Cleo,

Do you know what a palatal injection is? Have you ever had one?

These injections are referred to as nerve blocks and even with the best technique, they can be uncomfortable and perhaps even painful. Also, the interpretation of the experience will differ from one person to another for many, many reasons.

The palate is a very sensitive area of the mouth and the tissue covering the palate is very thick, very fibrous and very tightly connected to the underlying bone. In order to penetrate the palate well enough to infiltrate the pathway of nerves with the anesthetic the needle has to be pushed far enough in or the anesthetic will not be effective. Some people feel the needle going in, while others do not. Sometimes it will feel sharp, other times it won't.

Based on what the poster stated, she was very nervous, in pain, and had an inflamed and infected tooth. Her dentist gave her a poor impression of himself as he seemed to have little compassion for her anxiety. All of those physical and emotional things happening at the same time will cause an elevation in her cortisol (adrenaline). The combination of heightened cortisol, pain and fear will cause the psycho-biological nervous system to become more sensitive or acute making everything and anything very uncomfortable.

There are techniques that can be used to try and reduce the discomfort during a palatal injection. However, we really don't know if they were used or not by this dentist because his poor attitude was perceived as sadistic. You cannot always use pain as an indicator of something bad happening. But when you are in a heightened state of fear, any pain will be perceived as bad.

I am not condoning this guys chair side manner or his lack of compassion. I feel he could have and should have been more caring and obliging to this patient. I also cannot vouch for his skill or the technique that he used because I was not there.

There is no such thing as a "normal" injection when talking about anatomy or pain as everyone's anatomy is a bit different and everyone perceives pain and discomfort differently. An injection can be given according to the textbook and still end up wrong due to that patients anatomy. Because we cannot see through the skin to visualize the nerve pathways, we have to assume that they are at least somewhat in the vicinity of where they are suppose to be.

It is not unusual for a dental patient to move, jump or wince during an oral injection. After all, a needle is being put into a sensitive area of the body and the perception of that can be quite disturbing. It is also not unusual or automatically harmful to feel pain, stinging, burning or other radiating pain during an oral injection. At the same time, any or all of those sensations can be indicative of a nerve injury.

I am well aware that injection injuries do occur and acknowledge that they are often un-diagnosed or misdiagnosed. I think it is important that a dental patient make their dentist aware if they have searing pain during an injection either during the injection or after so that it is written up in their chart just in case there are lingering problems.

I am also aware that some dentists give lousy, careless injections. But the majority of dentists tend to be concerned about the ramifications and although they may not be gentle with the injection, they still deliver it properly.

Dentistry is complicated due to the different anatomical features from one person to another. So it's important to keep in mind that as a lay person naturally one would assume anything out of the "textbook norm" would be injurious. But in reality, that's just not the case at all.

Bryanna