Chapters
Why Injections Hurt — and What Most People Get Wrong
[00:00:00 – 00:04:19]
Most dental anxiety centres on the needle, but the needle itself is rarely the real culprit. Pain during a dental injection is almost always caused by the speed and pressure at which the anaesthetic solution is delivered into confined tissue — not the act of piercing the gum.
When anaesthetic is pushed in too quickly, it stretches surrounding tissue faster than it can accommodate the liquid, activating pain receptors. This is particularly noticeable in areas with little room for expansion, such as the palate. A slow, controlled delivery rate changes the experience entirely.
Applying a topical anaesthetic cream for a minute or two before any injection further reduces sensation at the entry point. The challenge is that delivering anaesthetic by hand at a consistently slow and even rate is genuinely difficult — especially under time pressure.
What Is the Wand, and How Does It Work?
[00:04:20 – 00:07:24]
The Wand — formally known as STA, or Single Tooth Anaesthesia — is a computer-controlled local anaesthetic delivery device. Rather than relying on thumb pressure, it uses a microchip to deliver anaesthetic at a precisely regulated flow rate, continuously adjusting for tissue resistance.
In practice, the device emits a rhythmic beeping as it releases tiny drops of anaesthetic in sequence. The first quarter of a cartridge can take 30 to 40 seconds to deliver, after which the pace can be increased via a foot pedal. When patients are asked to rate discomfort on a scale of zero to ten, most report a zero.
OptiSmile uses the Wand for virtually every injection across all six treatment rooms. As part of their broader commitment to restorative dentistry, the practice treats patient comfort as a clinical standard rather than an optional extra.
The Psychology of the Pen-Shaped Device
[00:07:25 – 00:09:45]
The Wand looks nothing like a traditional metal syringe. It resembles a slim pen, and this matters: psychological research confirms that visual cues significantly influence pain perception and anticipatory anxiety. A less threatening-looking instrument reduces stress before a single drop of anaesthetic is delivered.
For very young children or highly anxious patients, the needle end can be concealed entirely within the clinician’s hand, hidden from view in the same way one might palm a key. Combined with topical anaesthetic, many children as young as three or four years old receive injections without registering that anything has happened.
Single-Tooth Anaesthesia: Keeping the Lip and Cheek Feeling Normal
[00:09:46 – 00:12:28]
One of the Wand’s headline capabilities is single-tooth anaesthesia — delivering anaesthetic directly into the periodontal ligament surrounding a specific tooth, numbing it in isolation without affecting the lips, cheeks, or tongue. Patients can speak, smile, and present in meetings immediately after treatment.
In practice, this technique is most useful for upper teeth — for example, when preparing for crowns — where a targeted palatal injection can numb an entire arch without affecting facial expression. For lower-jaw restorative work involving multiple teeth, a conventional block injection delivered slowly through the Wand is often the more practical choice, since repeated intraligamentary injections can leave gum tissue tender the following day.
Why Anxious Patients and Children Benefit Most
[00:12:29 – 00:13:34]
Dental anxiety, especially during checkups, is frequently driven by three factors: the sight of a large syringe, the sensation of pressure during injection, and the prolonged numbness that follows. The Wand addresses all three simultaneously — it looks unthreatening, delivers anaesthetic comfortably, and can limit numbness to the treated area when appropriate.
Clinical studies support its use in paediatric dentistry specifically. When a child’s first injection is painless, the likelihood of lifelong dental avoidance drops considerably — an outcome that has a direct bearing on long-term oral health and the cost of future dental treatment.
Time, Cost, and Why More Dentists Don’t Use It
[00:13:34 – 00:18:54]
The Wand is deliberately slower than a manual syringe — and that is the point. Patients occasionally ask when the injection is coming, unaware it has already begun. Taking an extra minute to deliver anaesthetic comfortably is straightforwardly preferable to a faster, more painful experience.
The barrier to adoption is largely financial. Each unit costs in the region of R70,000 to R80,000, and the disposable handpieces add ongoing consumable costs. OptiSmile runs six units across the practice — a significant capital investment made on the basis that pain reduction is a clinical priority, not a luxury add-on.
In high-volume, fee-constrained environments, dentists may not find it practical to absorb those costs. A careful, unhurried clinician using a conventional syringe can approach comparable results, but consistency is harder to guarantee. The Wand has been available for close to two decades; limited uptake reflects economics more than clinical evidence.
