Articaine in Paediatric Dental Practice: A Critical Appraisal of Clinical Efficacy and Safety

Abstract

Articaine hydrochloride has become one of the most frequently administered injectable local anaesthetics in dentistry for children, yet its reputation rests on a combination of pharmacological reasoning, practitioner experience and a clinical literature whose methodological quality remains uneven. The thiophene ring and the metabolically labile ester side chain of the molecule are held to confer superior diffusion through mineralised tissue and rapid systemic inactivation, and these properties have been used to justify replacing the inferior alveolar nerve block with buccal infiltration in children, omitting palatal injections during maxillary extractions, and extending use to hypomineralised or acutely inflamed teeth. This critical narrative review examines whether the accumulated clinical evidence supports those claims, and whether the safety profile of a four per cent formulation in a paediatric population has been characterised adequately. Literature was identified through structured searching of biomedical bibliographic sources, supplemented by citation tracking and appraisal of professional guidance, and was synthesised thematically rather than pooled quantitatively. The evidence indicates that articaine infiltration achieves outcomes broadly equivalent to lidocaine nerve block for routine treatment of primary mandibular molars, that its advantage narrows as procedural depth increases towards permanent molars and inflamed pulps, and that superiority claims frequently confound the anaesthetic agent with the injection technique to which it is assigned. Findings on maxillary palatal-injection avoidance are directly contradictory across adequately designed trials. Safety data show no excess of clinically important adverse events in children over four years of age, while pharmacovigilance signals concerning neurosensory disturbance derive predominantly from adult mandibular block exposure and cannot be transferred uncritically to paediatric infiltration practice. Evidence for children below four years remains thin and is dominated by single centres. Priorities include adequately powered pragmatic trials with pulpal rather than behavioural endpoints, harmonised outcome definitions, and prospective active surveillance capable of resolving the concentration-related safety question.