Developing a method for preventing adverse reactions after local anesthesia in outpatient dental care: a digital solution

Background: The risks and incidence of adverse reactions after local anesthesia in dentistry are constantly increasing. Aim: To improve the safety of local anesthesia in outpatient dental care. Methods: The study was conducted between 2022 and 2024. A survey during history taking revealed that all patients had previously received anesthesia. The patients measured their blood pressure (BP) and heart rate using automated tonometers and documented the results. The anesthetic risk was assessed using the American Society of Anesthesiologists scale. Anesthesia was administered with 2% lidocaine solution and 4% articaine and epinephrine solution (1:200,000). The efficacy of local anesthesia was assessed using a visual analogue scale that took into account both patient and physician perspectives. The safety was assessed using a dedicated scale; the assessment involved monitoring and documenting all adverse events (including their severity and association with the study drug). The next day, a mobile survey of patients was performed. Results: A total of 1,600 patients (900 females and 700 males) aged 18 to 70 years were examined. Baseline BP parameters were within the normal range: systolic BP 131.45 [124.0; 136.0] mm Hg, diastolic BP 81.98 [75.0; 84.0] mm Hg, heart rate 74.65 [72.0; 80.0] bpm. The patients received 850 injections of 2% lidocaine solution (state-funded) and 750 injections of 4% articaine and epinephrine solution (1:200,000). 2% lidocaine solution (2 mL) was used in all cases of local anesthesia, with an efficacy of 75.4 to 79.3%; the efficacy of 4% articaine and epinephrine solution at a concentration of 1:200,000 (1.8 mL) ranged from 95.4 to 99.3%. A safety assessment using a dedicated scale demonstrated high safety of local anesthesia. No adverse reactions were reported. Conclusion: The proposed safety protocol, which is based on the risk assessment of adverse reactions (emergencies) following local anesthesia, has shown that local anesthesia is safe, with no adverse reactions.