Clinical tip: Perfecting the painless palatal injection

Ready to ensure your palatal injections are as painless as possible? Dr. Darin O'Bryan talks about that topic this week in our "CDOCS Weekly Bytes" segment.

You can also visit CDOCS to learn more, and learn more about CDOCS' hands-on workshops.

In the video below, Dr. O'Bryan gives his tips on palatal injections that he believes can benefit any dental patient.

Video transcript

"I want to go over how to help give a more painless palatal injection. The trouble that we have with the palatal injection is with the keratinized tissue on the palate, the topicals that we typically utilize don't really penetrate that keratinized tissue, allowing for any sort of prenumbing to occur, which then means the injection is going to sting more. The needle goes in and we're injecting our anesthetic slowly. However, what we can do is if we prenumb with some ice, if we get that area cold enough, it will actually go numb.

"Now you can freeze an anesthetic cart, much like you would use for endo testing, and that will work, although you have to hold it there for a fair amount of time to really get the area numb. You can do almost like an ice massage with it and that will work. However, my preferred method is I use good old Endo Ice. This is the same stuff we're gonna use to do our endo pulp testing, so we have it laying around the operatories.

"All we're going to do is utilize this and spray it on a cotton tip applicator or a cotton pellet on a pair of hemostats or cotton forceps. This is then applied to that palatal tissue and is held there long enough. Now, Endo Ice is cold enough. You will see some frosting of the tissue. This is usually just crystallization of the saliva and it doesn't really cause any permanent damage to the hard tissues or the soft tissues. So we apply this ... allow that to set. Then, once I take that, I switch out to my mirror and put some added pressure there and I inject with the needle. This takes away the vast majority of the discomfort that you're going to feel with a palatal injection. I then drop a few drops of anesthetic in there and let that sit. Once it has sat there for a little while, now we can go ahead and inject more fully, because we've already got some pre-numbing by having given the injection after numbing it with some cold and then added pressure with your mirror hand."