Skip to main content
NCBI home page
International Journal of Clinical Pediatric Dentistry logoLink to International Journal of Clinical Pediatric Dentistry
. 2026 Apr 17;19(5):648–654. doi: 10.5005/jp-journals-10005-3513

Safety Evaluation of Articaine and Lignocaine as Local Anesthetic Agents in Pediatric Dental Patients: A Systematic Review and Meta-analysis

Purva B Babhulgaonkar 1,✉, Prasanna T Dahake 2, Mahesh V Dadpe 3, Yogesh J Kale 4, Shrikant B Kendre 5, Nilima R Thosar 6
PMCID: PMC13262021  PMID: 42291007

Abstract

Aims and background

Articaine is known to be safe in children; however, it is not suggested for children under the age of four. Various studies have been performed that show articaine as a superior local anesthetic (LA) agent when compared with lignocaine. This study aimed to systematically review the safety of lignocaine and articaine as LA agents in pediatric dental patients.

Method

An electronic search of randomized controlled trials (RCTs) reporting on adverse reactions of lignocaine and articaine in children between 4 and 13 years of age was conducted. The databases searched included PubMed, Cochrane Library, CBM, Embase, Web of Science, and CNKI. A thorough electronic search was conducted for studies published up to May 2024. Seven articles were included in the systematic review. For each of the included studies, the methodological quality and risk of bias (RoB) were assessed. Relative risk (RR) and standard deviations were used to summarize the data from each of the studies, and meta-analyses were conducted with studies of limited heterogeneity.

Results

Based on the available evidence, lignocaine and articaine appear to have similar safety profiles when used as LA agents in pediatric dental patients. Meta-analysis showed a nonsignificant statistical difference in favor of soft tissue injury [RR = 0.47, 95% confidence interval (CI) (0.17, 1.28), p = 0.14], postoperative pain (RR = 1.68, 95% CI (0.56, 5.08), p = 0.36), and edema (RR = 1.78, 95% CI (0.17, 18.81), p = 0.63). Overall adverse events were also nonsignificant (RR = 1.26, 95% CI (0.62, 2.54), p = 0.52).

Conclusion

Buccal infiltration with 4% articaine was equally safe as inferior alveolar nerve block (IANB) with 2% lignocaine for primary tooth extraction and endodontic procedures. More clinical trials should be conducted that measure the effects of lignocaine and articaine on blood pressure, pulse rate, and tissue rehabilitation.

How to cite this article

Babhulgaonkar PB, Dahake PT, Dadpe MV, et al. Safety Evaluation of Articaine and Lignocaine as Local Anesthetic Agents in Pediatric Dental Patients: A Systematic Review and Meta-analysis. Int J Clin Pediatr Dent 2026;19(5):648–654.

Keywords: Articaine, Children, Lignocaine, Local anesthetic, Pediatric patients

Introduction

One of the key elements of managing a child's behavior in a dental office is ensuring that the child is not in pain throughout the dental procedures. A sufficient amount of local anesthetic (LA) alleviates pain during dental procedures, creating a favorable and efficient treatment.1 Lignocaine is an amide type of LA that undergoes biotransformation in the liver. It is a well-established LA. Compared with more recently produced LAs, it is considered the “gold standard” owing to its efficient operation with few side effects.2

In 2000, 4% articaine with 1:1,00,000 epinephrine, which comes under an amide type of LA, was first made available in the United States. Its functions are comparable to other amide analgesics, but, due to the thiophene ring in its unique chemical structure, it is more effective and lipid-soluble, allowing it to pass into both soft and hard tissues.3 An increased medication concentration is therefore administered using a lesser volume of solution, which will also minimize the discomfort associated with LA administration.4

Local anesthetics are partitioned into two forms to block the sodium channels—the charged acid form (RNH+), which attaches itself to the interior pore of sodium channels, and the uncharged basic form (RH), which crosses the cell membrane. The voltage-gated sodium channels (VGSCs) can be classified into two classes—those that are resistant to toxins [tetrodotoxin-resistant (TTX-R)] and those that are inhibited by toxins TTX. The potential of LAs to prevent the expression of further VGSCs in the heart or central nervous system (CNS) is thought to be responsible for many side effects.5 The six main categories of potential adverse events associated with LAs are systemic symptoms; peripheral nerve paresthesia; cardiovascular responses; methemoglobinemia; allergic reactions to the anesthetic and/or latex; and anesthetic-related reactions involving a sulfite antioxidant.5 The most essential considerations of any LA agent are safety and efficacy.6

