Thanks for your curteous reply. I will now respond to you if I may.
1. Articaine may be an excellent local anesthetic, but so is lidocaine and is by far the safer choice. ALL studies indicate the incidence of paresthesia from lido is significantly less. I pity the patient who experiences a long term or permanent paresthesia from your mandibular blocks, should that occur (and it will). What will you tell the patient... I'm sorry? Sorry doesn't cut it here... this is life altering and life threatening... and there is no drug, no therapy, and no surgery that can fix the problem. NONE.
2. Please review this article published in Dentistry Today on Malamed's "study", the one he used to get articaine approved by the FDA.
http://www.nodentalpain.com/ArticaineParesthesia.html
Are you saying this is untrue? This is fact. Perhaps you were not aware of the statistical analysis, or the flawed analysis by Malamed? Giving lower mandibular blocks to people using articaine is indeed playing russian roulette with their lives. A 1 in 21% chance of paresthesia is absolutely unacceptable. Who are you kidding?
3. No argument from me there... but even lido is far safer even though it is neuro and hepato toxic.
4. In fact I don't mind having dental work without an anesthetic and am quite capable of withstanding the discomfort. Even before my injury I almost never used it. My latest root canal post injury was done without any until the roots had to be scraped. At that juncture I had my dentist use carbocaine directly into the roots. It worked, and I had no danger of neural injury. Perhaps this technique should be applied more often.
5. I am not overstating anything. The literature is clear, nerve injury is always greater when articaine is used, and is always decreased when lidocaine is used for the same procedure. The incidence of paresthesia jumps up wildly when articaine is used for lower mandibular blocks.
In my opinion articaine should never be used when safer alternatives exist that work just as well (and the literature again proves this, even Malamed says it's so). In EVERY study the incidence of injury jumps when articaine is used, regardless of what type of block is employed. When used for mandibular blocks, lingual injury jumps up wildly. This is inexcusable, and God forbid if one of your patients should suffer this injury you will see first hand the horror of this persons plight. Sorry, if a safer alternative is available, it should be used. If you care to read the package insert for Septocaine you will see the WARNING the company itself gives for mandibular blocks.
Finally you may wish to peruse the following site to read about some the horrific injuries people experience from anesthetic injections. This is a far under reported event, and one that should not go unnoticed. Some folks choose to take their own lives due to the tortuous symptoms they must endure for life. If there is anything you as a dentist can do to minimize the risk you MUST, anything less is neglegent IMO.
http://www.sciential.net/cgi-bin/dcforum/dcboard.cgi
quote=aphistis;7568771]1) Articaine is an excellent local anesthetic and I am glad to have it in my armamentarium. I use it most frequently for local infiltration of mandibular teeth that are refractory to nerve block, but have used it on numerous occasions to place mandibular or inferior alveolar nerve blocks when I did not have lidocaine immediately available. I do not apologize for this.
2) While I sympathize with your condition (and I mean that sincerely), your claim that either 4% or 22% (I can't tell which you mean) of patients receiving articaine experience permanent nerve damage is patently ridiculous, and merits neither consideration nor rebuttal.
3) Procaine is an ester local anesthetic whose metabolites include para-aminobenzoic acid, a highly allergenic compound responsible for allergic reactions in a significant number of patients. Furthermore, its slow, unpredictable onset and short, unpredictable duration make it an extremely suboptimal agent.
4) Your reluctance to undergo local anesthesia after your injury is understandable, but nobody is forcing you to do anything.
5) Nobody is playing Russian roulette with anything, and your insistence on overstating the risks of local anesthesia isn't helping your argument.
As a licensed dentist, I can assure you I know a goodly amount about what I speak. I value patient autonomy very highly and would never impose my wishes on an unwilling patient; nonetheless, if someone refuses to let me anesthetize them for a procedure known to be significantly painful, they will be given a listing of other dentists and be politely shown the door.
Again, I genuinely empathize with your plight and I wouldn't wish your situation on anyone, but local anesthesia is one of the landmark achievements of modern medicine, and articaine is a contributing ingredient to its success. Sequelae such as yours are truly unfortunate; however, they can occur with any drug, they are quite uncommon, and--most importantly--the cumulative benefit a drug like articaine offers our patients
far exceeds the remote risks it poses.[/quote]