> My previous dentist's injections were generally painless. Unfortunately his
> other dental work was very poor, so I changed dentists.

> My new dentist only recently completed her training. Her injections are the
> most painful I have ever known. And that's despite her using a local
> aneisthetic before injecting.

> One injection she gave me (for a central upper incisor) was the most
> painful I have ever experienced. It caused me to yell loudly. Her
> explanation was that there "is not much room for the liquid to go".

> Why would one dentist's injections be generally more painful than
> another's?

> Thank you..

> Al

>    I'd cut her some slack.  Some areas of the mouth are more difficult to
>get numb; some injections are easier to miss altogether.
>    If the injection was under the lip for the upper central incisor, it
>tends to be more painful--probably because there are a significant
>number of muscle fibers inserting from the peri{*filter*}musculature.
>    If the injection was on the roof of the mouth, her explanation makes
>perfect sense.  The palatal tissue is firm, and bound down to the bone
>by heavy connective tissue.  Injection must be made under pressure, and
>the only place for the anesthetic solution to go is within or under the
>periosteal tissue (because the tissue is tightly attached here.
>    An endodontist taught me a trick for making these injections less
>painful--a very low-tech and easy method.  But it was not taught to us
>in school.
>    Of course, I'd like to think that with practice you get better--more
>accurate, less painful.  But short of not knowing the anatomy or a shaky
>hand, most dentists' injections are probably pretty much alike.
>    There are some newer injection methods that may be less painful in
>select applications.  But by and large, certain injections are just
>going to hurt--and the roof of the mouth behind the upper front teeth is
>number 1 on most dentists' lists.

>Steve

> An endodontist taught me a trick for making these injections less
> painful--a very low-tech and easy method.

> If the injection was on the roof of the mouth, her explanation makes
> perfect sense.

> On Wed, 14 Mar 2012 18:22:34 -0400, Steven Bornfeld

>>        I'd cut her some slack.  Some areas of the mouth are more difficult to
>> get numb; some injections are easier to miss altogether.
>>        If the injection was under the lip for the upper central incisor, it
>> tends to be more painful--probably because there are a significant
>> number of muscle fibers inserting from the peri{*filter*}musculature.
>>        If the injection was on the roof of the mouth, her explanation makes
>> perfect sense.  The palatal tissue is firm, and bound down to the bone
>> by heavy connective tissue.  Injection must be made under pressure, and
>> the only place for the anesthetic solution to go is within or under the
>> periosteal tissue (because the tissue is tightly attached here.
>>        An endodontist taught me a trick for making these injections less
>> painful--a very low-tech and easy method.  But it was not taught to us
>> in school.
>>        Of course, I'd like to think that with practice you get better--more
>> accurate, less painful.  But short of not knowing the anatomy or a shaky
>> hand, most dentists' injections are probably pretty much alike.
>>        There are some newer injection methods that may be less painful in
>> select applications.  But by and large, certain injections are just
>> going to hurt--and the roof of the mouth behind the upper front teeth is
>> number 1 on most dentists' lists.

>> Steve

> Certainly location is a big factor but so is the speed of injection. A
> quick injection will hurt more.

>> An endodontist taught me a trick for making these injections less
>> painful--a very low-tech and easy method.

> Would you mind sharing the method?

> --
> Ankur

> My previous dentist's injections were generally painless.
> Unfortunately his
> other dental work was very poor, so I changed dentists.

> My new dentist only recently completed her training. Her injections
> are the
> most painful I have ever known. And that's despite her using a local
> aneisthetic before injecting.

>>> An endodontist taught me a trick for making these injections less
>>> painful--a very low-tech and easy method.

>> Would you mind sharing the method?

>> --
>> Ankur

> Not at all--I have a couple of patients waiting--but promise to post later.

> Steve

> http://www.google.com/url?source=imglanding&ct=img&q=http://www.atlan...

>    There tends to be some variation in the application of this general
>rule (so often repeated in school, so often ignored in practice).  In
>loose areolar connective tissue, it is not nearly so important than in
>attached, heavily collagenized tissue (such as on the palate).
>    So too, different patients will have varying perceptions of discomfort,
>based on not only the elicited response, but also the duration of the
>painful stimulus.

>Steve

> I presume the pressure desensitizes the area by transient ischemia,
> much as one's foot can sometimes go to sleep if you sit in an odd
> position (say, sitting on your feet).
> The effectiveness varies somewhat, but most patients (and I do ask)
> tell me that the injection given this way was not painful, or only
> slightly so.

>> I presume the pressure desensitizes the area by transient ischemia,
>> much as one's foot can sometimes go to sleep if you sit in an odd
>> position (say, sitting on your feet).
>> The effectiveness varies somewhat, but most patients (and I do ask)
>> tell me that the injection given this way was not painful, or only
>> slightly so.

> I had heard about applying pressure before a palatal injection, but
> that particular trick seems very clever. Thank you for sharing :)

> --
> Ankur

>> If the injection was on the roof of the mouth, her explanation makes
>> perfect sense.

> Thanks for the unput. That particular (and most painful) injection, was
> under the lip - not into the roof of the mouth.

> Four out of the five of her injections have been more painful than most
> injections I've had from other dentists.

> Al

> 130.133.4.11:

>>> If the injection was on the roof of the mouth, her explanation makes
>>> perfect sense.

>> Thanks for the unput. That particular (and most painful) injection, was
>> under the lip - not into the roof of the mouth.

>> Four out of the five of her injections have been more painful than most
>> injections I've had from other dentists.

>> Al

> PS...

> Unfortunately, the trend continues! I had another injection yesterday, from
> the same dentist. It was the most painful I have ever experienced. She may
> have hit a nerve or something, because the sudden pain was so intense. I
> yelled very loudly and instinctively pushed her hand away from my face
> (which she complained about afterwards). This particular injection was for
> the very back tooth on the bottom left, and the injection was into the
> inner side of the gum.

> The percentage of her injections that are intensely painful are many times
> that of any other dentist I've been to in 55 years. It seems that about one
> in three of her injections hurt like hell.

> Should I change dentists?

> TIA

> Al

>      I assume she was attempting an injection called an "inferior
>      alveolar
> block".
>      In this particular injection, we aim for the area that the nerve
> serving the lower teeth on that side exits the inside of the lower
> jaw.
>   The aim is to deposit the anesthetic close enough to the nerve that
> all sensation from that point outward is "blocked".  Sometimes we are
> "lucky" (you may be forgiven for not accepting this descriptive) and
> hit the nerve directly with the needle.  The result is a sharp,
> stabbing pain that usually radiates from the point of injection out to
> that side of the lower lip.  It is also possible to get a radiating
> pain out to the tongue, if the needle happens to touch the lingual
> nerve--which it may.
>      There are injections for the lower jaw that avoid this area, but
>      I'd
> guess most dentists (myself included) usually still use the old
> tried-and-true inferior alveolar block.
>      If this is what happened, you were just unlucky--it could happen
>      to
> anyone, and from any dentist utilizing this injection, and thus
> wouldn't in my view be reason enough to change dentists.  If I have
> not described the pain accurately, there may be another cause, and
> that I cannot comment on.  Certainly if there is a clear pattern of
> painful injections, after a certain amount of time it's more than bad
> luck.  The dentist should get help improving her technique, and you
> may consider given the total package of dentist whether you should
> change dentists.

> Steve