Studies have acknowledged and supported the use of articaine hydrochloride because of its positive results in randomized controlled trials (RCTs).6–8 A few studies have investigated the safety of articaine and lignocaine after usage in children, even though the efficacy of these drugs in adult populations is the primary focus of the available literature. The aim of this systematic review was to evaluate the safety of both anesthetics in pediatric patients. We therefore updated our research for relevant publications and carried out a systematic review.

Method

After the systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database, the Preferred Reporting Items for Systematic Reviews (PRISMA) statement requirements were followed while the review was reported (PROSPERO-CRD42023479803). The research question of this systematic review was “Which local anesthetic agent between lignocaine and articaine is safe in pediatric patients?”

Study Selection

The aim of this review was to assess outcomes in terms of adverse reactions to lignocaine and articaine to determine the safety of these agents. The focused study question, “Which local anesthetic agent between lignocaine and articaine is safe in pediatric patients?” was put forth in the Participants (P), Intervention (I), Comparison (C), Outcome (O) format9:

P (Participants): Patient population aged 4–13 years.

I (Intervention): Articaine (4%) dental local anesthesia.

C (Comparison): Lignocaine (2%) dental local anesthesia.

O (Outcome): Safety of articaine and lignocaine.

S (Study design): In vivo studies, RCTs, comparative studies.

Selection of Research to be Included

Inclusion Criteria for the Search

  • All of the present studies involving articaine as an intervention from its release date to May 2024.

  • Studies including populations aged between 4 and 13 years.

  • Experimental group: Administration of articaine.

  • Control group: Administration of lignocaine.

  • Randomized controlled trials used in studies.

  • Studies that compared experimental and control groups involving routine dental procedures.

  • Studies published in the English language.

Exclusion Criteria for the Search

  • Trials on animals/in vitro studies.

  • Complex dental procedures, such as soft tissue surgery and bone removal.

  • Studies in which medically compromised individuals have participated.

  • Case reports, series, and letters addressed to the editors.

Search Strategy

A thorough electronic search was conducted for studies published up to May 2024 using the following databases—PubMed, Cochrane Library, CNKI, CBM, Embase, and Web of Science, as these databases are freely accessible.

Boolean operators such as AND were combined with appropriate key phrases and medical subject heading (MeSH) concepts. Using the following keywords and their combinations, the pertinent data were found: (local anesthetic[Title/Abstract]) OR (dental anesthetic[Title/Abstract]) OR (safety[Title/Abstract]) OR (adverse effects[Title/Abstract]) AND (lignocaine[Title/Abstract]) OR (articaine[Title/Abstract]) OR (septocaine[Title/Abstract]) OR (articaine[Title/Abstract]) AND (pediatric patients[Title/Abstract]) OR (children[Title/Abstract]).

Screening

First, research from all the databases was imported into Zotero (http://www.zotero.org) following a thorough MeSH keyword search, and duplicates were eliminated. An automation tool was used to screen the studies. Records marked as ineligible by the automation tool were excluded. Subsequently, abstracts and titles were screened. After that, possible articles were added for a thorough evaluation. Two reviewers separately extracted pertinent data from the included studies using custom extraction forms independently.

Collection of Data

Two reviewers (PD and PB) independently analyzed data extracted as per author, year of publication, patients included in the study, age range, follow-up time, intervention, LA used, adverse events occurred, and tabulated individually for every article.2

Quality Assessment

In accordance with the Cochrane Handbook of Systematic Reviews of Interventions 5.0.2, risk of bias (RoB) 2 is the recommended tool for RoB assessment of randomized trials. The tool includes: (1) generation of a random sequence; (2) concealment of the allocation; (3) participant and personnel blinding; (4) blinding of the outcome evaluation; (5) selective reporting; and (6) overall bias risk. In every investigation, two reviewers assessed the RoB. When all fields were found to be at low risk (LR), a low RoB was considered when the total RoB of the individual research was evaluated. When one or more fields were found to be unknown, an unclear RoB was considered. When one or more fields were determined to be at high risk (HR), there was a high RoB. When needed, a third reviewer was consulted. In the case of a disagreement, everyone agreed to settle the overall RoB after discussing it with their fellow researchers.

