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JADA examines effectiveness of local anesthetics

March 04, 2019

By Kimber Solana

March 2019 JADA coverWhat’s more effective, buffered or nonbuffered local anesthetics?

When it comes to using mandibular or maxillary anesthesia in pulpally involved teeth, buffered local anesthetics are more effective, according to the cover story of the March issue of The Journal of the American Dental Association.

The authors of the article, “Do Buffered Local Anesthetics Provide More Successful Anesthesia Than  Do Nonbuffered Solutions in Patients with Pulpally Involved Teeth Requiring Dental Therapy? A Systemic Review,” examined studies found in electronic databases, along with searching for completed studies that are not yet published in various platforms. In addition, the authors hand searched major textbooks and identified trials and review articles to find potentially relevant articles.

According to the authors, investigators have suggested buffering local anesthetics to improve injection comfort and increase the clinical efficacy of local anesthetics. The most common method of buffering local anesthetic is the addition of sodium bicarbonate just before injection. The interaction of sodium bicarbonate with hydrochloric acid in the local anesthetic creates water and carbon dioxide.

Based on the studies reviewed, the authors found that success rates for buffered and nonbuffered local anesthetics ranged from lows of 32 percent and 40 percent, respectively, to highs of 92.5 percent and 80 percent, respective.

“For combined studies, buffered [local anesthetics] were more likely than nonbuffered [local anesthetics] to achieve successful anesthesia,” the authors wrote. “The main conclusion from this meta-analysis is that there is significant advantage to buffering [local anesthetics] because it increases the quality of the anesthetic blockade.”

Other highlights of the March issue include a study on the pharmacokinetics of 38 percent topical silver diamine fluoride in health adult volunteers; an article on the efficacy of a 3 percent potassium nitrate mounthrinse for the relief of dentinal hypersensitivy; and a point/counterpoint examining the need for a new paradigm for specialty and subspecialty development in dentistry.

Each month, JADA articles are published online at in advance of the print publication.