Apply Topical Anesthetic

Topical anesthetic reduces the slight discomfort associated with insertion of the needle. It is effective to a depth of 2-3mm. It is applied only at the site of preparation. The clinician should avoid excessive amounts that can anesthetize the soft palate and pharynx. The topical anesthetic should remain in contact with the soft tissue 1-2 minutes.

“Now I’m rubbing (goofy, cherry, bubble gum) tooth jelly next to your tooth. If it begins to feel too warm or goofy, let me know and I’ll wash it away with my sleepy water.”

Figure 6. Application of topical anesthetic

Figure 6. Application of topical anesthetic

The following steps can be performed during application of the topical anesthetic.

Determine the Temperature of the Anesthetic Solution

The temperature of the anesthetic solution should be between room and body temperature. Commercial cartridge warmers are available that provide a constant source of heat to the cartridge using a small bulb as the heat source. However, it can overheat the anesthetic solution causing discomfort to the patient during injection. Another technique is to run warm water for a few seconds over the cartridge in a manner similar to warming a baby bottle. If the cartridge feels warm to the administrator’s gloved hand, it is probably too warm.

Assemble the Syringe

There is debate among clinicians as to whether the syringe and its components should be assembled in view or out of view of the patient. Proponents of assembling the syringe in view of the patient assert that doing so acts a desensitization technique. The patient has the opportunity to touch and feel the individual non-threatening components that reduces patient apprehension linked to prior injections. Proponents of assembling the syringe out of the patient’s sight assert that most children have developed a fear of the injection during prior visits to the pediatrician and the slightest suspicion that they are getting an injection will set them off. This is especially true when told stories by older siblings and friends.

It is preferable to assemble the syringe out of sight of the child patient as this may provoke unnecessary fear in the patient. It is also desirable to distract the patient when receiving the anesthetic syringe from the dental assistant.