Comparison of onset anesthesia time and injection discomfort of 4% articaine and 2% mepivacaine during teeth extractions

Abstract

Objective:To investigate the speed of action and injection discomfort of 4% articaine and 2% mepivacaine for upper teeth extractions.Materials and Methods:Forty-five patients were included in the articaine 4% group, and 45 in the mepivacaine 2% control group. After all injections, soft and hard tissue numbness was objectively gauged by dental probe at intervals of 15 s. Furthermore, the discomfort of the injections were recorded by the patients after each treatment on standard 100 mm visual analog scales, tagged at the endpoints with “no pain” (0 mm) and “unbearable pain” (100 mm).Results:There were significant differences in the meantime of first numbness to associated palatal mucosa and tooth of patients between mepivacaine and articaine buccal infiltration (BI) groups P = 0.01 and 0.01. Patients in the articaine group recorded earlier palatal mucosa and teeth numbness than those in the mepivacaine group. With regards to the discomfort of the needle injections, palatal injection was significantly more painful than BI (t-test: P < 0.001). Articaine buccal injection was significantly more painful than mepivacaine buccal injection (t-test: P <0.001). However, articaine palatal injection was less painful than articaine BI. Clinically, anesthesia onset time was faster in anterior upper teeth than upper middle and posterior teeth.Conclusions:BIs with 4% articaine was faster in achieving palate and teeth anesthesia than 2% mepivacaine for extraction of upper maxillary teeth. Patients in mepivacaine BI and articaine palatal injection groups reported less pain with needle injection. Failure of anesthesia was noticeable with maxillary multiple-rooted teeth.

2% lidocaine versus 3% prilocaine for oral and maxillofacial surgery

“…Greater lipid solubility enhances diffusion through the nerve. [ 20 ] So, lidocaine and prilocaine differ from articaine by the presence of a benzene ring instead of a thiophene ring. [ 21 ]…”

“…[ 22 ] This means prilocaine has more numbers of uncharged base LA molecules that are present to diffuse through the nerve sheath than lidocaine, and consequently, faster onset time of action will be achieved. As a general idea in the pharmacology of LA, “Agents having lower pKa have a greater proportion in tertiary, diffusible state, and this hastens onset.”[ 20 21 ]…”

Novel Dimethylacetamide-Containing Formulation Improves Infraorbital Anaesthesia Efficacy in Rats with Periodontitis

“…Practitioners often experience great difficulties with the induction of sufficient depth and duration of tooth anaesthesia with inflammation when using the infiltration method or nerve blockade during pulpitis or apical periodontitis [3]. Clinical studies demonstrate failure in 30-45% or low success in 19-56% of patients with inflammatory process of the lower molars during inferior alveolar nerve blockade even in case of anaesthesiological benefits produced by an experienced clinician [4]. Neither the combination of infiltration anaesthesia of cheek and tongue, nor the traditional block of the nerve is accompanied by an increase in the efficiency of manipulation.…”

“…Neither the combination of infiltration anaesthesia of cheek and tongue, nor the traditional block of the nerve is accompanied by an increase in the efficiency of manipulation. us, the problem of adequate anaesthesia in dentistry now is an important challenge for both clinical and experimental pharmacologists [1,4].…”

Painless palatal local anesthetic injection: A low-cost, effective technique

“…We read with interest the recently published original article by Gazal et al . [ 1 ] The authors observe that palatal injections are much more painful than buccal infiltrations. An existing method of overcoming discomfort is to anesthetize the keratinized, tightly-bound palatal mucosal epithelium with a topical anesthetic preparatory to the injection.…”