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Copyright (c) 2025 Nouf Omar Mohammed Hamzi, Raed Obaid Awadh Alhirsani, Roaa Magbul Hadi Maghfuri, Abdulmohsen Eissa Abdulmohsen Aleissa, Bashayer Hail Fandi Alruwailli, Amani Hassan Ahmed Al Hazmi
This work is licensed under a Creative Commons Attribution 4.0 International License.
Local Anesthetic Drugs in Dentistry: Clinical, Pharmaceutical, Nursing, and Patient Safety Perspectives-An Updated Review
Corresponding Author(s) : Nouf Omar Mohammed Hamzi
Saudi Journal of Medicine and Public Health,
Vol. 2 No. 2 (2025)
Abstract
Background: Local anesthetic drugs represent a cornerstone in modern dentistry, transforming pain-associated procedures into safe and tolerable clinical interventions. Their introduction has significantly improved patient acceptance, treatment efficiency, and overall oral healthcare delivery. These agents act through reversible blockade of voltage-gated sodium channels, preventing nerve impulse propagation and pain transmission.
Aim: This updated review aims to comprehensively analyze local anesthetic drugs in dentistry from clinical, pharmacological, nursing, and patient safety perspectives, with emphasis on drug classification, mechanisms of action, clinical applications, safety considerations, and technological advancements in delivery systems.
Methods: A narrative review approach was adopted based on synthesis of established pharmacological principles and clinical evidence reported in contemporary dental anesthesia literature. Data were analyzed across major categories of local anesthetics, including ester and amide types, alongside commonly used agents such as lidocaine, articaine, prilocaine, mepivacaine, and bupivacaine. Additional evaluation included topical anesthetics, dosage calculations, toxicity thresholds, and computer-controlled delivery systems.
Results: Findings demonstrate that amide anesthetics dominate modern dental practice due to superior safety and efficacy profiles. Lidocaine remains the reference standard, while articaine offers enhanced diffusion and rapid metabolism. Prilocaine and mepivacaine provide advantages in medically compromised patients, and bupivacaine is reserved for prolonged analgesia. Toxicity remains a critical concern, strongly related to dose, patient factors, and administration technique. Innovations such as computer-controlled local anesthesia delivery systems significantly improve patient comfort and reduce injection-related anxiety.
Conclusion: Local anesthetic agents are essential to contemporary dentistry, requiring careful selection based on pharmacological properties, patient condition, and procedural demands. Safe administration, accurate dosing, and technological advancements collectively enhance clinical outcomes and patient-centered care.
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- 1. Decloux D, Ouanounou A. Local anaesthesia in dentistry: a review. Int Dent J. 2020 Sep 17;71(2):87-95.
- 2. Sheikh NK, Dua A. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): May 8, 2023. Procaine.
- 3. Gazal G, Omar E, Elmalky W. Rules of selection for a safe local anesthetic in dentistry. J Taibah Univ Med Sci. 2023 Dec;18(6):1195-1196.
- 4. Karm MH, Park FD, Kang M, Kim HJ, Kang JW, Kim S, Kim YD, Kim CH, Seo KS, Kwon KH, Kim CH, Lee JW, Hong SW, Lim MH, Nam SK, Cho JM. Comparison of the efficacy and safety of 2% lidocaine HCl with different epinephrine concentration for local anesthesia in participants undergoing surgical extraction of impacted mandibular third molars: A multicenter, randomized, double-blind, crossover, phase IV trial. Medicine (Baltimore). 2017 May;96(21):e6753.
- 5. Torres-Lagares D, Serrera-Figallo MÁ, Machuca-Portillo G, Corcuera-Flores JR, Machuca-Portillo C, Castillo-Oyagüe R, Gutiérrez-Pérez JL. Cardiovascular effect of dental anesthesia with articaine (40 mg with epinefrine 0,5 mg % and 40 mg with epinefrine 1 mg%) versus mepivacaine (30 mg and 20 mg with epinefrine 1 mg%) in medically compromised cardiac patients: a cross-over, randomized, single blinded study. Med Oral Patol Oral Cir Bucal. 2012 Jul 01;17(4):e655-60.
