Local Anesthetic Drugs in Dentistry: Clinical, Pharmaceutical, Nursing, and Patient Safety Perspectives-An Updated Review

Abstract

Background: Local anesthetic drugs represent a cornerstone in modern dentistry, transforming pain-associated procedures into safe and tolerable clinical interventions. Their introduction has significantly improved patient acceptance, treatment efficiency, and overall oral healthcare delivery. These agents act through reversible blockade of voltage-gated sodium channels, preventing nerve impulse propagation and pain transmission. Aim: This updated review aims to comprehensively analyze local anesthetic drugs in dentistry from clinical, pharmacological, nursing, and patient safety perspectives, with emphasis on drug classification, mechanisms of action, clinical applications, safety considerations, and technological advancements in delivery systems. Methods: A narrative review approach was adopted based on synthesis of established pharmacological principles and clinical evidence reported in contemporary dental anesthesia literature. Data were analyzed across major categories of local anesthetics, including ester and amide types, alongside commonly used agents such as lidocaine, articaine, prilocaine, mepivacaine, and bupivacaine. Additional evaluation included topical anesthetics, dosage calculations, toxicity thresholds, and computer-controlled delivery systems. Results: Findings demonstrate that amide anesthetics dominate modern dental practice due to superior safety and efficacy profiles. Lidocaine remains the reference standard, while articaine offers enhanced diffusion and rapid metabolism. Prilocaine and mepivacaine provide advantages in medically compromised patients, and bupivacaine is reserved for prolonged analgesia. Toxicity remains a critical concern, strongly related to dose, patient factors, and administration technique. Innovations such as computer-controlled local anesthesia delivery systems significantly improve patient comfort and reduce injection-related anxiety. Conclusion: Local anesthetic agents are essential to contemporary dentistry, requiring careful selection based on pharmacological properties, patient condition, and procedural demands. Safe administration, accurate dosing, and technological advancements collectively enhance clinical outcomes and patient-centered care.