Updated: Feb 15, 2021
So many people shy away from giving palatal injections. I mean let’s face it,. They HURT! Right?!?
I know I am not the only person who wasn’t jumping up and down with joy when my student partner was practicing on me. That left me not only dreading getting them, but not eager to give them either. However, after implementing these four simple steps, the injections more tolerable for patients and eased my anxiety about giving them as well.
The first item is fairly obvious, because it’s standard for all injections. Yep you guessed it, topical. Your options for topical may seem limited to only benzocaine but using a lidocaine gel on the keratinized palatal tissue helps gain deeper and more profound topical anesthesia. If your office doesn’t have a lidocaine gel on hand, I highly recommend it. This topical also works well for patients who are sensitive to the ester-based benzocaine.
Let’s not forget about ice either. While it isn’t in the anesthetic family it is a topical option we use. A simple way to apply the ice is by dipping a cotton swab in water then placing it in the back end of a clean unused anesthetic cap. Put the entire contraption in the freezer and voila you have instant popsicle swabs for the ready! If that is too much work, grab a can of endo ice and spray the swab. That will cool the cotton tip enough to transfer that cold sensation to the hard palate. All these items will help stop the sensory communication flow of the first couple layers of the hard palate. But to make it even better, incorporate pressure.
Pressure pairs nicely with the use of topical anesthetic. If you are using the cold swab method, it’s an easy one-two punch with just one item. When using the chemical based benzo- or lidocaine, I recommend letting the gel rest on the tissue for a couple of minutes then apply pressure. No matter what type of topical you are using make sure to press for about 30-60 seconds to create the desired “no feeling” effect. Also, keep your pressure going as you insert. Once you start to deposit ease off and let the solution flow. As a side note, the patient will still feel uncomfortable, however, it is more tolerable than the prick of a needle.
The other tip for having a successful palatal injection is using the right anesthetic type. Because the palate is a thin and porous bone anesthetic can easily penetrate. However, articaine (Septocaine) will penetrate the best. Because of its formulation a little of this solution goes a long way. This means you won’t have to deposit as much, and you have reduced hand fatigue which can accompany these injections. Plus having vasoconstrictor along with it, you will achieve excellent anesthesia and hemostasis. I call that a win/win!
Your final step to a successful palatal injection is having a clear understanding of your patient’s anatomy. Knowing where the foramen are, which nerves travel to the desired location and your superficial anatomy, allow you to select the appropriate injection. So, dust off those cobwebs, grab that textbook or log into that CE course to get your anatomy brush up happening. When you know what your target points are you will have a better picture of where you are depositing that anesthetic.
Whether you are giving a Greater Palatine, Nasopalatine or the Anterior Middle Superior Alveolar injection, I know when you implement these 4 processes you will have the confidence you need to give a smooth and relatively pain free palatal injection.
Ok now that we have reviewed the steps to giving a palatal injection, are you ready to get more information on these injections plus several more? Make sure you grab your FREE anesthesia guide. Head to www.teachertinardh.com and get it delivered straight to your email. Pretty cool right?