Tips for Successful Injections for the Dental Hygienist

The only thing more stressful than giving an injection, is giving it and it doesn’t work for you patient. Has this happened to you before? I definitely have. It isn’t fun to have something not so fun for a patient, like an injection, not take and have to redo the procedure for the patient. Here are some helpful tips to keep you as a dental hygienist in top shape as you give injections during your clinical day.

1. Know Your Anatomy Inside and Out

• Review landmarks for each injection frequently (we have lots of helpful videos on this to review!)

• Palpate before inserting the needle to confirm anatomy.

• Be aware of anatomical variations that may affect success (e.g., high mandibular foramen, bifid nerves).

2. Practice Confident Patient Communication

• Explain the procedure calmly and clearly, without alarming words.

• Reassure patients by describing what to expect in neutral or positive terms ("You’ll feel a small pinch, then some pressure.").

• Ask about previous anesthesia experiences and address fears proactively.

3. Positioning is Key

• Position the patient so the injection site is at your elbow level for better ergonomics.

• Have the patient open just enough—not excessively—for better access and comfort.

• Ensure your own posture is stable to avoid unnecessary hand movement during injection.

4. Use a Gentle, Controlled Technique

• Apply topical for at least 1 minute with pressure for deeper penetration.

• Stretch the tissue to stabilize it and reduce discomfort.

• Insert the needle slowly and steadily—don’t rush.

• Aspirate to avoid intravascular injection, and always re-aspirate if repositioning.

5. Deliver the Anesthetic Slowly

• Administer the anesthetic at a rate of about 1 mL/min or slower.

• Slow delivery significantly reduces discomfort and post-injection soreness.

6. Choose the Right Anesthetic and Volume

• Match anesthetic type and dose to the planned procedure (e.g., 4% articaine for short, profound anesthesia; 0.5% bupivacaine for longer procedures).

• Consider patient medical history when selecting vasoconstrictors.

7. Confirm Anesthesia Onset

• Test the area with a blunt instrument before beginning treatment.

• Ask the patient if their lip, cheek, or tongue feels numb depending on the injection given.

8. Manage Anxious Patients Thoughtfully

• Use distraction techniques (wiggling the lip, verbal cues, visualization).

• Consider using topical anesthetics with pleasant flavors to improve patient comfort.

• For needle-phobic patients, consider sedation referrals or alternative pain management if appropriate.

9. Be Ready for Failures and Have a Backup Plan

• Know the alternate techniques for missed blocks (e.g., Gow-Gates or Vazirani-Akinosi if IA fails).

• Be prepared to repeat or supplement injections if needed, but allow adequate onset time before assuming failure.

10. Reflect and Learn

• If an injection was difficult or didn’t succeed, take time to reflect:

  • Was the needle placed correctly?

  • Was enough anesthetic delivered?

  • Was there an anatomical variation?

• Use each experience to build clinical confidence and skill.

We know you can do it with a bit of reflection and practice! Happy injecting!

xoxo Melia Lewis, MEd, RDH