“Painless Dentistry” has been sought after for centuries but is elusive. I have gotten one step closer with the development of my eight-step injection technique. This technique is not absolute but, when perfected over years, leads to the best dental injections most people have ever had.
I Hate having Dental Shots Myself
I hate having dental injections, as most people do. My whole life they were painful.Once, while in dental school, a dentist hurt me so badly I made a vow to never treat a patient like that. At that moment, I began a quest to learn more comfortable ways to carry out dentistry .
This blog is on one of those ways. I consider it the most important because, for most patients, the shot is the most painful and least liked parts of dentistry.
8 Steps to Comfortable Dental Shots
These are all the steps that must be followed to deliver a comfortable injection.
- You must have a Gentle Heart
- The goal is for the patient to Feel Nothing
- Numbing Jelly must be used
- Use Warm Anesthetic
- Use Neutral pH Anesthetic
- Slow, slow, slow Injection
- Watch for Any Movement
- Get a Verbal Response from the patient
- I want to hear after every injection, “Doc, that was the best shot I have ever had.”
#1 A Gentle Heart and Patience
In order to give a comfortable injection, you must have a gentle heart that does not want to hurt people. This technique has many steps. It takes a lot of patience and precise focused attention. You have to want to do it on every injection; over and over, hundreds of times, day after day, year after year.
#2 The Goal is that You Feel Nothing
My goal for every injection is for you to feel nothing. Can I realistically do this 100% of the time? No. But my fall back goal is that the patient says “I felt something. I knew you were doing something but there was no pain.” I want every patient to say, “That was the best shot I have ever had.” After an injection, my patients consistently say, “Thanks, Doc. That is why I have been coming to you for so many years.”
If dentists were asked in a survey, “Is it possible to give a shot and the patient feel nothing?”, many would say “No.” I have heard the dentist say, “Shots hurt. That’s just the way it is.” If you do not believe it is possible, you will never find a way to do it.
#3 Numbing Jelly
I place a high quality, strong numbing jelly on the gums for 30 to 60 seconds. This numbs the gums to decrease the feel of the initial needle stick.
#4 Warm Local Anesthetic
The local anesthetic must be warmed to body temperature. Most injected local anesthetic is at room temperature, about 70 degrees. The body is at 98.6, about 100 degrees. That is nearly a 30-degree difference. Our bodies can detect temperature differences of less than half a degree. When the local anesthetic is 30 degrees colder enters the body, the sudden cold sensation is registered as pain. It subsides only after once the local anesthetic becomes body temperature. If you dip your finger in warm water, you feel nothing. Likewise, if the local anesthetic is body temperature you feel nothing. I have specially designed warmers that heat all my local anesthetics to body temperature.
#5 Neutral pH Anesthetic
Most local anesthetic is more acidic than our body’s natural pH level, which is very close to neutral. Because of this, we feel a burning sensation as it is injected. This burning sensation is registered as pain. It takes 30 to 60 seconds for the anesthetic to become neutralized by the body.
Combine the cold and burning sensations and the injection is doubly painful. I begin my injections with a special neutral pH anesthetic so there is no burning sensation. It is more expensive than the most widely used anesthetic but so much more comfortable for the patient.
#6 Slow Slow Slow Injection
The slower the injection is given, the more comfortable it is. Injecting fast expands the tissue quickly, causing pressure. Pressure is registered as pain.
I inject one drop of anesthetic and pause. That one drop placed where the numbing jelly starts to move into the tissue, numbing ahead as I pause a few seconds. My goal is to always be injecting into tissue that is already numb.
Remember the way your face gets real numb over several minutes after an injection? That is because the anesthetic is moving into the tissue slowly. Visualize a drop of food coloring into a bowl of water. I inject a few drops and pause. Then, another few drops and pause. The technique for doing this very slowly, one drop at a time is not an easy technique to perfect. It takes a gentle, steady hand with deep focus and a lot of practice.
Doing the injection this way takes me ten times longer than an average dentist. Yes, time is money but my vow to not hurt people overrides.
#7 Watch the Patient for any Flinch of Movement
I watch very carefully for any movement the patient might make during the injection. Just the flick of an eye or twitch of a finger could mean that the patient is feeling something. If I see anything, I pause.
#8 Get a Verbal Response From the Patient
I do not know what the patient is feeling. But I need to know every second if they are feeling anything in order to do the injection comfortably. I say to the patient “Give me an ’Uh huh’ if you start to feel anything”. This plugs me directly into what the patient is feeling every second of the injection. If the patient says “Uh huh”, I pause for 5 to 10 seconds, letting the anesthetic work ahead of me, always listening to the patient. This way, we are working together.This verbal response is very important and gives the patient a sense of control. They know if they say “Uh huh”, I will stop.
Following these eight steps, giving a comfortable injection is possible. Is this technique perfect? No. As I said previously, this technique has many steps, takes a lot of patience and a lot of precise, focused attention. You have to want to do it on every injection, over and over, hundreds of times, day after day, year after year.
Some patients have been so traumatized in the dental office that some form of sedation is necessary for them to be happy. I have been sedating high fear dental patients for over 30 years but with this eight-step injection technique, I have to sedate fewer patients. Come see for yourself.
Thomas N. Pezdek, DDS PA
412-D East Williams St.
Apex, NC 27502
Mon - Thu: 7:30 AM - 4:30 PM