Last year I took one of the best continuing education courses of my career. It was on a subject so simple, I would probably have avoided it had it not been set up through my local Seattle Study Club. It was a lecture on local anesthesia and it has made every day a little bit easier.
Local anesthesia is something we perform every single day, yet rarely attend lectures about. I challenge everyone to take a local anesthesia course at the next conference you attend. I promise that you will learn a ton of useful, practical information. The one I took last year was taught by a dental anesthesiologist out of Toronto named Dr. David Isen. If you get a chance to see him, please do. His program was phenomenal. On to the subject at hand. I am a big fan of articaine (Septocaine). I use it every day in my practice. I do not use it for IAN blocks but for infiltrations, it is my go-to anesthetic. In a future blog I will discuss why I don't use it for IAN blocks but today I will discuss using it as a supplement to IAN blocks.
Most of us probably perform an IAN block with 2% lidocaine with 1:100K epinepherine (one or two carpules). Sometimes this gives us adequate anesthesia and sometimes it does not. In situations where I do not get adequate anesthesia on a mandibular tooth mesial to the 2nd molar, I supplement the block with a local infiltration of Septocaine around the tooth I am working on. This almost always does the trick. If this does not work, something bigger is at play like an infection drastically altering the local environment.
An article confirming this is "Comparing anesthetic efficacy of articaine versus lidocaine as a supplemental buccal infiltration of the mandibular first molar after an inferior alveolar nerve block." J Am Dent Assoc. 2008 Oct;139(10):1312. Haase A, Reader A, Nusstein J, Beck M, Drum M.
Basically the study showed that profound anesthesia on a mandibular first molar was acheived 88% of the time with an IAN block 2% lidocaine with 1:100k epinepherine supplemented with a local infiltration of 4% articaine with 1:100k epinephrine (Septocaine). Lidocaine alone yielded profound anesthesia 71% of the time. That is a pretty significant difference!