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I suppose needles are the thing that comes to mind most often when people are thinking about the dentist. With today’s technology, needles are a fact of life in dentistry.

I have already written some about the history and some of the workings of local anesthetic, but today let’s learn a little about some of the less scientific part of dental anesthesia.

It is a fact that technique in delivery of local anesthetic has a lot to do with how much discomfort the patient will experience when an injection is done. You will find that to reduce sensation for the patient, the dentist penetrates the tissue quickly, but delivers the local anesthetic as slowly as possible. This does the most of anything to reduce the discomfort of the injection. What can you do to help? Some injections require maximum opening, some do not, so follow the dentist’s or assistant’s directions on how far open you should be. As well, some injections require only 2mm or less penetration into the tissue, some are much deeper. To maximize anesthetic effect, the anesthetic has to placed as close as possible to the proper location. When a patient moves as the needle is being placed, an injection that requires only 2mm penetration will end up deeper, sometimes much deeper. This will increase the discomfort because the injection is deeper than it needs to be, and reduce the effectiveness of the anesthetic agent because it is not in the optimum location. On an injection that is supposed to be placed quite deep in order to be effective, precise placement is even more important to the effectiveness of the anesthetic than a shallow injection. Movement as the needle is inserted places the anesthetic in a location other than where the dentist is aiming. This reduces and sometimes completely eliminates the anesthetic effect—resulting in the need for another needle and loss of 5-10 minutes as the dental staff wait to see if the anesthetic will work even though it was not placed in the best location. So to increase anesthetic effectiveness and reduce discomfort, be still when the needle is placed.

Another item of importance in reducing patient discomfort when a needle is given is reduction of anxiety. Anxiety reduces what is termed the threshold of pain. What this means is that for a nerve to tell you something hurts, there is a certain amount of tissue damage that will be needed. If a person is really intent on doing something, sometimes they will get a cut or jab themselves somehow and not even notice. Conversely, if a person is sure something will be nasty, just touching the person elicits pain. To a large extent, if a person is sure something will hurt, he is right. The opposite is also usually true. So if you are up tight about going to the dentist, talk it out with the dentist or the dental staff beforehand. You may want a mild sedative. It may help to know more about the procedure as it is progressing—or less about it as you see fit. Take some deep breaths before you go into the treatment area. Don’t look at the needle. Why would someone who is afraid do that? I can’t watch the nurse take my own blood. It just looks scary even though I’ve had it done many times, so I don’t look. Unless a person is going to administer his own anesthetic to himself, there comes the time you will have to give up and trust the dentist to do it right. It reduces anxiety for everyone concerned to give up early.

Control is an integral part of the whole process. These days, most dentists will stop if something hurts and use more anesthetic or otherwise change the procedure so it won’t hurt. If your dentist gives you this option, make sure you use it if there is trouble. If your dentist has not mentioned what to do if what he is doing hurts, you should ask before the procedure starts. Communication is needed for a patient to feel in control, and control means less anxiety which means less discomfort. If you worry about needles, ask your dentist if you have questions about how to reduce your apprehension.

- This article was written by Dr. Mike Christensen and published in the Daily Miner and News, and Enterprise. Local Kenora News Publicatons (1998-2006)

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