Palatal anesthesia: comparison of four techniques for decreasing injection discomfort.

Abstract

Introduction: The aim of this study was to evaluate the patient's perceived pain response to injection and anesthetic deposition for the greater palatine nerve block.

Methods: Heft-Parker Visual Analog Scale (VAS) pain scale measurements were used to compare the following techniques for the injection: (1) control (no concurrent stimulation), (2) pressure, (3) pressure and topical anesthetic (20% benzocaine), and (4) pressure and cold (TFE). Forty-two volunteers, 21 male and 21 female, participated in the study. A bilateral model was used on each patient to give an injection on each side of the palate with two different techniques followed by the next appointment (> or = two weeks later), when the two other injection techniques were used. Following injection given in the supine position, the patients were returned to an upright position and asked to rate their pain on a VAS.

Results: Pain upon needle insertion appears less than that of anesthetic deposition. There was no statistically significant difference in perceived pain response among the four techniques, the visit, the order, the side, or patient gender at either time point. Following the application of Endo Ice, 81% of participants reported a sore on their palate occurring two to 48 hours after cold application and persisting for one to 10 days. The pain score for this injection had a mean value of 30% (51.4/170).

Conclusions: This prospective, single-blind study evaluating three injection techniques to reduce posterior palatal injection pain to a control injection method showed no significant reduction in pain with any of the three techniques. Furthermore, 1,1,1,2-tetrafluoroethane placed with pressure for 10 seconds appeared injurious to the oral mucosa.