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Update of Dental Local Anesthesia

Update of Dental Local

Paul A. Moore, DMD, PhD, MPH Elliot V. Hersh, DMD, MS, PhD Sean G. Boynes, DMD, MS
Guest Editors

Possibly the most important skill required of all dental practitioners is the ability to
provide safe and effective local anesthesia. The agents and anesthetic delivery equip-
ment available today provide the practitioner an array of options to effectively manage
the pain associated with dental procedures. We have come a long way from the time
when the numbing properties of cocaine were first recognized; to its topical application
for ophthalmologic surgery; to the introduction of needles and syringes to permit nerve
block anesthesia; to the synthesis of procaine and ester anesthetics; and to the devel-
opment of the amide anesthetics used today.
This issue of Dental Clinics of North America focuses on the most recent develop-
ments in dental local anesthesia. As an introduction, a brief description of the pharma-
cology and toxicology of therapeutic agents currently available in dentistry is
presented, followed by an update of agents used in medicine. Recent research find-
ings associated with the use of the long-acting local anesthetic bupivacaine are then
provided. A review of the efficacy and potential indications for mandibular infiltration
anesthesia to supplement nerve blocks follows. The clinical research findings for the
novel application of phentolamine to reverse soft tissue anesthesia are provided as
well as the results of a meta-analyses assessing the efficacy of articaine formulations.
Advances in armamentarium used for dental anesthesia are updated as well.
The current knowledge regarding rare complications is also critically reviewed.
Topics specifically addressed include allergic reactions, unusual ocular complications,
methemoglobinemia, paresthesias, drug interactions with beta-antagonists, and nee-
dle breakage. Recommendations for safe use of local anesthetics for pregnant and
lactating patients are then provided. The basis for patient fears of needles, a significant
cause of psychogenic reactions, is additionally reviewed. Finally, regulations estab-
lished for the administration of local anesthesia by dental hygienists are described
and the safety record supporting this widening scope of practice is presented.

Dent Clin N Am 54 (2010) xiiixiv

0011-8532/10/$ see front matter 2010 Elsevier Inc. All rights reserved.
xiv Preface

As the editors of this issue, we are grateful for the support of the authors, and their
willingness to prepare the articles. They represent the leaders in the field of pharma-
cology and local anesthesia in dentistry. Several are authors of popular textbooks. A
few have established productive research careers. Many are program directors for
graduate programs in dental anesthesiology. All are teachers, dedicated to the safe
and effective use of local anesthesia by general dentists, dental specialists, and dental
Many of the articles in this issue have been authored or coauthored by students
enrolled in graduate programs and anesthesiology residencies. These CODA-
approved programs are educating the future leaders in dental anesthesia. It will be
through their vision of the future and their innovative efforts that safer and more effec-
tive methods for pain control will be developed. In 10 or 20 years, we hope that their
discoveries will be described in a follow-up Update of Dental Local Anesthesia issue
of Dental Clinics of North America. One could imagine articles entitled Effective Alter-
natives to Nerve Block Anesthesia; Pulpal Anesthesia Using Novel Topical Anes-
thetics; Latex and Antioxidant-Free Local Anesthetic Cartridges; or Local
Anesthetic Agents Selective for Nociception.
We look forward to reading them.

Paul A. Moore, DMD, PhD, MPH

Department of Dental Anesthesiology
University of Pittsburgh
School of Dental Medicine
623 Salk
3501 Terrace Street
Pittsburgh, PA 15261, USA
Elliot V. Hersh, DMD, MS, PhD
Department of Oral Surgery and Pharmacology
University of Pennsylvania
School of Dental Medicine
240 South 40th Street
Philadelphia, PA 19104-6030, USA
Sean G. Boynes, DMD, MS
Department of Dental Anesthesiology
University of Pittsburgh
School of Dental Medicine
622A Salk
3501 Terrace Street
Pittsburgh, PA 15261, USA
E-mail addresses: (P.A. Moore) (E.V. Hersh) (S.G. Boynes)