Buffering articaine with sodium bicarbonate may not only lower pain for patients, but it may also completely eliminate the burning sensation during administration, according to a study recently published in Endodontology.
Additionally, the onset of anesthesia was faster when it was buffered, the authors wrote.
“Buffering with sodium bicarbonate is a convenient and safe method that reduces pain on injection, lessens burning sensation, and provides faster onset of local anesthesia,” wrote the authors, led by Dr. Deepak Langade, a professor and head of pharmacology department at the D.Y. Patil University School of Medicine in India (Endodontology, April 10, 2026).
To assess pain perception and the anesthetic efficacy of 4% buffered articaine in upper jaw molar buccal infiltration in patients with symptomatic irreversible pulpitis, a double‑blind randomized controlled trial involving 40 patients was conducted.
The patients were divided evenly. One group was given 4% articaine, while the other was given 4% buffered articaine. For the buffered articaine preparation, 0.17 ml of 8.4% sodium bicarbonate solution was added.
During the administration, the patient was notified when it was completed and rated their pain perception using the visual analog scale. At 30 seconds after injecting articaine, the onset of anesthesia was checked with an electric pulp tester, according to the study.
With the buffered articaine, pain perception during solution deposition was significantly reduced (p < 0.0001). The burning sensation was completely absent with buffered articaine (p = 0.001), the authors wrote.
The average onset time for articaine was 60 seconds, but it was 30 seconds for buffered articaine, with a statistically significant difference (p = 0.0001), according to the study's authors.
Nevertheless, the study had limitations, including that the trial had minimal heterogeneity. The injections were performed by the same operator at the rate of 1 ml/min using 27 g needles, the authors wrote.
In the future, more studies involving larger sample sizes and diverse pulpal conditions are needed to assess the possible advantages of buffered local anesthetic solutions, they wrote.
“A single buccal infiltration of 4% buffered articaine in the maxillary first molar resulted in reduced injection pain, decreased burning sensation, and more rapid onset of anesthesia,” Langade and colleagues wrote.
