Articaine Hydrochloride

When using dental local anesthetics containing adrenaline as a vasoconstrictor, it is essential to exercise sufficient caution regarding hemodynamic fluctuations, particularly in patients with cardiovascular disease. In this report, we introduce a safe and simple method to halve the adrenaline concentration in anesthetic cartridges. The equipment used includes a syringe (1-3 mL), an IV catheter (22- or 24-G), and a metal needle, which are typically available in dental clinics for IV sedation or emergency use. By connecting the inner needle (24- or 27-G) of the IV catheter to the syringe and puncturing the edge of the rubber stopper at the head of the cartridge, 0.9 mL of anesthetic solution can be accurately aspirated while reducing the risk of coring. Furthermore, by injecting an equal volume of 2% lidocaine without adrenaline into the cartridge, the adrenaline concentration can be effectively halved. This method is quick, broadly applicable, and does not require any special equipment, making it feasible even for dentists who are not specialists in dental anesthesia. In Japan, four types of dental local anesthetics are commonly used. However, dental treatment cannot always be completed with a preparation that does not contain adrenaline, and there are many situations where the excellent anesthetic and hemostatic effects of adrenaline are required. Dentists must accurately assess these situations and confidently select and administer the appropriate anesthetic. It should be noted that articaine alone is not commercially available in Japan; therefore, this method can only be applied to cartridges containing 2% lidocaine with 1:80,000 adrenaline. Although local anesthetics containing 1:80,000 adrenaline are generally considered safe for patients with cardiovascular disease, the use of the lowest possible adrenaline concentration is desirable. Therefore, this method provides a practical approach to minimize cardiovascular risk while maintaining anesthetic efficacy and hemostasis, especially in procedures requiring large amounts of local anesthetic. Given the increasing number of patients with cardiovascular disease due to aging, this technique is considered a practical approach to ensuring safer dental treatment.

Local anaesthetics (LAs), almost indispensable aspect of dental practice for pain-free procedures, occasionally leads to worrisome adverse events (AEs). We aimed to compare serious and nonserious AEs of LAs for dental reasons in the US Food and Drug Administration AE Reporting System.

We retrospectively analysed dental AE reports associated with LAs in the Food and Drug Administration AE Reporting System database from its inception to April 2024. We described AEs by patients' demographic and clinical characteristics and compared ester and amide LA-associated AEs by their severity.

We identified 1956 dental cases with a significant increase of AE reports after 2017. Lidocaine and articaine were the most commonly reported LAs (40.4% and 39.2%, respectively). Serious AEs constituted 46.2%, more commonly in females than males (56.6% vs 43.4%, P < .001) and in those on concomitant medications (70.2% vs 42.2, P < .001). These were also significantly higher in epinephrine-containing LAs (70.1%) than that without (34.2%, P < .01). Ester LAs had increased risk of serious AEs (odds ratios [OR]: 3.86; 95% confidence intervals [CI]: 2.77-5.39), particularly as hospitalization, life-threatening event, or death. The odds of serious AEs were lower with lidocaine (OR: 0.59; 95% CI: 0.48-0.71) and articaine (OR: 0.63; 95% CI: 0.52-0.76).

Our study showed higher rate of serious AEs with ester LAs and those with vasoconstrictor-added practices. Besides, serious outcomes appear as more likely in females and those where additional drug use was reported.

The integration of clinical evidence with pharmacovigilance data has the potential to influence clinicians' LA preferences in dental practice, enabling more informed and evidence-based decision-making.