Letters may comment on articles published in the Journal and should offer constructive criticism. When appropriate, comment on the letter is sought from the author. Letters to the Editor may also address any aspect of the profession, including education, new modes of practice and concepts of disease and its management. Letters should be brief (no more than two A4 pages).
LETTERS TO THE EDITOR
Severe Adverse Reactions to Dental Local Anaesthetics
Article first published online: 30 NOV 2011
© 2011 Australian Dental Association
Australian Dental Journal
Volume 56, Issue 4, page 445, December 2011
How to Cite
Richter, E. (2011), Severe Adverse Reactions to Dental Local Anaesthetics. Australian Dental Journal, 56: 445. doi: 10.1111/j.1834-7819.2011.01377.x
- Issue published online: 30 NOV 2011
- Article first published online: 30 NOV 2011
- (Received 12 June 2011.)
In the article by Sambrook et al.,1 articaine is wrongly blamed to be a risk factor for methaemoglobinaemia in humans. In the article by Wilburn-Goo and Lloyd,2 cited as reference 18 by Sambrook et al., articaine is not even mentioned at all. Higher doses of articaine than commonly administered in dental practice did not increase methaemoglobin in humans undergoing liposuction.3,4 Besides, prilocaine which is without any doubt the local anaesthetic with the highest potency to induce methaemoglobinaemia, the second amide local anaesthetic mentioned by Wilburn-Goo and Lloyd2 is lidocaine. This is in line with conclusions from an extensive review of local anaesthetics that metabolize to 2,6-xylidine (bupivacaine, etidocaine, lidocaine, mepivacaine and ropivacaine) or o-toluidine (prilocaine).5 These two metabolites of amide local anaesthetics have a carcinogenic potential. Whereas 2,6-xylidine is classified by the International Agency for Research on Cancer as possibly carcinogenic (group 2B), o-toluidine is classified as carcinogenic to humans (group 1).6 Recently, oral administration of prilocaine has been shown to result in high adduct levels of o-toluidine, a direct proof of its metabolic activation to a carcinogen.7 This should be another reason to avoid therapeutic use of prilocaine when ever possible.
- 4Articaine pharmacokinetics in tumescent anaesthesia. Phlebologie 2010;39:218–225., , , , .
- 5Local anesthetics that metabolize to 2,6-xylidine or o-toluidine. Final review of toxicological literature. Prepared for the National Institute of Environmental Health Sciences, Contract No. N01-ES-65402, 2000. Available at: http://ntp.niehs.nih.gov/ntp/htdocs/Chem_Background/ExSumPdf/Anesthetics.pdf..
- 6International Agency for Research on Cancer. Agents Classified by the IARC Monographs, Volumes 1–100. Last update 13 April 2011. Available at: http://monographs.iarc.fr/ENG/Classification/index.php.