The objective of this review was to investigate the efficacy of dental local anesthetics, as it is well known among clinicians that local anesthesia may be challenging in some circumstances. Therefore, the focus of this review was on the efficacy of the products used in dental local anesthesia. In a Pubmed database literature search conducted, a total of 8646 articles were found to be related to dental local anesthetics. After having applied the inclusion criteria (human research, performed in the last 10 years, written in English language, and focus on dental local anesthetics) and having assessed the quality of the papers, 30 were deemed eligible for inclusion in this review. The conclusion of this review is that none of the dental local anesthetic amides provide 100% anesthesia. The problem appears to be more pronounced when mandibular teeth are attempted to be anaesthetized and especially if there is irreversible pulpitis involved. The authors conclude that this finding suggest exploration of more efficient techniques to administer dental local anesthesia, especially in the mandible, to establish a 100% efficacy, is needed.
Amides ; Anesthesia ; Anesthesia, Local ; Anesthetics, Local ; Mandible ; Pulpitis ; Tooth

Dental local anesthesia is performed daily on a global scale. Adverse effects are rare, but the topic of neurotoxicityof local anesthetics deserves to be explored, as publications can be controversial and confusing. Therefore,a need was felt to address and question the evidence for potential neurotoxicity of dental local anesthetics.This review aimed to assess the studies published on the neurotoxicity of dental local anesthetics. A PubmedⓇsearch was conducted between January 2019 and August 2019. This revealed 2802 hits on the topic of neurotoxicityor cytotoxicity of the following anesthetics: lidocaine, prilocaine, mepivacaine, articaine, ropivacaine, andbupivacaine. Only 23 papers were deemed eligible for this review: 17 in vitro studies, 3 reviews and 3 auditsof national inquiries. The heterogeneous literature on this topic showed that all dental local anesthetics arepotentially neurotoxic in a concentration and/or exposure time fashion. There seems no consensus about whatcell lines are to be used to investigate the neurotoxicity of local anesthetics, which makes the comparison betweenstudies difficult and ambiguous. However, the bottom line is that all dental local anesthetics have a neurotoxicpotential, but that there is no unanimity in the publications about which local anesthetic is the least or themost neurotoxic.