Fear of Painful Injections and Needles
“I’m terrified of dental injections. They hurt like hell! And the look of the syringe scares me to death.”
“I’m completely petrified of all needles. It’s the thought of injections that I can’t tolerate, to the point where I avoid them even when they are absolutely necessary.”
If you’re terrified of injections, you’re not alone! The Adult Dental Health Survey (UK) 2009 found that 28% of respondents were ‘extremely’ anxious about having a dental injection. It is estimated that 3.5% to 10% of the population may be phobic of needles in general 1 2.
The level of fear varies from person to person, and some people are afraid of dental injections in particular, while others are phobic about any sort of needle. Some people are phobic to the point of avoiding injections at all costs (including their life).
Some people are almost as scared of, or even more afraid of the numb sensation than of the injection itself.
Are dental injections painful?
Most needle phobics have had at least one bad experience with an injection (interestingly, toe injections are frequently mentioned!). There are various reasons why a dental injection may be painful:
An injection is more likely to cause pain when it is made into dense and tight tissues, and tends to be barely noticeable when made into loose tissue. For example, for upper back teeth, the injection is way up high on the cheek side of the jaw, where tissues are freely movable and “loose”. This type of injection tends to be painless regardless. In locations with denser tissue, your dentist’s technique becomes much more important when it comes to delivering painless injections.
Administering the anaesthetic too quickly:
This is perhaps the most common cause of injection pain. Some dentists administer local anaesthetic too rapidly. It’s difficult to say exactly how long a comfortable injection should take, because this varies a lot between different injections sites and techniques. The tighter the tissue, the more time needs to be taken. That’s because the liquid has to find a location to occupy, and squeezing the liquid too rapidly into dense tissues can cause them to tear, resulting in pain followed by soreness.
Not using a topical anaesthetic (numbing gel):
While it is possible to give local anaesthetic painlessly without numbing gel in some areas of the mouth, numbing gel should always be used for injections which could otherwise be painful. It really works, if it is left on for long enough – the soft tissue will be so numb that you cannot feel the needle going in.
Not making the tissue taut and injecting gently:
In some areas of the mouth, the tissue needs to be stretched to make the injection comfortable.
Applying pressure or vibration (using a finger or a q-tip, or a snazzy device called the Vibraject) can block out any feelings of pain (the nerves which transmit movement and pressure actually block some of the transmission of pain from the other nerves). The principle is the same as when you’re rubbing something better if it hurts, for example if you bump into something. This is also known as the “Gate Control Theory of Pain”.
Applying pressure is particularly important in areas where giving local painlessly is more difficult, especially the palate.
Causes of Burning Sensation during Injection:
A burning sensation while being given local can be the result of putting in the local anaesthetic too quickly (see above). But it can also be due to the difference in pH value between the local anaesthetic solution and the soft tissues in the mouth.
The duration of this sensation is only a few seconds – it’s not particularly painful, and many people aren’t even aware of it. But if you do feel some burning: the reason for the sensation is simply that the pH of the solution is lower than the pH of the tissues, and the sensation disappears within seconds as the tissues become numb.
Lack of empathy:
Perhaps surprisingly, the very first injections dental students give to their classmates in dental school are reported to be painless, but oftentimes, their injections become increasingly uncomfortable as time goes on. Interestingly, dental students apparently are surprised at how painless those first injections are, because some have experienced painful injections in the past when they were patients. The most likely explanation is that the students went out of their way to make the injection comfortable (knowing that they would be at the receiving end next, and having to face their classmates for the rest of their time at dental school!). “Taking turns” fosters empathy, but this empathy is sometimes lost as dentists move out of dental school and the job becomes routine and dentists are under time pressure. It can also be a defense mechanism – dentists frequently see people with painful problems such as abscesses or injuries. To avoid bearing the burden of every patient’s pain, dentists may become desensitised and simply don’t relate anymore. The key is to find a dentist who has not lost their compassion and really cares about their patients’ comfort – many if not most dentists do!
