How to increase patient comfort during dental anesthetic injections

March 27, 2019

Patients expect different experiences from a visit to the dentist-a minty taste in their mouth, maybe a sticker on the way out-but when a needle is involved, those expectations can tend to be negative. Expectations, or fear, of pain and numbness from dental anesthetic injections are shared by adult and child patients alike. Increasing patient comfort during these injections begins with addressing these expectations.

Dentists can’t simply rely on words; when told not to bite a numb lip, patients tend to do exactly that. One dentist goes so far as to use a syringe-administered topical anesthetic before needle injection mostly for the psychological benefit of the patient. His technique then involves carefully selected procedures and equipment such as the Transcodent Painless Steel Dental Injection Needle to surprise patients with a lack of pain or lasting numbness they would usually expect from an anesthetic injection.

Dr. Howard S. Glazer is a veteran dentist. With 43 years of experience, he has updated his practice over the years to incorporate new techniques and technologies. His criteria for altering his technique or adopting new tools is simple: a change must be faster, easier, and better for both the dentist and the patient. This checklist has served his patients by sparing them the negative effects of old-school anesthetic practices, such as hours of numbness on one side of their face. With carefully selected equipment, Dr. Glazer developed a new way of delivering anesthetic.

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“When I switched [to the new method], I would always ask them, ‘did you notice anything different?’ And they said, ‘Yeah, I didn’t know you were giving me the injection.’”

A new method of anesthetic delivery

The new way, which Dr. Glazer calls his “Ouchless Injection” method, keeps some of the old (such as the topical anesthetic) for the peace of mind that continuity gives to his long-time patients. The method really begins, though, by taking advantage of the gate control theory of pain. Essentially, the theory posits that nerves can only understand one input at a time, so a nonpainful stimulation of a nerve closes the nerve’s “gate” to a painful stimulus.1. So, before injecting anesthetic, dentists can vibrate the injection zone to introduce a nonpainful stimulus that keeps pain from registering with the patient.

The next element of Ouchless Injection is single-tooth injection. “Anybody practicing dentistry has done a mandibular block injection and missed,” Dr. Glazer says, but since the dentist must retry the injection, missing hinders patient comfort and can undermine patient trust. With single-tooth injection, anesthetic leakage is limited to about half a tooth to either side of the targeted tooth, so a single tooth can stay numb for as long as necessary while the patient never has to feel like half of his or her face is numbed for hours. Dr. Glazer uses this localized technique for both upper and lower procedures to target individual teeth with injections at between one and six points to encompass the tooth-mesiobuccal, buccal, distobuccal, mesiolingual, lingual and distolingual. However, to do this in the most comfortable way for patients, he needs the right kind of needle.   

Choosing the right needle

“The key feature that dentists often overlook when buying an anesthetic needle is the tip of the needle,” Dr. Glazer warns. Most needles are pointed, so they prick the tissue all at once. Dr. Glazer chooses Transcodent Painless Steel Dental Injection Needles, which feature three-edge lancet grinding.

“We’ve all had the unfortunate experience, whether it’s women shaving their legs or men shaving their face, where that razor slices your tissue and you never knew about it until you saw the blood,” Dr. Glazer says, adding that the three-edge lancet grinding means the Transcodent needle easily slices into tissue the same way. Dr. Glazer observes that slicing causes less sensitivity to the patient post-operatively than puncturing.

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Furthermore, the Transcodent needle’s siliconized cannula doesn’t cause any tearing of the tissue, he says, but rather slides easily through. As a result, the needle doesn’t cause tissue invagination, which is a cause of post-operative discomfort. The needle’s versatility is another plus. It can be used with any of the anesthetic solutions Dr. Glazer might use.

Other needles on the market share some of the needle’s characteristics but aren’t comparable in terms of expense. Transcodent offers its Painless Steel Dental Injection Needles at what Dr. Glazer calls a “crazy good price.” To him, that makes the needle a “game-changer.” He says he uses the 30 Gauge X Short about 80 percent of the time, most often for PDL injections. Because the needle only has to go into the sulcus, the short cannula is appropriate. He also uses 30 Gauge X Short to deliver any anesthetic to the lower teeth. For mucco-buccal fold injections, which are more tolerable for most patients, he opts for a 30 Gauge Short needle. Dr. Glazer rarely performs an inferior alveolar nerve block, but when he does, he reaches for a 27 Gauge Short. Transcodent also offers the needles in 27 Gauge Long as well as 25 Gauge Short and Long.

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Other tips for patient comfort

Dr. Glazer’s practice isn’t all new, though, and several of his suggestions to ensure patient comfort are less technical. For example, he stresses the importance of delivering anesthetic solution in a slow, deliberate fashion. Injecting a bolus of anesthetic fluid into the tissue, which is already taught around the tooth, stretches the tissue, causes the fibers to stretch, and results in both immediate pain and post-operative inflammation. So, slowing down the injections helps to limit any pain and swelling.

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Additionally, he suggests that dentists err on the side of more delivery points to avoid causing pain to the patient by failing to account for something before the procedure. Some procedures, such as an extraction, call for the use of all six delivery points automatically. He also cautions that patients who feel numb longer are at higher risk of hurting themselves, either accidentally or by testing their numbness. The risk is especially high for children and should be monitored by the dentist. Using Transcodent Painless Steel Needles and following the Ouchless Injection method can limit this particular danger.

By implementing good technique and using the right equipment, dentists can spare patients a great deal of discomfort when delivering dental anesthetics. Dr. Glazer says that while Ouchless Injection is a practice-builder, he doesn’t want to keep the method to himself. He taught his own dentist the method and shares his secret broadly with students. According to the experienced dentist, there’s no excuse for unnecessary numbness now that tools like Transcodent Painless Steel Dental Injection Needles can give patients a much more comfortable experience.

Reference

1. https://en.wikipedia.org/wiki/Gate_control_theory