Local anesthetics in oral and maxillofacial medicine: pharmacology, adverse effects, drug interactions and clinical manifestations

A dentist’s ability to safely and accurately deliver regional anesthesia is crucial for pain-free dental treatment. Despite local anesthetics being the most widely used drugs in the field of dentistry, patients are becoming increasingly more susceptible to adverse physiological reactions as a consequence of many potential drug interactions with local anesthetic components. This review offers an update on the basic pharmacology of local anesthesia, the types of reactions following an injection, the most notable drug interactions with vasoconstrictor-containing preparations, and common ways to manage their associated systemic complications. A thorough search for peer-reviewed journal articles was conducted utilizing databases such as PubMed, MEDLINE, ScienceDirect, and the Cochrane Library. In total, 560 articles were identified, 105 investigated and 52 cited in this review. The content was mainly formulated from scientific reviews and peer-edited manuscripts published within the last 5 years, and included relevant keywords in the search process. The exclusion and inclusion criteria regarding the search strategies were also displayed in a table. Specifically, the manuscript provides a pharmacological overview of the various adverse reactions associated with local anesthesia delivery, such as psychogenic complications, allergies, toxicity, methemoglobinemia, and paraesthesia. In addition, the use of vasoconstrictors in local anesthetic preparations, their interactions with other agents, as well as their relevant precautions and contraindications were discussed. A section examining different local anesthesia injection techniques, including infiltrations and nerve blocks in both the mandible and maxilla, with their respective clinical advantages and risks, was also included. Lastly, this paper highlights the pertinence of comprehending a patient’s medication history and medical background to evaluate the potential risks and benefits of local anesthesia delivery during dental treatment. Fortunately, the distinctive signs or symptoms of adverse reactions make the diagnosis and treatment a relatively quick process, with serious physiological drug responses being rare and unlikely to result in severe harm when promptly addressed.