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Title Four Percent Articaine Administered For Routine Dental Procedures May Or May Not Increase The Risk of Paresthesia Compared To 2% Lidocaine
Clinical Question In patients requiring local anesthesia for dental procedures, is articaine administration more likely to cause paresthesia than lidocaine administration?
Clinical Bottom Line Randomized controlled trials report similar rates of paresthesia between 2% lidocaine and 4% articaine. FDA adverse events reporting indicates a higher-than-expected frequency of paresthesia after dental anesthetic administration of both 4% articaine and 4% prilocaine. (See Comments on the CAT below)
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 20592403Garisto/2010Dental patientsCase Series
Key results94.5% of cases of post-dental local anesthetic paresthesia were from mandibular nerve block. Reports of paresthesia following administration of 4% articaine occurred 3.6 times more often than expected, and following 4% prilocaine occurred 7.3 times more often than expected (chi-squared analysis, P<0.0001).
#2) 11217590Malamed/2001Dental patientsMulticenter Randomized Controlled Trial
Key resultsOverall adverse effects incidence was 22% for the articaine group and 20% for the lidocaine group. 4% of each group experienced adverse events. 18 of 882 patients in the articaine group, and 7 of 443 patients in the lidocaine group, reported hypesthesia or paresthesia.
Evidence Search "Carticaine/adverse effects"[Mesh] AND ("paraesthesia"[All Fields] OR "paresthesia"[MeSH Terms] OR "paresthesia"[All Fields]) AND (Randomized Controlled Trial[ptyp] OR "Cohort Studies"[Mesh])
Comments on
The Evidence
The Garisto paper summarized 248 cases of paresthesia from dental local anesthetics reported to the US FDA Adverse Event Reporting System from November 1997 through August 2008.The Malamed paper summarized 3 identical trials, over 27 centers, which were randomized and double-blind including a total of 1325 patients. 882 of these patients received 4 percent articaine with 1:100,000 epinephrine and the other 443 received 2 percent lidocaine with 1:100,000 epinephrine. Patients were stratified by simple or complex dental procedures. Twice as many patients were assigned to the articaine as to the lidocaine group to increase the likelihood of capturing adverse events. Patients were evaluated intraoperatively, and interviewed by telephone at 24 hours and 7 days post-operatively, for determination of adverse events. The two groups did not differ in mean age, ethnicity distribution, sex distribution, nor weight distribution, nor in ratio of simple to complex dental procedures.
Applicability The Garisto study included all US cases of dental anesthesia-related oral paresthesia (broadly defined) in the study period, but excluded cases involving surgical procedures or use of an intraosseous injection device. The Malamed studies included patients with routine dental operative or oral surgical needs from ages 4 to 80 years at 8 clinical sites in Great Britain and 19 sites in the USA. Exclusion criteria were impacted third molars, local soft tissue infection, 24 hr history of oral analgesic consumption, or various medical complications.
Specialty/Discipline (General Dentistry)
Keywords Local anesthesia, paresthesia, articaine, lidocaine, prilocaine
ID# 2068
Date of submission: 07/07/2011spacer
E-mail curtisjg@livemail.uthscsa.edu
Author Joseph Curtis
Co-author(s) e-mail
Faculty mentor/Co-author S. Thomas Deahl, II, DMD, PhD
Faculty mentor/Co-author e-mail DEAHL@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
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Comments and Evidence-Based Updates on the CAT
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by Kirk Sutton (San Antonio, Texas) on 07/09/2012
The current literature supports your conclusion that 4% Articaine solution may have a higher incidence of paresthesias following IANB injection compared to 2% Lidocaine solution. However, it is noted that further randomized control trials are needed with larger sample sizes to provide a more definite answer to this question. PMID: 20831934

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