Dentists use local anesthetics such as lidocaine and articaine to help control pain during procedures. However, some studies have reported that articaine could have some adverse effects on the patient in the form of prolonged paresthesias and increased neurotoxicity after the procedure compared to lidocaine. Now, the University of Pennsylvania says articaine is as safe as lidocaine for dental procedures.
The researchers performed an in vitro study in which human-derived cells were tested with dental-grade concentrations of articaine and lidocaine. To test the neurotoxicity of these anesthetics, the cells were exposed to each drug for five minutes, washed, and then exposed to the live/dead cell assay for 30 minutes, which determines cell viability.
To test recovery time, experiments were designed to examine depolarization 30 minutes after treatment with the drug and how quickly the cell was responding after exposure to the anesthetic. To confirm their results, the researchers used exactly the same methods of testing the pure, powdered form of each drug to ensure that any additives to the dental-grade drugs were not affecting the outcome. The researchers found the results surprising.
Contrary to their original hypothesis, they found that the neurotoxicity levels in dental-grade articaine and lidocaine were similar, but the pure lidocaine appeared to have increased neurotoxicity compared to articaine. This was surprising, the researchers said, as some retrospective clinical surveys seemed to indicate that articaine may be more neurotoxic for dental nerve block.
Regarding prolonged post-procedural drug effects, lidocaine was found to have a reduction in cell responsiveness after 30 minutes, again contradicting the original hypothesis and previously presented study data. The researchers found that articaine did not cause increased neurotoxicity or delayed responsiveness in human-derived cells compared to lidocaine.
Although lidocaine did create a more delayed post-procedural responsiveness, the researchers noted that there is no indication that lidocaine is unsafe or should create cause for concern, as it has been well documented as a safe anesthetic in a dental clinic setting. The most important conclusion is that articaine is no more neurotoxic than lidocaine in this in vitro study.
The study, “Effects of Lidocaine and Articaine on Neuronal Survival and Recovery,” was published by Anesthesia Progress.
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