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Medical Forum / General / Dentistry / November 2007Articaine
I haven't used it--yet. Anyone wish to comment on efficacy? Too dangerous to do nerve blocks? Any "untoward" effects? TIA, Steve  SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 On Nov 27, 12:05 pm, Mark & Steven Bornfeld <bornfeldm...@dentaltwins.com> wrote: > I haven't used it--yet. Anyone wish to comment on efficacy? Too > dangerous to do nerve blocks? Any "untoward" effects? [quoted text clipped - 6 lines] > Brooklyn, NY > 718-258-5001 Hey Steve, I've been using Articaine (Septocaine, Ultracaine) for many years without any adverse effects for infiltrations and blocks. I haven't encountered any post-operative problems whatsoever. It seems to infiltrate quite well, but whether it's better at that than any other anesthetics I really can't say. For example, I've never had palatal anesthesia after just infiltrating on the buccal of an upper tooth. It's no miracle anesthetic and most likely not any more dangerous than other ones available at least in my experience. Zzzdentist www.dentalminds.com > On Nov 27, 12:05 pm, Mark & Steven Bornfeld > <bornfeldm...@dentaltwins.com> wrote: [quoted text clipped - 24 lines] > Zzzdentist > www.dentalminds.com Thanks. My brother has a patient who is refractory to anesthesia. I know I've read of prolonged anesthesia and paresthesia, but I know the stated incidence is rare. Seems worth a shot. Thanks, Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 >Seems worth a shot. > >Thanks, >Steve That's a good one. Have been using it for years without incident. Believe it has a 20+ yr history in Europe. Faster onset, and a little shorter duration than Lido. Forget what the max dose is. It's a 4% solution rather than a 2% Signature/ Amatus / > >>Seems worth a shot. [quoted text clipped - 11 lines] > > Forget what the max dose is. >> Seems worth a shot. >> [quoted text clipped - 10 lines] > > Forget what the max dose is. Thank you, oh Strat man! Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 The only cases I have seen personally of post-injection parasthesia were using mepivicaine with no vasoconstrictor Signature/ Amatus / >> On Nov 27, 12:05 pm, Mark & Steven Bornfeld >> <bornfeldm...@dentaltwins.com> wrote: [quoted text clipped - 32 lines] > Thanks, > Steve > The only cases I have seen personally of post-injection parasthesia were > using mepivicaine with no vasoconstrictor Really--Mark just found a citation somewhere of prolonged paresthesia with prilocaine. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 4% anesthetics do have a higher rate of paresthesia when used for lower blocks. It is not an extreme difference, but it is pretty well documented. You just have to evaluate if you percieve enough of a benefit from using Articaine to outweigh the increased risks. There are two local anesthesia experts on another dental list. One says he would not recommend 4% anesthetic solution for blocks. The other one says it's OK. One study had Articaine about 4X more likely to result in paresthesia, but since the incidence is so low with regular anesthetics, that 4X still does not translate into large numbers. I had two cases of paresthesia with 4% Citanest Forte (prilocaine) in less than 100 IANBs. None with any other anesthetic, but I very rarely use Articaine for blocks (and don't use Citanest Forte in that use either!). IME, Stabident or X-tips are great for anesthesia problems, but I wouldn't be against using Articaine since this risk is not that great and the paresthesias are almost always temporary. D >> The only cases I have seen personally of post-injection parasthesia >> were using mepivicaine with no vasoconstrictor [quoted text clipped - 3 lines] > > Steve > 4% anesthetics do have a higher rate of paresthesia when used for > lower blocks. [quoted text clipped - 20 lines] > > D Thanks, Steve! Steve BTW, I do have some Septocaine and Zorcaine in the office. I have not personally found any great shakes from the stuff, but I'm going to continue to use it here and there. I mainly got it when I had trouble getting Citanest Forte. I use it mainly for infiltrations. I have seen nothing better than with the Citanest (just a higher bill <G>). Steve >> 4% anesthetics do have a higher rate of paresthesia when used for >> lower blocks. [quoted text clipped - 24 lines] > > Steve Have used 6 - 8 for full mouth anesthesia <4quads SC&RP> but if more anesthesia is required switch to Mepivi 3% plain <lingual block> Sometimes may use lido 2% 1/50k for supplementary IANB. No cases of paresthesia yet <knock on wood>. >BTW, I do have some Septocaine and Zorcaine in the office. I have not >personally found any great shakes from the stuff, but I'm going to [quoted text clipped - 34 lines] >> >> Steve I use it often. No problems. Watch maximum dosages. Signature/ Amatus / > > I haven't used it--yet. Anyone wish to comment on efficacy? Too > dangerous to do nerve blocks? Any "untoward" effects? > > TIA, > Steve > I use it often. No problems. Watch maximum dosages. Thanks. Offhand, do you know the maximum dose for an average man? Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 Half of your 2% lido with 1:100,000 epi Signature/ Amatus / >> I use it often. No problems. Watch maximum dosages. > > Thanks. Offhand, do you know the maximum dose for an average man? > > Steve > Half of your 2% lido with 1:100,000 epi Thanks. I've heard the toxic dose for lido 2% is about 12-15 cartridges, but I don't think I've ever used more than 5 in a visit (for multiple extractions. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 Think more like 8 Signature/ Amatus / >> Half of your 2% lido with 1:100,000 epi > [quoted text clipped - 3 lines] > > Steve > Think more like 8 I hope I never find out. ;-) Steve 10 max (1:100.000) -- All the best, Proka will crush you with my power - the healer says I be love for you with all my might ~ > > Think more like 8 > > I hope I never find out. ;-) > > Steve On Nov 27, 7:05 pm, Mark & Steven Bornfeld <bornfeldm...@dentaltwins.com> wrote: > I haven't used it--yet. Anyone wish to comment on efficacy? Too > dangerous to do nerve blocks? Any "untoward" effects? [quoted text clipped - 6 lines] > Brooklyn, NY > 718-258-5001 That was our standard anaesthetic in dental school (3M ubistesin forte). When I went into practice for the first time I used lido exclusively and I wondered why I was getting more failed blocks than I did in school. That feeling of somehow getting worse instead of getting better was quite depressing at the time... Regards, George > On Nov 27, 7:05 pm, Mark & Steven Bornfeld > <bornfeldm...@dentaltwins.com> wrote: [quoted text clipped - 17 lines] > Regards, > George Wow--I wonder how many schools are now using it as the default anesthetic. Thanks, Steve On Nov 27, 10:00 pm, Steven Bornfeld <dentaltwinm...@earthlink.net> wrote: > Wow--I wonder how many schools are now using it as the default anesthetic. Well, don't forget that articaine was available in Europe for many years before the US/UK. In Greece it was just what everybody was using at that time. Interestingly, most concerns about articaine and paraesthesia were raised after it was introduced in litigious countries (US/UK)... Regards, George The only problem I have with articaine is when dentists start hoping a 'new' anesthetic will solve their problems with missed lower blocks when what they need is to learn proper placement of whatever local is in the syringe. Failure to get a patient numb using a 30 ga. short with a 'poke and hope' technique does not scream out for a better anesthetic. It screams out for a better delivery technique. If the anesthetic is placed in the proper location, 3% mepivicaine will completely numb lower teeth for normal treatment. You may need some help with 'hot' endo teeth or extractions, but that is true with any local. JME, D > Well, don't forget that articaine was available in Europe for many > years before the US/UK. In Greece it was just what everybody was using [quoted text clipped - 4 lines] > Regards, > George > The only problem I have with articaine is when dentists start hoping > a 'new' anesthetic will solve their problems with missed lower blocks [quoted text clipped - 12 lines] > JME, > D You use a short needle for mandibular blocks? Steve >> Well, don't forget that articaine was available in Europe for many >> years before the US/UK. In Greece it was just what everybody was using [quoted text clipped - 4 lines] >> Regards, >> George SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 Heck no. I use a 25 long. I was just commenting that some dentists try to use a 30 short for lower blocks and then wonder why the patient doesn't get numb. D >> The only problem I have with articaine is when dentists start hoping >> a 'new' anesthetic will solve their problems with missed lower blocks [quoted text clipped - 25 lines] >>> Regards, >>> George > Heck no. I use