It’s Not the Needle; It’s the Anesthetic

Kit Dangler, DDS, MAGD

Your peers may describe you as the best general dentist in the area. However, if your patients receive painful anesthesia injections, they are not likely to think you are a good dentist. Many dentists believe that using a larger diameter needle, say a 25 gauge, will result in a more painful injection. Flanagan and others (2007) are among those who say this is just not true.

It is the acidity of the anesthetic that patients feel during the injection. For this reason, I was happy to be introduced to Citanest at a PEAK meeting. I now use Citanest daily. Plain Citanest 4% has a pH of 6.0–7.0. You remember that water is neutral with a pH of 7.0. The neutral Citanest anesthetic does not burn when being injected. You can produce comfortable soft tissue anesthesia.

Of course, the first part of a comfortable injection is thoroughly drying the tissue with gauze before applying the topical. After the topical application, I deposit 1/4 carpule of Citanest plain 4%. I follow this injection with either lidocaine with epinephrine for a block or septocaine with epinephrine for an infiltration. With the extra preparation of the Citanest, the patient cannot feel either the needle penetration or the deposition of the acidic solution.

Table 1 shows the differences between the pH values of different anesthetics (Goodchild and Donaldson 2016). As you know, the lower the pH, the stronger the acid.

No discussion of comfortable anesthesia is complete without mentioning “The Wand.” The Wand, a computer controlled dental anesthetic delivery system, is my rescue tool. Occasionally, we all have a tooth that is not completely numb. Then, I will use The Wand on the PDL setting. I usually place the needle in the PDL at the buccal line angles of the tooth. A couple drops of the additional anesthetic from The Wand produces profound anesthesia.