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My painless injection
technique
Apologize profusely in advance I dont know whether its help full but Il
get amaring result by these technique. Although we all learned about
painless injection technique at college, there are some special tips from
my side to make patient smile during injection at dental office.
Thanx in advance
Dr piyali patel
Introduction
I noticed someone mentioning on the forum that they hate hurting people so I decided to
share how I do local anesthesia. Maybe that would help someone here. I can't promise that
patients won't feel a thing (although it does happen often). At least, it will be a pinch or
pressure.
It goes without saying that pain is one of the biggest barriers to dental care. Because of
painful experiences in dental chair, everybody suffers.
General principles
First, you must develop a gentle touch. "Doctor should have the wisdom of a serpent and
touch of a girl". Avicenna, afaik. The mouth is the most sensitive part of our body
(remember sensory homunculus?), so it's even more important in dentistry.
This is how I practiced gentle touch. The hands should feel weightless for the patient. If
someone puts an arm on your shoulder with all its weight, it's unpleasant. It's even more
painful when that weight is placed on the needle. Exercise: touch your left hand with the
right middle finger, so that you barely feel the touch, like a feather. That's how it should feel
to the patient. Now, notice which muscles in your shoulder and arm are working. You
should feel those muscles contracted when treating a patient.
When injecting someone for the first time, I never tell the patient, esp. a child, that they
won't feel anything. It's not true and breaks the trust right out of the gate. They still feel a
pinch and they will feel pressure/cold/movement during extraction.
Instead, I say, "You will feel a pinch, like this (and pinch the skin on their hand lightly with
my fingernails). Can you cope with that?". Usually they will say yes.
Inject slowly, about 1 minute per carpule. It decreases the pain from rapidly expanding the
tissue with 1.7 ml of liquid. Usually pain is from rapid expansion of tissue, not from the
needle itself. Stick yourself in the mucobuccal fold with a needle, you'll feel it. Plus, AFAIK,
slow injections are more profound.
Rapid injection doesn't save time. We get 20-30 seconds more, but the patient is tense,
less trusting, and more likely to cancel later because of fear. So, I think, spending 40
seconds more per injection is a good time investment if patients are happier. It doesnt
hurt, Mom! is pretty good free advertising :)
Insert the needle slowly, pushing anesthetic in front of the needle, (it pushes tissue away
from the needle).
Then, always wait for at least 5 minutes. I have a timer set in my watch, so I do something
during those 5 minutes until it beeps. I run the water through the high speed (if it's the first
patient of the day), show them a video with post-extraction instructions, etc.
If the patient isn't numb after 5 minutes, I'd add intraseptal on mesial and distal with 4%
septocaine 1:100K epi. Inject right into the papilla at 45 degree angle, stick the needle in
the bone. Inject, until the tissue becomes white.
For the mandibular block, if the initial injection was with lidocaine, you can also add IAN
block with mepivacaine. Endo trick.
If I find out that the patient is very afraid/sensitive, I use septocaine instead of lidocaine for
infiltration. I warn them that they can be numb for several hours later and it's OK.
Needles
Always use a triple bevel needle at first. Stick yourself to find the least painful one. That
will also give you a right to say that it won't hurt much.
The first injection is always with a X-short 30G needle. I use Shotgum from SAFCO: triple
bevelled and cheap. And yes, I stuck myself with them to know what my patients feel.
Since it's only 10 mm long, it doesn't look as scary as a 2 inch-long 27G needle.
The second injection may be with 27G for mandibular blocks
them to try to do as you say the second time. I always tell them "It should be deeper (or
faster). The faster and deeper you inhale, the less you feel."
Ask the patient if they felt the injection. That gives you feedback in every case so you can
improve. Just pay attention to it as you do it. To the patient, it shows that you care.
Conclusion
All of these things decrease the pain from injection. Thus, if something fails (say, the
patient doesn't inhale as well as you want), it'll still hurt less.