Is There a Needle-Free Dental Anesthetic?
Yes, for a limited group of procedures. Kovanaze is a nasal spray that the FDA approved in June 2016 to numb upper teeth for fillings and similar work without an injection. It works only on the upper front teeth and premolars, not on lower teeth or upper molars, and whether it is stocked by a given office varies, so ask your dentist whether it is an option for you.
How does a nasal spray numb a tooth?
Kovanaze combines two drugs. Tetracaine is a local anesthetic. Oxymetazoline is the decongestant found in many over-the-counter nasal sprays. When it is sprayed into the nostril on the same side as the tooth, the anesthetic reaches nerves that supply the upper front teeth. The decongestant narrows blood vessels so the anesthetic stays in place longer. Research showed the spray did not work well without it.
Because of where those nerves run, the spray can reach upper teeth from the second premolar forward. It cannot reach the nerves of the lower jaw or the upper molars, so those teeth still need conventional numbing.
What did the main trial show?
The key study was published in the Journal of the American Dental Association in 2016 by Elliot Hersh and colleagues at the University of Pennsylvania and other centers. It asked whether the spray could numb upper teeth well enough to complete a filling without a needle.
Design: 150 adults who needed a single filling on an upper tooth from the second premolar forward were randomly assigned to the active spray or a placebo spray. Neither patients nor clinicians knew which one was used.
Success measure: finishing the procedure without needing a rescue injection.
Result: 88 percent succeeded with the active spray, compared with 28 percent with the placebo.
Side effects: a runny nose (57 percent) and nasal congestion (26 percent) were the most common. No serious adverse events were reported.
A review by the same research group found success rates of 83 to 90 percent across the published trials. It also noted that two of 186 people who received the drug had a rise in blood pressure, most likely from the decongestant.
What are the limits?
It is approved for restorative work such as fillings, not for extractions, root canals or gum procedures.
It covers only the upper teeth listed above.
It is approved for adults and children who weigh at least 40 kg (88 lb).
Because oxymetazoline can raise blood pressure, tell your dentist about high blood pressure, thyroid conditions, heart conditions and all medications before any anesthetic is chosen.
What if needles make you anxious?
Fear of the injection is common, and it is worth saying out loud. Dentists have several ways to make numbing more comfortable, such as a topical numbing gel before the injection and giving the anesthetic slowly. You can read more about how dental numbness works and how long it lasts and about care for anxious patients.
If you are in Jacksonville and want to talk through your options before treatment, contact our office or call 904-398-1549.
Sources
Hersh EV, Pinto A, Saraghi M, et al. Double-masked, randomized, placebo-controlled study to evaluate the efficacy and tolerability of intranasal K305 (3% tetracaine plus 0.05% oxymetazoline) in anesthetizing maxillary teeth. J Am Dent Assoc. 2016;147(4):278-287. doi:10.1016/j.adaj.2015.12.008. Retrieved via PubMed.
Hersh EV, Saraghi M, Moore PA. Intranasal tetracaine and oxymetazoline: a newly approved drug formulation that provides maxillary dental anesthesia without needles. Curr Med Res Opin. 2016;32(11):1919-1925. doi:10.1080/03007995.2016.1238352. Retrieved via PubMed.
National Library of Medicine, DailyMed. Kovanaze (tetracaine and oxymetazoline) nasal spray label. Retrieved October 6, 2026.
About the author. CJ Henley, DMD, is a general dentist in Jacksonville whose practice focuses on cosmetic and restorative dentistry, dental implants and dental care around head and neck cancer. Meet Dr. Henley.
CJ Henley, DMD, PA · 3675 Hendricks Avenue, Jacksonville, FL 32207 · 904-398-1549
Updated October 2026.