Neurosensory complications associated with articaine use in dental procedures: a narrative literature review

Abstract

Local anesthesia is essential for pain control in dentistry; however, neurosensory complications, particularly paresthesia affecting the lingual and inferior alveolar nerves, remain clinically significant adverse events. This narrative review critically evaluated the association between 4% articaine and neurosensory disturbances in dental practice. Methods: A comprehensive search of PubMed, SciELO, LILACS Plus (via BVS), and Google Scholar was conducted in May 2026. Controlled vocabulary and free-text terms were combined for articaine/carticaine, adverse drug effects, paresthesia, facial paralysis, formication, and dysesthesia. Of 320 records identified, 16 studies met predefined PICO-based eligibility criteria after deduplication and screening. Studies involving articaine combined with other anesthetics, animal models, or non-dental settings were excluded. Results: Included studies, published between 1995 and 2026, comprised pharmacovigilance analyses, randomized clinical trials, and case reports. Pharmacovigilance data suggested disproportionate reporting of paresthesia after 4% articaine compared with 2% lidocaine, with estimated incidences of approximately 1:609,000 and 1:1,100,000 injections, respectively, and relative risks up to 3.6 times higher than expected by market share. Conversely, prospective randomized trials did not identify statistically significant differences in neurotoxicity between articaine and lidocaine. The lingual nerve accounted for 70-79% of mandibular nerve injuries, possibly owing to its superficial location and predominantly unifascicular architecture. Most pharmacovigilance studies did not report anesthetic volume, symptom duration, or adequately control for surgical trauma, injection technique, and anatomical variation. Evidence from peripheral regional anesthesia in medicine has not demonstrated a reproducible articaine-specific neurotoxic signal. Conclusions: Current evidence does not support intrinsic, exclusive neurotoxicity of 4% articaine. Neurosensory complications are likely multifactorial, involving anatomical vulnerability, needle trauma, injection technique, anesthetic concentration, and administered volume. Disproportionate reporting may reflect reporting bias, preferential use in complex inflammatory cases, and procedure-related confounding. Prospective studies with standardized reporting of dose, volume, symptom duration, and permanent versus temporary injury are needed.