Reducing the pain and discomfort of dental procedures should be a high priority for dentists in all specialties. The use of anesthesia can actually determine how a patient feels about their office visit more than the skill of the dentist and outcome of the procedure. With the use of a topically applied anesthetic, a procedure can be made pain-free and comfortable. Patients who have a pain-free experience at their dental visit are more likely to have a positive image of their dentist and refer their friends and family. Routine dental care, whether it is for scaling and root planing or a regular cleaning, is often avoided simply due to anxiety about pain. This pain can be reduced with the use of topical anesthetic gels.
Compound topical anesthetics are used for a variety of procedures including:
- Scaling and root planing
- Soft tissue and palatal procedures
- Pre-injection numbing
- Placement of orthodontic Temporary Anchorage Devices (TADs)
- Taking impressions and intra-oral radiographs
Scaling and Root Planing
Scaling and root planing (SRP) can be painful and a majority of patients report that they experience pain during their treatments. The initial periodontal probing of untreated and inflamed tissue can be especially painful. Topical anesthetic gel can be applied using an oral syringe in all areas that will be probed.
Patients with periodontal disease must return regularly for maintenance visits. For patients who must return to the office on a schedule, an effective topical anesthesia can make them more likely to keep their appointments. If appointments are missed and periodontal disease goes untreated it will worsen and the next follow-up appointment can be even more painful.
The most common adverse reactions associated with administering local anesthetic are due to a patient’s anxiety. Symptoms induced by anxiety can include fainting, nausea, and hyperventilation. Because of their similarity to an allergic reaction, these psychogenic symptoms can sometimes be misdiagnosed. In fact, although allergic reactions to local anesthetic are often reported by patients they tend to be due to psychogenic factors not allergies. Using a topical anesthetic gel prior to injection of local anesthetic can help reduce these adverse reactions. The less pain and discomfort a patient feels the less anxiety they will have.
About 1 out of 4 adult patients fear dental injections and more report experiencing pain during their last injection. A majority of patients, if given the choice, would prefer to have an anesthetic gel over a local injectable anesthetic. One study showed that patients were willing to pay more to have a dental anesthetic gel available to them.
For placement of temporary anchorage devices and other orthodontic procedures a topical anesthetic can be a great way to reduce pain while avoiding local anesthesia. For most orthodontic procedures injection of local anesthesia is not necessary. However topical numbing can be useful for many mildly invasive procedures including miniscrew insertion and band seating.
One treatment that orthodontists frequently use our topical anesthetic gels for is Propel. The Propel method accelerates orthodontic treatment by making small perforations in the bone to stimulate cellular activity. The protocol calls for the use of either “The Baddest Topical in Town” (BTT 12.5) or Profound gel before the procedure.
Taking Impressions and Intra-Oral Radiographs
Impressions can sometimes be stopped by patient gagging. Tetracaine lollipops have frequently been used to prevent gagging when taking impressions. Topical anesthetic ointments can also provide effective numbing when applied with a Q-tip to the palate and back of the tongue. It can be useful to have an anesthetic available for this purpose with a flavor to make it more palatable.
Topical Anesthetic in Place of Local Anesthetic
For some procedures local anesthetic and a topical numbing gel is sufficient. A tooth extraction in a pediatric patient likely does not require local anesthetic but a topical anesthetic can make the experience much easier. Topical anesthetic compounds usually will have much higher strengths than injectable local anesthetics in order for them to be effective when applied to mucosal barriers. Even though overdose reactions can occur with a topical they are much less common than with injectable anesthetics.
Many states require supervision by a dentist for local anesthesia but not for application of topical anesthesia. That makes compound topical anesthetic gels especially popular with hygienists. A gel or mouth rinse can make treatments easier for patients who are sensitive to dental tools or who are nervous about their visit.
Combining Ingredients for a Better Topical Anesthetic
Eutectic mixtures of anesthetics can provide more effective anesthesia than one anesthetic used alone. Topical anesthetic gels can include multiple ingredients in different strengths. Lidocaine, tetracaine, and prilocaine are the most commonly used anesthetics that are combined. A vasoconstrictor like phenylephrine is also added to many formulations to improve the effectiveness of anesthetic ingredients.
Phenylephrine is added to slow the rate of absorption of the anesthetics into the blood stream. This increases the amount of time the anesthetic stays in the area where it is applied. It also reduces the risk of toxicity that may occur through excessive systemic absorption.
The addition of phenylephrine may not be recommended for gels that will be used for periodontal disease treatments where there is excessive inflammation. A vasoconstrictor can make an already acidic area even more acidic, which can lead to difficulty in obtaining anesthesia.
There are other topical anesthetics for dentists besides gels or ointments. Dyclonine is a topical anesthetic made in solution form that can be used as a rinse prior to a procedure. The patient swishes the solution around, which provides topical anesthetic to the entire mouth. Hygienists find this to be a useful product to have for cleanings as it makes sensitive patients feel more comfortable. Dyclonine can also be combined with chlorhexidine to both anesthetize and improve healing.
Some Tips for Using Topical Anesthetics
There are multiple ways that topical anesthetic gels can be applied. A gel can be applied with a plastic oral syringe while an ointment is often applied with a Q-tip. A piece of gauze placed on top of a gel can hold it in place and prevent anesthetic from reaching the back of the throat. Topical anesthetics can also be placed directly on the gauze, which is then placed on the area to be numbed. In all situations a topical anesthetic should only be applied to the area that will be treated or the injection site. Most topical anesthetics should be left on for about three or four minutes then removed to prevent sloughing and irritation.
Popular Compound Topical Anesthetics
Woodland Hills Pharmacy provides a variety of custom topical anesthetics for use in dentistry. Our highly trained pharmacists meet the needs of dentists and orthodontists seeking effective anesthetic solutions for their practice. All of our compound topical anesthetics are available in five different flavors in either an extra thick gel or plasticized ointment base. These are some of the more
popular combinations of anesthetics and strengths that we make for dentists at our pharmacy.
TAC 20 Alternate: lidocaine 20%, tetracaine 4%, phenylephrine 2%
BTT 12.5 “The Baddest Topical in Town”: lidocaine 12.5%, tetracaine 12.5%, prilocaine 3%, and phenylephrine 3%
Profound (PFG): prilocaine 10%, lidocaine 10%, tetracaine 4%
PFG Lite: prilocaine 5%, lidocaine 5%, tetracaine 2%
PFP: prilocaine 10%, lidocaine 10%, tetracaine 4%, phenylephrine 2%
Comparison of Popular Topical Anesthetic Compounds
Order Your Topical Anesthetic Gels Today
Topical anesthetics have a wide range of uses in dentistry and can be an effective way to improve patient experiences. Letting a patient know that they will have a topical anesthetic to make their procedure more comfortable can immediately decrease anxiety. For both dental professionals and patients, topical anesthetic gels with multiple effective ingredients combined can make procedures easier and improve outcomes. If you are interested in learning more about available formulations or have questions for a pharmacist, gives us a call at 855-876-3060 or fill out our contact form.
Note: All compounded products require a prescription. There is no compounding without a prescription for “office use” per FDA regulations.