Dental Dose: Why lidocaine is the golden child of dentistry

By Theresa Pablos, DrBicuspid.com editor in chief

June 4, 2021 -- Everybody loves lidocaine. It is a great anesthetic agent. It has so many advantages that it's hard to keep track of them all. But should lidocaine be held in as high regard as it is? Pharmacologist Tom Viola, RPh, asked and answered this question in the latest episode of Dental Dose.

"Lidocaine has always been the gold standard," Viola said. "Why does lidocaine have the status it does in dentistry when there are other anesthetic agents that work just as well?"

1. Lidocaine has been around forever.

Lidocaine has been around since the 1940s, Viola said in the episode. And although Carbocaine (mepivacaine) was developed not long after, it's still not as popular of an anesthetic agent.

"Why? Because lidocaine just came first," Viola said. "There's a lot of prestige with the fact that lidocaine came on the scene at a time when we needed it the most."

2. Lidocaine has a reliable and safe history.

Before the creation of lidocaine, dentists relied on Novocain, an ester anesthetic. But ester anesthetics don't have the same safety of amide anesthetics, such as lidocaine.

Furthermore, lidocaine's 2% concentration has a predictable effect on patients. This allows dental professionals to titrate the volume to get the desired effect.

"You just knew what you were going to get from lidocaine -- the good and the bad," Viola said.

3. Lidocaine is available everywhere.

If you go to a big-box store and look in the first aid aisle, it would be hard to find a cut or burn product that doesn't have lidocaine, Viola said. As a result, patients know about lidocaine and may feel more comfortable using it.

4. Lidocaine is (generally) safe during pregnancy.

When the U.S. Food and Drug Administration (FDA) used to rate anesthetic safety for pregnant women, the FDA placed lidocaine into category B, ranking the agent higher than many of its competitors, which fell into category C.

"Obstetricians are taught this too," Viola said. "They know if the dentist calls them, they're going to say use lidocaine."

However, Viola cautioned that lidocaine may not be ideal for all pregnant women. Because it's packaged with epinephrine, it's not the best choice for patients with a sulfite allergy or someone who has pregnancy complications that could worsen with epinephrine. As a result, it's important to specify with a doctor that lidocaine is OK for a patient, including pregnant women, when it is packaged with epinephrine.

"It's important to have that conversation with the doctor," Viola said.

Watch the episode below to learn more about the history of lidocaine, as well as its pros and cons.

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