Pain control is the best practice builder for a dentist.
Patients love the dentist who is skilled at providing comfortable injections and achieving profound anesthesia. You can and must develop your skills in this arena. The following are some mentoring tips to help you.
Begin with drying the tissue with a cotton role and placing topical anesthetic. The key is to allow the topical to remain in contact with the tissue for 2 minutes. Pull the tissue taught and inject over 1 minute. Slow and steady.
Needle Gauge
Studies have shown there is no difference in pain perception with needle diameter. I preferred to use a 25 gauge long for IANBs and PSAs. Always aspirate. I preferred the 27 gauge short for maxillary infiltrations.
Key Mentoring Tip
Each time you perform an IANB injection it is important to also block the long buccal nerve. Enter middle to distal buccal of the 2nd mandibular molar and penetrate 2-3mm and deposit ¼ carpule then angle the needle 45 degrees and penetrate an additional 3 mm depositing another ¼carpule to pick up the accessory fibers of the facial nerve. It’s these fibers that often cause the patient to feel discomfort even when knocking out the IAN. This is the technique I used for all my IA blocks. I performed most of the oral surgery that walked through my doors and this works well. Familiarize yourself and become proficient at being able to perform an effective Gow Gates injection. Alway aspirate when performing IAs , PSA’s, and Gow Gates.
Always be sure to check for barbs at the needle tip !
Septocaine [ Articaine HCL and Epinephrine 1:100,000 ]
This is the go to anesthetic for Infiltrations. Onset is rapid and anesthesia is profound.
I would NOT use Articaine HCL for IANB’s due to the reported higher incidence of nerve paresthesias. In my opinion, it’s simply not worth the risk! Stay away from the mental nerve foramen as well. Create a permanent paresthesia on a patient who came in for a routine filling and you open yourself up for a lawsuit. The word will spread quickly ! It’s just not worth it.
Lidocaine 1:100,000 Epinephrine
This is my go to for the IANB’s and to anesthetize the mental nerve. Use my technique above and you will consistently get patients numb.
Palatal nerve!
When a patient is still experiencing pain on a first molar following buccal infiltration, deposit a few drops into the palatal nerve and that will do the trick. Use a cotton swab to apply pressure first and slide the needle next to the tip. Warn the patient that it will hurt!
Intraosseous Injections
Two systems : Stabident and X tip . These can be difficult for some doctors. They work ,however you will need to hit the hole created in the buccal bone so as to deposit into the medullary or cancellous bone. Stay distal to the tooth you want to numb.
PDL Injections
A 25- 27 gauge short needle works well . You should feel back pressure . Deposit slow. Let the patient know that it WILL hurt. 80% of patients will have post op discomfort so have them take non- steroidal anti inflammatory meds like Advill or tylenol as soon as they get home.
IntraPulpal Injection
When performing endo, access the pulp . Place a 25 ga. short needle into the canal until you feel back pressure and deposit ¼ carpule.
Remember: Inform Before You Perform
You should have an informed consent that addresses the potential for complications from local anesthetic . Manage patient expectations. Better to do it before, rather than after , or the patient sees it as an excuse. My advice is to practice defensively and communicate with your patients! It will keep you out of trouble.
Conclusion
Patients gain confidence in the dentist who is able to provide them with profound anesthesia during a procedure. It is the BEST practice builder. Be sure to call patients in the evening after a difficult procedure. I did this my entire career. They really appreciate it and it will set you apart from your competition. Let them know you will be calling or they may not answer as people screen calls today more than ever . I hope this helps you become a better dentist!