Incorrect angle of the bevel:
The bevel (the tip of the needle) should be oriented correctly towards the bone for a comfortable injection.
Using a dull needle:
This has become an almost non-existent issue, because nowadays disposable needles are used. But it used to be a common cause of painful injections. The issue can still arise today though with multiple injections – the needle should be changed after 3 or 4 times. If you remember very painful injections many years ago, the type of needle used back then may well have been the cause! Modern dental needles are much finer than those used 20 years ago. They are also manufactured and prepared in a different way to make injections pain free.
Type of injection:
Some types of injections (not the most commonly used ones) can be difficult to do without causing any discomfort. It’s not possible to guarantee that every injection will be 100% painless. But discomfort can be minimized by making sure topical anaesthetic is left on for long enough to work properly, by injecting very slowly, and by applying pressure for certain types of injections. Such injections are easier to give without causing discomfort using the Wand.
Animated-teeth.com have an excellent page on this topic – it’s really detailed and well worth a read if you want to find out more about this topic: Why do some shots hurt and others not so much?
What can I do about my fear of needles?
Find a dentist who cares
Find a dentist who truly believes in patient comfort. These dentists will have studied techniques that make dental injections as comfortable as possible. If they have the Wand (see below) or similar devices at their disposal, all the better!
By and large, dentists tend to be amazingly truthful about their ability (or inability) to make dental injections comfortable. It’s a good idea to ask your potential dentist outright if the injections will hurt, and if they use numbing gel.
Topical anaesthetic comes in lots of yummy flavors, though the plain flavor (which is most commonly used) works just as well! Numbing gel can be a real eye-opener if your fear is the initial going in of the needle – but it has to be left on for long enough to take effect, especially for lower back and upper front teeth. The wide availability of numbing gel nowadays has meant that lots of people have lost their fear of injections. You might even want to do a practice run:
“For people like me who truly loathe any type of shot, perhaps a good idea would be to do a test run. Have the dentist or hygienist liberally apply the gel, so you can “feel” that it works. If I had known such a thing existed a couple years ago, I firstly would have had my filling taken care of pronto but it would have drastically helped ease the moment come time for the shot, to have had the prior positive experience.”
Find out all about it on our page about topical anaesthesia!
Many people on our forum have commented that they found the Wand hugely helpful in getting over their needle phobia. The Wand virtually guarantees painless injections, because the speed of injection is controlled by a computer. And the few injections which could potentially be uncomfortable, even in skilled hands, are possible to do quite comfortably using the Wand.
In addition, it looks nothing like a syringe! So if the sight of a needle or a syringe is a major turn-off for you, this may be your ticket… find out more on our page about The Wand!
Another gadget which helps eliminate injection pain, this small vibrating device is attached to a standard syringe. You can find out more here: Vibraject – Why nothing should be too much trouble for our anxious patients
Working with a Psychologist
It can be a great idea to find a qualified clinical psychologist who will work with you to reduce or eliminate your fear of needles – especially if you have a generalised phobia of all injections. There are many techniques that can be used.
Among them are systematic desensitization, deep breathing, visualization and guided imagery, positive affirmations, and reward systems. The added bonus is that some psychologists who specialize in phobias and anxiety disorders work together with phobic-friendly dentists. In that case, you won’t have to search for a suitable dentist, once you’re ready for it.
If you suffer with a general phobia of injections or needle phobia, working with a qualified psychologist tends to be the method of choice.
Working with a Dentist – Desensitisation and Systematic Desensitisation
This technique can work really well also for more severe needle phobias. But you need to be open to the idea. Some people simply “don’t want to know”, and this technique requires you to actually expose yourself to the noxious stimulus.
The problem is that relatively few dentists are trained to use it. So if this is a method you fancy, make sure your dentist of choice is familiar with it (or a similar technique).
You can find detailed examples of needle phobia desensitisation here.
