View Full Version : Needle Phobia

12-20-2006, 11:55 PM
The Problem:
"I'm terrified of dental injections. They hurt like hell! The syringe looks like a medieval torture instrument, and the needle is about 10 inches long!"
"I'm completely terrified of all needles. It's the thought of shots that I can't tolerate, to the point where I avoid them even when they are absolutely necessary."

The facts about needle phobia
If you're very anxious about needles, you're not alone! The Adult Dental Health Survey (UK) 1988 stated that 8% reported a fear of injections (Todd & Lader 1991). Some studies suggest that almost 5% of the population may be phobic of needles in general.
The level of fear varies from person to person, and some people are afraid of dental injections in particular, while others are phobic about any sort of needle. Some people are phobic to the point of avoiding injections at all costs (including their life).
Thankfully, there are various methods of help available.
Local anaesthetic administration can be entirely painless (I can say this with absolute certainty because I've never had a painful dental injection in my life! I've read all about them, though.)

Causes of Painful Dental Injections
Most needle phobics have had a very bad experience with an injection. There are various reasons why a dental injection may be painful:

Lack of empathy:
Perhaps surprisingly, the very first injections dental students give to their classmates in dental school are painless, but oftentimes, their injections become increasingly uncomfortable as time goes on. Interestingly, dental students are surprised at how painless those first injections are, because some have experienced painful injections in the past when they were patients. The most likely explanation is that the students went out of their way to make the injection painless (knowing that they would 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.
Not using a topical anesthetic (numbing gel):
While it is possible to give painless injections without numbing gel in some areas of the mouth, numbing gel should always be used for injections which would otherwise be traumatic. It really works, if it is left on for long enough - the soft tissue will be so numb that you cannot feel the needle going in.

Using a dull needle
This has become very rare nowadays, because disposable needles are used, but it used to be a common cause of painful injections. The issue can still arise today with multiple injections - the needle should be changed after 3 or 4 penetrations.

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 (using a finger or a q-tip) 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".
Applying pressure is particularly important in areas where painless injections are more difficult, especially the palate.

Administering the anaesthetic too quickly:
This is the most common cause of injection pain. Quite a few dentists administer local anesthetic too rapidly. Rapid injections can tear the tissue, which results in immedate pain followed by soreness. It's difficult to say exactly how long a comfortable injection should take, because this varies a lot between different injections sites and techniques.

Type of injection:
Some types of injections (not the most commonly used ones) can be very difficult to do without causing slight discomfort. It's not possible to guarantee that every injection will be absolutely painless. But discomfort can be minimized by making sure topical anesthetic 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 the Wand.

You will need to find a dentist who truly believes that injections do not have to be painful. These dentists (consciously or subconsciously) will have developed techniques that make dental injections as painless as possible.
By and large, dentists these days tend to be amazingly truthful about their ability (or inability) to give painless injections. But if you want to know without having to go in there and ask, the best way of finding a dentist who gives comfortable injections is by asking other people for recommendations. It's a good idea to ask your potential dentist outright if s/he can give painless injections, and if they use numbing gel.

Causes of Burning Sensation during Injection
A burning sensation during an injection can be the result of firing in the local anesthetic too quickly (see above). But more commonly, it's because of the difference in pH value between the local anesthetic solution and the soft tissues in the mouth.
The duration of this sensation is only a few seconds - it's not particularly painful, and many people aren't even aware of it. But if you do feel some burning: the reason for the sensation is simply that the pH of the solution is lower than the pH of the tissues, and the sensation disappears within seconds as the tissues become numb.

What can I do about my fear of needles?
Depending on your fear or phobia, there are various methods of help available:

Numbing Gel
Topical anesthetic can come in lots of yummy flavors, though the plain flavor works just as well! Numbing gel can be a real eye-opener if your fear is the initial penetration of the needle. The wide availability of numbing gel nowadays has meant that lots of people have lost their fear of injections.

The Wand
The Wand has been hugely recommended by some needle phobics who've visited this site. The Wand virtually guarantees painless injections, because the speed of injection is controlled by a computer. And the few injections which could potentially be uncomfortable, even in skilled hands, are possible to do quite comfortably using the Wand.
In addition, it looks nothing like a syringe! So if the sight of the needle is a major turn-off for you, this may be your ticket...

