Choosing a local anaesthetic in dentistry

Local anaesthetics for infiltration or regional block in dentistry outlines properties of local anaesthetic preparations for infiltration or regional block in dentistry. Consult a source of drug information for precautions, contraindications, drug interactions and adverse effects.

Table 1. Local anaesthetics for infiltration or regional block in dentistry
Local anaesthetic	Comments
Short- to intermediate-acting preparations
lidocaine	shorter acting—use in dentistry may be limited
lidocaine with adrenaline (epinephrine) [NB1]	intermediate acting first line for routine dental procedures
prilocaine [NB1]	shorter acting—use in dentistry may be limited
prilocaine with adrenaline (epinephrine) [NB1]	intermediate acting
prilocaine with felypressin [NB1]	intermediate acting first line for routine dental procedures when adrenaline (epinephrine) is contraindicated
mepivacaine [NB1]	shorter acting—use in dentistry may be limited do not use in children younger than 3 years
mepivacaine with adrenaline (epinephrine) [NB1]	intermediate acting do not use in children younger than 3 years
articaine with adrenaline (epinephrine) [NB1]	risk of prolonged or permanent anaesthesia for infiltration only—do not use for regional blocks (injection close to inferior alveolar, lingual and mental nerves) do not use in children younger than 4 years
Long-acting preparations
ropivacaine	useful for situations in which prolonged analgesia (eg 12 to 18 hours) is required, postoperative pain, and refractory acute dental pain concentrations up to 0.5% can be used in children
bupivacaine	similar indications to ropivacaine more cardiotoxic than ropivacaine cardiac toxicity may manifest before neurological toxicity do not use in children younger than 12 years
bupivacaine with adrenaline (epinephrine)	similar indications to ropivacaine more cardiotoxic than ropivacaine cardiac toxicity may manifest before neurological toxicity do not use in children younger than 12 years
Note: NB1: Available in dental cartridges.