Local Anesthesia Techniques in Dental Practice

Local anaesthesia underpins pain control in modern dentistry, encompassing a spectrum of approaches from topical application to advanced delivery systems. Infiltration techniques involve deposition of anaesthetic solution in close proximity to target tissues, commonly employed in maxillary procedures owing to favourable bone porosity. Mandibular treatments frequently use inferior alveolar nerve blocks, directing agents adjacent to the mandibular foramen to achieve profound pulpal and soft-tissue anaesthesia. Supplemental methods include intraosseous injection, which delivers solution directly into cancellous bone for rapid onset, and periodontal ligament injections that target individual teeth without large-volume soft-tissue involvement. Topical formulations such as creams and gels provide superficial mucosal anaesthesia for needle-free procedures or as adjuncts to injection. Innovative delivery platforms, notably computer-controlled local anaesthetic devices and microneedle patches, have been developed to modulate flow rate and pressure, reducing discomfort at administration while maintaining efficacy. Formulation enhancements, including buffering to physiological pH and incorporation or exclusion of vasoconstrictors like epinephrine, aim to optimise onset time, duration and patient experience. Differential pharmacokinetic and toxicity profiles among amino-amide (e.g. lidocaine, articaine) and amino-ester agents inform choice of anaesthetic, balancing rapid onset, depth of block and risk of neurotoxicity or prolonged soft-tissue numbness. Globally, these techniques support a wide range of dental interventions from routine restorative work to surgical extractions, with ongoing research refining safety, efficiency and patient acceptability.

Research from Nature Portfolio

Recent studies have explored topical anaesthetic agents enhanced by delivery systems. One randomised clinical trial comparing EMLA cream alone, EMLA with microneedle patches, and conventional palatal injections in children aged seven to eleven demonstrated that both topical approaches significantly reduced pain during administration compared with standard injections. Incorporation of microneedle patches further minimised discomfort without compromising anaesthetic efficacy, indicating a promising less-invasive alternative for paediatric palatal procedures.

Local Anesthesia Techniques in Dental Practice publication trend

The graph below shows the total number of articles in local anesthesia techniques in dental practice across all publications each year (not limited to Nature Index journals).

Technical terms

Infiltration anaesthesia: Local injection of anaesthetic adjacent to small nerve endings in soft tissue and bone, typically used in maxillary procedures.

Nerve block: Deposition of anaesthetic near a major nerve trunk (e.g. inferior alveolar nerve) to achieve widespread regional anaesthesia.

Buffered formulation: Adjustment of anaesthetic solution to physiological pH to reduce injection pain and accelerate onset of action.

Microneedle patch: Array of microscopic projections that enhance transdermal delivery of topical agents by creating micro-channels in the mucosa.

Paresthesia: Persistent altered sensation such as numbness or tingling, sometimes following nerve injury or high-concentration anaesthetic exposure.

References

1. Evaluation of EMLA cream with microneedle patches in palatal anesthesia in children: a randomized controlled clinical trial. Scientific Reports (2024).
2. A Buffered Local Anesthetic Without Epinephrine: Development, Characterization, and In Vivo Efficacy and Toxicity Analysis. Pharmaceutics (2024).
3. Schwann cells exposed to articaine display distinct toxic pathways compared to lidocaine. Chemico-Biological Interactions (2024).
4. Articaine in dentistry: an overview of the evidence and meta-analysis of the latest randomised controlled trials on articaine safety and efficacy compared to lidocaine for routine dental treatment. BDJ Open (2021).