The practice of modern dentistry is inconceivable without the
application of local anesthesia. The dentist has various devices and
procedures available for achievement of local anesthesia at his/her disposal. However, it is a
paradox that the local anesthesia procedure enables painless work in the
mouth also causes patients the most discomfort and fear. Research has shown
that the administration of the injection is the primary fear-inducing
stimulus in children, and in patients in general.1–5
The painful experience of the injection is the most frequent reason for
fear of the dentist in children. Local anesthesia in children's dentistry
not only enables the therapeutic procedure in the child, but also enables
the child to experience the procedure as pleasant and to remain relaxed. Of
interest, studies have also shown that not only does the child fear the
painful procedure and discomfort during treatment, but that dentists are
also more apprehensive.5
Successfully administered local anesthesia is of crucial importance allowing
the dentist to perform a number of therapeutic procedures on the tooth and
in the oral cavity. Unfortunately, the
administration of the injection of local anesthesia remains the main problem
connected with painful sensation and the occurrence of dental anxiety in the
patients, particularly children. Consequently, numerous studies in the field
of pain control and fear have concentrated on reducing or completely
eliminating pain when administering local anesthesia.3,6,7
Indeed, many techniques of local anesthesia administration can be made nontraumatic
and without significant discomfort for the patient. This goal is possible
also for mandibular blockade and infiltration anesthetic in the palatal
mucosa. For administration of painless anesthesia, the dentist must possess
certain knowledge, readiness, and skill. In this respect, concentrated efforts of the
dentist to learn painless local anesthesia techniques are of exceptional
Injection of local anesthesia is still the most common and effective method
of anesthesia in clinical dental pediatric practice, in spite of many
attempts to find an alternative less painful and more pleasant procedure for dental
treatment. The application of jet injections without needles is only a
partial solution of the problem because many areas in the oral cavity cannot
be adequately anesthetized without the use of the traditional needle/syringe
Dental procedures are associated with pain and discomfort by the patient.
This is the main reason for the development of dental fear and anxiety in
children, with additional possible serious consequences for future dental
treatment. For this reason alone, the painless administration of anesthetic
is an important step in avoiding the development of fearful and
To control or reduce the patient's pain perception during the administration
of intraoral injection, dentists must focus on the factors that influence
that perception. The pain of intraoral injection is attributed primarily to
Tissue damage by the needle
Pressure created by the anesthetic solution
Flow rate of the anesthetic
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