Outlines the benefits and possible risks of using articaine rather than lidocaine.
Presents the results of a systematic search of the literature to determine the safety of articaine in inferior alveolar block anaesthesia.
Advises the profession following analysis of the results.
This is a preview of subscription content, access via your institution
Subscribe to Journal
Get full journal access for 1 year
only $4.96 per issue
All prices are NET prices.
VAT will be added later in the checkout.
Tax calculation will be finalised during checkout.
Get time limited or full article access on ReadCube.
All prices are NET prices.
Renton T . Oral surgery: part 4. minimising and managing nerve injuries and other complications. Br Dent J 2013; 215: 393–399.
Brandt R G, Anderson P F, McDonald N J, Sohn W, Peters M C . The pulpal anesthetic efficacy of articaine versus lidocaine in dentistry: a meta-analysis. J Am Dent Assoc 2011; 142: 493–504.
Su N, Li C, Wang H, Shen J, Liu W, Kou L . Efficacy and safety of articaine versus lidocaine for irreversible pulpitis treatment: a systematic review and meta-analysis of randomised controlled trials. Aust Endod J 2016; 42: 4–15.
Malamed S F, Gagnon S, Leblanc D . Efficacy of articaine: a new amide local anesthetic. J Am Dent Assoc 2000; 131: 635–642.
Powell V . Articaine is superior to lidocaine in providing pulpal anesthesia. J Am Dent Assoc 2012; 143: 897–898.
Paxton K, Thome D E . Efficacy of articaine formulations: quantitative reviews. Dent Clin North Am 2010; 54: 643–653.
Haase A, Reader A, Nusstein J, Beck M, Drum M . Comparing anesthetic efficacy of articaine versus lidocaine as a supplemental buccal infiltration of the mandibular first molar after an inferior alveolar nerve block. J Am Dent Assoc 2008: 139: 1228–1235.
Kanaa M D, Whitworth J M, Meechan J G . A comparison of the efficacy of 4% articaine with 1:100,000 epinephrine and 2% lidocaine with 1:80,000 epinephrine in achieving pulpal anesthesia in maxillary teeth with irreversible pulpitis. J Endod 2012; 38: 279–282.
Bartlett G, Mansoor J . Articaine buccal infiltration vs lidocaine inferior dental block - a review of the literature. Br Dent J 2016; 220: 117–120.
Yapp K E, Hopcraft M S, Parashos P . Articaine: a review of the literature. Br Dent J 2011; 210: 323–329.
Costa C G, Tortamano I P, Rocha R G, Francischone C E, Tortamano N . Onset and duration periods of articaine and lidocaine on maxillary infiltration. Quintessence Int 2005; 36: 197–201.
Katyal V . The efficacy and safety of articaine versus lignocaine in dental treatments: a meta-analysis. J Dent 2010; 38: 307–317.
Srinivasan N, Kavitha M, Loganathan C S, Padmini G . Comparison of anesthetic efficacy of 4% articaine and 2% lidocaine for maxillary buccal infiltration in patients with irreversible pulpitis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009; 107: 133–136.
Robertson D, Nusstein J, Reader A, Beck M, McCartney M . The anesthetic efficacy of articaine in buccal infiltration of mandibular posterior teeth. J Am Dent Assoc 2007; 138: 1104–1112.
Darawade D A, Kumar S, Budhiraja S, Mittal M, Mehta T N . A clinical study of efficacy of 4% articaine hydrochloride versus 2% lignocaine hydrochloride in dentistry. J Int Oral Health 2014; 6: 81–83.
Balto K . Administration of articaine anesthesia may lead to superior profound pulpal anesthesia compared with lidocaine in adult patients. J Evid Based Dent Pract 2011; 11: 183–184.
Haas D A, Lennon D . A 21 year retrospective study of reports of paresthesia following local anesthetic administration. J Can Dent Assoc 1995; 61: 319–320, 323–326, 329–330.
Hillerup S, Jensen R . Nerve injury caused by mandibular block analgesia. Int J Oral Maxillofac Surg 2006; 35: 437–443.
