Dental Dose: Don't be married to benzocaine

By Theresa Pablos, DrBicuspid.com editor in chief

April 29, 2022 -- Dental Dose is a twice-monthly video series featuring pharmacologist Tom Viola, RPh. In each episode, Viola shares bite-sized pieces of dental pharmacology news, facts, and myths.

Pharmacologist Tom Viola knows many things. One of them is that in the world of dentistry, the No. 1 contender for topical anesthetic of the year is benzocaine. But is benzocaine worthy of that status?

"Everybody loves benzocaine," Viola said. "Don't be so married to benzocaine."

Topical benzocaine does have some drawbacks. It can have acid in the preparation, causing tissue burning and trauma. In addition, it's an ester, meaning there's potential for an allergic reaction. In one rare patient case, an extraordinarily high dose of topical benzocaine led to methemoglobinemia that required treatment in the emergency room.

But dental professionals love benzocaine because, like the local anesthetic lidocaine, it's predictable, reliable, and fast-acting. It also doesn't have many interactions or contraindications.

Still, Viola wants dental professionals to at least consider using other less acidic topical anesthetics for some healthy patients. One his favorites, cetacaine, combines short-acting benzocaine with intermediate- and long-lasting agents.

"A wide range of topical anesthetics are available out there, and I encourage everyone who's listening to think about using others besides benzocaine," Viola said. "Many don't have as much acid, and, therefore, don't cause as much trauma to tissue."

Learn more about benzocaine alternatives in the video below.

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Have a topic suggestion for Dental Dose? We'd love to hear it. Send your ideas to Theresa Pablos.


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