Narrative review: the evidence for neurotoxicity ofdental local anesthetics

ABSTRACT

Dental local anesthesia is performed daily on a global scale. Adverse effects are rare, but the topic of neurotoxicityof local anesthetics deserves to be explored, as publications can be controversial and confusing. Therefore,a need was felt to address and question the evidence for potential neurotoxicity of dental local anesthetics.This review aimed to assess the studies published on the neurotoxicity of dental local anesthetics. A PubmedⓇsearch was conducted between January 2019 and August 2019. This revealed 2802 hits on the topic of neurotoxicityor cytotoxicity of the following anesthetics lidocaine, prilocaine, mepivacaine, articaine, ropivacaine, andbupivacaine. Only 23 papers were deemed eligible for this review 17 in vitro studies, 3 reviews and 3 auditsof national inquiries. The heterogeneous literature on this topic showed that all dental local anesthetics arepotentially neurotoxic in a concentration and/or exposure time fashion. There seems no consensus about whatcell lines are to be used to investigate the neurotoxicity of local anesthetics, which makes the comparison betweenstudies difficult and ambiguous. However, the bottom line is that all dental local anesthetics have a neurotoxicpotential, but that there is no unanimity in the publications about which local anesthetic is the least or themost neurotoxic.