Sir, we write further to the recent paper on local anaesthetic administration for the paediatric patient.1 In an era where, as Robson2 illustrates in his recent letter, children and young people (CYP) are waiting substantial periods of time for hospital dental extractions, this paper illustrates how dental professionals can develop their clinical and behavioural management techniques to minimise pain experienced during injections.1

Rather than a blind 'unwillingness' per se to carry out extractions in primary care, we feel it is more likely to be a reluctance resulting from lack of confidence, as well as access to sedation, to administer comfortable analgesia. This in turn may result in complete loss of compliance, fostering negative memories resulting in the child or adolescent avoiding all future care in that setting. Students are actively encouraged to gain experience of analgesia administration in CYP, so they become adept and confident in its use.

Patient age should not be a contraindication for local analgesic use, even for mandibular blocks in children, where some clinicians advocate the 'Rule of Ten' should be considered: the primary tooth to be anaesthetised is allocated a number according to position in the arch (central incisor = 1, second molar = 5); this number is then added to the child's age (in years); if 10 or less, an infiltration is most appropriate; if greater than 10, an inferior dental block (IDB) is likely to be more effective.1,3

Shorter needles, such as the Ultra Safety Plus 30G Extra Short [Septodont, France] are suitable for infiltrations, IDBs and long buccal anaesthesia in children.1 These are easily recognisable by their short 10 mm needle and unique purple cap. Despite the paucity of evidence on dental phobia and needle length, it could be hypothesised that needle phobia may increase with needle length, hence, a needle shorter than the average fingernail may help.