Background The COVID‐19 pandemic forced dental educators to quickly modify the teaching‐learning platform without testing outcomes of alternative teaching methods prior to implementation. One critical course affected was the teaching of local anesthesia (LA) that moved from practicing injections using the traditional student‐to‐student method to the simulation model using manikins. Purpose This study compared two LA teaching methods (student‐to‐student versus simulation) in two consecutive cohorts before and during the pandemic to assess differences in students’ skill level and self‐confidence. Methods This quasi‐experimental study recruited a convenience sample of dental hygiene students at the University of Minnesota during 2020 and 2021. Consent was collected prior to student‐to‐student injection practice and survey distribution. Data collected were clinical and summative clinical assessments to determine LA skill level, and student surveys to assess self‐confidence. Analyses included descriptive statistics, linear models within and between cohorts, and inductive analysis for qualitative survey responses. Results Fifty of 57 students (88%) completed the survey, and 54 (95%) consented access to their clinical assessments. Skill level was significantly higher for the simulation cohort compared to the student‐to‐student cohort on the LA summative clinical assessment (59.0 vs. 55.6, p = 0.004). No differences were found in self‐confidence between cohorts. A positive association was found between students’ self‐confidence and skill levels for both cohorts, but only student‐to‐student cohort results were statistically significant (student‐to‐student: r = 0.44, p = 0.02; simulation: r = 0.24, p = 0.26). Conclusion Results support incorporating simulation manikin teaching methods for LA with a student‐to‐student partner component.