What's new in local anaesthesia?

In this paper I have explored four areas of current interest to pain control in dentistry. Articaine HCl, the most recent addition to the dental LA armamentarium, has become a favoured drug in many, if not most, countries in which it is available. Rapid onset and improved hard- and soft-tissue penetration enable articaine HCl to be administered with great success as a mandibular infiltration, precluding the need, in most situations, to employ it by inferior alveolar nerve block. The 'question' about an increased risk of paresthesia following articaine administration via IANB has been answered by careful evaluation of case reports. C-CLAD systems have enabled the administration of LA to become much more comfortable, especially in the palate, and with accessory techniques such as the periodontal ligament injection (PDL, ILI). Two highly successful techniques, the AMSA and P-ASA, have been developed as a result of C-CLAD systems. Phentolamine mesylate (OraVerse) allows for the reversal of residual soft-tissue anaesthesia, decreasing its duration by approximately 50%. Reversal enables patients to 'feel normal' more quickly after dental treatment and should decrease the risk of traumatic injury to soft tissues. Knowledge of the maximum dosages of LAs to be administered to all patients, but to younger, lighter-weight patients in particular, is essential to safety. The prevention of LA overdose is more gratifying than managing this fear-inducing medical emergency. When used properly, local anaesthetics represent the safest and most effective drugs in all of medicine for the prevention and management of pain.