Local anesthetics in dentistry: An update review

Abstract

Introduction: Pain management in dentistry, where local anesthetics are crucial, is fundamental to ensure patient comfort and treatment success by performing virtually painless procedures. Objective: To analyze the literature on lidocaine, mepivacaine and articaine anesthetics, particularly their chemical characteristics, mechanism of action, pharmacokinetics and administration. Methodology: An electronic search was performed through PubMed, Google Scholar and Scopus, using the terms: anesthesia, pain management, dentistry, mepivacaine, lidocaine, articaine. Results: Lidocaine continues to be the “gold standard” in dental local anesthesia due to its rapid onset of action and adequate duration. It is used in a variety of procedures, from conservative treatments to complex surgeries. Mepivacaine is the third most commonly used in dentistry, after articaine and lidocaine. It has a short action and rapid onset, with less vasodilatation than lidocaine, which prolongs its effect even without vasoconstrictor. It is used in local infiltration, nerve block and epidural anesthesia. Articaine is safe and widely used in dental surgery, both for local infiltration and peripheral nerve block. It is also applied in epidural, ocular, spinal and regional intravenous anesthesia. Conclusions: The choice of dental anesthetic should be based on a comprehensive approach that considers the patient's health profile (medical history, allergies and contraindications), the characteristics of the procedure, drug interactions and adverse effects, prioritizing the balance between efficacy and tolerability. This personalized strategy minimizes risks and optimizes clinical outcomes.