Malamed S F, Gagnon S, LeBlanc D . Articaine hydrochloride: a study of the safety of a new amide local anesthetic. J Am Dent Assoc 2001; 132: 177–185.
Pogrel M A . Permanent nerve damage from inferior alveolar nerve blocks: a current update. J Calif Dent Assoc 2012; 40: 795–797.
Griffiths P . Evidence informing practice: introducing the mini-review. Br J Community Nurs 2002; 7: 38–39.
Petrisor B A, Keating J, Schemitsch E . Grading the evidence: levels of evidence and grades of recommendation. Injury 2006; 37: 321–327.
Makela M, Witt K . How to read a paper: critical appraisal of studies for application in healthcare. Singapore Med J 2005: 46: 108–114.
Higgins J P T, Altman D G, Gøtzsche P C et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 2011; 343: d5928.
Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J . Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 2003; 73: 712–716.
Pogrel M A . Permanent nerve damage from inferior alveolar nerve blocks--an update to include articaine. J Calif Dent Assoc 2007; 35: 271–273.
Garisto G A, Gaffen A S, Lawrence H P, Tenenbaum H C, Haas D A . Occurrence of paresthesia after dental local anesthetic administration in the United States. J Am Dent Assoc 2010; 141: 836–844.
Gaffen A S, Haas D A . Retrospective review of voluntary reports of nonsurgical paresthesia in dentistry. J Can Dent Assoc 2009; 75: 579.
Saxon E . Defining the null hypothesis. BMC Biol 2015; 13: 68.
Pogrel M A, Thamby S . Permanent nerve involvement resulting: from inferior alveolar nerve blocks. J Am Dent Assoc 2000; 131: 901–907.
Robinson P P . Observations on the recovery of sensation following inferior alveolar nerve injuries. Br J Oral Maxillofac Surg 1988; 26: 177–189.
Robinson P P, Smith K G, Johnson F P, Coppins D A . Equipment and methods for simple sensory testing. Br J Oral Maxillofac Surg 1992; 30: 387–389.
Corbett I P, Kanaa M D, Whitworth J M, Meechan J G . Articaine infiltration for anesthesia of mandibular first molars. J Endod 2008; 34: 514–518.
Kanaa M D, Whitworth J M, Corbett I P, Meechan J G . Articaine buccal infiltration enhances the effectiveness of lidocaine inferior alveolar nerve block. Int Endod J 2009; 42: 238–246.
Poorni S, Veniashok B, Senthilkumar A D, Indira R, Ramachandran S . Anesthetic efficacy of four percent articaine for pulpal anesthesia by using inferior alveolar nerve block and buccal infiltration techniques in patients with irreversible pulpitis: a prospective randomized double-blind clinical trial. J Endod 2011; 37: 1603–1607.
Leith R, Lynch K, O'Connell A C . Articaine use in children: a review. Eur Arch Paediatr Dent 2012; 13: 293–296.
Malamed S F . Is the mandibular nerve block passé? J Am Dent Assoc 2011; 142 (Spec Iss): 3S–7S.
Hillerup S, Bakke M, Larsen J O, Thomsen C E, Gerds T E . Concentration-dependent neurotoxicity of articaine: an electrophysiological and stereological study of the rat sciatic nerve. Anesth Analg 2011; 112: 1330–1338.
Malet A, Faure M, Deletage N, Pereira B, Haas J, Lambert G . The comparative cytotoxic effects of different local anesthetics on a human neuroblastoma cell line. Anesth Analg 2015; 120: 589–596.
Malamed S F . Local anesthetics: dentistry's most important drugs, clinical update 2006. J Calif Dent Assoc 2006; 34: 971–976.
Malamed S F . Articaine versus lidocaine: the author responds. J Calif Dent Assoc 2007; 35: 383–385.
Hintze A, Paessler L . Comparative investigations on the efficacy of articaine 4% (epinephrine 1:200,000) and articaine 2% (epinephrine 1:200,000) in local infiltration anaesthesia in dentistry-a randomised double-blind study. Clin Oral Investig 2006; 10: 145–150.
