Local Anesthetics in Dentistry Dr. Peter Nkansah explains why blocks fail, how toxicity happens and what every dentist should know about safer, more reliable pain control. Local anesthetics make fillings, extractions and root canals possible without pain. For most patients, that’s the difference between getting treatment and avoiding the dental chair altogether. But while local anesthesia is part of everyday practice, getting it right every time isn’t as simple as it seems. Anatomy varies, infections interfere and drug choice and dosage matter. “Everybody misses local anesthesia from time to time,” says Dr. Peter Nkansah, a dentist-anesthesiologist and assistant professor at the University of Toronto. “The only practitioner who has never missed a block is the one who hasn’t done very many.” It’s a reminder that successful pain control takes more than good technique. It also depends on understanding how these drugs work, how to choose a safe dose, and why anesthesia sometimes falls short even in experienced hands. Two Main Local Anesthetic Classes: Esters and Amides Dr. Nkansah reminds his colleagues that local anesthetics in dentistry fall into two major chemical structural classes: ester anesthetics and amide anesthetics. Ester anesthetics are most commonly used as topical agents rather than injectable drugs. Benzocaine is a typical example. Historically, procaine (Novocaine) was an injectable ester anesthetic that replaced cocaine, which had significant side effects. In modern practice, ester anesthetics are used primarily on mucosal surfaces because they are highly lipid soluble and provide rapid topical anesthesia. Dr. Peter Nkansah Dentist-anesthesiologist and assistant professor at the University of Toronto. Successful pain control takes more than good technique. It also depends on understanding how these drugs work, how to choose a safe dose, and why anesthesia sometimes falls short even in experienced hands. 32 | 2026 | Issue 3
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