The best technique is tell, show, do. You must be talking to the children all time, during the injection, in order to distract their attention to the process. You can explain the sensations they will be feeling and use a single lenguage that they can understand. Remember that each children is unique and you must know the family enviroment.

Regards

Dental air abrasion technique is designed to reduce anxiety and fear as there is no noise production, less heat generation and less need for anaesthesia. Evidence shows that 80-90% of patients treated with air abrasion don't require anesthesia making it a technique of choice for treating children.

What I learned recently from some swiss pedodontists: Fill the children up with sweets, this shall have an anaesthetic effect.

It was not main topic, so just mentioned, and there was no time for discussing this, thus I can't give any hints which treatments can be done, which age is best...

Funny, now you get sweets >ad libidum by your dentist... But they sounded serious. I already requested more information, will put it here then...

Have you ever tried Hypnosis?

Personally not.

We have some colleagues in our department doing that, also using combinations with laughing gas or sedation. They work on that also scientifically.

Some experiences I got to know:

For hypnosis you need an age / a development where phantasy is developed/can be activated. The child has to have an age of at least several years.

It is not easy in a clinic to find a place which is suitable for hypnosis - the clinics have not been built for that purpose, so they are quite noisy mostly...

Hypnosis requires quite some time.

Hypnosis works quite well if patient is responsive. Teeth may be removed without local anesthesia.

Laughing gas can't be used if the applicator is disturbing the access (i.e. treatment in the front of the upper jaw - basic problem in trauma cases).

Costs are mostly not covered by insurances and have therefore to be paid by patients or their parents.

Children starting at the age of 6-7 respond extremely well to hypnosis.

Below that age the use of Dormicum is highly recommended.

We have a tv screen on the ceiling, about 40% of the kids are distracted enough to be treated (kids that are referred to us because treatment was not possible in private offices). Apart from that I agree with Liviu, small kids usually respond well to Dormicum, bigger kids and adolescents can be treated with N2O sedation (eventually in combination with hypnosis). I'd say the key to successful treatment in anxious kids is to find out the way of best distraction. Tell-Show-Do addresses rational understanding, but that might not be enough in panicking kids.

Computer-assisted syringe might be helpful because it looks different, but a light thumb is more gentle than the "wand".

Excellent!

Hypnosis is great, but you have to know what you are doing. It is about establishing a rapport with the subject, and supporting them through the experience emotionally. It can be used to help a person deny pain, but it can also be used to help people resolve their fear and discomfort, and can be used in conjunction with modern techniques, such as local anesthesia. In this way, treatment fatigue is reduced, and treatment becomes a bonding experience rather than a nightmare.It should not be used in depressed patients where ego strengthening can have dire consequences. The other issue is that parents don't always want their children to bond with health professionals. It depends very much on whether you truly have their trust. Techniques such as tell show do, distraction, and nitrous are useful but they are not the whole story. With hypnosis, the experience must be positive. Hurting people with the local just does not fit into the equation. Use of topical, slow administration, talking people through it, having distractions present are all helpful. For children alleviating their fear of the unknown is essential. If this is their first experience of anaesthetic they sometimes are worried it will stay like that, and sometimes they interpret numbness as pain. Which brings us to the original premise, that when we treat, we treat, but we support people emotionally through the experience as well.

I explain pt. Regarding the treatment i am going to do and then tell the pt. To join his/her both the palms tightly with fingers mingled with each other and concentrate only on both the palms and i start counting 1 to 10 loudly as explained before starting of the treatment ....it works

My motto: Be honest, be fast - and then extremely slow.

Some own observations and how I do local anaesthesia personally.

Under the limitations Klaus mentioned (child is "accessible")

To avoid phobia: Prevent bad experiences. Reduce the experience of pain as far as possible / avoid unnecessary pain.

Tell before what you do - and never try to lie. That would be a betrayal of confidence which you will never be able to repair.

A. Punctuation of tissues

From my experience the pain from puncturing the tissues with the needle is by far the smaller problem.

1. I try to puncture the tissues very fast. I use sometimes a surface anaesthetic, sometimes some pressure before. Depends how I judge the patient or whether he asks for that.

2. For (nearly) every new puncture of tissues I use a fresh needle. At least if you had contact to bone - never try to use this needle again. And even if you just had contact to soft tissues the needles lose a bit of their sharpness. Needles damage tissues and cause pain if they are not sharp...

3. There are needles with special bevels to reduce pain during puncturing.

http://www.septodont.ca/products/septoject-xl?from=668&cat=4

4. I try to reduce the number of tissue punctures as far as possible. The modern anaesthetic solutions are really good, they can quite well spread within the tissues. You definitely don't need a depot every half a centimeter. And you can protrude the needle within the tissues..

B. Injection

What is bad for most patients is the feeling of burning during the injection of the anaesthic solution. It is quite a volume which has to be injected: Thus the tissues are damaged, cells must part from each other.

The less pressure, the less pain:

1. Find a place with lots of subepithelial tissues: injecting into the fixed gingiva requires high pressure, it is a torture. On the palatal aspect I use the region with lots of small salivary glands - I prefer blocking the nerve at the palatal foramen and the incisal foramen instead of doing an terminal anesthesia.

2. Needles: I don't use these very thin needles, the pressure in the tissues increases with diameter reduction! Also in children, also palatally, I use g25 (orange) - and never what most colleagues use in children: G30(grey).

3. There are needles with reduced thickness of the wall, thus allowing a bigger inner diameter with the same outer diameter. http://www.septodont.ca/products/septoject-xl?from=668&cat=4

(same link as above)

4. I take my time and inject very carefully (veeeeery slowly): just a little drop of the solution and then stop waiting for the effect of the anaesthesic. With the needle in place... That takes some seconds. Then another drop, which is announced as perhaps still a bit noticeable.

We have "The Wand" in our department - I never use it. Yes, the pencil design may be an advantage, but what a waste of material, and what amount of anaesthetic solutions trapped in the tubes...

As long as my patients tell that they have never got such a well done injection, with this little pain, I don't see the need for this device. And no, I don't have golden hands. The "light thumb" (like this expression from Klaus) - it is not a matter of the hands, it is a matter of the head, and the heart. It is just the will to consider some banalities, fed by some knowledge, own experiences, and some thinking. I am sure that every dentist could inject at very low pain levels... It is the will to invest some time for the injection - instead of injecting fast and then nervously waiting for the effect.