Evidence suggests that 4% articaine provides superior pulpal anaesthesia to 2% lidocaine

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The ability to provide pain- free dentistry is important  and the American Dental Association Center for Evidence-Based Dentistry (ADA-EBD)has just published this critical summary of  a 2011 systematic review by Brandt et al . The review compares the efffecacy  of  two local anaesthetics ( 4% articaine and 2% lidocaine)   in providing successful pulpal anaesthesia. The review has also been the subject of a commentary in the journal of Evidence-based Dental Practice by Balto ( 2011).

The  ADA-EBD summariser considered  that the search strategy was well conducted by there were methodological queries they consider could have overstated the results. Overall the number of participants included was small but the study results were consistent in showing that 4% articaine is more likely to provide successful anaesthesia than is 2 % lidocaine for routine dental procedures.

The  commentary by Balto gave the review a B Grade strength of Recommendation.

The Dental Elf has covered a number of trials over the past 12 months that have also looked at the effectiveness of articaine.


ADA-EBD Summary -Articaine is superior to lidocaine in providing pulpal anesthesia

Balto K. Administration of articaine anesthesia may lead to superior profound  pulpal anesthesia compared with lidocaine in adult patients. J Evid Based Dent Pract. 2011 Dec;11(4):183-4. PubMed PMID: 22078827.

Brandt RG, Anderson PF, McDonald NJ, Sohn W, Peters MC. The pulpal anesthetic  efficacy of articaine versus lidocaine in dentistry: a meta-analysis. J Am Dent Assoc. 2011 May;142(5):493-504. PubMed PMID: 21531931.

Dental Elf  18th July  2012

Dental Elf  7th June 2012

Dental Elf 16th February 2012

Dental Elf 2nd September 2011

Dental Elf 1st August 2011




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Derek Richards

Derek Richards is a specialist in dental public health, Director of the Centre for Evidence-Based Dentistry and Specialist Advisor to the Scottish Dental Clinical Effectiveness Programme (SDCEP) Development Team. A former editor of the Evidence-Based Dentistry Journal and chief blogger for the Dental Elf website until December 2023. Derek has been involved with a wide range of evidence-based initiatives both nationally and internationally since 1994. Derek retired from the NHS in 2019 remaining as a part-time senior lecturer at Dundee Dental School until the end of 2023.

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