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Administration of local anesthesia (LA) for dental procedures is a frequent cause of discomfort, apprehension 1 , 2 and anxiety 1 in patients. Various modalities are practiced to reduce this discomfort, which include warming the cartridge, providing vibration, pressure, or cold at the site of injection, distraction techniques, and lastly application of topical anesthesia, which is commonly practiced in modern dentistry. 3 Topical anesthetics target free nerve endings in the mucosa and block nerve impulse conduction thereby

GENERAL PROPERTIES OF LOCAL ANESTHETICS Local anesthetics interrupt neural conduction by inhibiting the influx of sodium ions. In most cases, this follows their diffusion through the neural membrane into the axoplasm, where they enter sodium channels and prevent them from assuming an active or “open” state. The local anesthetic molecule consists of 3 components: (a) lipophilic aromatic ring, (b) intermediate ester or amide chain, and (c) terminal amine. Each of these contributes distinct properties to the molecule ( Figure 1

Local anesthetics interrupt neural conduction by inhibiting the influx of sodium ions through channels or ionophores within neuronal membranes. Normally these channels exist in a resting state, during which sodium ions are denied entry. When the neuron is stimulated, the channel assumes an activated or open state, in which sodium ions diffuse into the cell, initiating depolarization. Following this sudden change in membrane voltage, the sodium channel assumes an inactivated state, during which further influx is denied while active transport mechanisms

Local anesthesia forms the backbone of pain control techniques in the dental profession. Local anesthetics represent the safest and most effective method for managing pain associated with dental treatment. They are the only drugs that prevent the nociceptive impulse from reaching the patient's brain. Local anesthetics need to be deposited as close to the nerve as possible so that optimal diffusion of the drug may occur, providing profound anesthesia and a pain-free dental experience. The importance of this is demonstrated by the fact

Local anesthetics in combination with vasoconstrictors comprise the foundation of pain control in dentistry and oral and maxillofacial surgery and provide ample benefits for the patient and the clinician. However, patients may experience dental fear and anxiety for a variety of reasons, including the use of local anesthesia. In a recent clinical study, 26 of 100 patients undergoing oral surgery reported being afraid of pain during and after the procedure as well as fearing the local anesthetic injection. 1 Therefore, achieving optimal intra

Local anesthetics enable dental treatment to be performed painlessly by reversibly blocking the conduction of the sensory nerves. 1 Intraoral local anesthetic injections are safe procedures most dentists use daily that commonly involve drug administration near a terminal nerve branch (ie, supraperiosteal infiltration or field block) or a nerve trunk (ie, a nerve block). 2 The most popular anesthetic in many countries around the world, including the United States, is lidocaine, although in some countries, articaine is used more often. 3

Reports of adverse reactions to local anesthetics are usually attributed to a reaction to epinephrine, vasovagal syncope, or overdose toxicity. Patients may then interpret adverse reactions as an allergy to local anesthetic. True allergy to amide local anesthetics is considered to be rare. 1 All injectable local anesthetics are composed of 3 different structural parts: (a) an aromatic or lipophilic portion, necessary for the drug to penetrate the lipid-rich nerve membrane; (b) an amino terminus, ensuring solubility in aqueous medium

General anesthesia is a form of advanced behavior management utilized by dentists to provide quality dental care for children otherwise unable to tolerate dentistry in an outpatient setting. 1 The use of local anesthesia in conjunction with general anesthesia is an area with conflicting research. The addition of local anesthesia during dental rehabilitations has some potential benefits: decreased postoperative pain, improved hemorrhage control, and reduced need for anesthesiologist intervention. In regards to postoperative pain

Anxiety has a significant impact on the practice of dentistry. 1 An aspect of dental treatment that produces anxiety in patients is local anesthesia. 2 The delivery of local anesthetic injections also produces anxiety among dentists. In a study by Simon et al, 3 19% of dentists reported administration of local anesthesia caused them distress; 6% considered this problem serious. Only 2% of the respondents in that study reported no negative reaction to the administration of local anesthesia. A study 4 of the attitudes of US university students toward

Epinephrine, a vasoconstrictor, is often added to local anesthetics for dental use to enhance and prolong the local anesthetic effect, prevent local anesthetic systematic toxicity, and impart a hemostatic effect. 1 Epinephrine-containing local anesthetics are commonly used for surgical procedures involving the oral cavity and facial bones, such as tooth extraction, radicular cystectomy, implant placement, and jawbone resection. 2 – 5 The vasoconstrictive effect of epinephrine in the maxilla and mandible has not been sufficiently described