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THE NEXTDDS Student Ambassador Blogs

Painless Dental Appointments

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A whooping 15% of Americans fear going to the dentist. It doesn’t help that one of the major factors instilling dental phobia in our patient pool is the dreaded dental injection. Our needles are long, shiny, and above all, pointy. As dental students we rely on local anesthesia to ease our patient’s feeling of discomfort in just about every procedure – from simple restorations, to aesthetic veneer preps, to tooth extractions. 



Listed below are several injections that all dental students should have in their toolkits along with a few tips on reducing anxiety and pain in your patients pre-injection and during the injection.



Greater Palatine Nerve Block  

Needle: 27 short

AnatomicLandmarks: Greater palatine foramen

Technique: Locate the greater palatine foramen – located around the maxillary 2M/3M. Use the blunted end of a mirror and place pressure on the tissues adjacent to area of needle injection.

Why? The greater palatine nerve block anesthetizes the palatal soft tissues distal to the canine.

Maxillary Infiltration  

Needle:  27 short

Anatomic Landmarks: Roots of teeth, mucobuccal fold

Technique: Aim the needle at a 45-degree angle at the mucobuccal fold of the maxillary teeth that are going to be anesthetized. Make sure the needle hits bone. This will prevent the mucosa from swelling too much from delivery of the local anesthesia.

Why? The maxillary infiltration anesthetizes the pulp and mucoperiosteum of the selected tooth.



Inferior Alveolar Nerve Block  

Needle: 27 long

Anatomic Landmarks: Coronoid notch, pteygomandibular raphe

Technique: With your thumb, feel for the coronoid notch. Then aim the needle along the occlusal plane lateral to the pteygomandibular raphe from the contralateral PMs. Your needle should penetrate 20-25mm before hitting bone. If the needle hits bone too soon, pull out slightly and redirect the needle slightly more medially.

Why? The IABN anesthetizes mandibular teeth up to the midline, anterior 2/3 of the tongue, buccal mucosa anterior to mental foramen, and lingual soft tissues.



Apply topical anesthetic. This will reduce the twinge of needle penetration. For the “numbing jelly” to work more effectively, dry the mucosa prior to application to allow better absorption.

Stretch the mucosa or tissue to ensure tautness, ensuring comfort as the needle moves further into the soft tissues. 

Apply a vibrating motion or pressure with the back of a mirror to the periphery of the site of injection to distract your patient from the needle movement.


During the Injection  

Slow and steady delivery of anesthesia will reduce post-op soreness of tissues.



Good Luck!