Severe adverse reactions to dental local anaesthetics: systemic reactions

Abstract

Background: Occasionally, patients suffer systemic adverse effects from injections of local anaesthetic solutions. This may range from minor transient vasovagal attacks to life-threatening collapse. Methods: The suspected adverse reactions reported to the Office of Product Review of the Therapeutic Goods Administration (TGA) were analysed in detail.Results: There was a high incidence (70%) of adverse reactions associated with prilocaine, which is much greater than its market share (less than 20%). There is a tendency to consider all systemic adverse reactions as being 'allergic' reactions although this is rarely the case. Syncope, cardiovascular and central nervous system reactions are much more common. There is also a risk of methaemoglobinaemia to prilocaine and articaine. A small series of cases referred to one of the authors were also reported. Conclusions: Recommendations are made as to the prevention, acute care and subsequent investigation of adverse reactions. The most important conclusion is not to just label the response as allergic and to use an alternative agent. Detailed investigation and reporting should be made for all cases of suspected severe adverse reaction to local anaesthetic agents.

Severe adverse reactions to dental local anaesthetics: prolonged mandibular and lingual nerve anaesthesia

“…The usage of prilocaine has recently decreased and articaine increased. 2 Mepivocaine and bupivacaine are grouped, as not widely used in general dental practice. 19 A recent study based on voluntary reports in Ontario, Canada showed different incidence figures for different types of LA agents with 1 in 332 000 for prilocaine, 1 in 410 000 for articaine and 1 in 2 580 000 for lignocaine.…”

“…1 However, there may be systemic adverse reactions ranging from briefly feeling unwell to total collapse, which is reviewed separately. 2 A different group of adverse reactions to LA injection is when the loss of sensation is prolonged. This may be temporary, where after a few days, weeks or months, sensation returns, or it may be permanent.…”

Proposta de um instrumento para avaliar eventos adversos em odontologia

“…The literature includes reports of local and/or systemic alterations that range from the most common situations, like hematomas and fainting, to rarer situations like methehemoglobinemia, allergic reactions, and toxic reactions, even resulting in death 17,18,19 .…”

Severe Adverse Reactions to Dental Local Anaesthetics: Authors’ Reply

“…In the article by Sambrook et al, 1 articaine is wrongly blamed to be a risk factor for methaemoglobinaemia in humans. In the article by Wilburn-Goo and Lloyd, 2 cited as reference 18 by Sambrook et al, articaine is not even mentioned at all.…”