What do systematic reviews say?

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

4% articaine, 1:100,000 epinephrine may leads to higher success of local anaesthesia (pulpal, electric pulp tester; healthy… compared with 2% lidocaine, 1:100,000 epinephrine (low certainty).

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  OR 2.71 [1.74, 4.22]
  8 studies · 309 participants
  Low

4% articaine, 1:100,000 epinephrine vs 2% lidocaine, 1:80,000 epinephrine

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  No data available for meta-analysis; orphan data summarized in Table 6. Not pooled/graded.
  Studies not reported
  GRADE not reported

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

It is very uncertain whether 4% articaine, 1:200,000 epinephrine changes success of local anaesthesia (pulpal, electric pulp tester; healthy… compared with 2% lidocaine, 1:100,000 epinephrine (very low certainty).

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  RR 1.33 [0.33, 5.36]
  2 studies · 28 participants
  Very low

2% lidocaine, 1:50,000 epinephrine vs 2% lidocaine, 1:80,000 epinephrine

It is very uncertain whether 2% lidocaine, 1:50,000 epinephrine changes success of local anaesthesia (pulpal, electric pulp tester; healthy… compared with 2% lidocaine, 1:80,000 epinephrine (very low certainty).

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  RR 0.81 [0.65, 1.01]
  2 studies · 60 participants
  Very low

2% lidocaine, 1:80,000 epinephrine vs 2% lidocaine, 1:100,000 epinephrine

It is very uncertain whether 2% lidocaine, 1:80,000 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 1.27 [1.01, 1.59]
  2 studies · 60 participants
  Very low

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

4% prilocaine plain may leads to lower 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

  5-30 minutes
  RR 0.86 [0.75, 0.99]
  2 studies · 228 participants
  Low

4% articaine, 1:200,000 epinephrine vs 0.5% bupivacaine, 1:200,000 epinephrine

4% articaine, 1:200,000 epinephrine showed no clear difference in success of local anaesthesia, absence of pain (clinical testing of… compared with 0.5% bupivacaine, 1:200,000 epinephrine (low certainty).

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

  10 minutes post-injection to end of clinical procedure
  OR 0.87 [0.27, 2.83]
  2 studies · 37 participants
  Low

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

4% prilocaine, 1:200,000 epinephrine may leads to higher success of local anaesthesia (pulpal, electric pulp tester; healthy… compared with 4% articaine, 1:100,000 epinephrine (low certainty).

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  RR 1.74 [1.16, 2.60]
  2 studies · 78 participants
  Low

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

4% articaine, 1:200,000 epinephrine showed no clear difference in success of local anaesthesia (pulpal, electric pulp tester; healthy… compared with 4% articaine, 1:100,000 epinephrine (low certainty).

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  RR 0.97 [0.87, 1.08]
  5 studies · 248 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 (pulpal, electric pulp tester; healthy… compared with 2% lidocaine, 1:100,000 epinephrine (low certainty).

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  RR 0.80 [0.62, 1.05]
  3 studies · 90 participants
  Low

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

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  'Other comparisons with 100% success': IANB - Sampaio 2012 35/35 vs 35/35; Fernandez 2005 39/39 vs 39/39. Both formulations 100% successful; no meta-analysis (no difference).
  2 studies · 74 participants
  GRADE not reported

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

4% prilocaine, 1:200,000 epinephrine showed no clear difference in success of local anaesthesia (pulpal, electric pulp tester; healthy… compared with 2% lidocaine, 1:100,000 epinephrine (low certainty).

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  RR 1.14 [0.91, 1.43]
  2 studies · 48 participants
  Low

3% prilocaine, 0.03 IU felypressin vs 2% lidocaine, 1:100,000 epinephrine

3% prilocaine, 0.03 IU felypressin probably leads to lower success of local anaesthesia, absence of pain (clinical testing of… compared with 2% lidocaine, 1:100,000 epinephrine (moderate certainty).

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

  Not reported (estimated < 2 hours)
  RR 0.86 [0.79, 0.95]
  2 studies · 907 participants
  Moderate

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

It is very uncertain whether 4% articaine, 1:200,000 epinephrine changes success of local anaesthesia, absence of pain (clinical testing of… compared with 4% articaine, 1:100,000 epinephrine (very low certainty).

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

  5 minutes post-injection to end of clinical procedure
  RR 0.85 [0.71, 1.02]
  3 studies · 930 participants
  Very low

2% mepivacaine, 1:20,000 levonordefrin vs 2% lidocaine, 1:100,000 epinephrine

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  No data available for meta-analysis; orphan clinical success data summarized in Table 6 (e.g. clinical anaesthesia success 2% lidocaine 1:100,000 64/110 vs 2% mepivacaine 1:20,000 levonordefrin 99/113). Not…
  Studies not reported
  GRADE not reported

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

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  No data available for meta-analysis; data summarized in Table 5 (orphan). Not pooled/graded.
  Studies not reported
  GRADE not reported

Counter-stimulation and distraction (combined) vs Conventional treatment

The review found no eligible studies for this question.

• Interventions for increasing acceptance of local anaesthetic in children and adolescents having dental treatment 2020 · Cochrane All outcomes

  During LA
  Acceptance of LA: included studies did not report on this outcome
  Studies not reported
  No studies found

Video modelling acclimatisation vs Acclimatisation in clinic (tell-show-do)

Video modelling acclimatisation showed no clear difference in pre- and post-operative anxiety measures (Venham's scale) compared with acclimatisation in clinic (tell-show-do); GRADE not reported.

• Interventions for increasing acceptance of local anaesthetic in children and adolescents having dental treatment 2020 · Cochrane All outcomes

  In advance of LA
  MD 0.13 [-0.37, 0.63]
  1 study · 46 participants
  GRADE not reported

Hypnosis vs Conventional treatment

Hypnosis led to lower physical/verbal resistance and self-reported pain during LA (other… compared with conventional treatment; GRADE not reported.

• Interventions for increasing acceptance of local anaesthetic in children and adolescents having dental treatment 2020 · Cochrane All outcomes

  Immediately before or during LA · Oberoi 2016 (resistance)
  RR 0.47 [0.34, 0.65]
  1 study · 200 participants
  GRADE not reported

Video modelling acclimatisation for LA vs Oral hygiene video

Video modelling acclimatisation for LA may leads to lower self- or observational assessment of intraoperative… compared with oral hygiene video (low certainty).

• Interventions for increasing acceptance of local anaesthetic in children and adolescents having dental treatment 2020 · Cochrane All outcomes

  In advance of LA
  MD -37.16 [-50.94, -23.38]
  1 study · 66 participants
  Low