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Dental Anesthesia

Which is Safer Septocaine or Lidocaine?

11/18/2011

Question:

I was wondering which one of those anesthesias is safer. Also,can the septocaine without epinephrine really numb the area where the tooth will be extracted? Can it cause me any palpitations,numb other areas of the mouth,cause me not to be able to taste food or any other discomforts?

Answer:

All local anesthetics used in dentistry are very safe so long as the dentist does not exceed the maximum recommended dose.

Typically the dose of the local anesthetic needed to numb the tooth being treated is fairly small, so the likelihood of the dentist giving too much is quite small for most procedures.
 
However, since the maximum recommended dose for a given local anesthetic is primarily based upon the patient's body weight, this maximum dose is reached more quickly for small adults and children as well as for frail or significantly medically compromised patients. Less body weight means that a smaller total dose can be given.

The maximum recommended dose for both lidocaine with epinephrine and articaine with epinephrine is the same, 7 mg per kilogram of body weight. Lidocaine without epinephrine is such a short acting anesthetic that is is rarely used in dentistry because it wears off before the dentist can do a procedure.

Lidocaine with epinephrine is the most popular dental local anesthetic in the U.S. Articaine is not marketed in the U.S without epinephrine. Both drugs have about the same rapid onset time for numbness to develop and about an equally moderate duration of numbness.

There is some evidence that under certain clinical circumstances, articaine is a bit more effective for a tooth that is difficult to numb but basically they are pretty much equal for most procedures.

There is a difference between the 2 drugs if large doses are needed for an extensive dental procedure involving multiple teeth, like 4 crowns on the upper jaw and 4 crowns on the lower jaw or the extraction of all remaining teeth or 4 impacted wisdom teeth.

Lidocaine with epinephrine is marketed in a 2% concentration so that each glass cartridge of anesthetic in the dentist's syringe contains 36 milligrams of lidocaine. Articaine is marketed in a 4% concentration (twice as concentrated) so that each glass cartridge contains 72 mg of articaine. Thus the maximum recommended total dose of articaine is reached with half the number of glass cartridges injected compared to the more dilute concentration of lidocaine.

For a small 2 year old child weighing 22 pounds (10 kilograms), the maximum recommended dose for articaine is 70 mg, so the dentist is limited to slightly less than one cartridge of articaine (72mg) with epi compared to slightly less than 2 cartridges of lidocaine with epi (36 mg times 2 cartridges = 72mg).
 
So if articaine is chosen, the dentist might not be able to numb up multiple teeth using the 1 cartridge limit of articaine but might be able to complete everything with the 2 cartridge limit with lidocaine.

Finally, if the short period of heart palpitations that sometimes occurs with the concentration of 1:100,000 epinephrine (which is one part epinephrine diluted is 100,000 parts of water) , articaine also is marketed with a more diluted concentration of epinephrine (1:200,000) so that the epinephrine dose is cut in half . Thus the articaine with 1:200,000 concentration may be a little less stimulating to the heart than the articaine with 1:100,000 concentration of epi or the lidocaine with 1:100,000 epi.

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Response by:

Joel M Weaver, II, DDS, PhD
Faculty Emeritus
Dentistry Administration
College of Dentistry
The Ohio State University