Little Things...
There are various little things that can be done to make injections easier. For example:
• Some people find it easier to receive an injection if they keep their eyes closed.
• Most dentists will chat to you while administering the local in order to distract you and keep your mind off it.
• Some people find Bach Flower Remedies useful (especially "rescue remedy", but also "Rose Rock", "Aspen" and "Mimulus"). These are available without prescription in pharmacies and health stores.
• Self relaxation techniques can also be useful.
• It can really help to have an appointment where you have only an injection and no treatment. This way, you only have to deal with one fear at a time. Dealing with more than one fear at a time can be overwhelming.

Working with a Psychologist
It can be a great idea to find a psychologist who will work with you to reduce or eliminate your fear of needles. There are many different approaches and techniques, often used in combination, which will allow you to become less scared of injections.
Among them are hypnosis, systematic desensitization, deep breathing, visualization and guided imagery, positive affirmations, and reward systems. The added bonus is that some therapists 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.
If you suffer with a general, intense phobia of needles, working with a qualified psychologist is the method of choice.

Desensitisation and Systematic Desensitisation
This technique can work really well also for more severe needle phobias. But you need to be open to the idea. Some people "don't want to know", and this technique requires you to actually expose yourself to the "noxious stimulus".
The problem is that relatively few dentists are trained to use it. So if this is a method you fancy, make sure your dentist of choice is familiar with it (or a similar technique).
Desensitisation is when anxiety is reduced by gradually getting used to the things that cause fear. In the case of dental injection phobia, the order might be something like this:
1. You are shown the numbing gel (the least threatening stimulus).
2. Some numbing gel is put onto your gums, so that you can try it. It is explained that this makes the tissue numb so that the needle can pass painlessly into it.
3. You are shown and allowed to hold the cartridge that contains the local anesthetic solution, which looks like water. You then get an explanation how it works.
4. You are shown the syringe and encouraged to hold it, and maybe figure out how to insert the cartridge.
5. Once you are comfortable with this, you can have a look at the needle if you think you can manage. You can see how small the tip is, and you might be shown how easily it glides into things. A cap is put back onto the needle immediately afterwards.
6. If you feel you are ready, the next big milestone is the "cap on" practice. Here, you practice the first step again (putting on the numbing gel), and then your dentist holds the needle (with the plastic cap on!) against your mucosa. This step is repeated quite a few times, until you feel fully comfortable.
7. When you have built up enough trust and rapport to want to move on, the same thing is repeated with the "cap off" the needle. No injection is given.
8. Once you are happy to take the final step, you can give consent to try a gentle injection. Obviously, numbing gel will have to be reapplied beforehand.
The steps above are an example of desensitisation, and it may take anything from half an hour to three appointments to get to step 8.
Systematic desensitisation is essentially the same, except that a relaxation exercise is built in. For example:
1. You may be asked to imagine you're in a car looking at the speedo. The faster the speed, the more nervous you feel. Then you try to imagine lowering the speed and thus lowering your anxiety.
2. Then, you and your dentist get an empty syringe with no needle on it. That goes to your mouth, you have to lower the "speed" as the two of you are doing it. This is repeated 5 or 6 times until you are completely relaxed.
3. Then you "escalate", the needle is attached but with the cap on, and the same is repeated until you've lowered the speed so that you feel completely relaxed.
4. The same is repeated with the local anesthetic cartridge in the syringe, but with the needle still capped.
5. Then, the cap is taken off the needle but the needle isn't inserted.
6. And so on...
All this would take a dentist skilled with this technique about half and hour.
IV Sedation (with nitrous oxide)
If it's the thought of needles that has you terrified, and you simply do not want to be aware of injections, then IV sedation may be the way to go. Most severe needle phobics are able to tolerate dental injections that way. If you suffer with generalized needle phobia, nitrous oxide can be used to relax you enough to tolerate the venflon necessary for IV sedation. The area where the venflon is put can be deeply numbed using topical anaesthetic (EMLA cream or Ametop). For the best effect, EMLA should be applied an hour or two beforehand.

General Anesthesia
This is a very last resort, if everything else has failed. GA involves a certain amount of risk, and it should not be chosen lightly. Also, while it can be useful for things like extractions, it's not ideal for things like fillings and other restorative work (due to technical issues).