Articaine Doubts Remain Despite Safety Evidence
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- Published: Wednesday, 21 December 2022 09:42
- Written by Peter Ingle
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When the Berlin Wall fell in 1989 one of the first things that East German dentists wanted to get from their colleagues in the West was the local anaesthetic, Articaine.
It took until 1998 for it to arrive in the UK. As it gained popularity, concerns began to be raised about reports of increased levels of nerve damage, particularly following inferior alveolar nerve blocks (IANBs)
A new study published in Cureus demonstrates that it has been hard to shake off the negative perceptions. The paper, “A Cross-Sectional Study on the Evidence-Based Dentistry, Perception Basis, and Use of Articaine Among Dental Practitioners” begins with a brief history of the damage to the anaesthetic’s reputation. Shortly after its introduction there were reports of a higher incidence of lingual nerve paraesthesia following its use, than with other agents. However, from 2010 various studies confirmed its safety, many of them being meta-analyses and systematic reviews. Data reported more recently, including that from clinical studies and randomized controlled trials, has not reported any permanent lingual nerve paraesthesia after the use of Articaine. Despite this, many dentists appear remain reluctant to use the anaesthetic.
A survey of Australian dentists published in 2012 showed that the majority used Articaine, but that nearly one third of those, did not use it when giving IANBs. The study reported in Cureus intended to follow this up and also see if dentists were using evidence based dentistry in their practice, when it came to local anaesthetic selection.
864 Indian dentists working in general and specialist as well as private and public sector practices were surveyed. 60% used Articaine, 33% Lidocaine and the remainder used other agents. However when it came to IANBs, while 20% used it for all procedures, 43% were using it for some injections but excluded IANBs.
It was noted that limitations associated with the study, included the authenticity of the participants completing the study questionnaire, and the higher cost of Articaine than Lidocaine, which might limit its use.
The study concluded that despite the reported efficacy and safety of Articaine as a local anaesthetic for all dental procedures, many dental practitioners refrain from using it, especially for IANBs. The authors added that this showed a difference between current research evidence and reported clinical practice.
The study also sought to find out on what basis respondents decided which local anaesthetics they would use. County based guidelines, post graduate courses, and their initial training, were the largest influences, with evidence based literature rarely mentioned.
Cureus, published by the Springer group is an open access general medical journal and is subject to both pre and post publication peer review.
I use lidocaine for the first and second carp, the third if it doesnt work is articaine. Many times I just give it bucally and papillary as an Intra Oss and it works fine.
I also use lidocaine the same way basically for simple shallow fillings
To sum up for shallow fillings ,around the mental nerve and the first 2 carps for a block lidocaine , for upper anteriors(where the rapid spread is much more apparant) ,third carp blocks and deep fillings for sure articaine.
1/200 is also faster acting but faster dissapearing and is ideal for any kind of sub periosteal injection to avoid pain as it spreads faster.
Articaine Doubts Remain Despite Safety Evidence
I have used articaine for many years including for block injections and never once had an adverse reaction.The study conducted in 2004 also reported that the use of articaine as a local anesthetic agent for dental procedures is efficacious and safe, with no reported major adverse effects [4]. These results were also supported by other studies by various authors reporting that articaine is safe and efficacious for dental procedures with no major adverse effects. Although the efficacy and safety of articaine allow it to be used as a local anesthetic for dental procedures, its use is still limited as various dental practitioners are still afraid of initial reports mentioning lingual nerve paresthesia
I find it quite curious that given it is such a safe and effective LA, we are still frightened of using it based upon some unevidenced opinions.
Its fortunate we don't apply such reluctance to other effective drugs as we would stay in the dark ages.
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