Articaine hydrochloride: is it the solution?

In a recently published, well-written review paper by Kakroudi et al the clinical safety of articaine (hydrochloride) pertaining to the claims that it is particularly neurotoxic (ie causing paraesthesia or, more correctly, hypoaesthesia) has been briefly discussed.¹ The authors correctly state that this focus on paraesthesia largely stems from postmarketing observational research done in Denmark, but supported by similar observations elsewhere after the introduction of articaine for dental use.^2,3 Most cases examined articaine used for inferior alveolar nerve blocks (IANB).

Two important questions arise from the paper by Kakroudi et al. The first question is why does articaine cause paraesthesia, in spite of the fact that its cytotoxic potential compared to the other commonly used local anaesthetic agents in dentistry, is among the lowest?^4,5 The second question is, why do we see a sudden increase in paraesthesias following the introduction of articaine local anaesthesia to dentists in countries which previously did not have access to it, while in Germany, where articaine was introduced to dentistry in 1976, they apparently do not have a high/abnormal rate of articaine-induced paraesthesia?