The effectiveness of topical anesthesia to reduce needle insertion pain has been met with mixed results. In our study, topical anesthetic effectiveness was found to be related to the location of the injection. For the inferior alveolar nerve block injection (Figure), no significant difference was found between the no pain/pain ratings when topical anesthetic was used. Our results and those of Nakanishi et al and Meechan et al agree on the lack of effectiveness of 20% benzocaine in reducing pain during needle insertion in the pterygomandibular raphe area when using a 27-gauge needle for an inferior alveolar nerve block. Similarly, topical anesthetic did not significantly reduce the pain of needle insertion over the maxillary first molars (Figure).

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A total of 1080 patients with a mean age of 25 years (range 18-49 years) participated in this study and received a total of 2336 injections. There were 1635 injections (1121 men/514 women) in the inferior alveolar nerve block group with an age range of 18-49 years (mean = 25), 279 injections (197 men/82 women) in the maxillary first molar infiltration group with an age range of 19-43 years (mean = 26), and 422 injections (297 men/125 women) in the maxillary lateral incisor infiltration group with an age range of 19-43 years (mean = 26). Within the inferior alveolar nerve block group, 470 injections received topical anesthetic prior to needle insertion, whereas 1165 did not. In the maxillary lateral incisor infiltration group, 128 injections received topical anesthetic and 294 did not. In the maxillary first molar infiltration group, 122 injections received topical anesthetic prior to needle insertion and 157 received none. The age and sex of each subject, by individual injection within the topical and no topical groups, was not recorded in the original studies.
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A total of 1080 adult patients participated in this study. They received a total of 2336 injections. Patients included in this retrospective study were participants in 25 independent, cross-over anesthetic research studies conducted at The Ohio State University. All patients were in good health as determined by a written health history and oral questioning. No patient was taking any medication that would alter pain perception. All patients were asymptomatic and volunteered for participation in their respective studies. The Ohio State University Human Subjects Committee approved each study, and written informed consent was obtained from each patient. Patients received either a conventional inferior alveolar nerve block, an infiltration over a maxillary lateral incisor, or a maxillary infiltration over a first molar. A 27-gauge needle was used for each injection.

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Fear of the needle has been reported as one of the major causes of apprehension in dental patients. Patients have reported that the feeling of the needle being inserted into the tissue is a chief source of anxiety. Empirically, it makes sense to attempt to reduce this source of anxiety and assure the patient that everything possible is being done to make their appointment comfortable. Topical anesthesia has been advocated for the reduction of a patient’s anxiety and pain.

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