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. 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 sections. The first, “Are 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 section, “What can I do about my fear of needles?”, gives practical tips.
Are 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 various reasons why a dental injection may be painful:
Administering 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.
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 (knowing that they’d 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 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 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 and better designed.
Some brands (e.g. Septodont) have introduced better bevel designs, to help them slip into the tissue easily.
Incorrect 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 (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 one can minimise discomfort 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 a computer-assisted injection system such as the Wand.
Animated-teeth.com have some very detailed information on 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.
By and large, dentists tend to be amazingly truthful about their ability (or inability) to make dental injections comfortable. We’ve already mentioned this once, but it’s important enough to say again:
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
Topical anaesthetic comes in lots of yummy flavours, though the plain flavour (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 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 topical anaesthesia!
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 computer-assisted injection system in the UK. Many people on our forum have commented that they found The Wand hugely helpful in getting over their needle phobia. It virtually 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, are possible to do quite comfortably using the Wand.
Other computer-controlled injection systems use similar technology.
Another gadget which helps eliminate injection pain, this small vibrating device attaches 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
If you have a phobia of injections more generally, and it is the thought of needles that terrifies you, it can be a great idea to get the support of a clinical psychologist who will work with you 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, 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.
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 the noxious stimulus.
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 terrifies you, and you feel you simply cannot handle the idea of being aware of injections, then IV sedation may be the way to go. Even if you have a generalised, severe needle phobia, there is usually a way of making sedation work for you.
How to get the IV in if you have a needle phobia
You can use nitrous oxide to relax you enough to get the IV line in.
You can also take an oral anti-anxiety pre-medication to make you feel more chilled.
Important: put topical anaesthetic (EMLA cream or AMETOP) on the area of skin where the IV will go in (discuss with your dentist beforehand to make sure you know where!). This will deeply numb the area.
- EMLA cream: for best effect, apply EMLA cream an hour or two beforehand.
- AMETOP is even more powerful than EMLA. Rub it onto the area you want to numb 30 to 45 minutes beforehand, then remove. The site will stay numb for 4 to 6 hours.
These are available without prescription, although your dentist or GP may be able to prescribe it for you. Most pharmacies won’t have AMETOP 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 available under extraordinary circumstances. In the UK, general anaesthesia can only be 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 necessary (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 as a means of making the child comply – by using threats such as “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 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:
- the dentist chatting to you while giving the injection
- keeping the syringe out of sight
- keeping your eyes closed if you prefer
- listening to relaxation or other music during the injection
- other distraction techniques
- relaxation techniques, especially beforehand (hardly anyone is composed enough to use them during the event)
- Bach Flower Remedies (especially “rescue remedy”, but also “Rose Rock”, “Aspen” and “Mimulus”), which are available without prescription in pharmacies and health stores. It may be a placebo effect, but if they work for you, why not use them?
- have an appointment where you have only an injection and no treatment. That way, you only have to deal with one fear at a time. Dealing with more than one fear at a time can be overwhelming.
Visit our support forum to get help with this and other fears, or to simply get things off your chest!
You may also like:
- 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)
- Malamed, Stanley (2019). Handbook of Local Anaesthesia. Chapter 11: Basic Injection Technique