One of the biggest fears individuals have about going to the dentist is the experience of receiving a local anesthesia injection. The dreaded “shot”. It’s a serious phobia many can’t quell. Their fears either stem from their own experiences they draw from in their life or from what they hear from friends family or what they may read or watch.
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| Armamentarium for local anesthesia injection |
I myself am not fearful of receiving a local anesthesia injection, I do recall several as a child, but I have winced more at getting a vaccination or other type of injection and more so with a blood draw or from an intravenous indwelling angiocath. Both of them much more uncomfortable than a local anesthesia injection. It’s my belief that individuals have this phobia mostly because of their feeling vulnerable sitting with an open mouth, unable to physically react and frightened that they may move during the procedure.
There is a remedy I recommend to allaying this fear and to make patients comfortable during the experience and realize it can be performed pain free.
It starts first with trust.
HOW TO ADMINISTER A PAINLESS INJECTION OF LOCAL ANESTHESIA:
1. Talk with your patient. Make them feel comfortable with you and allow them to ask questions to build their trust. You do this by being honest and show them empathy when you see they have real fear. Let them know it’s ok to be frightened but that it is not necessary and you want to help support them. Express your goal in the importance of this objective during their treatment.
2. Explain the procedure, tell them that you use agents to make the procedure as comfortable as possible. Use non-threatening terms and phrases.
3. With the use of topical anesthesia the initial pinprick is undetectable. Dry the mucosa with a cotton roll and apply a generous amount of topical benzocaine to the proposed injection site and allow several minutes for it to take effect. Most patients will experience a sensation of warmth and heat at the site. I tell children that it may be warm or a little spicy so they are prepared for what to expect.
4. Once you are ready to administer the local injection, use warmed cartridges from a local anesthesia warmer that heats the anesthetic to a temperature close to body temperature. Thus making the injection undetectable. Be sure to administer the local before it cools to room temperature. Therefore once the syringe is loaded administer the anesthetic without delay.
5. Right before administering, shake the patients upper or lower lip and squeeze it ever so slightly. This idea works off the Gate Theory of pain, as we all know when we hit our funny bone or hurt an area the first thing we do is rub it or press it. This is the same idea, as it becomes a distraction where the patients will miss the initial needle bevel penetration.
6. Once the mucosa has been penetrated and the bevel is covered and just under the mucosa inject a small drop and wait a several seconds and then aspirate the syringe. Continue slowly with aspirating and injecting a drop, just enough until you have reached the desired depth of administration.
7. Once at the site of administration, do so slowly and methodically. A slow injection makes a world of difference. During this process, speak with your patient to distract them.
8. If after speaking with your patient, it’s obvious they may need additional help to calm themselves down and allow them to cooperate, I offer nitrous oxide analgesia. As it is an analgesic which will also limit the perception of the initial mucosal penetration. A perfect adjunct for many patients. Nitrous oxide is an agent that providers need special training to administer and should only be used by professionals trained in its use. It should be administered with caution with the elderly and the very young. It should also avoided in those with certain dietary deficiencies like B12.
HOW TO ADMINISTER A PAINLESS INJECTION OF LOCAL ANESTHESIA FOR CHILDREN:
1 . It’s important to use all the same techniques with children and to be honest by using non-threatening language. Many kids will ask me “Am I going to get a shot?” My answer. ”No we don’t shoot people here, you know that’s not nice” Another way I may answer them is by saying ” We are going to put the area to sleep” or “It will feel fat and fuzzy, just like when your arm or leg falls asleep” Using a comparison like this is honest without the need for them to know exactly what we are doing. Most people don’t like the feeling of when an extremity is “asleep” but it isn’t typically painful. Some kids that press me about a “needle” I will explain” it’s local anesthesia”. I never use the word “needle” or “shot”.
2. Explain what you expect of them and explain how they are to behave in order for this all to be perfect. Also, let them feel like they have some control over what is to happen. Let them know that they can stop you if they need to take a break. Tell them that they are to remain still in the chair with their chins up and their mouth open wide and arms and hands at your sides please. In some cases we use a rubber bite-block to protect the patient from closing their mouth. As a right handed provider I instruct them to raise their left hand if they need me to stop. I also give them a dry run to show me how they will do this if it seems they need to know. Giving them the thought that they have the ability to control the procedure does gain trust at that moment. That’s a win-win.
3. Keeping all the instrumentation covered and out of view doesn’t allow them to see the instrumentation. This is very important. In addition, my assistant hands me the syringe out of the patients eyeshot, behind the patients head. My hands, arms and body block their field of view from my the syringe. In addition I start to speak to them about something unrelated or something we may have discussed before so as to keep their mind off of what is to come.
4. My well trained dental assistants are prepared for all patients to lift their hands or to move and often times comfort the patient with a warm touch or holds their hands and also speak to them as to distract them. My assistant knows that they have a time to speak with the patient as we don’t compete for their attention.
5. The lip shake is the final distraction that precedes mucosal penetration by the bevel. During this we praise the patient for their cooperative behavior by describing their good behavior and what they are doing correctly. In addition I explain that we are almost done and for them to “continue to do a great job”. Offering praise is important as it boosts positive behavior.
My experience as a patient or as an observer when the provider penetrates unanesthetized mucosa and drives the needle to the injection site quickly, without anesthetizing the path of the injection is an uncomfortable experience. This is unnecessary and imprints an unfavorable experience and memory.
My patients often times compliment me on my local anesthesia administration technique and expertise. Using the proper armamentarium is necessary. Your patients will appreciate the fact that you care enough to take your time and to keep them comfortable. It only adds a few minutes to your procedure but it adds so much more to the Doctor-Patient relationship, your reputation and patients future perception. It’s also a practice builder, one that many dentists should add to their “doctor-bag”.
Equipment/Armamentarium: Local Anesthetic Cartridge Warmer
Smallest Gauge Needle, 30G vs 27G vs 25G
Bib to cover instrumentation on the dental tray
Benzocaine topical, flavored
Cotton Rolls
Self-Aspirating Dental Syringe
Local Anesthesia Cartridges of your choice
The Girldoc😉
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