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Local Anesthetics

In dentistry, the ability to administer effective local anesthesia is crucial for managing pain. Today, there are multiple options available for practitioners to effectively control the pain associated with dental procedures. These local anesthetic agents are known for their high level of safety and their ability to fulfill the characteristics of an ideal local anesthetic.

They can be administered with minimal irritation to the surrounding tissue and have a very low risk of causing allergic reactions. Additionally, they provide quick onset of anesthesia and sufficient duration for surgical procedures.

The specific attributes of these local anesthetics, such as how quickly they take effect, their potency, and how long they last, can be attributed to the differences in their chemical structures.

Chemical Characteristics and Anesthetic Properties

Benefit 1

Ester anesthetics, like procaine (Novacain), have a slow onset because they exist primarily in an ionized state. This is due to their pKa of 8.9, which causes them to be 98% ionized at a normal tissue pH of 7.4.

Benefit 2

The potency of a local anesthetic is primarily determined by its lipid solubility. Procaine, being one of the local anesthetics with the lowest lipid solubility, is also one of the least potent. On the other hand, bupivacaine, which possesses high lipid solubility, is considered one of the most potent local anesthetics.

Benefit 3

The duration of anesthesia is primarily influenced by the protein binding characteristics. The reason behind the short duration of lidocaine and the long duration of bupivacaine can be attributed to their distinct protein binding characteristics.

Benefit 4

Therefore, it can be concluded that the clinical characteristics of local anesthetics are influenced by their lipid solubility, ionization, and protein binding properties. However, other factors such as the injection site, the presence of a vasoconstrictor, the concentration and volume of the drug being injected, and the inherent vasodilatory properties of the anesthetic also play a role in determining its clinical effectiveness.

Pharmacological Properties of Amide Local Anesthetics

Because of their superior chemical and anesthetic properties, rarely reported allergenic reactions, and excellent safety profiles, only amide anesthetics are currently formulated into dental cartridges for injection.

Lidocaine Hydrochloride (Formulated as 2% lidocaine with 1:100,000 epinephrine and 2% lidocaine with 1:50,000 epinephrine)

Mepivacaine Hydrochloride (Formulated as 3% mepivacaine plain and 2% mepivacaine 1:20,000 levonordefrin)

Prilocaine Hydrochloride (Formulated as 4% prilocaine plain and 4% prilocaine with 1:200,000 epinephrine)

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