Painful Injections and Needle Phobia

Written by the Dental Fear Central Web Team and reviewed by Lincoln Hirst BDS
Last updated on January 17, 2021

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.

syringe


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. You may be afraid of dental injections in particular, or you may be afraid of any sort of needle. Some people are phobic to the point of avoiding injections at all costs (including their life).

Or maybe you are almost as scared of, or even more afraid of the numb sensation than of the injection itself.

This page has two main parts. The first, “What makes dental injections painful?”, explains what can cause injections to be painful. You can skip this if you don’t want to know all the nitty-gritty details. The second part, “What can I do about my fear of needles?”, gives practical tips.


Part 1: What makes dental injections painful?

Many if not most needle phobics have had at least one bad experience with an injection (interestingly, they often mention toe injections!). There are a number of reasons why a dental injection may be painful:

Giving the anaesthetic too quickly

This is probably the most common cause of injection pain. The most important thing is to give local anaesthetic S-L-O-W-L-Y:

Painful injections aren’t from the needle going in – which is virtually a hair’s breadth – but from the pressure of injecting the anaesthetic. I ask my patients to score my injections on a scale of 1 – 10 where 1 is they barely knew I had done it to 10 is the worst possible agony. Never had higher than a 3. Have had several 0s! Ask your dentist how they make sure the injections are comfortable – if they don’t know, or say it’s not possible, ask another one. – Celia Burns, BDS

Here’s an interesting anecdote from our dental advisory board member Mike Gow from his dental school days:

I can still remember my lecturer David Stenhouse standing on one side of the lecture theatre in Glasgow and arching a full cartridge of local anaesthetic across the lecture room, reminding us that actually, with what seems like not a huge amount of pressure, stuff will come out the tip very fast and quite traumatically, if you’re not careful.

You can see how important it is to go slow with the local anaesthetic!

Location

An injection is more likely to cause pain when you give it into dense and tight tissue. Whereas when you give it into loose tissue, it tends to be barely noticeable.

The tighter the tissue, the more slowly one needs to go. That’s because the liquid has to find some free space. And squeezing the liquid too quickly into dense tissues can cause them to tear. This results in pain, followed by soreness.

Here’s an 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 other places, such as the palate, tissues are denser. Here, technique becomes much more important for delivering painless injections.

It’s difficult to say exactly how long a comfortable injection should take because this varies a lot between different injections sites and techniques.

Not using a topical anaesthetic (numbing gel)

While it’s possible to give local anaesthetic painlessly without numbing gel in some areas of the mouth, one should always use it for injections which could otherwise be painful. It really works, if it’s 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”.

The trick of applying pressure comes in really handy in areas such as the palate, where giving painless injections is more difficult.

Causes of Burning Sensation during Injection

There are 2 main reasons for a burning sensation during an injection:

  • putting in the local anaesthetic too quickly (see above)
  • the pH of the local anaesthetic solution is lower (more acidic) than the pH of your soft tissues.

Most of the time, there won’t be a burning sensation. But if it does happen, it may be useful to know that the burning feeling will disappear within seconds as the tissues become numb.

The problem can be avoided by first numbing up the area with a fairly pH-neutral local anaesthetic (such as Scandonest Plain 3%). This can then be topped up with another local anaesthetic if needed.

Lack of empathy

Perhaps surprisingly, the very first injections dental students give to their classmates in dental school tend to be painless. But often, their injections become more uncomfortable as time goes on. Dental students apparently are surprised at how painless those first injections are because some have experienced painful injections in the past when they were patients3. The most likely explanation is that the students went out of their way to make the injection comfortable. They would have known that they’d be on the receiving end next. Not just that, but they’d have to face their classmates for the rest of their time at dental school!

Two hands about to touch, signifying empathy

“Taking turns” fosters empathy, but this empathy is sometimes lost as people move out of dental school, the job becomes routine and they’re under time pressure. It can also be a defence 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!

Using a dull needle

This has become much less of an issue, because nowadays dentists use disposable needles. But in years gone by, it used to be a common cause of painful injections. The problem can still arise today with multiple injections.

If you remember painful injections many years ago, the type of needle used back then may well have been the cause! Modern dental needles are much finer and better designed.

Bevel design

Some brands (e.g. Septodont) have introduced better bevel designs, to help them slip into the tissue easily.