Data Analysis

Meta-analyses were done on trials with similar treatments and comparable results, indicating limited heterogeneity. Data from each trial was summarized using relative risk (RR) and standard deviations. The 95% confidence intervals (CI) and mean differences were calculated. The data were examined using Review Manager (RevMan) Version 5.4.

Heterogeneity

We investigated clinical and methodological heterogeneity by analyzing study characteristics, participants, treatments, and outcomes based on the inclusion criteria. Meta-analyses were evaluated for statistical heterogeneity using the I2 test. Significant heterogeneity is indicated by results of >50% for the I2 statistic.

Subgroup Analysis

If sufficient data is available, subgroup analysis will explore the influence of study characteristics such as soft tissue injury, postoperative pain, and edema.

Sensitivity Analysis

We analyzed papers stratified by design or RoB (low vs HR) to identify outcome similarities or differences.

Results

Search Results

In six digital resources (CBM: 32, CNKI: 118, PubMed: 36, Embase: 11, Cochrane: 76, Web of Science: 62), encompassing the gray literature, 335 results were found during the first round of research selection. About 303 studies remained for the examination of titles and abstracts after repetitive or duplicate findings were removed. Only 134 papers were qualified for the full-text analysis following the comprehensive examination, and 127 articles were found to be eliminated. Figure 1 illustrates the process of searching, identifying, including, and excluding articles with reasons for exclusion. The systematic review included a total of seven publications.

Fig. 1:

Fig. 1:

Open in a new tab

PRISMA flowchart

Characteristics of Eligible Studies

The main characteristics of seven selected in vivo studies are presented in Table 1. RCTs with children aged 4–13 are included in the research. A total of 384 subjects were administered articaine and 356 subjects were administered lignocaine for routine dental procedures. The subjects were then compared for adverse reactions.

Table 1:

Characteristics extracted from selected studies

Author, year Number of patients Age-group Follow-up time Intervention Adverse effects
Lignocaine Articaine
Malamed et al., 200010 70 4–13 years 24 hours, 7 days Articaine (4%) with vasoconstrictor 1:1,00,000
Lignocaine (2%) with vasoconstrictor 1:1,00,000		 Accidental injury = 0, headache = 0, injection site pain = 0, pain = 2 Accidental injury = 1, headache = 1, injection site pain = 1, pain = 1
Ram and Amir, 200611 62 5–13 years 1, 2, or more hours Articaine (4%) with 1:2,00,000 vasoconstrictor
Lignocaine (2%) with 1:1,00,000 vasoconstrictor		 Soft tissue injuries = 2, postprocedural pain = 1, edema = 1 Soft tissue injuries = 1, postprocedural pain = 3, edema = 0
Arrow, 201212 57 Average age: 12.4 years 2 hours, 4 hours, 24 hours, 1 week Articaine (4%) with 1:1,00,000 adrenaline
Lignocaine (2%) with 1:80,000 vasoconstrictor		 Lip-bite = 1, cheek-bite = 1, aching jaw = 2 Pain at injection site = 1, tender tooth = 1, aching jaw = 2
Alzahrani et al., 20188 98 5–9 years 24 hours Articaine (4%) with 1:1,00,000 vasoconstrictor
Lignocaine (2%) and 1:80,000 vasoconstrictor		 Need to reanesthetize = 1, pain = none, soft tissue injuries = 1, medication = 2, other = 0 Need to reanesthetize = 3, pain = 4, soft tissue injuries = 1, medication = 9, others = 1
Massignan et al., 202013 43 6–10 years 2, 6, 24 hours Articaine (4%) 1:1,00,000 vasoconstrictor
Lignocaine (2%) 1:1,00,000 vasoconstrictor		 Nausea = 0, edema = 2 Nausea = 1, edema = 8
Khanna et al., 20217 100 6–8 years 24 hours Articaine (4%) with 1:1,00,000 vasoconstrictor
Lignocaine (2%) with 1:80,000 vasoconstrictor		 Need to reanesthetize = 6, pain = 2, soft tissue injuries = 3 Need to reanesthetize = 3, pain = 2, soft tissue injuries = 0
Jain et al. 202114 92 5–10 years 24 hours Articaine (4%) with 1:1,00,000 vasoconstrictor
Lignocaine (2%) with 1:80,000 vasoconstrictor		 Lip injury = 4 Lip injury = 2
Open in a new tab

