“Numbing Jelly” or Dental Topical Anesthesia.
I often ask my patients what they hate the most about a trip to the dentist, and a solid majority always says one thing: The Shot. There are other things that patients do not like, and I even compiled an abridged list of things patients have told me they dread:
- The sound of the dental drill.
- The feeling of “too many things” in their mouth.
- Being tilted back too far.
- The thought of a “hole” being drilled into a body part.
- The “suction thingy” (a.k.a. saliva ejector or spit sucker).
- The spray of the water.
- The taste of metal instruments.
- Two individuals (dentist and assistant) staring into their mouth
- And literally hundreds of other things…
All of these things are reasons why patients avoid the dentist. However, based on my experience as a dentist, these items all pale in comparison to the administration of local anesthetic. Local anesthetic is necessary for all types of dental procedures, including fillings, crowns, root canals, implants, etc. It doesn’t matter whether you’re in Orange, CT where I practice or thousands of miles away, patients hate the shot!
Not surprisingly, dentists and dental supply manufacturers have been identifying and developing techniques over the years to eliminate the pain and fear associated with the local anesthesia injection. Perhaps the biggest and most significant development was the introduction of narrow diameter disposable needles. Prior to the 1950s, the needles used were much larger in order for them to be able to stand up to multiple sterilization cycles. I’ve had many older patients who experienced dental procedures back in the 1940s who described these as “horse needles.” Now we use much narrower disposable needles. I will cover the history of dental needles in a future blog post. But regardless, a needle is still a needle!
Enter Dental Topical Anesthetic
Topical anesthetic is simply a local anesthetic that is applied to the soft tissue of the mouth prior to the shot. It has the consistency of jelly or jam and is often referred to as “numbing jelly.” I apply it with a cotton swab and allow it to remain on the soft tissue for at least 90 seconds. The topical anesthetic numbs the soft tissue so that the patient feels little to no sensation of the needle. Most topical anesthetics are composed of 20% benzocaine which is similar to what is found in OTC products such as Orajel and Orabase.
Does dental topical anesthetic work?
Yes! As a practicing dentist who administers approximately 10 injections per day, I use topical anesthetic every time I need to numb a patient. My experience is that topical anesthesia works for two reasons. First, it anesthetizes the soft tissue as described above so little to no sensation of the needle is felt. Secondly and more importantly, it also works because the patient believes they will feel very little of the shot.
While the topical anesthetic is on the tissue, my patient’s anxieties are diminishing, their muscles are relaxing, and they are breathing normally. My assistant and I talk to them about topics unrelated to dentistry to get their mind off the upcoming procedure. They feel a tingling sensation at the location of the topical reminding them that the area is getting numb. They become very relaxed and stop focusing on what is going to happen next. Then when I then go to administer the local anesthetic, they feel little to no sensation of the actual needle. This is because they are no longer expecting it to hurt!
There are many other approaches to reduce the anxiety associated with The Shot. Some of these will be described in future blog posts. I occasionally use a more concentrated solution of topical anesthetic on many kids under the age of 12. I will also occasionally use Nitrous Oxide (also referred to as “laughing gas”.) I will often shake or wiggle the soft tissue prior to administering the local anesthetic, as this can also distract the patient. Redheads are scientifically proven to need more local anesthetic than people with different hair colors, as I discussed at length here. I ALWAYS use lots of topical anesthetic with redheads.
On a related note, most formulations of topical anesthesia contain gluten. So those individuals with either celiac disease or gluten sensitivity should avoid the topical anesthesia. For more information on gluten in the dental office, see this page.
For patients who are so anxious about the needle and dental procedures in general that topical anesthesia is not sufficient, I use conscious sedation.
If your dentist does not use topical anesthetic, simply ask for it.