Effectiveness for Root Canals and Difficult Cases
[00:15:38 – 00:16:54]
The Wand is particularly valuable when conventional anaesthesia is unpredictable — most commonly with inflamed teeth requiring root canal treatment, or lower molars that prove difficult to numb fully. In these situations, a periodontal ligament injection delivered via the Wand provides reliable, targeted anaesthesia where a standard block has fallen short.
This application comes up regularly in practice — roughly every week or fortnight — and represents one of the most clinically useful aspects of the technology beyond its role in managing anxious patients.
What Patients Actually Say
[00:18:54 – 00:20:27]
The most common response after a Wand injection is mild confusion: patients ask when the injection is coming, or notice their face feels numb without having registered the moment anaesthetic was given. For anxious patients, this is often a turning point — one comfortable experience can reshape how they engage with dental care for the rest of their lives.
The underlying principle is straightforward: comfort builds trust, trust supports regular attendance, and regular attendance enables the kind of preventive care that keeps treatment costs down over time.
Transcript
[Eon Engelbrecht – E-Radio-SA] (0:05 – 1:22)
Hello and welcome once again to Save Your Money, Save Your Teeth, the podcast
where we help you make smarter, healthier and often more affordable decisions about
your dental health. I’m Eon and, as always, I’m joined by Dr Clifford Yudelman from
OptiSmile, and today we’re talking about one of the biggest fears that people have
when they go to the dentist. That’s probably the number one fear, why they’re actually
so worried about going to the dentist, and that is injections.
But what if the part most people fear is not actually the needle itself? What if modern
dentistry has found a better, gentler and far more precise way to make dental
injections much more comfortable? So in this episode we’re unpacking the technology
behind what some patients call the magic wand, how it works, why it can make
injections feel far less painful, and also why it may completely change the experience
for anxious adults and children alike.
So if fear of needles has ever delayed your dental treatment, this is definitely an
episode worth hearing, and I’m also excited to hear all about it. Dr Yudelman, welcome
back.
[Dr Clifford Yudelman – OptiSmile] (1:23 – 1:27)
Thank you, thanks for having me back, and a little bit of magic today.
[Eon Engelbrecht – E-Radio-SA] (1:28 – 1:45)
Yes, looking forward to this magic, and I’m sure everybody’s listening very, very
attentively now. Dr Yudelman, is it true that the needle itself is not usually what causes
the pain, but rather the pressure of the anaesthetic going in?
[Dr Clifford Yudelman – OptiSmile] (1:45 – 4:19)
One hundred per cent, that’s absolutely correct, and it’s one of the biggest
misconceptions in dentistry. Most of the discomfort people associate with injections
doesn’t come when we actually pop the needle gently into the gum, especially if we’ve
used topical anaesthetic, which is like numbing cream. So, in fact, I’ll wind it back a little
bit.
So before we give any injection, any humane dentist in 2026 should put a little bit of
topical anaesthetic. It’s like a strawberry or cherry flavoured cream, and you’ve got to
leave it on for a good minute or two so that it can actually numb the area before you
even use the needle. So when you do put a needle there, most people are completely
unaware, but if you’re using a normal syringe and you start pressing down with your
thumb, it’s very hard to give an injection very, very slowly and always the same every
time.
So the pain actually comes from how quickly and forcefully the anaesthetic solution is
delivered into a confined space. When the anaesthetic injection is done too quickly, it
stretches the surrounding tissue faster than it can accommodate the liquid, and that
activates the pain receptors. This is especially noticeable if you’re getting an injection in
an area where there’s very little room for expansion, which, say for instance, is in the
palate, which we very rarely need to do in our everyday practice, but I’m sure people
listening to this have had an injection in their palate if they were getting an extraction
or maybe a root canal, and it can really be very, very painful if the dentist pushes the
anaesthetic in too fast. The needle going in doesn’t feel too bad, but when they start
pushing, it can be very painful.
So decades of research in pain physiology and dentistry show that very slow, extremely
slow, controlled delivery dramatically reduces the discomfort. The problem is that
humans are not very good at giving anaesthetic at a perfectly consistent and ultra slow
rate by hand, especially if they’re in a hurry. This understanding, this distinction, helps
us to focus on the real solution, which is controlling the flow rate and the pressure
rather than just trying to be gentle with a syringe.
