Updated for 2018

Though local anesthetics are safe and effective, considerable research is on-going to make them even more effective. Computer-controlled local anesthetic delivery systems (C-CLAD) and buffered local anesthetic solutions promise to allow painless injections to be delivered to dental patients almost anywhere in the oral cavity. Fear of injections is primarily based on the needle. The development of an intranasal local anesthetic mist has been shown to provide successful pulpal anesthesia of maxillary teeth – without a needle. Epinephrine is added to injectable local anesthetics to increase their effectiveness, duration and safety. However the duration of residual soft tissue anesthesia – usually unnecessary and occasionally a potential danger – is extended when epinephrine is used in the anesthetic solution. Self-inflicted soft tissue injury is a real problem associated with this anesthesia in all patient age groups but especially pediatric and geriatric patients. Phentolamine mesylate – an alpha adrenergic antagonist – has been shown to significantly reduce the duration of residual soft tissue anesthesia when administered at the conclusion of the traumatic part of dental treatment.

Learning Objectives: 

1. Discuss the current research on intranasal local anesthesia in dentistry
2. Describe the effect of pH on the onset, depth & comfort of anesthesia with local anesthetics
3. Describe the mechanism of action of the buffering agent sodium bicarbonate on local anesthetics
4. List the benefits of local anesthetic buffering in dentistry
5. Discuss the local anesthetic reversal agent - phentolamine mesylate
6. Describe the advantages & disadvantages of Computer-Controlled Local Anesthetic Delivery (C-CLAD)
7. Describe the clinical effects of the intranasal local anesthetic mist