a 25 long. > > I was just commenting that some dentists try to use a 30 short > for lower blocks and then wonder why the patient doesn't get numb. > > D Just so we understand each other! ;-) Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 Don't mind clarifying the issue at all. I have heard speakers at CE advocate this kind of stuff with my own ears. They aren't lecturing about local anesthesia, but while discussing one part of treatment they have digressed into their 'favorite' technique for getting patients numb. Makes you wonder if they have a clue about the rest of their spiel. ;-( Steve >> Heck no. I use a 25 long. >> [quoted text clipped - 6 lines] > > Steve > The only problem I have with articaine is when dentists start hoping > a 'new' anesthetic will solve their problems with missed lower blocks [quoted text clipped - 9 lines] > help with 'hot' endo teeth or extractions, but that is true with any > local. Good point Steve. I think the problem with blocks is that it is essentially a "blind" technique, ie you cannot actually see what you are injecting but have to rely on landmarks and there is great variation of the anatomy among patients. This is probably why blocks are not a very predictable technique that produces consistent results. Most of the work we carry out are fillings or preps, so we don't usually see the effects of a "failed" block because we achieve a level of anaesthesia good enough to carry out the treatment. The problem comes when we need profound anaesthesia for difficult extractions or hot pulps. I once show a statistic showing 35% success rate for a lidocaine block in the case of an acutely inflamed pulp. Articaine may be a valuable tool in these cases, especially when used intraosseously. Regards, George ON tough cases to get numb,,,,,, try using one carpule of Lido first, then a carpule of either mepivicaine or articaine. The combination works better than either one alone. Signature/ Amatus / >> The only problem I have with articaine is when dentists start hoping >> a 'new' anesthetic will solve their problems with missed lower blocks [quoted text clipped - 26 lines] > Regards, > George And you won't get a paresthesia (most often with the lingual nerve) with that delivery technique. :-) Steve Articaine may > be a valuable tool in these cases, especially when used > intraosseously. > > Regards, > George >> The only problem I have with articaine is when dentists start hoping >> a 'new' anesthetic will solve their problems with missed lower blocks [quoted text clipped - 26 lines] >Regards, >George Only once did I use an anesthetic with vasoconstrictor for intraosseous anesthesia. You can guess why. Now use mepivi 3% plain for IO . I use 3% mepivicaine for IANBs with excellent success. Local anesthetic is like real estate....location, location, location. ;-) Steve > That was our standard anaesthetic in dental school (3M ubistesin > forte). When I went into practice for the first time I used lido [quoted text clipped - 4 lines] > Regards, > George Wish I could get a "hands on" training session from you. >I use 3% mepivicaine for IANBs with excellent success. Local anesthetic >is like real estate....location, location, location. [quoted text clipped - 10 lines] >> Regards, >> George I'd be happy to try, but I would just be passing on my best attempts at what I have learned from a reknowned expert. You'd be better getting it from Dr. Ken Reed. I've taken his course twice. He lectures in the morning and then you 'shoot' each other in the afternoon. Nothing like the pressure to numb another dentist with several other dentists watching. I concentrated on the Div. II with a palatal aproach the first time, and then on the IANB the second. Not sure how often, or where you might catch him, but he would be glad to e-mail you if you asked. <www.dentalzzz.com> is his home page. Go to CE and there is a document with his mandibular block technique. For sharp needles, Accudent and J. Morita are good choices. I think you can raise your lower blocks to 90% without much trouble (at least for the average, cooperative patient...obese/squirmy/non- opening/thick tongued patients lower the odds..if you can't see what you're aiming at, it's much tougher to hit <G>). One shot, hammer dead anesthesia sure makes the work easier. Best wishes, D > Wish I could get a "hands on" training session from you. > [quoted text clipped - 12 lines] >>>Regards, >>>George
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