The Patient and Local Anaesthesia

By Mr Stephen Davies & Daniel Watson

The delivery of Local Anaesthetic (LA) have totally different meanings for the patient and the dental operator. These two approaches to the same procedure can have very harsh affects as they can be at odds with each other.

To the clinician the administration of an LA injection is the first hurdle to jump over so that the actual procedure can get underway; whether that be restorations, root surface debridements, extractions, surgicals or implants. This means that occasionally the patient’s feelings towards this initial step is over looked and the LA is delivered very quick and it can be a traumatic event for the individual.

To the patient the administration of an LA injection is the only thing they are worried about, as it is the only thing they feel and this can be painful and traumatic if done incorrectly. Once the patient is numb, for them, the treatment is over; as any further treatment is pain free and usually comfortably tolerated.

So making LA injections as pain free as possible will make the patient experience so much better for them and they will love you for it. Here are 3 tips to aid in pain free LA:

  1. Where possible use topical. Yes it takes an extra 2 minutes and it can only anaesthetise 2-3mm deep but it will help and it will have a psychological benefit.
  1. Take your time to deliver the volume of LA. The mucosal spaces where the LA is being injected are small and have to expand. Slow delivery allows the physiological processes to adapt and desensitize the pain signal due to rapid expansion from volume and pressure.
  1. Mucosa to needle not needle to mucosa. For infiltration injection place the tip of the needle close to the site of injection on the mucosa, and then bring the lip over and onto the tip of the needle rather than taking the needle to the mucosa. The altered stimulation from moving the lip confuses the pain signal at the afferent ganglion (pain gate theory) and this reduces or totally eliminates the pain of the injection.

The link below shows a demonstration of the above clinical tips courtesy of Whitechapel Dental and Dr Dominic Hurst:

In summary, the irony is that the most important part of the procedure to the patient can be the least important part to the dentist, because once it has gone numb the patient can relax whereas for the dentist the job begins”

Give the LA injection due diligence and take you time. This is a huge element in the perception of the patient and our care is patient focused. The injection is usually all that the patient remembers. Inject into others as you would be injected into you.


Posted by

Daniel Watson

4th Year BDS