Articaine and paresthesia

INQUIRY Anesthesia Articaine and paresthesia Background.—Articaine, a local anesthetic widely used in dentistry because of its effectiveness, has been claimed by some to exert neurotoxic effects. Its possible relationship to neurologic adverse events such as paresthesia has led some practitioners to demand changes in its recommendations for use. The evidence for an increased risk of paresthesia with articaine and the possibility that injury is attributable to procedural trauma were investigated. International Evidence.—Most of the reports that link articaine with an increased risk of neurotoxicity are retrospective, biased in data recruitment, and offer a questionable level of evidence. As a result, they do not provide strong recommendations for changing the use of articaine. Paresthesia associated with articaine must be studied further, preferably using randomized clinical trials (RCTs), which provide the most reliable results. The single publication addressing the safety of articaine that provides high-quality evidence summarizes three identical single-dose, double-blind, parallel-group, activecontrolled trials that compare 4% articaine with epinephrine 1:100,000 with 2% lidocaine with epinephrine 1:100,000 for dental procedures in 1325 patients. Articaine and lidocaine were comparable in frequencies of paresthesia, at less than 1%. Articaine was not associated with an increased risk of paresthesia. Systematic Review Results.—The post-injection adverse events noted in a systematic review of articaine and lignocaine in maxillary and mandibular infiltrations and block anesthesia for patients having routine dental treatment showed no difference between the two anesthetics. Pain scores at the injection site after anesthetic reversal were slightly higher with articaine compared to lignocaine when recorded on a visual analog scale. However, the clinical impact of the higher post-injection pain scores for articaine compared to lignocaine was negligible, and the two agents have similar adverse effect profiles.

Articaine is more effective than lignocaine in providing anesthesia in the first molar region for routine dental procedures and is therefore recommended over lignocaine for this use. Concentration and Adverse Effects.—Although direct damage to the nerve caused by anesthetics containing 4% of active substance has not been scientifically proved, some reports have linked higher concentrations (4%) with a greater risk for nerve damage compared to lower concentrations (2%). To counter this possibility, some researchers promote the use of alternative techniques to the traditional inferior alveolar nerve block (IANB) rather than a switch of anesthetic. No reports of paresthesia have noted the use of an alternative block technique. Prolonged paresthesia may result from the intervention, therefore, rather than the articaine.

Clinical Significance.—The risk of paresthesia with articaine is extremely low, so the clinical significance of an increased incidence of neurotoxic effects with this agent is questionable. In addition, the experience of the surgeon has been found to be a significant factor in determining the occurrence of permanent lingual nerve and permanent IAN paresthesia, which indicates that the procedure itself may be the cause of trauma. In contrast, articaine has proved both effective and safe for most situations.

Toma M, Berghahn M, Loth S, et al: Articaine and paresthesia in dental anaesthesia: Neurotoxicity or procedural trauma? Oral Health J, February 2015 Reprints not available

Volume 60



Issue 5



2015

273