This review analyzes the current reports and publications involving the performance and clinical effectiveness of local anesthetics (efficacy) and the rare occurrence of post-operative prolonged numbness or tissue hypersensitivity (paresthesia, dysesthesia). No particular local anesthetic is scientifically singled out as causing this effect. Historically, scientific data on superior performance of one local anesthetic compared to another was lacking. One recently published report, however, showed the statistically significant and superior effectiveness of articaine in obtaining anesthesia of first permanent molars by infiltration when compared to lidocaine. The paresthesia debate regarding the potential of a 4% local anesthetic solution to be allegedly more neurotoxic than other currently administered local anesthetic solutions of lesser concentrations is examined. There is a lack of conclusive and experimentally reproducible evidence, of the cause and effect of specific local anesthetics to chemically result in post-operative sequelae such as paresthesia. An examination of the potential causative factors associated with paresthesia suggests mechanical and/or neurotoxic phenomena. Further evidence and scientific study are required to conclusively determine the significant role, or lack thereof, of each factor.

Oral irritations and ulcerations occur frequently in the general population. Recurrent aphthous ulcers (RAU) are the most common. There are three types of RAU — minor, major and herpetiform, the most common being minor aphthae. The exact etiology of RAU is not known. Systemic and local factors, as well as infectious agents, have been proposed. Certain medications and foods are associated with oral ulcerations, and chemicals such as sodium lauryl sulfate (SLS) contained in dentifrices have also been implicated. RAU also occur in more serious systemic diseases and where appropriate patients should be referred for screening and medical care. Treatment of recurrent aphthous ulcers is palliative, based on the severity of the lesions. Both topical and systemic medications are available. Nutritional and oral hygiene advice should also be given, and if patients are sensitive to SLS, a low-dose SLS or SLS-free dentifrice should be recommended.

Hand hygiene is important for the protection of patients and healthcare workers, and the Centers for Disease Control and Prevention issued recommendations in 2003 that specifically includes guidelines for hand hygiene in dental settings. Several options exist for hand hygiene prior to nonsurgical dental procedures, and the selected method may vary according to the level of contamination, the desired antimicrobial activity and the type of procedure. The most significant difference between hand hygiene for routine procedures and for surgical procedures is the need for persistent antimicrobial activity in products used for surgical hand antisepsis. Appropriate selection of products as well as appropriate hand care helps prevent adverse effects related to hand hygiene in the dental setting. Selecting the products that suit the types of procedures performed in a given practice, and the needs of the healthcare personnel in that practice are important considerations. It is likely that a combination of soap, alcohol-based hand sanitizer and lotions will be required to meet the needs of all individuals.

Many studies show that prilocaine is as effective as any amide local anesthetic in the marketplace for adults and children. The choice of which local anesthetic to use might be decided upon by considering the duration of pulpal anesthesia required. Prilocaine can produce maximum pulpal anesthesia with minimal vasoconstrictor use, or it can provide short duration pulpal anesthesia with no vasoconstrictor use. As well, there are advantages to limiting or even completely eliminating vasoconstrictor from the local anesthetic solution. The patient’s medical history, acidification of tissues and pulpal insult are some of the factors to consider. Prilocaine is an effective drug to add to your local anesthesia armamentarium.

Tobacco use continues to have a personal impact on individuals as well as having a public health impact. Tobacco use results in systemic conditions that include cardiovascular disease, lung disease, and numerous types of cancer, and is the single largest cause of death in the United States. With respect to oral health, it is associated with an increased risk of oral cancer and other mucosal lesions, periodontal disease, impaired healing, and caries. In addition, exposure to environmental smoke (secondhand smoke) is associated with oral and systemic diseases that include caries, cardiovascular and lung disease, and periodontal disease. Educating and advising patients on tobacco cessation, and referring them or implementing a program, helps patients stop using tobacco and improve their health.