BI, buccal infiltration; IANB, inferior alveolar nerve block; LA, local anesthetic; NR, not reported; RCT, randomized controlled trial

Quality Assessment

Anxiety, dizziness, irregular heartbeat, edema, headaches, tooth tenderness, hurting jaw, postoperative analgesic/medication use, postoperative soft tissue injury (accidental lip/cheek injury), and headaches were among the reported postoperative problems. Although the “need for anesthesia” was emphasized in Khanna et al.7 and Alzahrani et al.,8 it was not considered to have any negative consequences. Instead, it was viewed as an error in clinical practice. “Pain” was regarded by Alzahrani et al.8 as a recurrent response to the anesthetic agent. Parents either answered or directly solicited information from the patients for all studies that reported side effects, which were primarily obtained through postoperative phone calls. There was no appreciable variation in the risk of adverse reactions between lignocaine and articaine in any of the included studies that summarized the previously described adverse events.

Analysis of Outcome Measures

When overall adverse events were compared between the articaine and lignocaine groups, including 384 participants in the articaine group and 356 participants in the lignocaine group from seven included studies, the results showed no significant heterogeneity (p = 0.13, I2 = 40%). The RR was 1.26 (95% CI: 0.62, 2.54). There were no statistically significant variations between the treatment and control groups (p = 0.52) (Fig. 2).

Fig. 2:

Fig. 2:

Open in a new tab

Forest plot of adverse effect compared with articaine and lignocaine of the seven investigated RCT

Risk of Bias

There was no publishing bias for adverse events when the funnel plot (Figs 3 and 4) was visually examined.

Fig. 3:

Fig. 3:

Open in a new tab

Funnel plot of the seven investigated RCT; RR: risk ratio; SE: standard error

Fig. 4:

Fig. 4:

Open in a new tab

Graphical representation of RoB assessment

Risk was assessed and compiled for the selected articles based on three categories—HR, medium risk (MR), and LR. Four of the seven publications reported high-risk outcomes, mainly due to selection bias (randomization and allocation concealment bias) and nonblinding of the subjects.4,15–17 One of the studies indicated a MR since the concealment bias was not quite obvious.10 Two articles had a low RoB.18,19 Only two of the seven studies used participant and professional blinding.20,21 Four studies reported using random sequence generation and allocation concealment.8,15,19,20 On the contrary, every study that was presented used blinding of the outcome evaluation and selective reporting (Table 2 and Fig. 3).

Table 2:

RoB assessment summary

Article author and year Random sequence generation (selection bias) Allocation concealment (selection bias) Blinding of participants and personnel (performance bias) Blinding of outcome assessment (detection bias) Selective reporting (reporting bias) RoB
Malamed et al., 2000 ? ? ? Y Y HR
Ram and Amir, 2006 ? N ? Y Y HR
Arrow, 2012 Y Y Y Y Y LR
Alzahrani et al., 2018 Y Y ? Y Y MR
Massignan et al., 2020 Y Y Y Y Y LR
Khanna et al., 2021 ? N N Y Y HR
Jain et al., 2021 Y Y N Y Y HR
Open in a new tab

?, unclear; HR, high risk; LR, low risk; MR, medium risk; N, no; RoB, risk of bias; Y, yes

Subgroup Analysis

When soft tissue injury was evaluated between the articaine and lignocaine groups, it was observed that of the 363 participants studied under the articaine group and 334 participants studied under the lignocaine group from the six included studies, the results showed no significant heterogeneity (p = 0.90, I2 = 0%). The RR was 0.47 (95% CI: 0.17, 1.28), with no statistically significant differences between the treatment and control groups (p = 0.14). The incidence of soft tissue injury was higher in the lignocaine group than the articaine group, thus suggesting that articaine is a suitable LA agent to avoid soft tissue injury (Fig. 5).

