Assuming the proper materials and equipment have been chosen then the following
technique can be used to reduce the discomfort of buccal infiltration injections in the
maxilla posterior to the canine:
- Dry the mucosa and apply a topical anaesthetic for 5 min.
- Wipe off excess topical anaesthetic.
- Stretch the mucosa.
- Distract the patient (stretching the mucosa and gentle pressure on the lip between
finger and thumb can achieve this). - Insert the needle⎯if bone is contacted withdraw slightly.
- Aspirate, if positive reposition the needle without withdrawing from mucosa and
when negative proceed. - Inject 0.5-1.0 ml supraperiosteally very slowly (15-30 s or via computerized
system).
Anterior maxillary buccal infiltrations
Injection into the anterior aspect of the maxilla can be uncomfortable if some
preparatory steps are not taken. Using the method described in steps 1-6 above, about
0.2 ml of local anaesthetic is deposited painlessly in the first primary molar buccal
sulcus on the side to be treated (182HFig. 5.9). The next injection is placed anteriorly to
this a minute later when soft tissue anaesthesia has spread radially from the initial
injection site, and further 0.2 ml increments are placed in the anterior aspect of the
already anaesthetized area until the tooth of interest is reached. The buccal infiltration
of 0.5-1.0 ml can now be delivered painlessly through the already anaesthetized soft
tissue.
Palatal anaesthesia
Injection directly into the palatal mucosa is painful. In some individuals the
deposition of the solution close to a cotton-wool bud coated with topical anaesthetic
and applied with firm pressure may reduce discomfort, especially when the pressure
on the bud is increased simultaneously with needle insertion and the child is warned
of this pressure increase (183HFig. 5.10). However, as mentioned earlier, conventional
topical anaesthetics are not very effective on the attached mucosa of the hard palate
and this method is not universally successful. The use of computerized delivery
systems may reduce injection pain during palatal injections. When using conventional
syringes a method of reducing the discomfort of palatal injections is to approach the
palatal mucosa via already anaesthetized buccal interdental papillae. This is most
readily achieved using ultra-short (12 mm) 30-gauge needles which are inserted into
the base of the interdental papilla at an angle of approximately 90° to the surface. The
needle is advanced palatally while injecting local anaesthetic into the papilla. This is
performed through both the distal and mesial papillae. Blanching should be seen