Lidocaine is the progenitor and the standard of reference for the pharmacological family of local starch anesthetics, and, in many countries of the world, this type of drug is used most by the dentists. From a biochemical point of view, the molecule is based on the benzene ring (C6H6).
As already considered several times, the articaine represents a peculiarity within the same class. It is characterized by the presence of a thiophene ring (C4H4S), which gives the molecule a marked liposolubility, four times higher than that of lidocaine. In pharmacodynamics, this characteristic is expressed as an advantage regarding the onset time, which the study quantifies to be approximately 7.4 minutes compared to 8.7 minutes for lidocaine. The molecule has a second advantage, resulting from the mode of protein binding regarding the duration of action (this is longer than lidocaine).
Some authors, however, object to some critical issues related to the clinical use of the molecule in the dental field. In particular, there are references to possible traumatic risk to the lower alveolar nerve linked to its use in the molecule in the nerve block anesthesia technique (inferior alveolar nerve block). Such episodes may result in temporary or even permanent forms of paresthesia, affecting the corresponding innervated areas.
Since this risk is doubtful, even contradicted by other studies, Stirrup and Crean have considered it to be useful to carry out what they call a “mini systematic review” on the subject. The study was published last February in the British Dental Journal.
The research involved 3 sources – MEDLINE, Dentistry & Oral Sciences Source, The Cochrane Library, and it provided a total of 182 screened articles, 11 of which were relevant MEPs. 6 retrospective cohort studies and a single, randomized, double-blind clinical trial for a total of 7 studies were brought to final evaluation. The authors admit the partial lack of quality and the consequent need for further investigation to also clarify the reasons for the results reported below.
The single RCT and two of the cohort studies do not detect any increase in risk from the use of 4% articaine, which is, therefore, considered safe.
The remaining work, however, suggests greater caution linked to the high concentration to which the articaine is administered.
In the final analysis, it should be remembered that the complication under examination is also potentially related to aspects related to the technique of lower alveolar blockage and, therefore, independent of the molecule used. The article in question refers, for example, to the mechanical risk factor determined by the curvature of the needle tip following contact with the cortical bone. In this sense, it may be advisable to consider alternatives to the conventional procedure, which is still the most widely used in the approach to the posterior sectors of the lower arch, despite this and other critical issues.