[Eon Engelbrecht – E-Radio-SA] (4:20 – 4:30)
Now can you tell us about this magic wand, doctor, also known as STA, and how is it
different from a normal dental syringe?
[Dr Clifford Yudelman – OptiSmile] (4:30 – 7:24)
So actually they call it the wand, not magic wand, but people always put the word
magic in front of wand. In certain countries, I bought mine in Australia, and we’ve got
six in the practice. I bought a few in South Africa as well. It’s available, and I think every
good dentist should have a wand, or more than one if they’ve got more rooms. It’s not
something you really move from room to room, it’s something that stays put. The
correct name for it is STA, or single tooth anaesthesia, because you can use it just to
numb a single tooth.
We might talk about that a little bit later, but basically it’s a computer-controlled local
anaesthetic delivery device. Instead of relying on hand pressure, it uses a little
computer chip to deliver anaesthetic at a precisely controlled rate. The system
continuously adjusts the flow based on the tissue resistance, ensuring that the
anaesthetic is given slowly and evenly. It removes that variability that comes with a
manual injection. From a scientific standpoint, this consistency is critical because when
you read studies that compare computer-controlled systems to traditional syringes, it
consistently shows that when you give an injection, say in the palate or between the
gum and the tooth, called the intraligamentary injection, the wand removes the human
margin of error in one of the most anxiety-provoking parts of dentistry.
When I use the wand and I’ve given the patient topical and then I start the wand, it
goes bing, bing, bing quite slowly, and on the second or third bing, just as the
anaesthetic is maybe starting to come through, when I slide the needle just below the
level of the gum, most patients don’t actually even blink or know that I’ve done
anything. Then another one or two bings go past and then it releases one tiny drop of
anaesthetic, and then another two or three bings, another drop.
Actually, the first quarter of a syringe full of anaesthetic can take 30 or 40 seconds, and
then once we’ve done a quarter or half of a syringe, then we can make it go faster.
There’s a little foot pedal, and when I ask patients, if 10 is agony and zero is nothing,
was that a one or a two, most patients say it was a zero, which I’m very happy with. If
they’re terribly nervous, they might perceive something and then they say, oh, that was
a one. But that’s how you actually make people friends for life because once they’re
numb, most people don’t really care what you do to them.
[Eon Engelbrecht – E-Radio-SA] (7:25 – 7:35)
Wow, that’s really impressive. Tell us, does it look like a typical dental needle, or is it a
little bit less intimidating for the patients?
[Dr Clifford Yudelman – OptiSmile] (7:35 – 9:45)
The wand looks very different from a traditional syringe. It looks like a small pen rather
than a big metal instrument with a big barrel and a plunger, and this matters more
than people realise. Psychological research shows that visual cues strongly influence
pain perception and anxiety.
A device that looks less threatening reduces this anticipation and fear, especially in
children and anxious adults. The needle itself is very fine and short, but because it’s
housed in a pen, it looks just like a pen really. Patients often don’t even recognise that
it’s a needle at all, and that helps to prevent the stress response.
I tell them I’m not going to use a syringe to numb you today, so they take it that I’m not
going to use a needle. I’ve had patients, I remember one patient in Perth who was very,
very scared of injections, and I used it on him. After about six or seven visits, he said to
me, he said, oh, I really love the way you numb me because I hate needles and I could
never bear to have a needle stuck in my mouth again. I said to him, well, I’m sorry to
break the news to you, but every time we’ve given you an injection, there is a little
needle at the end of this pen.
What we’ve done with little kids, which is great with little kids, I’ve had three and fouryear-olds, is we actually snap the little pen off from where the needle attaches and all
you have is a little hollow tube where the liquid comes through. You can hold it kind of
like sleight of hand. If you imagine you holding your keys in your hand, instead of
holding your key like you’re going to put it into your car door or your front door, if you
flip the key around so that the key is facing your palm, it looks like you’re just holding
on to a little clear piece of tubing. Then when you move your hand near the child, or
even near a very nervous adult, the needle is completely covered by your hand, they
don’t see it, there’s no big syringe, and it’s not up in their face. Then they’ve got topical
anaesthetic there, you basically pull on their lip and the needle goes in, they don’t feel
it, it’s like nothing happened.
