One of the things that helps grow my practice more then any other, is the lengths I go to making sure it is as comfortable as possible when I give anesthesia. Whether patients are anxious about getting the “shot” or not, not one looks forward to it. and all of us brace ourselves in anticipation. Over the years I have continued to refine my anesthetic technique, because over and over patients comment on how surprised and pleased they are by how comfortable it is. When new patients arrive in our office on a referral, we hear over and over that their friends couldn’t believe how little our shots hurt, and how much effort we went to making them comfortable.
Having the injection be comfortable is a combination of techniques I have learned over the years. Having patients awed by the efforts we go to, comes from sharing with them all we do to that end. The first step in comfortable anesthesia, is slowing down and allowing enough time for this part of the appointment. For years I believed that topical was nothing more than a placebo. This belief disappeared once I learned how to use it effectively. The key is first to thoroughly dry the tissue int he area where you intend to place the topical. this allows the anesthetic to get in direct contact with the tissue and not float above it on a sheen of saliva. I use a dry 2 x 2 and thoroughly dry the tissue. Then I place the topical and wait, because the second piece is giving the gel enough time to work. The evidence is clear that the gel needs about 1 minute against the tissue to produce a decrease in pain response, and extending the time even longer does not increase the efficacy.
The next piece of the puzzle for me is to begin with a ph neutral anesthetic. I use carbocaine plain, with the intent of numbing the soft tissues int he area of the injection, not creating profound dental anesthesia. I deposit 1/4 to 1/2 a carpule in this first injection. The neutral anesthetic does not burn when being injected so can produce very comfortable soft tissue anesthesia. After waiting a minute or so, I follow this injection with the actual anesthetic of choice, Septicaine for infiltrations or Lidocaine with Epi for blocks. I can now go in without worry as the patient can not feel either the needle penetration or the deposition of the acidic solution.
The last piece of my technique is using “The Wand”. I have been using the computer-controlled dental anesthetic delivery system for ten years, and would not give it up for the world. I first became a fan after having it used in my mouth to receive anesthetic to numb my maxillary centrals. The delivery system has two speeds, and at the slowest speed it deposits the solution slower, causing way less tissue damage then I can make myself go. This decreases the discomfort of the injection as well as the post-op discomfort in the injection site.
The last piece of the puzzle is explaining our anesthetic process, and how we strive to have our patients be comfortable to any new patients in our office. Whether it is the first time they will be getting an injection, or they express concern about the process on the phone. My team loves to share with patients all the things we do to make the injection comfortable, and they all speak from personal experience as a patient.
and I have an additional word of advice that I learned in my residency: try it on yourself (including maxillary centrals). I routinely used to taste and test everything so that I could understand what I could do with my own hands to decrease any discomfort patients might feel- this includes infiltrations- makes you a lot slower when you try it on yourself!
can i have information about using that anesthesia technic in dentistry?
Dry the tissue thoroughly, Place topical and leave for one minute. Inject 1/4 to 1/2 carpule neutral ph anesthetic like citanest plain or carbocaine int he area of the infiltration or block, very slowly. I use a wand on the cruise setting.. Allow anesthesia to set in, approximately one minute, then follow with your infiltration or block, anesthetic of preference as they will not feel it at this point.
Or…if you’re working on the mandible and doing an IANB, unless you have a procedure that requires more than 40 minutes of pulpal anaesthesia or it requires hemostasis, there is often zero point in using the second shot of Lidocaine. Just use the Carbocaine 3%. A study has shown that it is just as effective as Lido for this purpose.
PTs don’t like the collateral numbness, and the “epi reaction”, so don’t just minimize the discomfort of the injection, but also other aspects. Carbocaine gives a PT about 90 minutes less collateral numbness and there’s no epi to react to.