Local Anesthesia in Pediatric Dentistry
Anesthetization of the Palatal Tissues

Palatal tissue anesthesia is necessary for procedures involving manipulation of the palatal tissues, i.e., extractions, gingivectomy and labial frenectomy. Unfortunately, it is one of the most traumatic and painful procedures experienced by a dental patient during treatment. The following techniques should aid in reducing patient discomfort and in a small number of cases eliminate it entirely. Malamed recommends that the clinician forewarn the patient that there might be discomfort, so they are mentally prepared. If the experience is atraumatic, the patient bestows the “golden hands” award on the clinician. If pain is experienced, the clinician can console the patient with “I’m sorry. I told you it might be uncomfortable” (avoid the “hurt” word).

The steps in atraumatic administration of anesthesia in all palatal areas are:

• Provide adequate topical anesthesia (at least 2 minutes) in the injection area. The applicator should be held in place by the clinician while applying sufficient pressure to cause blanching.
• Use pressure anesthesia at the injection site before and during needle penetration and solution deposition. The pressure is maintained with a cotton applicator with enough pressure to cause blanching.
• Maintain control over the needle. The use of an ultra-short needle will result in less deflection and greater control. A finger rest will aide in stabilizing the needle.
• Inject the anesthetic solution slowly. Because of the density of the palatal soft tissues and their firm adherence to the hard palate there is little room to spread during solution deposition. Slow injection reduces tissue pressure and results in a less traumatic experience.