Types of Local Anesthetic Dental Injections
Local anesthetic for dental pain control can be generalized into three categories — local infiltration, field block, and nerve block.
- Local Infiltration1,2
Supraperiosteal injection, also known as local infiltration, is the most common type of dental injection. It is used to anesthetize a single tooth and the small area close to the site of the tooth. It is used for routine dental procedures, such as fillings or extractions.
The procedure is performed by first locating the mucobuccal fold above the target tooth. The syringe is held against the long axis of the tooth.
The advantages of local infiltration are ease of injection and a high success rate. Infiltration cannot be used for procedures that need a larger area to be anesthetized, such as multiple teeth that need to be anesthetized, root canals, and crowns. Contraindications include acute inflammation and infection.
- Field Block2
Field block anesthesia is a dental injection that anesthetizes a larger area than local infiltration. The dentist will inject the anesthetic into several areas around the tooth or teeth that need to be treated. This type of injection may be used for more complex procedures such as root canals, crowns, or maxillary extractions.
- Nerve Block2
Nerve block anesthesia numbs a larger area of the mouth and face. It is used when two or three teeth are involved in the procedure, or for more complex procedures such as wisdom teeth removal. A local anesthetic is injected near one or more nerves that supply sensation to the area, away from the site of surgery near the main trunk of the nerve that is involved.
Selection of Local Anesthetic
The selection of injectable anesthetic depends on factors including the type of procedure, onset time, duration of action, and individual tolerance. Local anesthetic options are summarized in the table below.
Local Anesthetic |
Ingredients |
Each ml contains |
Uses |
Onset |
Duration in Pulpal Anesthesia |
Duration in Soft Tissue |
Xilonibsa 2% 1:80,000 |
Lidocaine HCl 2% Epinephrine 1:80,000 |
Lidocaine hydrochloride 20.00 mg
Epinephrine 0.0125 mg
|
Local infiltration and nerve block Adaptability to different procedures |
3 to 5 minutes |
60 minutes |
180 to 300 minutes |
Artinibsa 4% 1:100,000 |
Articaine HCl 4%
Epinephrine 1:100,000 |
Articaine hydrochloride 40 mg
Epinephrine tartrate 0.018 mg (equivalent to 0.01 mg epinephrine base)
|
Local infiltration and nerve block
Increased efficacy and duration for complicated procedures that require prolonged anesthesia |
2 minutes
|
60 to 75 minutes |
180 to 360 minutes |
Artinibsa 4% 1:200,000
|
Articaine HCl 4% Epinephrine 1:200,000 |
Articaine hydrochloride 40 mg Epinephrine tartrate 0.009 mg (equivalent to 0.005 mg epinephrine base)
|
Local infiltration and nerve block Increased efficacy and duration for complicated procedures that require prolonged anesthesia |
2 minutes |
45 to 60 minutes |
120 to 300 minutes |
Scandinibsa 2% 1:100,000
|
Mepivacaine HCl 2%
Epinephrine 1:100,000 |
Mepivacaine hydrochloride 20 mg
Epinephrine tartrate 0.01 mg
|
Local infiltration and nerve block Medium duration procedures |
2 to 3 minutes |
60 minutes |
180 to 300 minutes |
Scandinibsa 3%
|
Mepivacaine HCI 3% |
Mepivacaine hydrochloride 30 mg |
Local infiltration and nerve block
For patients with contraindications to vasoconstrictors
Often appropriate for pediatric and geriatric patients
|
3 to 5 minutes |
25 minutes for maxillary infiltration
40 minutes for inferior alveolar nerve block
|
90 minutes for maxillary infiltration
165 minutes for inferior alveolar nerve block
|
Inibsacain 0.5% 1:200,000
|
Bupivacaine HCl 0.5%
Epinephrine 1:200,000 |
Bupivacaine hydrochloride 5 mg
Epinephrine tartrate 0.009 mg (equivalent to 0.005 mg epinephrine base)
|
Local anesthesia for induction for dental procedures in adults, by injection or trunk blockade Long-acting postoperative pain management |
6 to 10 minutes |
90 to 180 minutes |
240 to 540 minutes |
Preparation for Injection With Topical Anesthetic Spray
Topical anesthetic spray can be used to help prevent discomfort, pain, and anxiety during dental procedures. The dosage varies according to the area to be anesthetized, the extent of vascularization, individual tolerance, and the anesthetic technique to be used. Use the lowest dose possible that provides the required anesthetic effect. It is recommended to spray onto a dry mucous membrane.3 Xilonibsa Spray 10% contains 100 mg of lidocaine in each ml. The onset of action is 1 to 3 minutes, and the duration of anesthesia of the mucous membrane is 15 minutes.
References:
- Ghavimi MA, Kananizadeh Y, Ghoreishizadeh S. Overview of Local Anesthesia Techniques. In: MHK Motamedi, ed. A Textbook of Advanced Oral and Maxillofacial Surgery Volume 2. IntechOpen. 2015. Accessed from: https://www.intechopen.com/chapters/47578
- Benaifer D, Preziosi, Hershkin AT, Seider PJ, Casey GM. Oral & Maxillofacial Regional Anesthesia. The New York School of Regional Anesthesia. Accessed May 28, 2022. Accessed from: https://www.nysora.com/topics/regional-anesthesia-for-specific-surgical-procedures/head-and-neck/maxillofacial/oral-maxillofacial-regional-anesthesia/
- Lee HS. Recent advances in topical anesthesia. J Dent Anesth Pain Med. 2016;16(4):237-244. doi:10.17245/jdapm.2016.16.4.237. Accessed from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5564188/
- Summary of Product Characteristics of Artinibsa 4% 1:100,000, Artinibsa 4% 1:200,000, Xilonibsa 2% 1:80,000, Xilonibsa Spray 10%, Scandinibsa 3% and Inibsacain 5 mg/ml + 0.005 mg/ml.