This article is intended to be a brief summary of the “classic” methods to reduce discomfort during the use of local anesthesia. Many of the main problems faced daily by the dentist are in fact also found in the procedures of skin infiltration or related to other medical specialties.
The preventive strategies of common interest will then be listed, some of which have already been discussed in detail on these pages.
- Topical anesthesia: before proceeding with the injection technique, it may be useful to use topical anesthetic in order to desensitize the most superficial nociceptors of the mucosa. In Italy spray formulas are the most widespread, while in other countries (i.e. in the United States) gels are the most common ones. As for sprays, cryoanesthesia with the same product commonly used for vitality test is also mentioned, but this is not a real anesthesia procedure. * link articolo anestesia topica
- Buffering: the action of local anesthetics – like that of all drugs – heavily depends on the drug’s pH. It should be noted that dentistry differs from other medical disciplines, since the anesthetic used in dentistry is in a 1.8 ml cartridge. . The anesthetic solution has an acid pH (4.5) (NOT ACCURATE). A buffered solution would reduce the pungent sensation felt by the patient due to the acidity of the anesthetic drug. It would also accelerate the pharmacokinetics of the anesthetic molecule, shifting the balance towards a non-ionized, more liposoluble form.What can reduce pain from dental anesthesia : (For a more complete treatment, please refer to the article *link).
- Heating: the manufacturers expressly indicate to keep the cartridge of the local anesthetic away from any source of light and at a temperature not exceeding 25°C. There are some indications that the use of solutions heated at a temperature between 37°C and 42°C before use would lead to a reduction in the painful symptoms during the injection. You can find out more about this theme *link.
- Needle type: thin needles (27 or 30 Gauge) are commonly used in dentistry, and that is a positive aspect. The use of a smaller gauge needle allows a larger area below the surface to be covered with a single injection than with a larger gauge needle.
- Speed and volume: it is better to control the pressure by slowly injecting (at an ideal speed of 1 cartridge/min) the anesthetic solution, and giving the minimum volume necessary to achieve the desired effect.
- Nerve block anesthesia: an underestimated aspect in the dental field which legitimately may find limiting some clinical aspects of the common inferior alveolar block, is the advantage that comes from being able to reach a precise anatomical area through a single dosing at the site of the nerve trunk. In this sense, it should be remembered that there are techniques with higher success rates, such as the Gow-Gates method.