What do systematic reviews say?

4% prilocaine plain vs 2% lidocaine, 1:100,000 epinephrine

4% prilocaine plain showed no clear difference in speed of onset of anaesthesia (soft tissue, simulated) compared with 2% lidocaine, 1:100,000 epinephrine (low certainty).

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  MD 0.02 [-0.10, 0.14]
  2 studies · 406 participants
  Low

4% articaine plain vs 4% articaine, 1:100,000 epinephrine

It is very uncertain whether 4% articaine plain changes speed of onset of anaesthesia (pulpal, electric pulp tester; healthy… compared with 4% articaine, 1:100,000 epinephrine (very low certainty).

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  MD 0.13 [-0.54, 0.80]
  2 studies · 100 participants
  Very low

4% prilocaine plain vs 2% lidocaine, 1:100,000 epinephrine

The review found no eligible studies for this question.

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  SoF: Not measured.
  0 studies
  No studies found

4% articaine, 1:100,000 epinephrine vs 2% mepivacaine, 1:100,000 epinephrine

It is very uncertain whether 4% articaine, 1:100,000 epinephrine changes success of local anaesthesia (soft tissue, self-reported) compared with 2% mepivacaine, 1:100,000 epinephrine (very low certainty).

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  RR 1.07 [0.73, 1.59]
  2 studies · 68 participants
  Very low

4% articaine plain vs 4% articaine, 1:100,000 epinephrine

It is very uncertain whether 4% articaine plain changes success of local anaesthesia (pulpal, electric pulp tester; healthy… compared with 4% articaine, 1:100,000 epinephrine (very low certainty).

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  RR 0.61 [0.38, 0.97]
  2 studies · 134 participants
  Very low

Hydroxyzine vs Different dosage/timing of hydroxyzine

• Sedation of children undergoing dental treatment 2018 · Cochrane All outcomes
  Any behavioural score - Hydroxyzine: 30 (1 study); VERY LOW. Insufficient evidence to determine whether any specific dose of hydroxyzine is effective.
  1 study · 30 participants
  Very low

Meperidine (intramuscular) vs placebo or no intervention

Meperidine (intramuscular) may leads to higher good or better behaviour compared with placebo (including no intervention) (low certainty).

• Sedation of children undergoing dental treatment 2018 · Cochrane All outcomes
  RR 5.33 [1.45, 19.64]
  1 study · 60 participants
  Low

2% lidocaine, 1:50,000 epinephrine vs 2% lidocaine, 1:100,000 epinephrine

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  '100% success' (lidocaine 1:100,000 vs 1:50,000): infraorbital block - Berberich 2009 40/40 vs 40/40; mandibular BI - Dagher 1997 30/30, Yonchak 2001 40/40; IANB - Yared 1997 30/30, Wali 2010 30/30. Both 100% successful.
  5 studies · 170 participants
  GRADE not reported

Ketamine/midazolam vs placebo or no intervention

• Sedation of children undergoing dental treatment 2018 · Cochrane All outcomes
  Moreira 2013: 0.5 mg/kg midazolam + 3 mg/kg ketamine produced significantly better behaviour than placebo and oral midazolam (P=0.03); not included in meta-analysis / not GRADE-rated. Narrative.
  1 study
  GRADE not reported

4% articaine, 1:200,000 epinephrine vs 4% articaine, 1:100,000 epinephrine

The review found no eligible studies for this question.

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  SoF: Not measured.
  0 studies
  No studies found

3% mepivacaine plain vs 2% lidocaine, 1:50,000 epinephrine

3% mepivacaine plain showed no clear difference in success of local anaesthesia (pulpal, electric pulp tester; healthy… compared with 2% lidocaine, 1:50,000 epinephrine (low certainty).

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  RR 0.97 [0.88, 1.07]
  2 studies · 70 participants
  Low

4% prilocaine, 1:200,000 epinephrine vs 2% lidocaine, 1:100,000 epinephrine

It is very uncertain whether 4% prilocaine, 1:200,000 epinephrine changes duration of anaesthesia (soft tissue, simulated) compared with 2% lidocaine, 1:100,000 epinephrine (very low certainty).

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  MD -11.80 [-27.76, 4.16]
  2 studies · 533 participants
  Very low

4% articaine plain vs 4% articaine, 1:200,000 epinephrine

It is very uncertain whether 4% articaine plain changes duration of anaesthesia (pulpal, electric pulp tester; healthy pulps) compared with 4% articaine, 1:200,000 epinephrine (very low certainty).

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  MD -28.36 [-42.06, -14.65]
  2 studies · 102 participants
  Very low

0.5% bupivacaine, 1:200,000 epinephrine vs 2% lidocaine, 1:100,000 epinephrine

It is very uncertain whether 0.5% bupivacaine, 1:200,000 epinephrine changes speed of onset of anaesthesia (soft tissue, simulated) compared with 2% lidocaine, 1:100,000 epinephrine (very low certainty).

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  MD 0.02 [-1.07, 1.10]
  3 studies · 79 participants
  Very low

4% articaine, 1:100,000 epinephrine vs 2% lidocaine, 1:100,000 epinephrine

4% articaine, 1:100,000 epinephrine showed no clear difference in success of local anaesthesia (soft tissue, self-reported) compared with 2% lidocaine, 1:100,000 epinephrine (moderate certainty).

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  RR 1.03 [0.99, 1.07]
  6 studies · 355 participants
  Moderate

Dexmedetomidine vs A different sedative agent

• Sedation of children undergoing dental treatment 2018 · Cochrane All outcomes
  Any behavioural score - Dexmedetomidine versus (other sedatives): 120 (2); VERY LOW
  2 studies · 120 participants
  Very low

4% articaine, 1:200,000 epinephrine vs 4% prilocaine, 1:200,000 epinephrine

It is very uncertain whether 4% articaine, 1:200,000 epinephrine changes success of local anaesthesia (pulpal, electric pulp tester; healthy… compared with 4% prilocaine, 1:200,000 epinephrine (very low certainty).

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  RR 1.15 [0.93, 1.41]
  3 studies · 97 participants
  Very low

4% prilocaine, 1:200,000 epinephrine vs 4% prilocaine plain

4% prilocaine, 1:200,000 epinephrine may leads to higher duration of anaesthesia (soft tissue, simulated) compared with 4% prilocaine plain (low certainty).

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  MD 18.78 [9.02, 28.54]
  2 studies · 506 participants
  Low

0.5% bupivacaine, 1:200,000 epinephrine vs 2% lidocaine, 1:100,000 epinephrine

0.5% bupivacaine, 1:200,000 epinephrine showed no clear difference in success of local anaesthesia, absence of pain (clinical testing of… compared with 2% lidocaine, 1:100,000 epinephrine (low certainty).

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes

  10 minutes post-injection to end of clinical procedure
  OR 0.58 [0.07, 5.12]
  2 studies · 31 participants
  Low

2% lidocaine, 1:200,000 epinephrine vs 2% lidocaine, 1:100,000 epinephrine

It is very uncertain whether 2% lidocaine, 1:200,000 epinephrine changes success of local anaesthesia (pulpal, electric pulp tester; healthy… compared with 2% lidocaine, 1:100,000 epinephrine (very low certainty).

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  RR 0.89 [0.63, 1.26]
  3 studies · 70 participants
  Very low