- 6. Torp KD, Metheny E, Simon LV. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Sep 16, 2025. Lidocaine Toxicity(Archived)
- 7. Gazal G. Is prilocaine safe and potent enough for use in the oral surgery of medically compromised patients. Saudi Med J. 2019 Jan;40(1):97-100.
- 8. Martin E, Nimmo A, Lee A, Jennings E. Articaine in dentistry: an overview of the evidence and meta-analysis of the latest randomised controlled trials on articaine safety and efficacy compared to lidocaine for routine dental treatment. BDJ Open. 2021 Jul 17;7(1):27.
- 9. Darawade DA, Kumar S, Budhiraja S, Mittal M, Mehta TN. A clinical study of efficacy of 4% articaine hydrochloride versus 2% lignocaine hydrochloride in dentistry. J Int Oral Health. 2014 Sep;6(5):81-3.
- 10. Becker DE, Reed KL. Local anesthetics: review of pharmacological considerations. Anesth Prog. 2012 Summer;59(2):90-101; quiz 102-3.
- 11. Luo W, Zheng K, Kuang H, Li Z, Wang J, Mei J. The potential of articaine as new generation of local anesthesia in dental clinics: A review. Medicine (Baltimore). 2022 Dec 02;101(48):e32089.
- 12. Snoeck M. Articaine: a review of its use for local and regional anesthesia. Local Reg Anesth. 2012;5:23-33.
- 13. Su N, Liu Y, Yang X, Shi Z, Huang Y. Efficacy and safety of mepivacaine compared with lidocaine in local anaesthesia in dentistry: a meta-analysis of randomised controlled trials. Int Dent J. 2014 Apr;64(2):96-107.
- 14. Brockmann WG. Mepivacaine: a closer look at its properties and current utility. Gen Dent. 2014 Nov-Dec;62(6):70-5; quiz 76.
- 15. Su N, Wang H, Zhang S, Liao S, Yang S, Huang Y. Efficacy and safety of bupivacaine versus lidocaine in dental treatments: a meta-analysis of randomised controlled trials. Int Dent J. 2014 Feb;64(1):34-45.
- 16. Becker DE, Reed KL. Essentials of local anesthetic pharmacology. Anesth Prog. 2006 Fall;53(3):98-108; quiz 109-10.
- 17. Lee HS. Recent advances in topical anesthesia. J Dent Anesth Pain Med. 2016 Dec;16(4):237-244.
- 18. Mathison M, Pepper T. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jun 1, 2023. Local Anesthesia Techniques in Dentistry and Oral Surgery.
- 19. Dempsy Chengappa MM, Prashanth AK. Evaluation of efficacy of computer-controlled local anaesthetic delivery system vs traditional injection system for minor pediatric surgical procedures in children. Med J Armed Forces India. 2022 Sep;78(Suppl 1):S89-S95.
- 20. Janik K, Niemczyk W, Peterek R, Rój R, Balicz A, Morawiec T. Computer-Controlled Local Anaesthesia Delivery efficacy - a literature review. Saudi Dent J. 2024 Aug;36(8):1066-1071.
References
1. Decloux D, Ouanounou A. Local anaesthesia in dentistry: a review. Int Dent J. 2020 Sep 17;71(2):87-95.
2. Sheikh NK, Dua A. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): May 8, 2023. Procaine.
3. Gazal G, Omar E, Elmalky W. Rules of selection for a safe local anesthetic in dentistry. J Taibah Univ Med Sci. 2023 Dec;18(6):1195-1196.
