Articaine (Septocaine, Articadent) has become one of the most widely used local anesthetics in dentistry, valued for its superior soft tissue diffusion and shorter duration. However, its association with persistent paresthesia warrants attention from all practitioners.

The Evidence

A review published in the Journal of the American Dental Association analyzed 248 cases of paresthesia following dental local anesthesia. Articaine was involved in 51% of cases despite representing approximately 35% of local anesthetic use. The lingual nerve was affected in 70% of reported cases.

The mechanism remains debated. Leading theories include higher concentration (4% vs. 2% lidocaine), potential neurotoxicity of the thiophene ring metabolite, or simply increased reporting due to articaine popularity.

Clinical Recommendations

The American Dental Association Council on Scientific Affairs has not recommended against articaine use but suggests practitioners weigh benefits against risks, particularly for inferior alveolar nerve blocks.

Many practitioners now reserve articaine for infiltration anesthesia, where its superior diffusion provides genuine clinical advantages, while using lidocaine for mandibular blocks. Others continue using articaine universally, citing overall low incidence rates (approximately 1 in 785,000 injections for permanent paresthesia).

Informed Consent Considerations

Regardless of anesthetic choice, paresthesia should be discussed during informed consent for procedures involving nerve blocks. Documentation should note the anesthetic used, concentration, and volume administered.

When paresthesia occurs, most cases resolve within 8 weeks. Persistent symptoms beyond 6 months may benefit from specialist referral for evaluation and potential pharmacologic management.