Local Anesthesia: Evidence & Science, or Hope? Part 1

Local Anesthesia: Evidence & Science, or Hope? Part 1

  • Sat, Nov 13, 2021 | 8:00 AM - Sat, Nov 13, 2021 | 9:30 AM

Art DiMarco, DMD 

Subject: Anesthesia
Primary Audience(s): Dentist
Additional Audience(s): Hygienist

CE Credits: 1.5

A student once asked for advice after experiencing their first local anesthetic failure. Their instructor said, “Dentistry begins once the anesthesia is in effect," and walked away. The desired outcome when educating new clinicians is that they will acquire expertise in local anesthesia delivery. They must have a solid knowledge of relevant pharmacology and must understand the basis of success and failure. Add in a need for a high level of technique mastery and the ability to balance patient factors with anesthetic choices as well as new developments.

And, so do the rest of us. Many clinicians grew up in what some have referred to as the articaine era. That includes everyone who graduated since 2000, the date the FDA approved articaine. In a European country with a population of more than 80 million, articaine had been in use for 24 years by the year 2000 and in Canada for almost 15 years. Recent evidence regarding articaine significantly raises the ante.

While every FDA-approved dental LA drug has its indications, in the specific situations and challenges in which some drugs and drug combinations have demonstrated greater effectiveness, they have done so with wide margins of superiority. Sensible modifications to common strategies are capable of accomplishing excellent outcomes, as well.

Mastery of techniques requires understanding specific parameters of the techniques as well as their importance.

A few examples:

It’s important to be aware of both reasons the Gow-Gates requires that patients open widely. It’s also important to know why Dr. Gow-Gates chose the neck of the condyle as the target site for his block. And, why the penetration site in an AMSA block doesn’t need to be as exacting as some other technique penetration sites. And, that determining the likely source of failure to be anatomic versus physiologic/pharmacologic is possible and matters.

Participants can look forward to learning about new and old techniques and updates in pharmacology, while learning how to apply evidence and science when making local anesthetic choices.

Learning Objectives

  • Describe situations in which specific drugs and/or techniques are more effective and why.
  • Identify strategies that safely and effectively address common and uncommon challenges.
  • Implement strategies that take advantage of recent developments in pharmacology and less well-known and/or less frequently accessed techniques that take advantage of recent developments.
  • How to perform techniques that can routinely save the day.
  • Simple modifications that can positively affect success rates.
  • Where hope really belongs – and it does play a role.


Art DiMarco, DMD is director of the UW School of Dentistry Regional Initiatives in Dental Education program in Spokane, where he is affiliate assistant professor and co-director of the 2nd-year local anesthesia curriculum. He is also director of the Pain Management curriculum for EWU Dental Hygiene. He has presented at regional, national, and international conferences and is co-author of two local anesthesia texts and numerous peer-reviewed articles. He has spent nearly three decades in private practice and a nearly equal amount of time educating students and clinicians.

PACE Approval 2019