Dr. Schertzer states that he sought "substantive reasons to utilize 4 percent articaine with 1:200,000 epinephrine instead of the usual 2 percent lidocaine with 1:100,000 epinephrine used by the vast majority of dentists in the United States." He stated that "I found no good reasons."
The three clinical trials reported in this article were designed solely to compare the efficacy and safety of 4 percent articaine HCl with the standard of comparison, 2 percent lidocaine HCl. The May JADA article presented efficacy results. An article to be published later will present results of the safety comparison.
As local anesthetics possess such great clinical effectiveness, given a dental population in need of all types of conservative treatment (as in these studies), it is indeed difficult to demonstrate that articaine is at all superior to lidocaine. And this was not the purpose of these studies. In order for a new drug to be introduced into clinical practice, the U.S. Food and Drug Administration requires clinical trials that demonstrate the safety and effectiveness of the drug to a standard, in this case lidocaine. The results, as presented in this article, demonstrate conclusively the efficacy of articaine HCl.
Articaine has been available worldwide since 1975 and has garnered a majority of the dental local anesthetic market in many of the countries in which it is available. Indeed, articaine currently commands 80 percent of dental local anesthetic sales in Germany (Lipp M. Articaine HCl: the German experience. Paper presented at: Local Dental Anesthetics Symposium; May 23, 2000; Paris).
In Canada, where it has been available since the mid-1980s, it is the most popular local anesthetic in many areas (
Haas DA, Lennon D. Local anesthetic use by dentists in Ontario. J Can Dent Assoc 1995;61(4):297–304[Medline]
).
Why? Clinical observations (as opposed to evidenced-based research) indicate that articaine possesses two features that practicing doctors find important: a faster onset of anesthesia and "you don’t miss as often." This latter claim requires clinical verification in studies in which "difficult-to-anesthetize patients" receive either articaine or a comparative drug, such as lidocaine.
The fact that articaine possesses both an amide and an ester linkage is of clinical significance in minimizing the risk of overdose (toxic reaction). The elimination half-life of most amide local anesthetics is approximately 90 minutes. Articaine’s is 27 minutes.
Dr. Schertzer is to be complimented on a thoughtful evaluation of our article and for presenting some well-considered questions. It is hoped that future publications will answer his questions much more fully.
Since this article’s publication, articaine HCl has received FDA approval and is marketed by Septodont in the United States as Septocaine (4 percent articaine HCl with epinephrine 1:100,000).