4. Karm MH, Park FD, Kang M, Kim HJ, Kang JW, Kim S, Kim YD, Kim CH, Seo KS, Kwon KH, Kim CH, Lee JW, Hong SW, Lim MH, Nam SK, Cho JM. Comparison of the efficacy and safety of 2% lidocaine HCl with different epinephrine concentration for local anesthesia in participants undergoing surgical extraction of impacted mandibular third molars: A multicenter, randomized, double-blind, crossover, phase IV trial. Medicine (Baltimore). 2017 May;96(21):e6753.
5. Torres-Lagares D, Serrera-Figallo MÁ, Machuca-Portillo G, Corcuera-Flores JR, Machuca-Portillo C, Castillo-Oyagüe R, Gutiérrez-Pérez JL. Cardiovascular effect of dental anesthesia with articaine (40 mg with epinefrine 0,5 mg % and 40 mg with epinefrine 1 mg%) versus mepivacaine (30 mg and 20 mg with epinefrine 1 mg%) in medically compromised cardiac patients: a cross-over, randomized, single blinded study. Med Oral Patol Oral Cir Bucal. 2012 Jul 01;17(4):e655-60.
6. Torp KD, Metheny E, Simon LV. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Sep 16, 2025. Lidocaine Toxicity(Archived)
7. Gazal G. Is prilocaine safe and potent enough for use in the oral surgery of medically compromised patients. Saudi Med J. 2019 Jan;40(1):97-100.
8. Martin E, Nimmo A, Lee A, Jennings E. Articaine in dentistry: an overview of the evidence and meta-analysis of the latest randomised controlled trials on articaine safety and efficacy compared to lidocaine for routine dental treatment. BDJ Open. 2021 Jul 17;7(1):27.
9. Darawade DA, Kumar S, Budhiraja S, Mittal M, Mehta TN. A clinical study of efficacy of 4% articaine hydrochloride versus 2% lignocaine hydrochloride in dentistry. J Int Oral Health. 2014 Sep;6(5):81-3.
10. Becker DE, Reed KL. Local anesthetics: review of pharmacological considerations. Anesth Prog. 2012 Summer;59(2):90-101; quiz 102-3.
11. Luo W, Zheng K, Kuang H, Li Z, Wang J, Mei J. The potential of articaine as new generation of local anesthesia in dental clinics: A review. Medicine (Baltimore). 2022 Dec 02;101(48):e32089.
12. Snoeck M. Articaine: a review of its use for local and regional anesthesia. Local Reg Anesth. 2012;5:23-33.
13. Su N, Liu Y, Yang X, Shi Z, Huang Y. Efficacy and safety of mepivacaine compared with lidocaine in local anaesthesia in dentistry: a meta-analysis of randomised controlled trials. Int Dent J. 2014 Apr;64(2):96-107.
14. Brockmann WG. Mepivacaine: a closer look at its properties and current utility. Gen Dent. 2014 Nov-Dec;62(6):70-5; quiz 76.
15. Su N, Wang H, Zhang S, Liao S, Yang S, Huang Y. Efficacy and safety of bupivacaine versus lidocaine in dental treatments: a meta-analysis of randomised controlled trials. Int Dent J. 2014 Feb;64(1):34-45.
16. Becker DE, Reed KL. Essentials of local anesthetic pharmacology. Anesth Prog. 2006 Fall;53(3):98-108; quiz 109-10.
17. Lee HS. Recent advances in topical anesthesia. J Dent Anesth Pain Med. 2016 Dec;16(4):237-244.
18. Mathison M, Pepper T. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jun 1, 2023. Local Anesthesia Techniques in Dentistry and Oral Surgery.
19. Dempsy Chengappa MM, Prashanth AK. Evaluation of efficacy of computer-controlled local anaesthetic delivery system vs traditional injection system for minor pediatric surgical procedures in children. Med J Armed Forces India. 2022 Sep;78(Suppl 1):S89-S95.
20. Janik K, Niemczyk W, Peterek R, Rój R, Balicz A, Morawiec T. Computer-Controlled Local Anaesthesia Delivery efficacy - a literature review. Saudi Dent J. 2024 Aug;36(8):1066-1071.