Chapter 55

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 importance.

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 system.

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 uncooperative patients.

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 the following:

1. Tissue damage by the needle

2. Pressure created by the anesthetic solution

3. Flow rate of the anesthetic

4. Temperature ...

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