Fig. 5:

Fig. 5:

Open in a new tab

Forest plot of soft tissue injury between articaine and lignocaine

When postoperative pain was compared between the articaine and lignocaine groups, 317 participants in the articaine group and 288 participants in the lignocaine group from the five included studies presented no significant heterogeneity in the results (p = 0.24, I2 = 28%). The treatment and control groups did not vary statistically significantly (p = 0.36), and the RR was 1.68 (95% CI: 0.56, 5.08). The incidence of postoperative pain was higher in the articaine group than the lignocaine group, thus suggesting lignocaine is a suitable LA agent to avoid postoperative pain (Fig. 6).

Fig. 6:

Fig. 6:

Open in a new tab

Forest plot of postoperative pain between articaine and lignocaine

When postoperative edema was evaluated between the articaine and lignocaine groups, 83 participants in the articaine group and 84 participants in the lignocaine group were included, and the results revealed no significant heterogeneity (p = 0.15, I2 = 51%). The RR was 1.78 (95% CI: 0.17, 18.81), with no statistically significant differences between the treatment and control groups (p = 0.63). The incidence of edema was higher in the articaine group than in the lignocaine group, thus suggesting lignocaine as a suitable LA agent for edema (Fig. 7).

Fig. 7:

Fig. 7:

Open in a new tab

Forest plot of edema between articaine and lignocaine

Discussion

This review was conducted to answer the following question: “Which local anesthetic agent between lignocaine and articaine is safe in pediatric patients?” Previous systematic reviews have evaluated adult patients' adverse reactions to lignocaine and articaine.20 In a systematic review by Li and Sun,2 the adverse effects of articaine and lignocaine were evaluated, and children younger than 4 years were included.

Age-group

For children, the dose should be calculated via the mg/kg ratio, similar to other drugs. Age affects the metabolism of articaine. As age increases, clearance and the volume of distribution fall.2 These studies indicate that the age-related changes in the pharmacokinetics of articaine do not warrant the establishment of a reduced mg/kg dose limit for children.4 Articaine is not recommended for use in children younger than 4 years, as it is not recommended by the manufacturer.21 Therefore, this study does not include the RCTs with an age-group younger than 4 years.

Anesthetic Concentration

Articaine concentrations of 2 and 4% are frequently used for anesthetics. Few studies compare 2 and 4% of articaine, and one study found that the duration of anesthesia was affected by concentration, with no discernible differences in other aspects.15

Type/Site of Local Anesthetic Administration

Different anesthetic techniques affect anesthesia's efficacy. Anesthesia is not easy to spread via infiltration. The inferior alveolar nerve block (IANB) is frequently employed while operating on mandibular molars because of the dense bone cortex of the jaw. However, a number of major side effects, including temporary facial paralysis, hematoma, nerve injury, and extended anesthesia, are linked to the IANB approach and can damage the lips and tongue. Local infiltration anesthesia can yield successful anesthesia in the maxilla and anterior portion of the mandible because of the existence of trabecular bone. However, the bone cortex at the body of the mandible is thick; consequently, local infiltration anesthesia only has a 54–94% success rate.16,18 The findings of this investigation indicated that articaine and lignocaine had comparable safety profiles. However, articaine was mostly implemented for infiltration anesthesia and lignocaine for IANB in the RCT that we selected. Despite claims that articaine is safe and effective for many dental treatments, many dentists are hesitant to use it, notably for IANB.17 Few studies have looked into articaine as an IANB in children. The increased use of articaine in infiltration anesthesia compared with lignocaine for IANB might be attributed to its superior infiltration performance. Martin et al. found that articaine had a 2.78-fold greater success rate in infiltration anesthesia than did lignocaine.6 Articaine can be used for local infiltration to provide effective anesthetic effects. However, it is unclear if articaine's high permeability for IANB will provide any safety risks in children. More studies are needed to determine whether it can be used in children for IANB.

Follow-up Time

In all of the included researches, adverse effects were mostly reported through postoperative phone calls, in which parents offered replies or solicited them directly from the patients. There was no direct observation by the clinician of postoperative adverse reactions.

