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Palatal injection: Needed or not?

Background

The use of an infiltration and/or block palatal injection is commonly done when maxillary teeth are removed under local anesthesia. However, patients experience considerable discomfort with this technique, attributable to the rich nerve supply of the area and the firm attachment of the palatal tissues to bone. Various techniques have been developed to minimize the discomfort, but a more important question is whether palatal injection for maxillary tooth extraction is needed.

Methods

The literature search included the PubMed, EMBASE, and Cochrane CENTRAL databases. The criteria for inclusion focused on trials examining outcomes of maxillary tooth extraction where buccal injection of local anesthetic was used for one or more test groups. Fifteen studies met the criteria, including 6 randomized controlled trials (RCTs), 4 controlled clinical trials, and 5 clinical trials that were not controlled.

Results

The outcome variables were pain of the local anesthetic injection versus the control group, number of cases requiring supplemental buccal or palatal injection when local anesthesia is not effective, and pain during the procedure. A secondary outcome was pain on probing of the mucosa.

The variation in study methods permitted interpretation only within the framework of the protocol for each particular study, with no meta-analysis for each outcome variable. All 9 of the controlled studies that

Discussion

Palatal injection for the removal of maxillary teeth did not improve the outcomes for patients. RCTs are needed that use larger patient samples and similar protocols to more definitively address the question of whether palatal injection is needed for maxillary tooth removal.