Patients consistently cite pain as one of their main concerns about receiving dental treatment. In a survey by Dental Law, 42% of patients said the fear of pain was the aspect they most disliked about visiting the dentist. In the UK, 36% of people are believed to suffer from dental fear or anxiety and a further 12% have a dental phobia, with pain believed to play a significant role.

Dentists are very conscious of this and recognise the need to manage their patients’ pain. When interviewed by Septodont, a cohort of dentists from across the United States and Europe rated the importance of anaesthesia as 9.4 out of 10. Pain-controlled patients, they told us, are more relaxed, easier to treat, more likely to return, and more likely to recommend the dentist to others.

Despite this awareness, it seems that dentists are missing a golden opportunity to provide a pain-free, satisfying treatment experience: topical anaesthetic.

Topical anaesthetic is used to numb oral tissues prior to dental treatment. Affecting the superficial mucosa, it can reduce the sensation of pain while conduction or infiltration anaesthesia is administered by injection. It can also facilitate treatments like root planing in the presence of inflammation, or superficial submucosal abscess incision, among many other applications.

When used as a pre-injection anaesthetic, for example, products like Septodont’s Xylonor Spray, X’Ogel or Projel-20 are fast-acting and effective with an excellent safety profile. This seems like an easy win for both the patient and the dentist. And yet, only a third of the dentists we interviewed said that they used topical anaesthesia before giving the patient an injection. In one country, topical anaesthetics were given to only 7% of patients.

As we emerge from an incredibly damaging pandemic, many dentists are struggling to stay financially viable. Now more than ever, each product used in the operatory must earn its place. Topical anaesthetics, it could be argued, are an expense that should be reserved for only the most exceptional cases.

While that’s a valid concern in these difficult times, it fails to take into account the long-term business benefits to be gained from providing a pain-free experience for every patient.

The dentists we surveyed identified two types of patient that impacted their business. The anxious patient takes longer to treat, is less likely to return, and may harm the business via word-of-mouth. The no-show leaves a gap in the schedule that can’t be filled, interrupting workflow and losing the dentist money. Both, dentists said, caused them to feel stressed and demotivated at work.

Interestingly, dentists didn’t make much of a connection between the two. They estimated that only 7% of their no-shows were due to patient anxiety, but the Dental Law survey indicates that this number is far higher. 28% of respondents, they report, claimed to have cancelled or missed appointments due to anxiety.

Some dentists forgo topical anaesthetics because they believe that, with the right needle in skilled hands, they can deliver almost painless injections. While that may be the case, it offers little comfort to anxious patients.

The expectation or anticipation of pain can be almost as traumatic – sometimes worse – than the pain itself, motivating some patients to delay or avoid treatment. In the case of injections, research shows that anxiety can actually intensify the patient’s perception of pain during the injection. This creates negative expectations for future treatment, reinforcing the anxiety-pain connection.

Offering a topical anaesthetic is a simple way to break this connection. Patients are more likely to show up if you can assure them that the injection – not just the procedure that follows it – will be pain-free. During the appointment, the effect time gives you the opportunity to practice general anxiety and behavioural management techniques with your patient (e.g. breathing exercises). And when you deliver a better treatment experience (for you as well as the patient!), you can create positive expectations for future visits and reduce those costly, frustrating no-shows.

So there’s a clear-cut case for using topical anaesthetics on your anxious patients, but what about the rest of your patient population?

Well, your patient may not be anxious at present, but research tells us that there’s a strong correlation between dental anxiety and a previous painful experience. In the Dental Law survey, 46% of people claimed to have had a bad experience, with 74% of those mentioning pain or discomfort, and 84% feeling anxious about visiting the dentist again. It only takes one difficult experience to colour future interactions, so it’s worth pre-empting this with pro-active, universally applied pain management.

Anxiety aside, even your most resilient patients will judge you on their pain experience. Patients assess their satisfaction with providers based on a number of criteria, with more than half of them relating to pain management.

While your patient may not be distressed in the chair, that doesn’t necessarily mean they’re satisfied. And it’s not always logical when pain is involved; even if the patient understands on a rational level that you’re only trying to help, you are ultimately the source of their pain and thus, the target of their frustration.

An unsatisfied patient is less likely to comply with your recommendations and more likely to delay future dental care, leading to more complicated treatment needs and poorer outcomes down the line. If the patient is particularly unhappy, they may switch providers or share their experiences with others. As is the case with dental anxiety, this can be pre-emptively managed with a simple act of care in the form of topical anaesthesia.

Just as we emphasise preventive care over reactive treatment, we must take a preventative approach to pain management and patient satisfaction. We must also keep in mind that, if some patients delay or miss treatment due to their fear of pain, we won’t always be aware of their anxiety or have the opportunity to manage it – but we will still be very much affected by it. With that in mind, any opportunity we do have is one that shouldn’t be missed.

This is especially critical during the COVID-19 pandemic. When people are already reluctant to seek dental care due to financial concerns or health vulnerabilities, the prospect of a painful treatment can be the final straw. While universal topical anaesthetics will no doubt require a little extra time and expense, we believe they’re a powerful tool that no dentist can afford to be without, during the pandemic and beyond.