A Comparison between Articaine HCL and Lidocaine HCL in Pediatric Dental Patients

Meghan Sullivan Walsh January 12, 2011

Literature Review - St. Joseph/LMC Pediatric Dentistry

A Comparison between Articaine HCL and Lidocaine HCL in Pediatric Dental Patients

Resident: Meghan Sullivan Walsh

Program: Lutheran Medical Center- Providence

Article Title: A Comparison between Articaine HCL and Lidocaine HCL in Pediatric Dental Patients

Authors: Stanley F. Malamed, DDS; Suzanne Gagnon, MD; Dominique Leblanc, D Pharm

Journal: Pediatric Dentistry

Volume (number), Year, Page #’s; 22:4, 2000, pages 307-311

Major Topic: Use of Articaine HCL in the pediatric population

Overview of Method of Research: Three identical single-dose, randomized, double-blinded, parallel group, active-controlled, multi center studies were conducted comparing 4% Articaine with 1:100,000 epi to 2%Lidocaine with 1:100,000 epi in patient’s ages 4-79 years old. A subgroup analysis was done on the subjects ages 4 to 13 years old. These pediatric patients were separated into complex and simple dental procedures. The subjects were randomized with a 2.5:1 ratio of the anesthetic use Articaine to Lidocaine. Efficacy of the drug was determined using the VAS scale ranging from 0 (smiley face) “it didn’t hurt at all” to 10 (frown face) “worst hurt imaginable.” The parents explained the scale to the children so they could understand what to do and an investigator also marked his/her opinion of the patient’s pain during the procedure. Vital signs were monitored before and after administration of anesthetic. Adverse effects were followed during the study as well as during follow-up phone calls 24 hours and 7 days after the procedure.

Findings: 50 subjects under the age of 13 were treated with Articaine and 20 subjects under 13 treated with Lidocaine. Patients received comparable volumes of the anesthetic, however higher mg/kg doses were given to the Articaine subjects due to the higher concentration of Articaine (4%) to Lidocaine (2%). VAS scores for Articaine were 0.5 plus or minus 0.18 for simple procedures and 1.1 plus or minus 0.33 for complex procedures. The investigator scores ranged from 0.4 plus or minus 0.14 to 0.6 plus or minus 0.28. VAS scores for Lidocaine were 0.7 plus or minus 0.26 simple and 2.3 plus or minus 2.25 complex. These number indicated that Articaine is an effective local anesthetic for children. No serious adverse effects were noted. 4/50 articaine patients and 2/20 Lidocaine patients reported at least one minor adverse effect including post-procedural pain, headache, injection site pain and accidental injury. One patient received more than the recommended maximum dosage of Articaine but reported no adverse effects. The only adverse effect noted in the Articaine grouping was accidental lip injury. Vital signs were not clinically significant and not associated with any adverse effects.

Key Points: Summary: Articaine 4% with epinephrine 1:100;000 is safe and effective for use on the pediatric population of at least four years of age. In this study no significant difference in pain relief was observed between the Articaine and Lidocaine groups. Time and onset of 4% Articaine is appropriate for clinic use.

Assessment of the Article: Great clean study comparing Lidocaine with Articaine in the pediatric population. There is mention of previous studies recommending use of 4% Articaine as opposed to a lower dosage such a 2% due to less effectiveness of the later concentration but no differences in toxicity when using the higher concentration. In addition the article does mention that Articaine is not for use in patients with known sensitivity to amide-type local anesthetic or with sulfite sensitivity. It should also be used with caution when treating patients with hepatic disease and significant impairments in cardiovascular function. Use of this drug for children under the age of four is not recommended.