You may think that the case is settled when it comes to dental anesthesia and pain management. However new research into this area of dentistry is being published all the time. Dental treatments of all complexities from simple to highly complex can involve pain for the patient. Anxiety about a procedure and the potential pain are the main reasons patients avoid the dentist and put off essential treatments. That is one reason significant research is conducted into dental pain management, although there are other reasons for exploring non-needle anesthetic options as well.

Aspects of Dental Pain and Anxiety

The anxiety and pain surrounding dental procedures are multifaceted. There is the pain associated with needle injections of local anesthetic, the pain of the actual procedure, and anxiety surrounding the entire dental visit experience. Dentists can effectively manage pain and anxiety using a combination of techniques. Some newer techniques may surprise dentists while others will be familiar as standard practice.

Aromatherapy

Aromatherapy is the use of essential oils to alleviate anxiety and pain with the power of scent. In a controlled trial of 126 pediatric patients undergoing tooth extraction, one group was given 100% lavender oil for 3 minutes before the procedure and another group was given no aromatherapy. The researchers analyzed both the patient’s subjective report on the experience as well as physiologic changes. After tooth extraction, the lavender group showed significantly lower anxiety and pain scores. Inhalation of lavender resulted in a lower blood pressure and a pulse rate drop.

Vibration

Many dentists are familiar with the use of a vibration or cooling device prior to an injection as a pain management technique. Many studies show that these techniques can have some beneficial effect on injection pain. Pediatric patients especially can have significant anxiety around dental procedures. Studies have shown that vibration used in conjunction with distraction techniques can alleviate anxiety and reduce perceptions of pain surrounding local anesthetic injections.

Needle-Free Anesthesia Devices

Fear of needles used for injection of local anesthetic is a primary cause of anxiety for many dental patients. Needle phobia is common and can show up in many medical specialties where needles are required to draw blood, administer medicine, and provide anesthesia. If there was a way to make a needle-free anesthetic that produced the same kind of profound anesthesia as local anesthetic blocks – dentists everywhere would be using it. The Numbee device is one so-called “needle-free” device that has been shown in studies to be significantly less effective than typical needle anesthesia.

One study compared a traditional inferior alveolar nerve block (IANB) with the Numbee needle-free anesthesia device. For the IANB, the incidence of profound anesthesia was 46%, and required rescue anesthesia was 20%. For the Numbee, the incidence of profound anesthesia was 0%, and required rescue anesthesia was 60%. This shows that the traditional needle technique outperforms the needle-free technique.

Topical Anesthetic Gels and Ointments

Topical anesthetics continue to be used by many dentists for pre-injection numbing, to provide anesthesia for scaling and root planing, for orthodontic placements, and more. For some dental procedures, topical anesthetics are a useful addition to traditional local anesthetic administration. The commercially available numbing agents have not changed much recently however compounded topical anesthetics continue to become more popular as they produce more profound anesthesia.

Social Media

You may not consider social media a part of the practice of dentistry besides for use in marketing efforts. In a study published in the Scandinavian Journal of Psychology it was shown that dentists who communicated with their patients via social media prior to a procedure helped alleviate anxiety in their patients. This randomized controlled trial used Instagram to have dentists answer questions for their patients prior to a procedure.

There were four groups in the study:

1. Communication only after the procedure.

2. Communication only before the procedure.

3. Communication before and after the procedure.

4. Control group who received no communication via social media.

The results showed that group 4, who received no communication via social media, had higher levels of anxiety than groups 2 and 3. Communication between the dentist and the patient before the procedure via Instagram helped alleviate dental anxiety.

Articles

Can lavender oil inhalation help to overcome dental anxiety and pain in children? A randomized clinical trial – European Journal of Pediatrics

Effect of vibration during local anesthesia administration on pain, anxiety, and behavior of pediatric patients aged 6-11 years: A crossover split-mouth study – Journal of Dental Anesthesia and Pain Medicine

Dentist-patient communication on dental anxiety using the social media: A randomized controlled trial – Scandinavian Journal of Psychology

Efficacy of Pulpal Anesthesia Using a Needle-less Syringe – Anesthesia Progress