Epinephrine-reduced articaine solution (1:400,000) in paediatric dentistry: a multicentre non-interventional clinical trial

Abstract

AimIn paediatric dentistry, epinephrine may contribute to systemic and local side-effects. On the other hand it is necessary to provide good and safe local analgesia. Therefore, an articaine solution with reduced epinephrine concentration was tested in a clinical setting.MethodsIn a non-interventional clinical study, dental treatment was performed in children and adolescents (4–17 years). For local analgesia, articaine 4 % plus epinephrine 1:400,000 was used in the technique chosen by the dentist. Efficacy and tolerance as well as duration of soft tissue analgesia and side-effects were evaluated.Results999 patients (50.5 % male, 49.5 % female) with a mean age of 7.9 (SD 2.34) years were treated. Two hundred seventy six patients (27.6 %) received sedation prior to treatment. The mean treatment time was 15 min (SD 10). In 93.5 % of cases, initial local analgesia was sufficient to perform the planned treatment. In 99 % of cases (n = 989) the planned treatment could be completed. A second injection was necessary in 6.5 % of cases. A mean duration of soft tissue analgesia of 2.19 h (SD 1.01) was seen. Slight side-effects occurred in 3.1 % of subjects.ConclusionsDue to high efficacy, tolerance and safety, the articaine 4 % solution with the reduced epinephrine concentration (1:400,000) was a safe and suitable drug for paediatric routine treatment.

Anaesthetic efficacy of 4% articaine and 2% lidocaine for extraction and pulpotomy of mandibular primary molars: an equivalence parallel prospective randomized controlled trial

“…The incident of pain and facial swelling was, however, unlikely associated with LA type or administration technique, but more probably due to extraction. High efficacy, tolerance, and safety of 4% articaine with different levels of epinephrine ranging from 1:400,000 to 1:100,000 have been reported in the literature…”

Hyperspectral Imaging to Study Dynamic Skin Perfusion after Injection of Articaine-4% with and without Epinephrine—Clinical Implications on Local Vasoconstriction

“…Clinically, the maximum reduction of peripheral blood flow must be set against the risk of local and systemic drug side effects. Nonetheless, appropriate concentrations of epinephrine should be combined with the LA to guarantee sufficient depth and duration of anaesthesia [ 1 , 11 , 21 ]. Regarding the bloodlessness of the surgical field, there is controversy in the literature about the time interval required between injection and incision.…”

“…Epinephrine has long been the community standard for local vasoconstriction, but it has some limitations due to potential cardiovascular and local toxic effects [ 10 ]. Since its complications are mainly dose-dependent, care should be taken when choosing vasoconstrictor-containing local anaesthetics to keep the epinephrine concentration as low as possible [ 1 , 11 ]. This is particularly important when alpha 1-adrenoreceptor mediated vasoconstriction is used to intentionally reduce blood flow to the surgical field.…”