Articaine (4%) Buccal Infiltration versus Lidocaine (2%) Inferior Alveolar Nerve Block for Mandibular Teeth Extraction in Patients on Warfarin Treatment

Abstract

Background: Although lidocaine inferior alveolar nerve block is a common dental injection in case of managing mandibular teeth, it may not be the first choice in specific situations. Patients on warfarin therapy are at high risk of bleeding during dental procedures. In this study we aimed to investigate and compare the efficacy of articaine buccal infiltration in mandibular teeth extraction with lidocaine inferior alveolar nerve block for extraction of mandibular teeth in patients on warfarin treatment. Methods: Patients included in the present study were on warfarin treatment and referred for simple dental extraction. Patients were divided randomly in two groups, one group received standard inferior alveolar nerve block (1.8 ml of 2% lidocaine with 1:80,000 adrenaline) and the second group received buccal infiltration supported with lingual infiltration using 4% articaine and 1:100,000 adrenaline. Data was analyzed by descriptive analysis using SPSS program V.17. A Mann-Whitney U test to compare the results and p value of less than 0.05 was considered significant. Results: A total of 23 adult patients (10 women and 13 men) aged 40 to 57 years (mean=48.9) were recruited into the study with 6 excluded as they needed a second local anesthetic cartridge to obtain profound anesthesia. The success rate of inferior alveolar nerve block using lidocaine was 81.8% while the success rate for articaine buccal infiltration in obtaining good profound pulpal anesthesia was 66.6%. Both surgeons and patients were satisfied with anesthesia using both drugs. Conclusion: Buccal infiltration of 4% Articaine for mandibular teeth can have a high success rate using one local anesthetic cartridge, and is considered a good alternative option for nerve block in patients on warfarin treatment to avoid complication related to the nerve block.