Today I had to assist a young patient in my practice with the removal of deciduous teeth A & J. The permanent premolars were erupting to the buccal and the lingual roots of the primary teeth had not dissolved. One of the challenges of many procedures that are otherwise straightforward is the need to establish palatal anesthesia. It is amazing to me how many years patients will remember and comment on an injection in the roof of their mouth. Because of this I have been in search of more patient friendly techniques for palatal anesthesia for years. Often I will give the patient the buccal infiltration. Once the labial is profoundly numb I will inject into the facial papilla slowly advancing the needle until the lingual papilla and the gingival tissues blanch indicating palatal infiltration. This approach works great to gain anesthesia for SCRP, crown preps and placing cord on the lingual. However, since the numbness is limited to a cuff of tissue at the sulcus it is not sufficient for an extraction.
When I need profound palatal anesthesia I use Cetacaine liquid (Benzocaine 14.0 %, Butamben 2.0 %, Tetracaine Hydrochloride 2.0 %) as a topical. I use the tip of the delivery syringe and place the Cetacaine in the sulcus and over the gingival tissue on the palatal. Cetacaine takes about 3-60 seconds for full effectiveness and has a duration of 30-60 minutes. I set a timer once the Cetacaine is in place and wait one full minute. I then place a needle into the sulcus at the mid-palatal of the tooth and deliver Septicaine. As I observe blanching I advance the needle deeper into the palatal tissues. I can now go back if it is indicated and give a greater palatine or incisive block. I have had great success with this technique and patients report little to no discomfort and profound anesthesia. The only time there is a pinch is if I advance the needle tip beyond the zone of blanching.
The gel form of Cetacaine also works very well, especially on the palatal mucosa prior to placing a sectional matrix separating ring.