Local and Regional Anesthesia in Dental and Oral Surgery

  • Stanley F. Malamed
  • Kenneth L. Reed
  • Amanda Okundaye
  • Andrea Fonner
Chapter

Key Points

  • Local anesthesia is the standard of care for dental surgery. While effective at controlling pain, regional procedures in dentistry are associated with rare but unique complications.

  • A variety of local anesthetics and nerve block approaches are used for dental procedures. Lidocaine represents the gold standard for dental local anesthesia.

  • Local complications related to dental regional anesthesia include risk of needle breakage, paresthesia, transient facial paralysis, and self-inflicted injury of still-insensate soft tissues. Local anesthetic toxicity and allergic reaction represent potential systemic complications.

  • New developments, including computer-controlled local anesthetic delivery systems, agents to reverse local anesthesia (e.g., phentolamine mesylate), and intranasal delivery of local anesthetic mist, may help to reduce complications going forward.

Keywords

Dentistry Local anesthesia Nerve block Complications Oral surgery 

References

  1. 1.
    Lopez-Valverde A, de Vicente J, Cutando A. The surgeons Halsted and Hall, cocaine and the discovery of dental anaesthesia by nerve blocking. Br Dent J. 2011;211:485–7.CrossRefPubMedGoogle Scholar
  2. 2.
    Lofgren N. Studies on local anesthetics: xylocaine, a new synthetic drug. Stockholm: Hoeggstroms; 1948.Google Scholar
  3. 3.
    Ruetsch YA, Boni T, Borgeat A. From cocaine to ropivacaine: the history of local anesthetic drugs. Curr Top Med Chem. 2001;1:175–82.CrossRefPubMedGoogle Scholar
  4. 4.
    Muschaweck R, Rippel R. A new local anesthetic (carticaine) from the thiopene-series. Prakt Anaesth. 1974;9:135–46.PubMedGoogle Scholar
  5. 5.
    Vree TB, Gielen MJ. Clinical pharmacology and the use of articaine for local and regional anaesthesia. Best Pract Res Clin Anaesthesiol. 2005;19:293–308.CrossRefPubMedGoogle Scholar
  6. 6.
    Ciancio SG, Marberger AD, Ayoub F, Garlapo DA, Pantera Jr EA, Pantera CT, Al-Mubarak S, Sobieraj BD, He DY, Myneni SR. Comparison of 3 intranasal mists for anesthetizing maxillary teeth in adults: a randomized, double-masked, multicenter phase 3 clinical trial. J Am Dent Assoc. 2017;147(5):339–347.e1.CrossRefGoogle Scholar
  7. 7.
    Gow-Gates GA. Mandibular conduction anesthesia: a new technique using extraoral landmarks. Oral Surg Oral Med Oral Pathol. 1973;36:321–8.CrossRefPubMedGoogle Scholar
  8. 8.
    Vazirani SJ. Closed mouth mandibular nerve block: a new technique. Dent Dig. 1960;66:10–3.Google Scholar
  9. 9.
    Akinosi JO. A new approach to the mandibular nerve block. Br J Oral Surg. 1977;15:83–7.CrossRefPubMedGoogle Scholar
  10. 10.
    Walton RE, Abbott BJ. Periodontal ligament injection: a clinical evaluation. J Am Dent Assoc. 1981;103:571–5.CrossRefPubMedGoogle Scholar
  11. 11.
    Leonard M. The Stabident System of intraosseous anesthesia. Dent Econ. 1997;87:51–60.PubMedGoogle Scholar
  12. 12.
    Malamed SF. Systemic complications. In: Malamed SF, editor. Handbook of local anesthesia. 6th ed. St. Louis: Elsevier Mosby; 2013. p. 311–40.Google Scholar
  13. 13.
    Malamed SF. Local anesthetics: dentistry’s most important drugs, clinical update 2006. J Calif Dent Assoc. 2006;34:971–6.PubMedGoogle Scholar
  14. 14.
    Becker DE, Reed KL. Essentials of local anesthetic pharmacology. Anesth Prog. 2006;53:98–108.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Kambalimath DH, Dolas RS, Kambalimath HV, Agrawal SM. Efficacy of 4 % articaine and 2 % lidocaine: a clinical study. J Maxillofac Oral Surg. 2013;12:3–10.CrossRefPubMedGoogle Scholar
  16. 16.
    Septocaine(R) with epinephrine 1:100,000 (package insert). Louisville: Septodont; 2013.Google Scholar
  17. 17.
    Surgicaine(TM) (bupivacaine HCl 0.5% and epinephrine 1:200,000 injection USP) (package insert). Cambridge: Novocol Pharmaceutical of Canada, Inc.; 2011.Google Scholar
  18. 18.
    2% xylocaine DENTAL with epinephrine 1:50,000/1:100,000 (lidocaine HCl and epinephrine injection, USP) (package insert). York: Dentsply Pharmaceutical; 2011.Google Scholar
  19. 19.