Wrong angle of the bevel

The bevel (the tip of the needle) should be oriented correctly towards the bone for a comfortable injection.

Type of injection

Some types of injections can be difficult to do without causing any discomfort. You can’t guarantee that every injection will be 100% painless. But any discomfort can be minimised by

  • making sure topical anaesthetic is left on for long enough to work properly
  • injecting very slowly, and
  • applying pressure for certain types of injections.

Such injections are easier to give without causing discomfort using a computer-assisted injection system such as the Wand.

Further reading

Animated-teeth.com have some very detailed information on this topic: Why do some shots hurt and others not so much?


Part 2: 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.

By and large, dentists tend to be amazingly truthful about their ability (or inability) to make dental injections comfortable. Here’s a tip straight from a dentist:

Ask your dentist how they make sure the injections are comfortable. If they don’t know, or say it’s not possible, ask another one. – Celia Burns, BDS

Simples!

Numbing Gel

Topical anaesthetic comes in lots of yummy flavours, though the plain flavour works just as well! Numbing gel can be a real game-changer if your fear is the initial going in of the needle. The key is to leave it on for long enough to take effect. This is especially true for lower back and upper front teeth. You might even want to do a practice run:

For people like me who truly loathe any type of shot, 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 of years ago, I firstly would have had my filling taken care of pronto. But it would also 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 numbing gel!

Computer-assisted injection systems (The Wand, QuickSleeper)

See if your dentist offers any of the following computer-assisted injection systems:

  • The Wand® STA
  • Quicksleeper 5 (more common in Europe and the UK)
  • Comfort Control Syringe, or CCS (more common in the USA)
  • Dentapen electronic syringe (a newcomer from Septodont).

The Wand STA is by far the most common system in the UK. Many people on our forum have said that they found The Wand hugely helpful for their needle phobia. It pretty much guarantees painless injections, because a computer controls the speed of the injection. And the few injections which could potentially be uncomfortable, even in skilled hands, can be done quite comfortably using the Wand.

Photo of the Wand STA system

Other computer-controlled injection systems use similar technology.

Vibraject

The vibraject is a small vibrating device which attaches to a standard syringe. The feeling of vibration competes with other sensations, and does away with injection pain.

Working with a Psychologist

Maybe you have a phobia of injections more generally, and the mere thought of needles terrifies you. In that case, it can be a great idea to work with a clinical psychologist to reduce the fear.

There are many techniques that can be used. Among them are systematic desensitisation, deep breathing, visualisation and guided imagery, positive affirmations, hypnosis, and reward systems. The added bonus is that some therapists who specialise in phobias and anxiety work together with phobic-friendly dentists. That way, you won’t have to search for a suitable dentist, once you’re ready for it.

Working with a Dentist – Desensitisation and Systematic Desensitisation

Systematic desensitisation 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 what you fear.

If this is a method you fancy, make sure your dentist of choice is familiar with it.

You can find detailed examples of needle phobia desensitisation here.

Sedation

If you are phobic of dental injections, inhalation sedation, oral sedation or IV sedation may be the way to go. Even if you have a needle phobia, there is often a way of making IV sedation work for you.

General Anaesthesia (GA)

These days, GA is only offered as a last resort. In the UK, it cannot be used outside of 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 only focus 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 the doctor will not have explained why the injection is necessary. So the child may conclude that the infliction of pain is a punishment for something. It’s important to let the child know about the positive aspects of an injection – it will stop pain, make us healthy, protect from nasty illnesses, and so on.

Some parents or caregivers use their child’s fear of injections as a means of making the child comply. They may use threats such as “if you don’t behave, I’ll ask the doctor or dentist to give you a big jab”. Not surprisingly, such childhood memories will make you associate injections with punishment, and foster fear and mistrust of the person who wields the syringe.

Break it up

It may be useful to think of the injection process as having two stages:

  1. the needle going in and
  2. delivery of the local anaesthetic or other medication.

As long as you can find a dentist who gives painless injections, there should be nothing 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.

Little things

There are various little things that can be done to make injections easier. For example:


Visit our support forum to get help with this and other fears, or to simply get things off your chest!

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Sources of Information

  1. American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, International Version 1995, Washington, DCAmerican Psychiatric Association[]
  2. 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)[]
  3. Malamed, Stanley (2019). Handbook of Local Anaesthesia. Chapter 11: Basic Injection Technique[]