Like any dentist with 43 years of experience, Dr. Howard S. Glazer has updated his practice with new techniques and technologies. Of course, the reason to make changes in a practice is never just to stay current, but to enhance care. Dr. Glazer has developed a set of criteria to determine whether to alter his technique or adopt new tools: any change must be faster, easier, better for the dentist, and better for the patient.
To spare patients the negative effects of old-school anesthetic practices, like hours of numbness on one side of their face, hours of what Dr. Glazer calls “fat face,” and drooling, he applied this checklist to design an “Ouchless Injection” method. To do this, he carefully considered the three factors that affect each patient’s level of comfort: their expectations, anesthetic equipment, and dentist technique.
Dentists like Dr. Glazer who can design methods to optimize for all three of these elements will provide the most comfortable care possible for their patients and, as a result, likely build their practice.
1. Patient Expectations
Patients expect different experiences from a visit to the dentist—a minty taste in their mouth, maybe a sticker on the way out—but when a needle is involved, those expectations tend to be negative. Expectations, or fear, of pain and numbness from dental anesthetic injections are shared by adult and child patients alike. Increasing patient comfort during these injections begins with addressing these expectations. Dentists cannot rely on words. When told not to bite a numb lip, patients tend to do exactly that.
For this reason, the first step in the “Ouchless Injection” method centers around patient psychology. Dr. Glazer uses a syringe-administered topical anesthetic before needle injection, primarily because patients expect it. This enables him to put patients at ease before moving to steps that involve newer technologies. He then takes advantage of the gate control theory of pain. Essentially, the theory posits that nerves can only understand one input at a time, so a non-painful stimulation of a nerve closes the nerve’s “gate” to a painful stimulus.1 So, before injecting an anesthetic, dentists can vibrate the injection zone to introduce a non-painful stimulus that keeps pain from registering with the patient.
2. Needle Selection
Patients who feel numb longer feel more discomfort and are also at higher risk of hurting themselves either accidentally or by testing their numbness. The risk is especially high for children and should be mitigated by the dentist as much as possible.
To help manage this risk, Ouchless Injection employs single-tooth injection, limiting anesthetic leakage to about half a tooth to either side of the targeted tooth. This allows a single tooth to stay numb for as long as necessary, yet patients never have to feel like half of their face is numbed for hours.
Dr. Glazer uses this localized technique for both upper and lower procedures to target individual teeth with injections at between one and six points to encompass the tooth—mesiobuccal, buccal, distobuccal, mesiolingual, lingual, and distolingual. However, to do this in the most comfortable way for patients, he needs the right kind of needle.
“The key feature that dentists often overlook when buying an anesthetic needle is the tip of the needle,” Dr. Glazer warns.
Most needles are pointed, so they prick the tissue all at once. Dr. Glazer has found slicing causes less sensitivity to the patient post-operatively than puncturing.
“We’ve all had the unfortunate experience, whether it’s women shaving their legs or men shaving their face, where that razor slices your tissue and you never knew about it until you saw the blood,” he says.
Dr. Glazer uses Transcodent Painless Steel Dental Injection Needles, which feature three-edge lancet grinding. This design allows the Transcodent needle to easily slice into tissue the same way a razor does, setting it apart from puncture needles. The needle’s siliconized cannula does not tear the tissue, he says, but slides easily through. As a result, the needle does not cause tissue invagination—a major cause of post-operative discomfort. The needle’s versatility is another plus. It can be used with any anesthetic solution.
Transcodent offers the Painless Steel Dental Injection Needles at what Dr. Glazer calls a “crazy good price.” To him, that makes the needle a “game-changer.”
3. Refining Technique
“When I switched [to the new method and Transcodent Painless Steel Injection Needles] I would always ask patients, ‘did you notice anything different?’” Dr. Glazer recalls. “And they said, ‘yeah, I didn’t know you were giving me the injection.’”
With carefully selected equipment and patient expectations in mind, the third critical element of patient comfort is expert technique. This includes knowing when to use what needle. Dr. Glazer says he uses the 30 Gauge X Short about 80% of the time, most often for PDL injections. Because the needle only has to go into the sulcus, the short cannula is appropriate.
He also uses 30 Gauge X Short to deliver anesthetic to lower teeth. For mucco-buccal fold injections, which are more tolerable for most patients, he opts for a 30 Gauge Short needle. Dr. Glazer rarely performs an inferior alveolar nerve block, but when he does, he reaches for a 27 Gauge Short. Transcodent also offers the needles in 27 Gauge Long, as well as 25 Gauge Short and Long.
Dr. Glazer also suggests delivering the anesthetic solution in a slow, deliberate fashion for improved patient comfort. Injecting a bolus of anesthetic fluid into the tissue, which is already taught around the tooth, stretches the tissue, causes the fibers to stretch, and results in both immediate pain and post-operative inflammation. Slowing down the injections helps to limit pain and swelling. Additionally, he suggests dentists err on the side of more delivery points to avoid causing pain by failing to account for something before the procedure, and that some procedures, an extraction for example, call for the use of all six delivery points automatically.