    Singh P. An emphasis on the wide usage and important role of local anesthesia in dentistry: a strategic review. Dent Res J (Isfahan). 2012;9:127–32.CrossRefGoogle Scholar
  20. 20.
    Jeske AH. Xylocaine: 50 years of clinical service to dentistry. Tex Dent J. 1998;115:9–13.PubMedGoogle Scholar
  21. 21.
    Isocaine(R) 3% plain (mepivacaine hydrochloride injection USP); isociane (R) 2% (with levonordefrin 1:20,000) (mepivacaine hydrochloride and levonordefrin injection, USP) (package insert). Cambridge: Novocol Pharmaceutical of Canada, Inc.; 2007.Google Scholar
  22. 22.
    4% Citanest Plain Dental prilocaine hydrochloride injection, USP (package insert). York: Dentsply Pharmaceutical; 2010.Google Scholar
  23. 23.
    Malamed SF. Techniques of maxillary anesthesia. In: Malamed SF, editor. Handbook of local. Anesthesia. 6th ed. St. Louis: Elsevier Mosby; 2013. p. 188–224.Google Scholar
  24. 24.
    Phillips WH. Anatomic considerations in local anesthesia. J Oral Surg. 1943;1:112–21.Google Scholar
  25. 25.
    Evers H, Haegerstam G. Introduction to dental local anesthesia. Newport Beach: Brownell & Carroll; 1991.Google Scholar
  26. 26.
    Jastak JT, Yagiela JA. Regional anesthesia of the oral cavity. C.V. Mosby Co.: St. Louis; 1981.Google Scholar
  27. 27.
    Reed KL. Advanced techniques of local anesthetic injection. Gen Dent. 1994;42:248–51.PubMedGoogle Scholar
  28. 28.
    Malamed SF. Techniques of mandibular anesthesia. In: Malamed SF, editor. Handbook of local anesthesia. 6th ed. St. Louis: Elsevier Mosby; 2013. p. 225–52.Google Scholar
  29. 29.
    Watson JE. Appendix: some anatomic aspects of the Gow-Gates technique for mandibular anesthesia. Oral Surg Oral Med Oral Pathol. 1973;36:328–30.CrossRefPubMedGoogle Scholar
  30. 30.
    Hochman MN. Supplemental injection techniques. In: Malamed SF, editor. Handbook of local anesthesia. 6th ed. St. Louis: Elsevier Mosby; 2013. p. 253–76.Google Scholar
  31. 31.
    Moore PA, Cuddy MA, Cooke MR, Sokolowski CJ. Periodontal ligament and intraosseous anesthetic injection techniques: alternatives to mandibular nerve blocks. J Am Dent Assoc. 2011;142(Suppl 3):13S–8S.CrossRefPubMedGoogle Scholar
  32. 32.
    Pogrel MA. Broken local anesthetic needles: a case series of 16 patients, with recommendations. J Am Dent Assoc. 2009;140:1517–22.CrossRefPubMedGoogle Scholar
  33. 33.
    Septodont reported wholesale sales. Newark: Septodont NA; 2006.Google Scholar
  34. 34.
    Malamed SF, Reed K, Poorsattar S. Needle breakage: incidence and prevention. Dent Clin N Am. 2010;54:745–56.CrossRefPubMedGoogle Scholar
  35. 35.
    Haas DA. Localized complications from local anesthesia. J Calif Dent Assoc. 1998;26:677–82.PubMedGoogle Scholar
  36. 36.
    Heller AA, Shankland WE. Alternative to the inferior alveolar nerve block anesthesia when placing mandibular dental implants posterior to the mental foramen. J Oral Implantol. 2001;27:127–33.CrossRefPubMedGoogle Scholar
  37. 37.
    Malden NJ, Maidment YG. Lingual nerve injury subsequent to wisdom teeth removal—a 5-year retrospective audit from a high street dental practice. Br Dent J. 2002;193:203–5.CrossRefPubMedGoogle Scholar
  38. 38.
    Pogrel MA, Thamby S. Permanent nerve involvement resulting from inferior alveolar nerve blocks. J Am Dent Assoc. 2000;131:901–7.CrossRefPubMedGoogle Scholar
  39. 39.
    Haas DA, Lennon D. A 21 year retrospective study of reports of paresthesia following local anesthetic administration. J Can Dent Assoc 1995;61:319–6, 329.Google Scholar
  40. 40.
    Garisto GA, Gaffen AS, Lawrence HP, Tenenbaum HC, Haas DA. Occurrence of paresthesia after dental local anesthetic administration in the United States. J Am Dent Assoc. 2010;141:836–44.CrossRefPubMedGoogle Scholar
  41. 41.
    Malamed SF. Nerve injury caused by mandibular block analgesia. Int J Oral Maxillofac Surg. 2006;35:876–7.CrossRefPubMedGoogle Scholar
  42. 42.
    Hillerup S, Jensen R. Nerve injury caused by mandibular block analgesia. Int J Oral Maxillofac Surg. 2006;35:437–43.CrossRefPubMedGoogle Scholar
  43. 43.
    Brandt RG, Anderson PF, McDonald NJ, Sohn W, Peters MC. The pulpal anesthetic efficacy of articaine versus lidocaine in dentistry: a meta-analysis. J Am Dent Assoc. 2011;142:493–504.CrossRefPubMedGoogle Scholar
