Sir, we read with interest the mini systematic review of articaine compared to lidocaine in relation to nerve damage for inferior alveolar nerve blocks (IANB).1
The paper provides a review of some of the literature regarding 4% articaine with 1:100,000 adrenaline and, as the authors' state, there remains controversy within the evidence base regarding whether there is an increased risk of nerve damage with use of articaine.
However, an important point to be considered is that although the literature clearly demonstrates that 4% articaine 1:100,000 adrenaline is superior to 2% lidocaine 1:80,000 adrenaline for infiltration anaesthesia, this is not the case for IANB,2,3 the two solutions being equally effective.
Therefore, as there is no benefit in using articaine over lidocaine for IANB, then the potential risk of nerve damage, however small, should lead to the conclusion 'why take the risk?'
References
Stirrup P, Crean S. Does articiane, rather than lidocaine, increase the risk of nerve damage when administered for inferior alveolar nerve blocks in patients undergoing local anaesthesia for dental treatment? A mini systematic review of the literature. Br Dent J 2019; 226: 213−223.
Kung J, McDonagh M, Sedgley C M. Does Articiane Provide an Advantage over Lidocaine in Patients with Symptomatic Irreversible Pulpitis? A Systematic Review and Meta-analysis. J Endod 2015; 41: 1784−1794.
Mikesell P, Nusstein J, Reader A, Beck M, Weaver J. A comparison of articiane and lidocaine for inferior alveolar nerve blocks. J Endod 2005; 31: 265−270.
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Currie, C., Corbett, I. Why take the risk?. Br Dent J 226, 541 (2019). https://doi.org/10.1038/s41415-019-0287-6
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DOI: https://doi.org/10.1038/s41415-019-0287-6