Basic Injection Technique

The anesthetic injection begins by stretching the tissue taut at the administration site. Insert the needle 1-2mm into the mucosa with the bevel oriented toward bone. Inject several drops of anesthetic before advancing the needle. Slowly advance the needle toward the target while injecting up to ¼ cartridge of anesthetic to anesthetize the soft tissue ahead of the advancing needle and then aspirate.

The depth of insertion will vary with the type of injection; however, one should never insert a needle in its entirety to the hub. Although a rare occurrence, retrieving a broken needle fully embedded in soft tissue is extremely difficult.

After confirming a negative aspiration, the injection process should take between 1-2 minutes. The clinician should be mindful of not injecting a greater amount of anesthetic than recommended for the patient’s weight.

Continue to speak to the patient throughout the injection process. Close observation of the patient’s eye and hand movements along with crying will alert the clinician to patient discomfort.

“Now I’m going to spray the sleepy water on your tooth. Open your mouth real wide like a crocodile and put your hands on your belly button so they don’t get wet. I’m spraying the water and it probably feels cold so I’m counting to five to warm it up. Let’s count 1, 2, 3, 4, 5. I think the cold went away so we can spray the rest of the water to make your tooth fat and funny. You’re doing so good sitting so still with your mouth wide open and your hands on your belly button. I need to give you a special reward. How about a sticker? Nah, you’re doing so good you should get two stickers and we have a whole selection of stickers. Do you like Spiderman stickers? Me too. How about puppy stickers? No. Okay. How about Princess stickers? Okay, we’re finished. You were great! You can pick out two stickers while we wait for your tooth to fall asleep and your lip to feel fat and funny.”

As a pediatric dentist, I reward the patient immediately after successfully completing a segment of the treatment rather than wait until after the entire treatment session is completed. I found it to reinforce positive behavior throughout the procedure.

After depositing the desired amount of anesthetic, the syringe is withdrawn, and the needle safely recapped. It is preferable to use a needle holder to avoid injuries by directly recapping the needle.

Do not leave the patient unattended while waiting for anesthesia symptoms to develop. Continually observe the patient for blanching of the skin, signs of allergic reactions or vasopressor reactions.

Record the name of the topical anesthetic, amount of anesthetic injected, vasoconstrictor dose, type of needle used and the patient’s reaction.

Upon completion of treatment and dismissal of the patient, the clinician says to the patient with the accompanying adult present:

“You were a terrific helper. You can pick out 3 more stickers and I’m giving you an extra special sticker that says ‘Careful, tooth, tongue, lips, asleep.’ Although we’re finished with today’s treatment, your tooth will be asleep, and your lip and tongue will feel fat and funny for another hour. I also want you to bite on this tooth pillow (cotton roll). Don’t eat or drink until your lip and tongue no longer feels fat and funny.”