo effect. Many different formulas of topical have been tested and all shown to be effective. The effectiveness is improved by drying the mucosa prior to application of the topical and allowing the topical to stay in contact with the tissue for a minimum of 1 minute, with 2 minute exposures having an increased effectiveness.
I would hold out that even the placebo impact of using topical has a valuable positive impact for patients. Whether they are apprehensive about the injection and being in our offices, or very comfortable all patients prefer to have less discomfort. The use of topical allows us to show patients we care about their experience and their comfort, and that making dental visits as pleasant as possible is part of the philosophy of care. In my we offer our patients the ability to chose from 5 different flavors of topical “numbing gel” when we bring them back to the operatory. It becomes fun as patients switch up flavors and joke about trying everything on our menu!