[Eon Engelbrecht – E-Radio-SA] (9:46 – 9:55)
Wow, that’s the way to do it. I also want to ask you, can this technology numb just one
tooth without making the whole lip, cheek or face feel numb?
[Dr Clifford Yudelman – OptiSmile] (9:56 – 12:28)
Yes, so it is an advantage of computer-controlled anaesthesia. Traditional injections,
especially on the lower jaw, can numb your whole side of your face, your tongue, your
cheeks, your lips, everybody hates it. The wand, when I first got it, I used it a lot for
single-tooth anaesthesia. That’s where you actually put the anaesthetic between the
gum and the tooth into the periodontal ligament, and just directly into the bone
surrounding a specific tooth. This can numb just that tooth without affecting the lips or
the cheek or the tongue, and the patient can smile, speak, they can get a root canal or
even a filling or a crown, with no drooling lip and no numb cheek.
Really, I think it’s a bit oversold, so I did use it quite a lot like that when I first got it, but
it is a bit more traumatic to the gum. If you’ve got a patient, say someone needs a
filling on the lower jaw, there’s normally more than one filling. When someone’s got
one, they need two or they need three, or they need an onlay and a filling. So if you’re
going to be putting two or three injections per tooth at the gum line, the next day one
or two of those little spots can get quite sore and ulcerated. So if you’re doing that
many times a day, every other day you’re going to have someone saying, oh, my gum
got really sore after that.
But when you get an injection at the back of your mouth with the wand, even though
you get a really numb lip and tongue and everything, when it wears off, there’s no pain
afterwards because you’re giving that injection slowly. I have had businessmen come in
for important treatment and they say, oh, am I going to be all right to speak, I’m
presenting at one o’clock, and I’ll go, yes, you’ll be fine. I’ll do the STA, I’ll use that
single-tooth one.
A lot of dentists swear by it where, if they’re doing veneers or crowns, more so for
crowns, if you want to numb the upper teeth instead of numbing the lip and the nose
and everything, you can give an STA injection in a particular area in the palate and it
numbs all the teeth without numbing the lip. But again, I’m not a big fan of that. The
patient can still smile, but we don’t do a lot of cutting teeth down into dentine and
doing full crowns where you need to be numb to fit them. To do injection moulding or
to fit a veneer, you don’t normally need to be numb. This is for people that are getting
turkey teeth.
[Eon Engelbrecht – E-Radio-SA] (12:29 – 12:39)
Okay, and why is this type of injection technology particularly helpful for children or
very anxious patients?
[Dr Clifford Yudelman – OptiSmile] (12:39 – 13:34)
Yes, so we’ve sort of covered that already. It’s just that most people are especially
sensitive to a loss of control or unfamiliar sensations. When people see a big syringe,
when they feel the pressure, when they have that really numb feeling, especially if
they’ve never had it before, that all increases dental anxiety. The wand addresses all
three. It looks less threatening, it delivers the anaesthetic more comfortably, and in
cases where you’ve used it for a single tooth, it limits the numbness to where it’s
needed.
It works really well for kids. A lot of studies have been done on that. By making these
dental experiences less traumatic, we reduce the likelihood of lifelong dental fear,
which then aligns strongly with good preventive and long-term oral health.
[Eon Engelbrecht – E-Radio-SA] (13:34 – 13:42)
So doctor, does it take longer to give an injection with the wand rather than with a
regular syringe?
[Dr Clifford Yudelman – OptiSmile] (13:42 – 14:44)
One hundred per cent. That’s the way it’s made, to give the injection very, very slowly. It
deliberately gives the anaesthetic slowly to minimise the discomfort.
Yes, look, sometimes the patient says, oh, when are you going to give me the injection?
Whatever that binging was, it seemed to go on. I’ve never actually timed it.
It always seems like a heck of a long time, but maybe instead of just jamming the
needle in and giving the injection in maybe three, five or ten seconds, however slowly
you can give it by hand, even if it takes a minute, you’re just sitting there, the patient’s
just sitting there, the thing is binging away, and so what if it takes a minute? We always
wait five, ten, fifteen minutes for the anaesthetic to kick in properly. Most patients
prefer that it takes a little bit longer and that it’s comfortable over getting something
over and done with really quickly and then it hurts. I think time efficiency should never
come at the cost of patient comfort.
