Painless Injections

“Dental injections become painless in Chester County”

Local dentist, Michael D. Matthias, surveyed dental specialists in Chester County in the fall of 2002 in order to improve injection techniques of the local dental community. The specialists were asked to share their secrets to a painless delivery of local anesthetics. All information was compiled and posted on www.yourdentistytoday.com and is available to dentists and the general public. “There is always room for improvement, and I’ve picked up some tips which can help my patients” remarked Dr. Matthias. “Patients are more likely to get the dental care they need if they know it will be comfortable” he added. People can down-load the results of the survey off the website sited above or call Dr. Matthias’ office for a copy.

To the Dental Community,

This survey was a result of the efforts of Dr. Steven Atlas, D.M.D., Dr. Thomas Brady, D.M.D., Dr. Peter Famiglio, D.M.D., Dr. Craig Hurtt, D.M.D., Dr. Samuel Kratchman, D.M.D., Dr. Brian Kunz, D.M.D., Dr. Joseph Leonetti, D.M.D., Dr. Carl Luchetti, D.M.D., Dr. Louis Manna, D.D.S., Dr. John Pardini, D.M.D., Dr. Louis Rubino, D.M.D., Dr. Matthew Swiatek, D.M.D. and Dr. Neil Weiss, D.M.D. I hope you can pick up a tip or two on how to improve your technique. If you have any special concerns or comments, please call me at 610-701-0102.

To the General Public,

Thank you for your interest. Feel free to download this information. You can even share it with your dentist. I would like to acknowledge the following: Dr. Steven Atlas, D.M.D., Dr. Thomas Brady, D.M.D., Dr. Peter Famiglio, D.M.D., Dr. Craig Hurtt, D.M.D., Dr. Samuel Kratchman, D.M.D., Dr. Brian Kunz, D.M.D., Dr. Joseph Leonetti, D.M.D., Dr. Carl Luchetti, D.M.D., Dr. Louis Manna, D.D.S., Dr. John Pardini, D.M.D., Dr. Louis Rubino, D.M.D., Dr. Matthew Swiatek, D.M.D. and Dr. Neil Weiss, D.M.D.

Michael D. Matthias, D.M.D.

“Technique to approach painless injections”

What brand or type of local anesthetic do you use and why? (i.e. Citanest forte)

-2% lidocaine 1:100,000 epi -3% mepivacaine HCL -0.5% marcaine 1:200,000 epi -Septocaine 4% (seems to work faster and longer) -Articaine (by septicaine) -Xylocaine (Dentsply) -avoid generic anesthetics

Do you use anything additional such as topical or EMLA?

-Topical -EMLA cream (about thirty minutes prior) -Dentipatch for palatal injections -Topical-Cetacaine (liquid) (14% Benzocaine) -All perio-maintenance patients are topically anesthetized

Any special injection techniques?

-Apply pressure to injection site -Massage cheek (wiggle) -Inject slowly -Infiltrate around tooth -For palatal injections, give deep bucal injection first. Then wait five minutes to give the palatal. -Lots of 30 guage needles and TLC. -Do not use septicaine for mandibular blocks due to parastesia risk. -Stretch tissue -Use perio injections after block has taken effect. -Stabident intraossious system -Allow adequate time for topical

Do you use any special phrases?

-Let them know that you are confident that they will do fine. -With kids: We explane that we can complete work without discomfort. We show them topical and even let them smell it to ease fear. After it is applied, we tell the kids that we are going to “scratch” the cheek so the medicine can work better. -Tell kids their teeth are going to get sleepy juice. -Procedures that require multiple injections: I often say a very small amount of anesthetic will be injected into several places. -For kids: compare to mosquito bite at worst. -Let patient know you will be as gental as possible! -Tell patient to breath through his/her nose. -Involve patient (child) in the tx decision: “Can you be a good helper for me?” The need to please is very strong. -pinch

Are there any words or phrases to avoid?

-Treat adults like adults and children like children. Don’t try to verbalize how this will not be anything bad. -Avoid the words: “injections, needles, shots, pain, hurt” -Brace yourself. -Electric shocks, sticks, don’t worry, this won’t hurt. -”OK?” after each phrase. (children use this as the oppertunity to reject tx, and Dr. doesn’t usually realize that he/she is doing this.) -Words that involve images of sharp pain

Any additional thoughts?

-Keep talking to patient to get their mind off of what is going on. -Keep the syringe out of site or have patient close their eyes. -Try to reassure patients as best as you can. -Try to discuss school or hobby before difficult procedures to develope truste.

Explain each part of the procedure as you are doing it.

Even little things such as “This is a cotton roll”.

-Have patient brush first, then rinse out with flavored mouthwash (minor stimulation / desensitization), then topical, allowing time for patient to relax and also conditions them to respond to your instructions. Finally, give injection. Same idea when taking impressions on patien with stron gag reflex. -Being comfortable and confident with your technique and using distraction techniques with a slow careful injections goes a long way to allaying patient discomfort during injections.

-Patients should be given informed consent initially as to risks of anesthesia

Survey completed by _________________________________ (your name)

Dr. Steven Atlas, D.M.D. Dr. Thomas Brady, D.M.D. Dr. Peter Famiglio, D.M.D. Dr. Craig Hurtt D.M.D. Dr. Samuel Kratchman, D.M.D. Dr. Brian Kunz, D.M.D. Dr. Joseph Leonetti, D.M.D. Dr. Carl Luchetti, D.M.D. Dr. Louis Manna, D.D.S. Dr. John Pardini, D.M.D. Dr. Louis Rubino, D.M.D. Dr. Matthew Swiatek, D.M.D. Dr. Neil Weiss, D.M.D.