It is difficult for me to comprehend that a quarter of a century has passed since I started writing the first edition of Handbook of Local Anesthesia (1978), but it has. Looking back at that first edition allows one a nostalgic visit to the (good?) "old days," when dentists were truly "wet fingered." No gloves, no masks, no face shields. The author sitting and administering local anesthetic injections, wearing a long-sleeved dress shirt and tie. An entirely different world indeed.

At that time (the late 1970s), the ability to provide a patient with clinically adequate pain control was a concern of dentists throughout the world. It remains so today.

Many changes have occurred over these years, most of a positive nature: changes in the local anesthetic drugs that are available for clinical use, changes in the armamentarium for delivering these drugs, and changes in the techniques for achieving pain control during dental therapies.

Local anesthetics are, in the author's opinion, the safest and the most effective drugs available in all of medicine for the prevention and management of pain. Indeed, there are no other drugs that truly prevent pain; no other drugs which actually prevent a prolonged nociceptive nerve impulse from reaching the patient's brain, where it would be interpreted as pain. Deposit a local anesthetic drug in close proximity to a sensory nerve and clinically adequate pain control will result in essentially all clinical situations.

As effective as our local anesthetics are, and as the likelihood of patients' experiencing truly pain-free dentistry increases, significant numbers of patients continue to fear intraoral injections. Fear of dentistry cannot be lightly dismissed by the doctor. The seemingly basic review of local anesthetic injection technique (Chapter 11) should become periodic required reading to ensure that all that can be done is being done to minimize stress at this critical juncture during the dental appointment.

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