[Eon Engelbrecht – E-Radio-SA] (14:45 – 14:52)
And is there any extra cost for patients when this technology is used at OptiSmile?
[Dr Clifford Yudelman – OptiSmile] (14:52 – 15:38)
It does cost us quite a bit. The wand, each one is disposable. It comes sealed in a sterile
packet and, to be honest, I don’t even know what the exact cost is. But all dentists in
South Africa, there’s a code where dentists will charge for giving anaesthetic.
If someone has a procedure and there’s no anaesthetic, it will be less. I don’t know
what other dentists charge for anaesthetic, but when we charge for anaesthetic, it’s the
same whether we use the wand or not. We pretty much use the wand for almost every
injection at OptiSmile.
Every dentist uses the wand, and for us, pain reduction is not a luxury, it’s a core
component of modern dentistry.
[Eon Engelbrecht – E-Radio-SA] (15:38 – 15:45)
Doctor, can the wand also be used for all types of dental procedures, including root
canals?
[Dr Clifford Yudelman – OptiSmile] (15:45 – 16:34)
Yes, it’s effective for almost every procedure, and it’s particularly useful in situations
where a normal anaesthetic may be less predictable, such as an inflamed tooth that
needs a root canal. They’re very hard to numb. Or a lower molar where the patient’s
had a few injections and it’s not getting numb. That’s where you would do that STA or
intraligamentary or PDL, periodontal ligament injection, and using a wand makes it, I
don’t want to say a no-brainer, you’ve got to know how to do it, but it works extremely
well. Maybe every week, every other week, if someone’s not 100 per cent numb, I’ll use
the wand in that way.
[Eon Engelbrecht – E-Radio-SA] (16:34 – 16:40)
I’m just wondering, if it works so well, why do more dentists not use it? Is it a cost
issue?
[Dr Clifford Yudelman – OptiSmile] (16:41 – 16:54)
Yes, that must be the main thing. They’re not cheap. They cost about 70 or 80 thousand
rand for one.
So we’ve got six here. Add it up. What’s that? Half a million rand just for the wand.
[Eon Engelbrecht – E-Radio-SA] (16:54 – 16:55)
Oh my goodness.
[Dr Clifford Yudelman – OptiSmile] (16:57 – 17:07)
So these little things we take for granted. We’ve got three microscopes, they’re like 800
thousand rand each. Dentistry is not cheap for a reason.
[Eon Engelbrecht – E-Radio-SA] (17:07 – 17:07)
Yes.
[Dr Clifford Yudelman – OptiSmile] (17:09 – 18:54)
There’s an investment in the equipment, in the training. There’s also the cost. Instead
of buying just the cheapest needle you can find from whichever dental distributor,
we’ve got to order in boxes of these, and every time it’s 4,000 or 5,000 rand for a box
of, I don’t even know how many are in there, 50, I don’t know, to be honest.
But also, some dentists, maybe if you’re in America, if it’s a PPO or HMO or National
Health in the UK, or if you’re in a medical aid practice in South Africa where time is
money and the dentists are getting very low fees and they just want to get you in and
out and they just shove in more anaesthetic, they’re not going to take the time to use a
wand.
Look, I mean, a dentist who’s very gentle and doesn’t have a wand and wants to use a
traditional syringe and takes the time and is very careful can get results very similar to
a wand, but others may not see the value because they underestimate how much
injection pain affects the patient experience. A lot of the time, this adoption, when I say
new technology, I think I’ve been in South Africa 11 years and I brought three wands
with me from Australia, and I had them there for, I think, about seven years. So it’s not
new technology.
The wand has been around, I’d imagine, almost 20 years. So just because people don’t
use it doesn’t mean it’s not available. When dentistry evolves, the patient experience is
taken seriously and discomfort is taken away.
[Eon Engelbrecht – E-Radio-SA] (18:54 – 19:04)
I have one more question for you. What kind of feedback do patients usually give after
having an injection with this system?
[Dr Clifford Yudelman – OptiSmile] (19:05 – 20:27)
I think I already gave that away earlier. The most common response is patients say,
when are you going to numb me? Or my face feels funny. When am I going to get my
injection? Or when I say, okay, are you feeling numb now, and they say, I didn’t feel
anything. Did you give me an injection?
