Articaine follows the mechanism or action of other local anesthetic drugs, but it detaches from itself by virtue of certain characteristics that ensure the drug is a peculiarity within its pharmacological class. The presence of a thiophene ring (C4H4S), with a lipophilic portion, increases the liposolubility and power of the drug. In fact, it gains in terms of intraneural concentration, longitudinal diffusion, and the ability to block conduction.
Articaine is available at a concentration of 4%, which is higher than the concentration at which the other drug of the same class are marketed. This should not entail an increased risk of toxicity. Authors such as Yapp (2011) objected that the choice of this concentration did not bring an advantage over, for example, a concentration of 2%.
In this sense, it seems interesting to consider the applicability to a specific class of patients, such as paediatric patients.
A study, recently published in Clinical Oral Investigations, evaluated the effectiveness of articaine at 2%, comparing it with the reference drug, lidocaine (still the most widely used local anaesthetic at the international level).
The survey involved a total of 180 patients with an average age of 9.4 ± 1.9 years; most of these (137) underwent an extraction, and the remaining 43 had pulpal therapy. In all cases, the technique adopted consisted of an inferior alveolar block injection.
A randomization method was used where patients were allocated to two numerically equivalent groups. A triple-blind regime was adopted. In other words, the operator also conducted the operation without knowing the administered drug.
The feeling of numbness in the lower lip was indicated as a sign of the onset of the anesthesia and also as a green light for the implementation of the clinical procedure . During the treatment itself, the efficacy was evaluated in three steps for the endodontic procedure (opening, pulpectomy, canal filling) and in two surgical phases through the subjective scale FPS-R (Faces Pain Scale – Revised); regarding this, only the data of the total absence of pain symptoms was considered negative, therefore, a score of 0.
The anaesthetic success rate in the three phases was 64.4%, 42.2%, and 81.8% respectively, lower than, although not significantly, for lidocaine (66.7%, 48.9%, and 85.7%). The “halved” solution, in other words, proved to be as effective as the standard.
Romina Brignardello-Petersen judged the article to be low bias risk and to have an adequate sample to support the results.
In conclusion, the use of 2% articaine (instead of 4%) in the paediatric patient is clinically supported and lends itself to be tested at the level of different substrates.