Nov 2, 2010
You probably didn’t know that at one time cocaine was the most commonly used local anesthetic in dentistry. It’s unbelievable, but it’s true. Although cocaine’s effect was short-lived, it was wonderfully successful at blocking pain and was widely used until the turn of the century when its addictive nature was discovered. Ethically, cocaine could no longer be used as an anesthetic. And so out of cocaine’s demise in dentistry, procaine was born.
Procaine appeared in 1905 and was marketed under the name Novocaine. The word “novocaine” is from the Latin “nov,” which means “new” and “caine,” which is a frequently used ending for alkaloids (chemical compounds which mainly contain basic nitrogen atoms) used as anesthetics. It is the oldest man-made local anesthetic and remained the most important local anesthetic until the 1940’s. Novocaine is chemically related to cocaine, has similar characteristics as cocaine, but does not have the toxicity of cocaine and lacks the addictive nature cocaine possesses. But it has been known to cause allergic reactions in some people. This is because Novocaine breaks down in the bloodstream and causes certain by-products to form. The allergic reactions were a factor in Novocaine’s demise. Therefore a search for new substances with a decreased chance of allergic reactions resulted.
Lidocaine was first created in 1943 and marketed under the name Xylocaine in 1947. It became the most widely used anesthetic in dentistry. Lidocaine is generally well tolerated because it is broken down in the liver and doesn’t produce allergic reactions. It is mildly toxic, has a long lasting effect, and is non-addictive. A disadvantage of lidocaine is that it is slow in taking effect.
At the end of the 1950’s prilocaine was introduced and is marketed und the name Citanest. It is a weaker and less toxic local anesthetic than lidocaine. One of prilocaine’s disadvantages is that it is effective only some of the time. This is believed to be because of the inflammatory reactions in the body.
Twenty-six years after prilocaine’s introduction articaine was produced and marketed under the name Ultracain, and then shortly thereafter under the name Septanest. Since that time, Scandotest has also been developed and approved as a local anesthetic. The active ingredient in Scandotest is scandicaine, which is a substance originally used in epidural anesthesia, and then developed into a local anesthetic. So far, there are no known side effects to Scandotest.
Local anesthesia has come a very long way. It’s very interesting to see how it all originated, and that it is ever-changing. When having a basic dental procedure such as filling a cavity, it is very reassuring to know that with one tiny injection comes the bliss of not having to feel the procedure itself.