So that’s like music to my ears. And also when we do numb a patient on the lower jaw
and the lip and the chin and the tongue and everything go really numb, the patient
says, doctor, I’m so numb, I can’t even feel my face. For me, that’s music to my ears. I
know for the patient it’s unpleasant, but it’s going to wear off, and we just love it when
patients don’t feel anything.
For anxious patients and children, it’s transformative. Reducing fear around injections
often changes how the patient approaches dentistry entirely. From an evidence-based
and ethical standpoint, we have the tools to reduce pain and anxiety safely and
predictably, so there’s no justification for just ignoring these. Comfort builds trust, trust
leads to prevention, and prevention saves teeth and money.
[Eon Engelbrecht – E-Radio-SA] (20:28 – 20:47)
Absolutely. And that was very interesting, as always, Dr Yudelman. Thank you so much.
I think a lot of people will be surprised to hear that one of the scariest parts of going to
the dentist has more to do with pressure and technique rather than the needle itself. I
always thought it was the needle, to be honest.
[Dr Clifford Yudelman – OptiSmile] (20:47 – 20:53)
Yes, no, that’s a very, very common misconception.
[Eon Engelbrecht – E-Radio-SA] (20:54 – 21:14)
Yes, absolutely. I think the fact that there’s technology available that can make these
injections more controlled and more precise and much more comfortable and bearable
is something that will reassure a lot of our listeners, especially parents and people who
have been putting off treatment because of fear, and especially fear of needles.
[Dr Clifford Yudelman – OptiSmile] (21:15 – 21:39)
Yes, one hundred per cent. So hopefully this helps them. Most dentists who’ve got a
wand will mention it somewhere on their website.
I’ve never Googled dentist with wand in Cape Town. Let me see. I’ll just Google it now.
Let’s see. Dentist, wand, Cape Town. We better show up there. But let’s see who else
has a wand in Cape Town.
[Eon Engelbrecht – E-Radio-SA] (21:40 – 21:42)
Can you see someone with a wand?
[Dr Clifford Yudelman – OptiSmile] (21:44 – 22:48)
Numbing wand. Oh, Tooth Fairy’s got a wand. There you go. Hout Bay Dental Studio, all
my friendly rivals. Andy Efting, Hout Bay. We offer our patients the wand. Enamel
Dentistry down the road from me. We use the wand in cases where we perform X and
Y. Daneka Dentistry. Then I think it’s just dentists in Cape Town. I don’t see… oh, Dino
Dent. It’s a very, very good paediatric dental practice just for kids. We use an electronic
dental wand.
So wherever you are in the world, if you listen to this and you Google dentists and
wand and where you are, hopefully you will find a few dentists that have the wand. And
if that’s your biggest fear, is needles or the injection or the pain from the injection, then
hopefully this podcast has helped you.
[Eon Engelbrecht – E-Radio-SA] (22:48 – 23:07)
Dr Yudelman, absolutely. Thank you so much once again for helping us to understand
how modern dentistry keeps getting better for patients. And also thanks to you for
listening to Save Your Money, Save Your Teeth. Until next time, take care of your mouth
and your mouth will take care of you.
[Announcer] (23:29 – 24:13)
Discover the world of dental excellence with OptiSmile. Join us for a weekly podcast
featuring Dr Clifford Yudelman, a seasoned expert with 40 years of dental experience
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Disclaimer: The content provided in this podcast, “Save Your Money Save Your Teeth” on Medical Mondays, is for informational and educational purposes only. It is not intended to serve as dental or medical advice. The insights and opinions expressed by Dr. Clifford Yudelman and any guests are designed to foster a better understanding of dental health, preventive measures, and general well-being, but should not be interpreted as professional dental or medical recommendations.Dr. Clifford Yudelman does not diagnose, treat, or offer prevention strategies for any health conditions directly through this podcast. This platform is not a substitute for the personalized care and advice provided by a licensed dental or healthcare professional. We strongly encourage our listeners to consult with their own dental care providers to address individual dental health needs and concerns.The information shared here aims to empower listeners with knowledge about dental health but must not be used as a basis for making health-related decisions without professional guidance. Your dental care provider is the best source of advice about your dental and overall health. Please always seek the advice of your dentist or other qualified health professionals regarding any questions or concerns about your dental health.
