Making Shots better
The most common thing that most dental procedures have in common is the shot. The shot is probably the most dreaded part of the entire procedures for most of my patients; however, I would bet that most of my patients do not want to go without getting numb. I understand this fear: it is a fairly large sized needle that is coming towards your face. Also combined with that many people have had bad experiences with shots, the fear of the pain is of a shot is usually worse than the shot itself. I do find it funny when people tell me that they are afraid of needles. I think it would be strange if someone was really happy to see a needle. Still though it is a necessary part of most dental treatment, and I spend a lot of time trying to make it as best as possible. My first three years of dentistry were spent learning to give shots to kids and have them not notice it, and I incorporate those tricks into my daily practice. The ways that I find help make dental anesthetic better are through mental preparation right before the shot, physical actions that are done during the shot, and last but not least, medications that I use to make it a better experience.
Unfortunately, the fear of pain is often worse than the pain itself, and I find that it is more often just the fear of the unknown amount of pain. People would rather have a medium pain at a certain point than a smaller pain at an unknown time. What I find works the best for most of my patients is that I start out by recommending deep nasal breathing as that helps calm the mind. The second thing I recommend is that patients close their eyes before the shot with the promise that I will tell them right before I give it, and I think that this works for two reasons. First I find that not seeing the needle actually makes it better as the needle always looks much bigger than what it is. The other reason I recommend closing the eyes is because when the needle goes out of view the fear of the shot starts to set in even more, and by allowing me to tell the patient when the shot will happen, it is easier to predict. The final recommendation is something to squeeze in the hand as that helps distract from it.
On my end, the actions that I and my assistant take are most distraction combined with trying to tell what is going on the entire time. The most useful distraction that I can do as the dentist is actually shaking of the lips or area where the shot is given. This not only distracts from the injection, but also helps stimulate the pressure nerves instead of the pain nerves. The nerves that transmit the pressure signal are much larger than the nerves that transmit the pain signal, and when both the nerves are stimulated at the same time, then the bigger nerve (i.e. the pressure nerve) sends the signal, but the pain nerve does not. My assistant’s biggest job is usually hand holding which helps because it is sometimes comforting to have someone holding hands. Also the assistant will usually help suction simultaneously as the shot is given as that helps keep the bad taste away from the tongue plus it helps add more pressure to the area to decrease the pain nerve flow. Finally, I find that giving play by play action of what is going on helps out as it helps my patients know what is going on as well as predict when something is going hurt. Being able to know when something painful is about to happen allows the body and mind to compensate for it and makes the action less painful.
Finally, last but not least, I use a couple different types of medicines to make dental anesthetic better. The first and most common one is a dental topical jelly. The topical jelly is similar to Orajel, but it is significantly stronger. While it won’t affect the deeper injections, it can take the initial sting of the injection down quite a bit. The second most common medication I use is laughing gas or nitrous oxide mixed with oxygen. This combination not only helps the dental anesthetic work better, but also can dull the pain quite significantly. For example, if I place a 4 year on laughing gas, I can easily give 4 shots and have zero tears. The third medication that I use is different strengths of dental anesthetics. As a rule of thumb, weaker anesthetics are typically less painful, and I find that by giving a weaker anesthetic first and following it with a stronger anesthetic, that the sting from the stronger anesthetic is not felt. Finally, the last medication that I give is ibuprofen right before the appointment. Ibuprofen helps block some of the pain receptors that the dental anesthetic cannot, but also helps control swelling and soreness after the procedure. Taking 600 mg of ibuprofen before a dental procedure can certainly make things better, and for most of my patients, it is a safe medication. The only times that I do not give it before the appointment is if the patient’s physician tells the patient that they cannot have NSAIDs.
I understand the fear of the shot and dental anesthetic; however, by using anesthesia, I can keep my patients comfortable even during invasive procedures. I work hard to give the best and least painful shot possible. While the techniques outlined here are not a silver bullet and do not work perfectly for every single patient every single time, I can promise that they do make it better. I want all my patients having the best experience possible no matter what work is being done. If getting a shot worries you quite a bit, please give my office a call at 504-383-9280, and I and my team will help you out.