Professor of Oral Surgery, King's College London; Honorary Consultant in Oral Surgery, King's College Hospital NHS Foundation Trust and Guy's and St Thomas' NHS Foundation Trust, London
A feared aspect of dental care for patients is their expectation of pain and injections. Local anaesthesia in dentistry is an important means of reducing procedural pain and increasing patient comfort during treatment. However, it can be a source of pain in itself. Fear of needles and painful injections is a significant contributing factor to dental anxiety and is a commonly reported concern among patients. This review aims to discuss modes by which the painless and effective injection can be achieved, exploring the causative factors of discomfort and how they can be modulated. Although a wide array of techniques and technologies exist within the field of local anaesthesia (which are outlined in this paper), there is no definitive method for delivering the perfect injection for each and every patient. By being more mindful of current research and understanding with regards to local anaesthesia, however, clinicians may become more confident in their ability to provide a more atraumatic experience.
CPD/Clinical Relevance: The aim of this review is to make clinicians aware of evidence-based suggestions for reducing the discomfort associated with delivering conventional local anaesthesia in routine dental practice, as well as to inform clinicians about alternative modes of administration of local anaesthesia which may serve as adjuncts in the management of anxious patients.
Article
It is no secret that a visit to the dentist is perceived within society as being an unpleasant or daunting experience and dental phobia is somewhat commonplace. Pain, insufficient anaesthesia, the sensation of injections and seeing needles are among some of the most common anxiety-provoking stimuli and source of complaint in the dental setting,1 and are, in part, responsible for creating this negative image of the profession.
There is evidence to show that people with higher levels of anxiety are more likely to attend the dentist irregularly2 and also are more likely to have poorer oral health.3 One study showed that more than 1 in 4 adults had some fear of dental injections, with 5% of those surveyed admitting to avoiding treatment due to this.4 Furthermore, fear of injection poses a potential clinical hazard which is not often considered. A survey of medical emergencies in North America showed that more than half of emergencies which occurred within the dental setting were vasovagal syncope associated with the administration of local anaesthetic.5
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