The Dreaded Dental Injection

Unpleasant but necessary, numbing an area before dental treatment is highly recommended to make certain that the treatment goes quickly, successfully, and most importantly, painlessly. Anesthetics are used daily in dental offices and are rated by their safety, duration, and effectiveness and each has benefits and risks. Clinicians use the proper anesthesia based on the patient's medical history and the duration and invasiveness of the procedure.

Before the actual injection, a topical anesthetic gel is applied to the area. This gel is responsible for numbing up to 2mm of tissue and keeps the insertion of the needle from being uncomfortable. Most dental topicals consist of Benzocaine 20% and are very effective when applied to the tissue and left alone for around 2 minutes. After the topical takes effect, the area is injected with a local anesthetic which numbs the tissue and the teeth. Although most patients refer to all dental anesthetic as Novocaine, newer and more effective anesthetics have evolved posing fewer complications such as allergic reactions.

Lidocaine is the most popular choice of anesthetic because of its effectiveness, safety, and medium duration of action. Numbness from Lidocaine usually lasts for 2-4 hours.  

Articaine – Articaine is probably the most effective local anesthetic available today and is surpassing Lidocaine in popularity because of its effectiveness. Like lidocaine, it has a medium duration of action. However, because it’s much more concentrated than Lidocaine, less can be used safely.

Bupivacaine is a local anesthetic mostly used in oral surgery because it has a very long duration. Oral surgeries such as wisdom teeth extractions and implant placements can take an extended period, so Bupivacaine is the anesthetic of choice to keep the patient comfortable.

Local anesthetics enlarge the blood vessels which increases bleeding, and excessive bleeding decreases the field of sight. For this reason, a vasoconstrictor (epinephrine) is added to constrict the blood vessels which decreases bleeding and makes the anesthetic last longer.

Although patient’s dislike getting a dental injection, the effects don’t last too long and being numb during the procedure is certainly worth a few uncomfortable minutes while the anesthesia is placed.