Safety Evaluation of Articaine and Lignocaine as Local Anesthetic Agents in Pediatric Dental Patients: A Systematic Review and Meta-analysis

Aims and background: Articaine is known to be safe in children; however, it is not suggested for children under the age of four.Various studies have been performed that show articaine as a superior local anesthetic (LA) agent when compared with lignocaine.This study aimed to systematically review the safety of lignocaine and articaine as LA agents in pediatric dental patients.Method: An electronic search of randomized controlled trials (RCTs) reporting on adverse reactions of lignocaine and articaine in children between 4 and 13 years of age was conducted.The databases searched included PubMed, Cochrane Library, CBM, Embase, Web of Science, and CNKI.A thorough electronic search was conducted for studies published up to May 2024.Seven articles were included in the systematic review.For each of the included studies, the methodological quality and risk of bias (RoB) were assessed.Relative risk (RR) and standard deviations were used to summarize the data from each of the studies, and meta-analyses were conducted with studies of limited heterogeneity.Results: Based on the available evidence, lignocaine and articaine appear to have similar safety profiles when used as LA agents in pediatric dental patients.Meta-analysis showed a nonsignificant statistical difference in favor of soft tissue injury [RR = 0.47, 95% confidence interval (CI) (0.17, 1.28), p = 0.14], postoperative pain (RR = 1.68, 95% CI (0.56, 5.08), p = 0.36), and edema (RR = 1.78, 95% CI (0.17, 18.81), p = 0.63).Overall adverse events were also nonsignificant (RR = 1.26, 95% CI (0.62, 2.54), p = 0.52).Conclusion: Buccal infiltration with 4% articaine was equally safe as inferior alveolar nerve block (IANB) with 2% lignocaine for primary tooth extraction and endodontic procedures.More clinical trials should be conducted that measure the effects of lignocaine and articaine on blood pressure, pulse rate, and tissue rehabilitation.