Adverse Effects

This evaluation was based on seven RCTs that documented the incidence rate of adverse reactions to articaine and lignocaine in pediatric dentistry and found that articaine had comparable safety performance in children. The rates of postoperative pain, soft tissue damage, and edema did not substantially differ across the treatment groups, indicating that articaine is as safe as lignocaine for dental procedures in children. However, a narrative review detailing additional adverse events related to LA, such as hematomas, allergies, jaw ankylosis, tissue necrosis, needle breakage, osteomyelitis, blanching, isolated atrial fibrillation, and neurological and ocular adverse reactions, highlights the need for additional clinical trials to enhance the findings of this review.19

This study has several limitations. An insufficient sample size leads to insufficient statistical efficiency. The safety of LA is essentially determined by multifactorial and multilevel analysis. The different techniques used for lignocaine and articaine administration may have led to bias in the results. Notably, patients or parents reported unfavorable reactions through phone calls that were not clinically validated, which might have led to a certain degree of bias. More clinical trials should be conducted that measure the effects of lignocaine and articaine on blood pressure, pulse rate, and tissue rehabilitation.

More affordable than lignocaine, articaine is extensively accessible on a global scale. Therefore, its use in standard dental procedures is a sensible option. However, no pertinent study has demonstrated the advantage of articaine over lignocaine in challenging dental operations performed on children.

Conclusion

In summary, it was found that for primary tooth extraction and endodontic treatments, the safety of buccal infiltration with 4% articaine was equivalent to that of IANB with 2% lignocaine. In all the groups, no significant adverse events were recorded during the 2- to 24-hour follow-up phone calls.

Registration Number

PROSPERO-CRD42023479803.

