There’s no question that for many patients (and dentists) one of the most dreaded parts about dental visits is injections. Patients’ fear of pain is what keeps many of them from completing dental work; the mere sight of a needle can trip the panic button.

So your skills in deftly handling the needle (i.e., keeping it out of sight as much as possible) and giving a painless injection will rank you high on your patients’ referral list. Yes, it may be but one small part of the patient experience, but your skills are paramount in this area.

So let’s assume your patient is in the chair, lying back comfortably, watching a show or listening to music with headphones and an N2O mask on.

Now, gently slip in some topical onto the injection site (we always use mint flavor for adults) and cover it with gauze or a cotton role to prevent it from leaking and anesthetizing the entire mouth and throat. After five minutes, remove the topical and begin the injection. If you have an electronic delivery system, by all means use it. If not, this slow injection technique uses the same concept—and I emphasize: slow is key.

First, be sure that the assistant passes the syringe to you behind the patient; in fact, always try to hold the syringe out of sight from your patients.

Then gently touch the patient’s cheek and softly isolate the area to be injected. I never tell the patients what I’m about to do; knowing that a painful incident may happen is sure to heighten their pain response. So be slow and gentle. Since our patients are usually under N20 and preoccupied with a TV or radio show, they never know I’ve even injected them; they are totally distracted.

We use infiltration on all maxillary and mandibular teeth from the 2nd premolar forward. This is the injection patients often say they never feel. Gently insert your smallest and thinnest needle slightly under the tissue and give one to two seconds of anesthesia very slowly. Then remove the needle and wait two minutes. The anesthesia will spread and you’ll be able to go a little deeper with your next injection.

During the second injection, continue to administer the anesthetic very slowly; and at the same time slowly push the needle toward the apex of the tooth you’re working on. We use a full carpule so that the adjacent teeth are also slightly anesthetized. (Our standard carpule is lidocaine with 1:100,000 epinephrine.) If you are working on other teeth in this area, simply use the leading edge of the anesthetized tissue and work your way forward or backward.

For maxillary and mandibulary blocks, place the topical on the injection site for five minutes, then slowly insert your needle and administer one to two seconds of a pre-injection to start the process. Wait for two minutes, then slowly reinsert more anesthetic and gently move closer toward your target. Again, it’s important to proceed slowly. The extra five minutes you take for this slow injection technique will pay for itself in the many compliments and referrals you receive from happy patients.