A woman goes to her doctor who verifies that she is pregnant. This is her first pregnancy. The doctor asks her if she has any questions. She replies, "Well, I'm a little worried about the pain. How much will childbirth hurt?" 
The doctor answered, "Well, that varies from woman to woman and pregnancy to pregnancy and besides, it's difficult to describe pain." 
"I know, but can't you give me some idea?" she asks. 
"Grab your upper lip and pull it out a little..." 
"Like this?"
"A little more..." 
"Like this?" 
"No. A little more..." 
"Like this?" 
"Yes. Does that hurt?"
"A little bit."
"Now stretch it over your head!"


If the procedures you perform involve pain, you have a built-in bedside manner generator. Just perform pain-free procedures. Patients rave about many practitioners who have absolutely no bedside manner, as defined throughout this book, just because they don’t hurt them during a procedure perceived to be painful.

The dentist and most dental specialties have this advantage. Since dentistry is probably the most feared health-care need, patients who survive without any pain will go back over and over, even if the doctor has no personality or people skills.

While performing pain-free procedures offers a way to be loved without all the usual skill sets, it also presents many challenges. There are reasons people fear dentistry. It does, at times, hurt. Everything from administering an injection to working on a tooth that can’t be numbed puts tremendous pressure on the dentist and justifies the anxiety and fears the patient experiences.

The importance of learning techniques to give virtually painless, highly effective injections is the key to winning over the patient. Leaning advanced techniques of sedation or general anesthesia, when indicated, should be considered since some cases involve unavoidable pain with conventional pain control modalities.

The dentist isn’t the only one delivering potentially painful procedures. Many other areas of practice are not as feared, so unsuspecting patients end up being catheterized, scoped, or otherwise probed and prodded painfully, but without the preconceived fear associated with going to the dentist.

Whatever services you perform, learn to do them as painlessly as possible, and you will have a patient for life. Make sure you utilize the latest and greatest techniques for pain control. Give extra anesthesia and wait longer for it to take effect if necessary. Don’t rush when it comes to pain control.

When you think the procedure can’t be done without pain, or if you believe the psyche of the patient is such that he is not a good candidate for the procedure, consider referring him to someone who can provide sedation if you don’t utilize that modality.

• Gabriela (2021/12/01 07:01)
I believe this is the most important thing we need to learn. As endodontists a lot of out patient are coming to us with either pain or history of pain. I have heard a lot, this is worse than giving birth! I think the pain management is not only giving q painless needle. If you develop a good relationship with the patient they will trust and there anxiety level goes a little down increasing theirgettin paint threshold. I also remember I would never give topical anesthesia because o always said it was a placebo, the think is that placebo, if it is, really really helps the patient. If it does not really numb the soft tissue it at least makes them see you care for them and again, that feeling helps the process. I don\'t think I have a particular technique for painless anesthesia other than giving it really slowly so I will do my research on that. And time I think that\'s key for successful anesthesia, making sure once we start they have no pain because from the moment they jump in your chair the game is over... I\'ve been there and intrapulpals are not fun!
• Craig (2021/11/30 21:22)
The Peak-End rule is a cognitive bias that people tend to have in which they remember and are more impacted by the peak (good or bad) and end of an experience. For many people the peak of the root canal experience is during the injection. If you can reduce the discomfort and intensity of anesthesia and diminish the impact that has on the person, and have a pleasant end to the appointment with some easy discussion, people will store the experience in their memory more favorably. This is one important factor to consider when thinking about the experience of your patients.
• Ben S (2021/11/30 13:00)
I agree that one of our biggest challenges as endodontists is to provide pain free treatment to our patients. It causes stress not only to our patients but to us as well. After 5+ years of practice, I am still constantly working on improving my techniques to deliver pain free and effective anesthesia. I especially need to improve my delivery of pain free palatal anesthesia. An anxious patient is often put at ease when anesthesia is achieved. As you\\\'ve stated, pain free delivery of care is a phenomenal practice builder and helps us to provide the absolute best care possible.
• Toni (2021/11/28 13:07)
The topic of pain is especially relevant in endodontics since we encounter patients with higher incidences of pre-op and post-op pain. As mentioned above, dentists also have to fight preconceived notions of pain, especially with receiving a root canal. Another added element in our every day clinical practice is management of children and their perception of dentistry, which could be largely influenced by their parents. Working on children and management of their pain is extremely important and have a variety of factors that need to be taken into consideration: adequate anesthesia, behavior management, shortened chair time, adjunct sedative techniques such as nitrous oxide, or a referral for deeper sedation.

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