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Patients either express a dislike or decide they are phobic about injections. Genuine phobics are very rare but people who do not like painful injections are very common.
Dentists are taught how to deliver near painless injections as students. After all they are introducing a product that stops pain and it works really quickly unlike your Doctor who might be injecting something quite unpleasant and irritant.
So much for the theory.
A painless injection requires care, sometimes a surface anaesthetic gel will help but it needs two or three minutes to work.
Even when it has worked, its anaesthetic effect is only on the surface millemetre and injecting below this can still be a problem.
Genuinely, the needles are so fine, that they do not hurt. What hurts is popping a quantity of half a teaspoon (2.2ml) of anaesthetic suddenly into your gum causing the tissues to suddenly stretch and balloon albeit only slightly.
Patients with a fear of injections understandably want it over quickly, unfortunately quick injections hurt.
If the anaesthetic is introduced slowly usually very much at the surface first and then very gently advanced behind the anaesthetised advancing front, then very little is felt.
Unfortunately the anatomy of the situation prevents perfection in all cases but it is still nice to know that the majority can be painless.
We now have several needle based systems that allow us to avoid painful injections and we have many anaesthetic agents so that we can find one that suits the individual patient.
For about 20 years I have had a device called a Syrijet which injects without needles. As the name implies it uses a pressure jet of anaesthetic. It feels like a little child's popgun going off against your gum.
There is also a computer aided device that injects very slowly and is well thought of. I just prefer the computer on my shoulders.
In nearly every case we convince so called phobics that they are just rightly distressed by previous experiences and gradually through experience we reduce their apprehension.
However there are genuine phobics and they really need sedation. Years ago I used Relative Analgesia regularly but increasingly I found that a careful injection technique eliminated the need for it. I have not referred a patient for sedation for over twenty years.
Local anaesthetic is one of the safest products around. They are used millions of times each day. There are very rare complications but dentists are fully trained to avoid or deal with them as they arise.
The most serious consequences I have ever read about arise under the "severe pilot error category" where the local anaesthetic has been massively misused and the issue of safety has been about the practitioner and not the anaesthetic.