Research proves articaine as safe as lidocaine for dental procedures
Dentists heavily depend on local anaesthetics, such as lidocaine and articaine, to help control pain during procedures. It has been reported that articaine could have some adverse effects on the patient in the form of prolonged paraesthesia and increased neurotoxicity after the procedure when compared with lidocaine.
Recently, researchers from the University of Pennsylvania published a study that compared the neurotoxicity levels and sustained length of the anaesthetic block caused by both articaine and lidocaine.
The researchers performed an in vitro study in which human-derived cells were tested with dental-grade concentrations of articaine and lidocaine. To test the neurotoxicity, the cells were exposed to each drug for 5 minutes, washed and then exposed to the Live/Dead cell assay for 30 minutes, which determines viability of cells.
To test the recovery time, experiments were designed to examine depolarization 30 minutes after treatment with the drug and how quickly the cell was responding after being exposed to the anaesthetic.
To confirm their results, the researchers used exactly the same methods of testing using the pure, powdered form of each drug to ensure that any additives to the dental-grade drugs were not affecting the outcome.
The researchers found the results surprising. Contrary to their original hypothesis, it was found that the neurotoxicity levels in dental-grade articaine and lidocaine were similar, but the pure lidocaine appeared to have increased neurotoxicity compared with articaine.
This was surprising as some retrospective clinical surveys seemed to indicate that articaine may be more neurotoxic than lidocaine for dental nerve block. Regarding prolonged post-procedural drug effects, lidocaine was found to have a reduction in cell responsiveness after 30 minutes, again contradicting the original hypothesis and previously presented study data.
The overall study results found that articaine did not cause increased neurotoxicity or delayed responsiveness in human-derived cells as compared with lidocaine. Although lidocaine did create a more delayed post-procedural responsiveness, the researchers’ stress that there is no indication that lidocaine is unsafe or should create cause for concern; it has been well documented as a safe anaesthetic in the dental clinical setting.
The most important conclusion is that articaine proved no more neurotoxic than lidocaine during this in vitro study.
Full text of the article, “Effects of Lidocaine and Articaine on Neuronal Survival and Recovery,” Anesthesia Progress, Vol. 65, No. 2, 2018, is now available here: http://www.anesthesiaprogress.org/doi/full/10.2344/anpr-65-02-02