Anesthesia and Sedation

This color-coding system, adopted by the ADA Council on Scientific Affairs in 2003, has been incorporated into ISO standard 11499, “Dentistry – Single-use cartridges for local anaesthetics.” Each single-use cartridge should have two indelible bands indicating the name and concentration of both the anesthetic ingredient (Table 1) and the vasoconstrictor (Table 2).

The tables below, which utilize the Pantone Matching System (PMS) for color identification, illustrate the appropriate colors for both ingredients. Although color-coding is a useful adjunct for anesthetic identification, it is prudent for dentists to read the labels of all drugs they administer.

Table 1. Local anaesthetic agent and concentration colors (Band 1)
Product	Band color (PMS)
Articaine - 4%	Gold 871	Gold 872	Gold 873	Gold 874	Gold 875
Bupivacaine - 0.5%	Blue 300	Blue 301
Lidocaine - 2%	Red 185	Red 186	Red 199	Red 200
Lidocaine - 3%	Purple 266	Purple 267
Mepivacaine - 2%	Brown 477	Brown 478	Brown 498	Brown 499
Mepivacaine - 3%	Tan 406	Tan 407	Tan 408
Prilocaine - 3%	Orange 136	Orange 137

Table 2. Vasoconstrictor and concentration colors (Band 2)
Product	Band color (PMS)
No vasoconstrictor	White	None
Epinephrine < 1:200 000	Yellow 108	Yellow 109	Yellow 110	Yellow 115	Yellow 116
Epinephrine < 1:100 000 to 1:200 000	Orange 136	Orange 137
Epinephrine < 1:50 000 to 1:100 000	Brown 477	Brown 478	Brown 498	Brown 499
Epinephrine 1:50 000	Green 347	Green 348	Green 355	Green 356
Levonordefrin	Black	None
Nor-epinephrine 1:100 000	Tan 406	Tan 407	Tan 408
Nor-epinephrine 1:25 000	Purple 266	Purple 267
Octapressin (felypressin)	Blue 300	Blue 301

ISO standard 11499 outlines additional criteria required of single-use cartridge labels applicable to size and placement of the colored bands:

• Band 1 shall be 3.0 ± 0.5 mm wide and commence between 8 mm and 20 mm from the plunger end of the cartridge.
• Band 2 shall be 1,5 ± 0,5mm wide and commence at (2 ± 0.5) mm from the cartridge disc end of Band 1.

A detailed diagram of a single-use cartridge can be found in Figure 1.

Source: ISO standard 11499

Dental Anesthesiology is a recognized dental specialty per the National Commission on Recognition of Dental Specialties and Certifying Boards. The recognition was awarded in March 2019 after the proposed specialty showed that it is distinct, well-defined, and requires unique and advanced knowledge and skills; and that it contributes new knowledge, education and research to the dental profession.

Guidelines for the Use of Sedation and General Anesthesia by Dentists (2016). Download a copy of the Guidelines (PDF). 

Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students (2016). Download a copy of the Guidelines (PDF).

Guidelines for Teaching Pediatric Pain Control and Sedation to Dentists and Dental Students (2021). Download a copy of the Guidelines (PDF).

ADA Policy Statement: The Use of Sedation and General Anesthesia by Dentists (2007). Download a copy of the Policy Statement (PDF).

MouthHealthy:

• Anesthesia and Sedation for Your Child: Questions to Ask Your Dentist
• Anesthesia and Sedation

ADA Sample (Filled-in) Sedation - Anesthesia Record (PDF)

Oral Health Topics: Nitrous Oxide

JADA: Benefits and harms of capnography during procedures involving moderate sedation

Guidelines for the Use of Sedation and General Anesthesia by Dentists (PDF)

Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students (PDF)

ADA Catalog: Sedation: A Guide to Patient Management

American Academy of Pediatric Dentistry:

• Preparing for Your Child’s Sedation Visit
• Policy for Selecting Anesthesia Providers for the Delivery of Office-based Deep Sedation/General Anesthesia
• Monitoring and Management of Pediatric Patients Before, During, and After Sedation for Diagnostic and Therapeutic Procedures: Update 2016
• Use of Anesthesia Providers in the Administration of Office-based Deep Sedation/General Anesthesia to the Pediatric Dental Patient
• Use of Local Anesthesia for Pediatric Dental Patients
• Use of Nitrous Oxide for Pediatric Dental Patients

American Academy of Pediatrics, American Academy of Pediatric Dentistry: Guidelines for Monitoring and Management of Pediatric Patients Before, During, and After Sedation

American Academy of Anesthesiologists: Practice Guidelines for Moderate Procedural Sedation and Analgesia 2018