Dental Anesthetics and Paresthesia Quiz

Local Anesthetics and Paresthesia in Dentistry

• Informed consent, including discussion of the risk of paresthesia, is necessary before dental procedures, especially those involving the lingual nerve.
• Over 95% of reported cases of paresthesia in dentistry occur in the mandible, with the lingual nerve being involved in the majority of cases.
• 4% articaine appears to be more neurotoxic than other local anesthetics, and its administration via IANB should be avoided.
• The lingual nerve is primarily involved in cases of paresthesia, despite the majority of local anesthetic volume being deposited close to the inferior alveolar nerve during IANB.
• Paresthesia is estimated to occur in 1 in 26,762 IANB injections, and there is no known prevention or treatment for permanent nerve damage.
• Lingual nerve damage is commonly seen as more profound, possibly due to mechanical trauma from the metal needle and the anatomy of the lingual nerve.
• Inferior alveolar nerve typically has more fascicles than the lingual nerve, leading to a smaller area of sensory involvement if damaged, compared to the lingual nerve.
• Paresthesia involving the distribution of the lingual nerve is likely caused by mechanical trauma from the metal needle, while causes for paresthesia involving the inferior alveolar nerve may include neurotoxicity of the local anesthetic, mechanical contact of the needle, edema, and hemorrhage.
• All local anesthetics are neurotoxic, but their neurotoxicity varies, as evidenced by the reported cases of paresthesia not aligning with market share.
• Lidocaine had a lower ratio of reported paresthesia cases to market share, while prilocaine and articaine had higher ratios, indicating their greater involvement in paresthesia cases.
• Articaine is reported to cause proportionate permanent inferior alveolar and lingual nerve damage relative to its market share.
• The number of paresthesia cases caused by lidocaine appears to be lower than its market share in the clinic's evaluation.

Articaine and Local Anesthesia in Dentistry

• Prilocaine caused 26% of cases since 2005 with only 8% market share
• Meta-analyses show articaine provides higher anaesthetic success and safety compared to lidocaine
• Articaine is not toxic to nervous structure, unlike lidocaine and prilocaine
• In vitro study found 2% lidocaine had lower neurotoxicity than 4% prilocaine
• Albalawi et al. reported articaine did not produce prolonged block of neuronal responsiveness or increased toxicity compared to lidocaine
• Benefit vs. risk should be considered before administering procedures or drugs
• No scientific evidence shows increased paresthesia risk with articaine
• Christenson stated that observations and studies do not support increased paresthesia with articaine
• Options for inferior alveolar nerve block (IANB) include 4% articaine, 2% lidocaine, or 2% mepivacaine
• 4% prilocaine with epinephrine has a greater risk of paresthesia
• Articaine provides similar anesthesia depth and duration as other local anesthetics
• Articaine is preferred in special patient populations due to its shorter elimination half-life and greater lipid solubility