I just completed reading the May JADA article "Efficacy of Articaine: A New Amide Local Anesthetic" by Dr. Stanley F. Malamed and colleagues.
I read the article several times looking for substantive reasons to utilize 4 percent articaine with 1:200,000 epinephrine instead of the usual 2 percent lidocaine with 1:100,000 epinephrine used by the vast majority of dentists in the United States. I found no good reasons.
The major difference listed in the article seems to be that articaine "is the only amide local anesthetic that contains a thiophene ring." And that it is the "only widely used amide local anesthetic that contains an additional ester ring."
Whatever those things mean to most of us in dentistry was left a mystery, for there was little obvious advantage cited for those of us generally utilizing lidocaine to switch to articaine. Patients are little impressed with thiophene rings and ester rings. Well, maybe chemists are impressed.
I was interested in, and the article failed to address, the maximum dose of articaine able to safely inject during a single dental appointment. Since a 4 percent concentration was recommended instead of the usual 2 percent concentration of lidocaine solutions, what is the safe maximum dose for 4 percent articaine solutions?
Other than using twice as much anesthetic by concentration to achieve virtually identical results as standard lidocaine solutions, what is the advantage to the use of 4 percent articaine. Is it just one more thing we need to purchase, or was there actually a point to the article?
