Title	4% Articaine (1:100,000 epi) Is More Effective At Pulpal Anesthesia Than 2% Lidocaine (1:100,000 epi) In Local Infiltration Anesthesia
Clinical Question	For local infiltration anesthesia, would 4% articaine (1:100,000 epi) be more effective in pulpal anesthesia than 2% lidocaine (1:100,000 epi) in dental treatments?
Clinical Bottom Line	In the meta-analysis of 13 different studies, articaine was found to have more efficacy than lidocaine at pulpal anesthesia.
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 21531931 Brandt/2011 From the pulpal anesthesia comparison only, there were 466 experimental (lidocaine) and 467 control (articaine). With both drugs having the same ratio of (1:100,000 epinephrine) Total population = 933 Meta-Analysis Key results When the author compared articaine to lidocaine in general dental treatments, 95% CI, 1.59-3.76 OR, P<.0001 with an average OR of 2.44 for the total sample size was found. When the author compared the efficacy of both drugs in pulpal anesthesia only, infiltration, the odds ratio increased to an average of 3.81, (95% Cl, 2.71-5.36 OR, P<.00001). From the results for infiltration, with a 95% CI you can expect the OR to fall between 2.71-5.36. With a narrow OR range, we can determine that through repetition of the experiment or general use of articaine versus lidocaine, results would prove that articaine would provide better anesthesia than lidocaine when used for infiltration. To reduce subjectivity of pulpal anesthesia, the author found articles that had EPT and VAS done, although the evaluation still depended on patients’ perception. 10 out of the 13 used the electric pulpal test and the rest were done with VAS. With the electric testing, 2 consecutive readings of EPT of 80 or above were acquired within 15 minutes of administration along with patients’ perception to ensure proper level of pulpal anesthesia.
Evidence Search	("carticaine"[MeSH Terms] OR "carticaine"[All Fields] OR "articaine"[All Fields]) AND versus[All Fields] AND ("lidocaine"[MeSH Terms] OR "lidocaine"[All Fields])
Comments on The Evidence	The article chosen was a systematic review of randomized controlled trials. The search was comprehensive, detailed, and relevant. Individual studies were assessed for validity. In total, 13 trials were selected and there were approximately 2052 patients. A meta-analysis was done on the data collected.
Applicability	This applies to patients who are undergoing treatments involving local infiltration anesthesia.
Specialty	(Endodontics) (General Dentistry) (Oral Surgery) (Pediatric Dentistry) (Periodontics) (Prosthodontics) (Restorative Dentistry) (Dental Hygiene)
Keywords	Local infiltration anesthesia, articaine, lidocaine
ID#	2416
Date of submission	03/21/2013
E-mail	yei@livemail.uthscsa.edu
Author	Shih-Jye Yei
Co-author(s)
Co-author(s) e-mail
Faculty mentor	Gregory K. Spackman, DDS, MBA
Faculty mentor e-mail	spackman@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?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) None available