IV Sedation (with nitrous oxide)
If it’s the thought of needles that has you terrified, and you feel you simply cannot tolerate the thought of being aware of injections, then IV sedation may be the way to go. Most severe needle phobics are able to tolerate dental injections that way. If you suffer with generalized needle phobia as many people do, nitrous oxide can be used to relax you enough to get the IV in. Alternatively or in addition to nitrous oxide, you can be offered an oral anti-anxiety pre-medication to put you into a more relaxed state. The area where the IV is can should be deeply numbed using topical anaesthetic (EMLA cream or AMETOP). For the best effect, EMLA should be applied an hour or two beforehand. AMETOP is even more powerful than EMLA. It is put in place 30 to 45 minutes beforehand and should not be left on for longer. The site will stay numb for 4 to 6 hours. It’s available without prescription and it’s cheap, but most pharmacies won’t have it in stock and will have to order it in for you. Here is a tip from one of our forum members:
AMETOP numbing cream. I have a mortal fear of needles, and I find injections unbearable. It doesn’t help being a redhead with sensitive skin. Every injection I’ve had in my life has been intolerable. However, my dentist managed to get the IV in without me even noticing. I actually just turned round and it was in. The stuff is that good. I did not even feel any pressure. You can get a tube of it from your pharmacist for a few pounds, and it needs to stay in the fridge. If you need proof, buy two tubes, and use one a couple of days before your operation, just to reassure yourself how deeply numb it makes you.
General Anaesthesia (GA)
This is a last resort and nowadays is only offered under extraordinary circumstances. In the UK, general anaesthesia is only used in hospitals. You can read more here: General Anaesthesia for Dental Treatment.
Focusing on the beneficial aspects of the injection
When you have a phobia of needles, you tend to focus solely on the possibility of pain from the needle penetration. It is easy to forget that the injection benefits you by eliminating any pain during dental treatment.
A lot of people will recall being dragged to the doctor by parents or caregivers to have the dreaded inoculations, and the dread and despair they felt at the prospect. Often the parent, caregiver or even the doctor will not have explained why the injection is being given (it will stop pain, make us healthy, protect from nasty illnesses etc) so the child may easily conclude that the infliction of pain is a punishment for something. Some parents or caregivers use their child’s fear of injections for exactly this purpose, recognising the desire to “do anything to get out of a visit to the doctor’s office” as a means of making the child comply – along the lines of “if you don’t behave, I’ll ask the doctor/dentist to give you a big jab”. Not surprisingly, such childhood memories will make you associate injections with punishment and foster increasing fear and mistrust of the doctor or dentist who wields the syringe.
It may be useful to think of the injection process as having two stages:
- the needle going in and
- delivery of the local anaesthetic or other medication.
As long as you can find a dentist who gives painless injections, there should be nothing at all to be feared from part one. And by making a conscious effort to remind yourself that the injection itself is beneficial and keeping it separate from the needle penetration, the whole process should be much more manageable.
There are various little things that can be done to make injections easier. For example:
- Some people find it easier to receive the local if they keep their eyes closed.
- Most dentists will chat to you while administering the local in order to distract you and keep the syringe out of sight.
- Listening to relaxation music during the injection can help (search for free apps in the App Store or on Google Play).
- Relaxation techniques can also be useful.
- Some people find Bach Flower Remedies useful (especially “rescue remedy”, but also “Rose Rock”, “Aspen” and “Mimulus”), even if the benefits may be due to a placebo effect. These are available without prescription in pharmacies and health stores.
- It can really help to have an appointment where you have only an injection and no treatment. This way, you only have to deal with one fear at a time. Dealing with more than one fear at a time can be overwhelming.
- American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, International Version 1995, Washington, DCAmerican Psychiatric Association
- Ayala ES, Meuret AE, Ritz T. Treatments for blood-injury-injection phobia: A critical review of current evidence, J Psychiatr Res, 2009, vol. 43 (pp 1235-42)