Orcid

Purva B Babhulgaonkar https://orcid.org/0009-0002-5528-4509

Prasanna T Dahake https://orcid.org/0000-0003-0295-5751

Mahesh V Dadpe https://orcid.org/0000-0003-4315-4432

Yogesh J Kale https://orcid.org/0000-0003-0612-0014

Shrikant B Kendre https://orcid.org/0000-0003-3070-0238

Footnotes

Source of support: Nil

Conflict of interest: None

References

  • 1.Dean JA. McDonald and Avery's Dentistry for the Child and Adolescent. 11th edition. Elsevier Health Sciences; 2022. p. 327. [Google Scholar]
  • 2.Li L, Sun D. Adverse effects of articaine versus lidocaine in pediatric dentistry: a meta-analysis. J Clin Pediatr Dent. 2023;47:21–29. doi: 10.22514/jocpd.2023.078. [DOI] [PubMed] [Google Scholar]
  • 3.Malamed SF, Gagnon S, Leblanc D. Articaine hydrochloride: a study of the safety of a new amide local anesthetic. J Am Dent Assoc. 2001;132(2):177–185. doi: 10.14219/jada.archive.2001.0152. [DOI] [PubMed] [Google Scholar]
  • 4.Leith R, Lynch K, O'Connell AC. Articaine use in children: a review. Eur Arch Paediatr Dent. 2012;13:293–296. doi: 10.1007/BF03320829. [DOI] [PubMed] [Google Scholar]
  • 5.Berman LH, Hargreaves KM. Cohen's Pathways of the Pulp. 12th edition. Canada: Elsevier Health Sciences; 2021. p. 641. [Google Scholar]
  • 6.Martin E, Nimmo A, Lee A, et al. Articaine in dentistry: an overview of the evidence and meta-analysis of the latest randomised controlled trials on articaine safety and efficacy compared to lidocaine for routine dental treatment. BDJ Open. 2021;7(1):27. doi: 10.1038/s41405-021-00082-5. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 7.Khanna SR, Rao D, Panwar S, et al. An in vivo, randomized, controlled comparative evaluation of efficacy, hemodynamic changes, and postoperative complications of 4% articaine using buccal infiltration and 2% lidocaine using inferior alveolar nerve block in mandibular primary molars of children aged 6 to 8 years. Quintessence Int. 2021;52(9):780–786. doi: 10.3290/j.qi.b1492247. [DOI] [PubMed] [Google Scholar]
  • 8.Alzahrani F, Duggal MS, Munyombwe T, et al. Anaesthetic efficacy of 4% articaine and 2% lidocaine for extraction and pulpotomy of mandibular primary molars: an equivalence parallel prospective randomized controlled trial. Int J Paediatr Dent. 2018;28(3):335–344. doi: 10.1111/ipd.12361. [DOI] [PubMed] [Google Scholar]
  • 9.Linares-Espinós E, Hernández V, Domínguez-Escrig JL, et al. Methodology of a systematic review. Actas Urol Esp. 2018;42(8):499–506. doi: 10.1016/j.acuro.2018.01.010. [DOI] [PubMed] [Google Scholar]
  • 10.Malamed SF, Gagnon S, Leblanc D. A comparison between articaine HCl and lidocaine HCl in pediatric dental patients. Pediatr Dent. 2000;22(4):307–311. [PubMed] [Google Scholar]
  • 11.Ram D, Amir E. Comparison of articaine 4% and lidocaine 2% in paediatric dental patients. Int J Paediatr Dent. 2006;16(4):252–256. doi: 10.1111/j.1365-263X.2006.00745.x. [DOI] [PubMed] [Google Scholar]
  • 12.Arrow P. A comparison of articaine 4% and lignocaine 2% in block and infiltration analgesia in children. Aust Dent J. 2012;57(3):325–333. doi: 10.1111/j.1834-7819.2012.01699.x. [DOI] [PubMed] [Google Scholar]
  • 13.Massignan C, Santos PS, Cardoso M, et al. Efficacy and adverse events of 4% articaine compared with 2% lidocaine on primary molar extraction: a randomised controlled trial. J Oral Rehabil. 2020;47(8):1031–1040. doi: 10.1111/joor.12989. [DOI] [PubMed] [Google Scholar]
  • 14.Jain K, Katge F, Chimata VK, et al. Comparative evaluation of anesthetic efficacy of 4% articaine infiltration versus 2% lignocaine inferior alveolar nerve block for extraction of primary mandibular molars: a prospective, split-mouth, randomized controlled trial. J Indian Soc Pedod Prev Dent. 2021;39(4):409–415. doi: 10.4103/jisppd.jisppd_260_21. [DOI] [PubMed] [Google Scholar]
  • 15.Kämmerer PW, Schneider D, Palarie V, et al. Comparison of anesthetic efficacy of 2 and 4% articaine in inferior alveolar nerve block for tooth extraction—a double-blinded randomized clinical trial. Clin Oral Investig. 2017;21(1):397–403. doi: 10.1007/s00784-016-1804-5. [DOI] [PubMed] [Google Scholar]
  • 16.Flanagan DF. The effectiveness of articaine in mandibular facial infiltrations. Local Reg Anesth. 2015;9:1–6. doi: 10.2147/LRA.S94647. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 17.Shree R, Kedia MR, Toshi T, et al. A cross-sectional study on the evidence-based dentistry, perception basis, and use of articaine among dental practitioners. Cureus. 2022;14(12):e32510. doi: 10.7759/cureus.32510. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 18.Ho JPTF, van Riet TCT, Afrian Y, et al. Adverse effects following dental local anesthesia: a literature review. J Dent Anesth Pain Med. 2021;21(6):507–525. doi: 10.17245/jdapm.2021.21.6.507. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 19.Katyal V. The efficacy and safety of articaine versus lignocaine in dental treatments: a meta-analysis. J Dent. 2010;38(4):307–317. doi: 10.1016/j.jdent.2009.12.003. [DOI] [PubMed] [Google Scholar]
  • 20.Ultracaine Product Monograph. Hoechst Canada Inc; 1984. [Google Scholar]
  • 21.Thiem DGE, Schnaith F, Van Aken CME, et al. Extraction of mandibular premolars and molars: comparison between local infiltration via pressure syringe and inferior alveolar nerve block anesthesia. Clin Oral Investig. 2018;22(3):1523–1530. doi: 10.1007/s00784-017-2251-7. [DOI] [PubMed] [Google Scholar]

Articles from International Journal of Clinical Pediatric Dentistry are provided here courtesy of Jaypee Brothers Medical Publishing (P) Ltd.

RESOURCES