Aguiar J, Chebroux A, Martinez-Taboada F, Leece E A . Analgesic effects of maxillary and inferior alveolar nerve blocks in cats undergoing dental extractions. J Feline Med Surg 2015; 17: 110–116.
Hung P, Chang H, Yang P, Kuo Y, Lan W, Lin C . Comparison of the Gow-Gates mandibular block and inferior alveolar nerve block using a standardized protocol. J Formos Med Assoc 2006; 105: 139–146.
Potocnik I, Tomsic M, Sketelj J, Bajroviä F F . Articaine is more effective than lidocaine or mepivacaine in rat sensory nerve conduction block in vitro. J Dent Res 2006; 85: 162–166.
Sisk A L . Evaluation of the Akinosi mandibular block technique in oral surgery. J Oral Maxillofac Surg 1986; 44: 113–115.
Baroni D B, Franz-Montan M, Cogo K et al. Effect of articaine on mental nerve anterior portion: histological analysis in rats. Acta Odontol Scand 2013; 71: 82–87.
Batista D S, Berto L A, Volpato M C et al. Anesthetic efficacy of articaine and lidocaine for incisive/mental nerve block. J Endod 2010; 36: 438–441.
Chopra R, Jindal G, Sachdev V, Sandhu M . Double-blind crossover study to compare pain experience during inferior alveolar nerve block administration using buffered two percent lidocaine in children. Pediatr Dent 2016; 38: 25–29.
Danielsson K, Evers H, Holmlund A, Kjellman O, Nordenram A, Persson N E . Long-acting local anaesthetics in oral surgery. Clinical evaluation of bupivacaine and etidocaine for mandibular nerve block. Int J Oral Maxillofac Surg 1986; 15: 119–126.
Rood J P . Inferior alveolar nerve blocks. The use of 5 per cent lignocaine. Br Dent J 1976; 140: 413–414.
Ahmad Z H, Ravikumar H, Karale R, Preethanath R S, Sukumaran A . Study of the anesthetic efficacy of inferior alveolar nerve block using articaine in irreversible pulpitis. J Contemp Dent Pract 2014; 15: 71–74.
Kambalimath D H, Dolas R S, Kambalimath H V, Agrawal S M . Efficacy of 4 % articaine and 2 % lidocaine: a clinical study. J Maxillofac Oral Surg 2013; 12: 3–10.
Moorthy A, Stassen L F . The occurrence of paraesthesia of the maxillary division of the trigeminal nerve after dental local anaesthetic use: a case report. J Ir Dent Assoc 2015; 61: 34–35.
Choi E, Seo J, Jung B, Park W . Diplopia after inferior alveolar nerve block anesthesia: report of 2 cases and literature review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009; 107: e21–e24.
Al-Sandook T, Al-Saraj A . Ocular complications after inferior alveolar nerve block: a case report. J Calif Dent Assoc 2010; 38: 57–59.
Wyman R J . Nerve injury following a mandibular block: a case report. Dent Today 2010; 29: 14.
Pedlar J . Prolonged paraesthesia. Br Dent J 2010; 195: 119.
Fowler S, Reader A . Is a volume of 3.6 mL better than 1.8 mL for inferior alveolar nerve blocks in patients with symptomatic irreversible pulpitis? J Endod 2013; 39: 970–972.
Steinkruger G, Nusstein J, Reader A, Beck M, Weaver J . The significance of needle bevel orientation in achieving a successful inferior alveolar nerve block. J Am Dent Assoc 2013; 137: 1685–1691.
About this article
Cite this article
Stirrup, P., Crean, S. Does articaine, rather than lidocaine, increase the risk of nerve damage when administered for inferior alveolar nerve blocks in patients undergoing local anaesthesia for dental treatment? A mini systematic review of the literature. Br Dent J 226, 213–223 (2019). https://doi.org/10.1038/sj.bdj.2019.98