Course Description:

This course consists of 7 modules. You’ll earn 9 CE credits upon completion.

Local anesthetics are the most used drugs in dentistry and are considered the most effective for pain management and prevention. However, the “shot” is the most fear-inducing facet of the dental experience for most patients. An estimated 75% of all dental office medical emergencies are stress-related and therefore preventable.

In this course, Dr. Stanley Malamed shares beneficial information on the injection armamentarium and comprehensive patient evaluation, as well as relevant anatomy and all injection techniques. You will learn about the localized and systemic complications that can arise with local anesthesia, and how to prevent and manage them. The course will cover the facts and fiction of local anesthesia and take an in-depth look at the future of pain control in dentistry.

Introduction and the Drugs

Local anesthetics are the safest and most effective drugs for the prevention and management of pain. This introduction covers the development of local anesthetics and the drug formulations currently available in dentistry, as well as the impact of fear and anxiety on local anesthetic effectiveness.

Objectives include:

  • The Pain Reaction Threshold (PRT)
  • A review of sedation as an important ally in the quest for fear and pain control
  • Local anesthetics; the types, history, and duration of action

Armamentarium, Patient Evaluation, and Basic Injection Technique

The basic armamentarium for local anesthetic delivery – the syringe, cartridge, and needle – is reviewed in this module along with evaluation of the patient prior to receiving an injection. A step-by-step review of the basic local anesthetic injection technique is provided.

Anatomy and Maxillary Techniques

Local anesthetic techniques providing pain control in the maxillary arch are described following a review of the anatomy of the trigeminal nerve. Techniques include infiltration (supraperiosteal), anterior superior alveolar nerve block; middle superior alveolar nerve block; posterior superior alveolar nerve block; anterior superior alveolar nerve block; and palatal injection techniques.

Mandibular Techniques and Supplemental Anesthetic Techniques

Techniques of anesthesia in the mandible are reviewed, including the traditional inferior alveolar, Gow-Gates, Vazirani-Akinosi, and incisive nerve blocks as well as several non-traditional injection techniques such as the periodontal ligament injection, intraosseous anesthesia, and the administration of the local anesthetic articaine HCl by mandibular infiltration in adult patients. Other topics in the module include:

  • Local anesthetics, facts & fiction
  • Problems achieving pain control
  • Is the mandibular block passé?

Complications of Local Anesthesia: Localized and Systemic

Complications associated with local anesthetic administration are rare, however, whenever drugs or injections are administered there is a risk involved. This module discusses localized complications such as facial nerve paralysis, hematoma, paresthesia, trismus, and needle breakage, their prevention, recognition, and management, as well as the two systemic adverse drug reactions – allergy and overdose.

Articaine: Is it the IDEAL Local Anesthetic for Dentistry? Facts & Fiction

Articaine HCl was introduced into the United States in 2000 and has become the 2nd most used local anesthetic in dentistry. We’ll take an in-depth look at articaine, its advantages and disadvantages when compared with other commonly used dental local anesthetics. There is also a thorough review of the ‘controversy’ alleging an increased risk of paresthesia following administration of 4% local anesthetics.

The Future of Pain Control in Dentistry

The final module will look at recent developments seeking to increase the safety, efficacy, and comfort of injectable local anesthetics. We’ll review buffered local anesthetics (the local anesthetic “ON” switch); phentolamine mesylate (the local anesthetic “OFF” switch); computer-controlled local anesthetic delivery and the use of an intranasal local anesthetic mist to provide pain control in maxillary teeth.


All sales are final.

Purchase of this course grants access for one year and requires an internet connection, a computer with video and audio capabilities, and in some cases, Adobe Reader to view handouts and articles.

Watch the video and complete the quiz to earn 9 CE credits.

Scientific support and additional resources are available here.

You can download this course and watch it anywhere using the DOCS APP. Get it on Google Play or the Apple Store.

NOTE: Many dental boards require that a specified portion of your CE credits be via in-person attendance at live courses. Check your state's rules!


340 Anesthesia and Pain Management (local anesthesia) – 9 hours

DOCS online courses are available to the purchaser for one year from date of purchase.
No refund of course tuition is available.

Doctor Malamed, a dentist anesthesiologist, graduated from the New York University College of Dentistry in 1969 and then completed a residency in anesthesiology at Montefiore Hospital and Medical Center in the Bronx, New York before serving for 2 years in the U.S. Army Dental Corps at Ft. Knox, Kentucky. In 1973, he joined the faculty of the University of Southern California School of Dentistry (now the Herman Ostrow School of Dentistry of U.S.C), in Los Angeles, retiring from full-time teaching in 2013. Dr. Malamed is an Emeritus Professor of Dentistry Herman Ostrow School of Dentistry of U.S.C.  

Dr. Malamed is a Diplomate of the American Dental Board of Anesthesiology, as well as a recipient of the Heidebrink Award [1996] from the American Dental Society of Anesthesiology and the Horace Wells Award from the International Federation of Dental Anesthesia Societies, 1997 (IFDAS). 

Doctor Malamed has authored more than 160 scientific papers and 17 chapters in various medical and dental journals and textbooks in the areas of physical evaluation, emergency medicine, local anesthesia, sedation, and general anesthesia.  

In addition, Dr. Malamed is the author of three widely used textbooks, published by CV Mosby: Handbook of Medical Emergencies in the Dental Office (7th edition 2015); Handbook of Local Anesthesia (6th edition 2012); and Sedation - a guide to patient management (6th edition 2017) and two interactive DVD’s: Emergency Medicine (2nd edition, 2008) and Malamed’s Local Anesthetic Technique DVD (2004) (edition 2 - 2012) 
In his spare time, Doctor Malamed is an avid runner, exercise enthusiast, and admits an addiction to the New York Times crossword puzzle, which he has done daily since his freshman year in dental school.



How can I meet my state’s requirements?

To learn more about how DOCS Education’s full range of courses can satisfy your state’s regulatory requirements, visit This unique online resource is kept up-to-date with the latest in sedation legislation by DOCS Education’s fulltime regulatory counsel. Contact one of our course advisers with any questions or visit our course listings to see upcoming classes and locations.

DOCS Education courses carry the AGD PACE certification

DOCS Education is the nation’s premier provider of safe sedation and advanced dentistry education, having trained almost 24,000 dentists. Since 2000, our courses have been accepted by the AGD for Fellowship/Mastership and membership maintenance credit. We offer extensive CE opportunities, both in-person and online, that meet your needs.

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DOCS Education is an exclusive community of professionals serving at the forefront of dentistry. We offer world-class courses on safe sedation and advanced dentistry, relying on instructors who are consistently ranked among the very best in the nation. We also are a supportive network of members who guide one another to be better, more confident, more successful dentists.