The Needle

-most needles are stainless steel and disposable

-reusable needles have no place in the practice of
Dentistry
-plastic hubs are not pre-threaded; metal hubs are
pre-threaded
-a needle whose point is more centered on the long
axis will have less deflection upon entry into soft
tissues than a beveled needle

All needles have these components in common:

1) Bevel: point or tip of needle; long, medium and
short
2) Shaft: long portion of the needle
(diameter of lumen)
3) Hub: plastic/metal piece that attaches the needle
to the syringe
4) Cartridge Penetrating End: perforates the
diaphragm of the cartridge

The Gauge
-the diameter of the lumen of the needle; the smaller the
number the greater the diameter of the lumen; 30-gauge
needle has a smaller internal diameter than a 25-gauge
needle; needles in the U.S. are color coded by diameter

30 Gauge (Blue)
27 Gauge (Yellow)
25 Gauge (Red)

-Dentists think that using smaller gauge needles

will result in a less traumatic injection
experience by the patient which is false
-In 1972, Hamburg proved that patients could
not differentiate between 23, 25, 27 and
30-gauge needles

Larger gauge needles have advantages over

smaller gauge needles:
1)less deflection of the needle tip results in greater
accuracy
2) less chance of needle breakage (separation)
3) easier aspiration of blood through the larger
lumens
4) undetectable pain differences between 25 and
30-gauge needles

-25 gauge is the needle of choice for injections that

have a high potential for a positive aspiration
(PSA, IANB and Mental Block)
-30-gauge needles are not recommended for any
specific injection

Rotational Insertion Technique

(minimizes deflection)
Bi-rotational insertion technique
the operator rotates the needle in a back-and-forth
rotational movement while advancing the needle
through the tissues; traditional hand-held syringes
cannot be rotated in this manner, however, The
Wand can be rotated in this fashion results in less
deflection, less force is needed for needle
penetration

Length
there are three lengths to dental needles: long, short
and ultrashort

-average length of short needles: 20 mm (hub to tip)

-average length of long needles: 32 mm (hub to tip)
-needles should not be inserted to the hub unless
absolutely necessary for the success of the
injection

-hub is the most common area for breakage because

this area has the highest level of stress
-when a needle is separated the elastic properties of
the tissues permit a rebound effect that completely
covers the needle (buries it)
-25 gauge long needle is the only needle any Dentist
needs to perform any dental injections per Malamed
(25 or 27-gauge short possible too)

Problems
-Stainless steel needles dull after 3-4 penetrations into soft
tissue causing more pain/post-operative discomfort;
change your needle
-If needles are to be penetrated into soft tissue more than
5 mm then the needle should not be bent; bending
needles weaken them
-No attempt should be made to change the direction of a
needle when it is embedded into tissue; you should
remove the needle and reinsert it completely
-Of 60 needles that separated and lead to litigation,
59 of them were 30-gauge short needles
(probably inserted too far and above rules broken)

Separated Needle

Problems
-Pain on withdrawal of needle could be due to fishhook
barbs due to errors in manufacturing or too hard contact
against bone
-Needle should be recapped immediately after it is withdrawn
from a patients mouth; avoids unintentional sticks
-Never put an uncapped needle on the tray for yourself or
someone else to inadvertently be stuck; always recap the
needle after you have given any injection

References
Malamed, Stanley. Handbook of Local Anesthesia. 5th Edition. Mosby.
2004