Dental local anesthetics

Dental local anesthetics

Dental local anesthetics are the numbing agents dentist use to ensure local anesthesia of teeth and gums in order to do our work. There are several types of anesthetic we can use and several techniques from which we can choose to deliver it.

Dental local anesthetics options

Lidocaine – use 1:200k instead of 1:1ook since same effectiveness and less risk, use 1:50k for hemostasis

Bupivicaine – only long lasting if block NOT if infiltration

Mepivicaine – no epi last 20-40 pupal  2-3 h soft tissue.  Lower pKa than lidocaine so better for inflamed tissue.  Shorter onset and longer duration than lidocaine.  More effective IAN for teeth getting RCT with apical periodontists Visconti JOE 2016

Prilocaine – 40-60 pulpal if block 5-10 infiltrate
Prilocaine w epi  – similar lido and mep but since 4% higher toxicity so don’t bother except…….
Prilo – works well on hard to anesthetize patient

Articaine – starts working a little faster and may be more profound.  No difference for block or max infiltration but is for infiltration in mand (v lido) Kung JOE 2015

I have an entire blog post on the articaine v lidocaine argument.

Dental local anesthetics by weight

This is a list of the common dental local anesthetics used in dentistry and how much can be used on a patient by weight.

Graph of dental local anesthetics by weight

Dental anesthetic injection techniques

Dental anesthetic injection techniques vary from dentist to dentist. I will cover a few studies on techniques in this section. An interesting study I ran across in JOE was on the impact of IAN injection and patient positioning. I was unaware that having the patient remain in the supine position results in slightly better success rates of anesthesia.

Wand vs traditional method

No difference in pain or time of onset found in study however, this study is on maxillary molars in kids. Why even bother with the wand in maxilla?

Having mandibular nerve block failures?

When the IAN block is successful but still does not produce sufficient anesthesia for the patient try

  1. Lingual infiltration to anesthetize accessory innervation via the mylohyoid from the lingual
  2. Anesthetize retromolar area 8% have retromolar foramina that may be accessory innervation from long buccal
  3. In anterior cross the midline and place anesthetic
  4. Try switching to Gow-Gates (many feel this is superior from the get go).  Also would likely get any bifurcated mandibular nerves which are thought to occur .1-.9% (pretty low really) and innervation from long buccal through the retromolar foramina.
  5. PDL and Intraosseous

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  1. Articaine vs lidocaine - June 1, 2016

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