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similar environments, both can quickly resurface. 4 It has been reported that painless and/or less painful needle penetration, particularly at the beginning of an injection, can reduce at least some of the fear and anxiety dental patients experience. 2 , 4 , 5 A more effective topical anesthetic would have the potential for minimizing pain from injections, particularly at the beginning. Kosaraju and Vanderwalle 6 investigated a dental application method for the placement of a refrigerant topical agent. They concluded the refrigerant “was more effective than

alveolar nerve block, 3 Prediabetes, 208 Preinjection, 55 Propofol, 67, 80, 116, 147, 175, 185 Rabbit, 17 Radiographs, 95 Recovery profile, 175 Refrigerant, 55 Remifentanil, 116 Ropivacaine, 71 Salivary secretion, 185 Sedation, 67 Sensing, 95 Sevoflurane, 42, 175 Sex, 67 Solubility, 42 Tachyarrhythmias, 95 Takayasu arteritis, 31 Tetany, 25 Tooth extraction, 156 Topical agents, 55 Type 2 diabetes, 208

agents (refrigerants and anesthetics). Characteristics of pain associated with injections have been described as (1) irritation from the antiseptic used on the skin, (2) properties of the parenteral formulation, (3) sensitivity of the tissue at the injection site, (4) mechanical trauma caused by needle penetration into the tissue, and (5) distension resulting from discharge of the contents of the syringe. 4 , 5 Several clinical studies have shown that the application of topical anesthetic to dry oral mucosa for at least 2 minutes is effective in the reduction

Infiltration anesthesia is commonly performed for pain relief in clinical dentistry. However, the pain caused by this procedure itself is stressful for patients. Although various methods to alleviate pain during the injection of infiltration anesthesia have been compared, including slow injection speed, heating the cartridge, and using a refrigerant at the injection site, none provide consistent pain relief. 1 – 3 Topical anesthesia is often used to reduce the pain of infiltration anesthesia. Commonly used topical anesthetics with an

for Robertson et al, 2 the results of the current study are similar to the onset times recorded by the other 2 authors. In general, onset times for buccal infiltration of the mandibular first molar with a cartridge of 4% articaine with 1∶100,000 epinephrine would range from 4 to 7 minutes. Pulp testing the tooth with an electric pulp tester or a cold refrigerant will give the clinician a reliable indicator of onset of pulpal anesthesia. The Figure demonstrates the decline in pulpal anesthesia over 60 minutes for the initial infiltration plus the mock

its Components. The authors do not have any financial interest in the companies whose materials are discussed in this manuscript. REFERENCES 1.  Kosaraju A, Vandewalle KS. A comparison of a refrigerant and a topical anesthetic gel as preinjection anesthetics: a clinical evaluation . J Am Dent Assoc . 2009 ; 140 : 68 – 72

. 1989 ; 15 : 27 – 28 . 11.  Kosaraju A, Vandewalle KS. A comparison of a refrigerant and a topical anesthetic gel as preinjection anesthetics: a clinical evaluation . J Am Dent Assoc . 2009 ; 140 : 68 – 72 . 12.  Jayasuriya NSS

anesthesia. Therefore, in general, onset times for maxillary infiltrations with these solutions would range from 2–5 minutes. 1 – 10 , 13 – 15 , 17 , 18 Pulp testing of the tooth with an electric pulp tester or a cold refrigerant will give the clinician a reliable indicator of onset of pulpal anesthesia. Figure 1 demonstrates the decline of pulpal anesthesia over 60 minutes for the lateral incisor. For the 2% lidocaine with 1 : 100,000 epinephrine formulation, approximately 63% of subjects had pulpal anesthesia at 30 minutes, 47% at 45 minutes, and only