  44. 44.
    Katyal V. The efficacy and safety of articaine versus lignocaine in dental treatments: a meta-analysis. J Dent. 2010;38:307–17.CrossRefPubMedGoogle Scholar
  45. 45.
    College C, Feigal R, Wandera A, Strange M. Bilateral versus unilateral mandibular block anesthesia in a pediatric population. Pediatr Dent. 2000;22:453–7.PubMedGoogle Scholar
  46. 46.
    Malamed SF. Local anesthesia reversal. Dent Today. 2010;29:65–2.PubMedGoogle Scholar
  47. 47.
    Haas DA. An update on local anesthetics in dentistry. J Can Dent Assoc. 2002;68:546–51.PubMedGoogle Scholar
  48. 48.
    Scott DB. Toxicity caused by local anaesthetic drugs. Br J Anaesth. 1981;53:553–4.CrossRefPubMedGoogle Scholar
  49. 49.
    Becker DE, Reed KL. Local anesthetics: review of pharmacological considerations. Anesth Prog. 2012;59:90–101.CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    Hochman M, Chiarello D, Hochman CB, Lopatkin R, Pergola S. Computerized local anesthetic delivery vs. traditional syringe technique. Subjective pain response. N Y State Dent J. 1997;63:24–9.PubMedGoogle Scholar
  51. 51.
    Friedman MJ, Hochman MN. A 21st century computerized injection system for local pain control. Compend Contin Educ Dent. 1997;18:995–3.PubMedGoogle Scholar
  52. 52.
    Ghelber O, Gebhard RE, Adebayo G, Szmuk P, Hagberg C, Iannucci DG. Utilization of the CompuFlo(R) in determining the pressure of the epidural space: a pilot study. Anesth Analg. 2005;100:S-189.CrossRefGoogle Scholar
  53. 53.
    Tavares M, Goodson JM, Studen-Pavlovich D, Yagiela JA, Navalta LA, Rogy S, Rutherford B, Gordon S, Papas AS. Reversal of soft-tissue local anesthesia with phentolamine mesylate in pediatric patients. J Am Dent Assoc. 2008;139:1095–104.CrossRefPubMedGoogle Scholar
  54. 54.
    Drug monograph: phentolamine. Philadelphia: Elsevier; 2015.Google Scholar
  55. 55.
    Rhoney D, Peacock WF. Intravenous therapy for hypertensive emergencies, part 2. Am J Health Syst Pharm. 2009;66:1448–57.CrossRefPubMedGoogle Scholar
  56. 56.
    Simons FE, Lieberman PL, Read Jr EJ, Edwards ES. Hazards of unintentional injection of epinephrine from autoinjectors: a systematic review. Ann Allergy Asthma Immunol. 2009;102:282–7.CrossRefPubMedGoogle Scholar
  57. 57.
    Zentgraf M, Ludwig G, Ziegler M. How safe is the treatment of impotence with intracavernous autoinjection? Eur Urol. 1989;16:165–71.PubMedGoogle Scholar
  58. 58.
    U.S. Food and Drug Administration (FDA): new dental anesthetic reversal agent receives FDA approval. Accessed 12 May 2008.Google Scholar
  59. 59.
    Hersh EV, Moore PA, Papas AS, Goodson JM, Navalta LA, Rogy S, Rutherford B, Yagiela JA. Reversal of soft-tissue local anesthesia with phentolamine mesylate in adolescents and adults. J Am Dent Assoc. 2008;139:1080–93.CrossRefPubMedGoogle Scholar
  60. 60.
    Metzinger SE, Bailey DJ, Boyce RG, Lyons GD. Local anesthesia in rhinoplasty: a new twist? Ear Nose Throat J. 1992;71:405–6.PubMedGoogle Scholar
  61. 61.
    Stewart JH, Chinn SE, Cole GW, Klein JA. Neutralized lidocaine with epinephrine for local anesthesia—II. J Dermatol Surg Oncol. 1990;16:842–5.CrossRefPubMedGoogle Scholar
  62. 62.
    Malamed SF, Falkel M. Buffered local anaesthetics: the importance of pH and CO2. SAAD Dig. 2013;29:9–17.PubMedGoogle Scholar
  63. 63.
    Malamed SF, Tavana S, Falkel M: Faster onset and more comfortable injection with alkalinized 2 % lidocaine with epinephrine 1:100,000. Compend Contin Educ Dent 2013; 34(Spec No 1): 10–20Google Scholar
  64. 64.
    Malamed SF. Emergency medicine: beyond the basics. J Am Dent Assoc. 1997;128:843–54.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  • Stanley F. Malamed
    • 1
  • Kenneth L. Reed
    • 2
  • Amanda Okundaye
    • 3
  • Andrea Fonner
    • 4
  1. 1.Herman Ostrow School of Dentistry of U.S.C.Los AngelesUSA
  2. 2.New York University College of DentistryNew YorkUSA
  3. 3.Department of Hospital DentistryUCLALos AngelesUSA
  4. 4.The Herman Ostrow School of Dentistry of the University of Southern CaliforniaLos AngelesUSA

Personalised recommendations