Reversal of soft-tissue local anesthesia with phentolamine mesylate in adolescents and adults

Elliot V. Hersh, Paul A. Moore, Athena S. Papas, J. Max Goodson, Laura A. Mavalta, Siegfried Rogy, Bruce Rutherford, John A. Yagiela, Jeffrey Bennett, Hafsteinn Eggertsson, Jodie L. Jarrett, Melissa S. Mau, Sean G. Boynes, Anne L. Lemak, Jayme G. Zovko, Maribeth Krzesinski, O. Basil Aboosi, Andres Pinto, Stacey A. Secreto, Bridget GallagherMorton Rosenberg, Mabi Singh, Nooruddin Sadruddin Pradhan, Medha Singh, Ted P. Raybould, John L. Pfail, David V. Valauri, Yordanka K. Ivanova, Sharon M. Gordon, Alfredo Arribas, Vidya Sankar, Ernest B. Luce, Ernest E. Valdez, Noemi C. Gonzales, Anthony Henegar, Andrea Schreiber, Kenneth Allen, James LoPresti, Judith Kreismann, Margaret Andrew, George A. Freer, Scott Kelsey McGavin, Georgia Blissett, Pauline McCallister, Jodi Smith, Kim Beales, William V. Giannobile, Amy S. Kim, Mark D. Snyder, Paul R. Snow, Steven Y. Luo, Amanda Robinson, Steffany Peralta, Michelle Hudson, Jacqueline Kleven, Mary Tavares, Jennifer Soncini, Maria Chvetchkova, Christine Roberts, Lora Murray, Jacyn Stultz, Constantinos C. Floros, Christine M. Hayashi, Indira Torres, Melinda Parisi, Jennifer S. Goss, Deborah Shiba

Research output: Contribution to journalArticlepeer-review


Background. The authors conducted two multicenter, randomized, double-blinded, controlled Phase III clinical trials to study the efficacy and safety of phentolamine mesylate (PM) in shortening the duration and burden of soft-tissue anesthesia. The study involved 484 subjects who received one of four commercially available local anesthetic solutions containing vasoconstrictors for restorative or scaling procedures. Methods. On completion of the dental procedure, subjects randomly received a PM or a sham injection (an injection in which a needle does not penetrate the soft tissue) in the same site as the local anesthetic injection. The investigators measured the duration of soft-tissue anesthesia by using standardized lip- and tongue-tapping procedures every five minutes for five hours. They also evaluated functional measures and subject-perceived altered function, sensation, appearance and safety. Results. Median recovery times in the lower Hp and tongue for subjects in the PM group were 70 minutes and 60 minutes, respectively. Median recovery times in the lower lip and tongue for subjects in the sham group were 155 minutes and 125 minutes, respectively. Upper lip median recovery times were 50 minutes for subjects in the PM group and 133 minutes for subjects in the sham group. These differences were significant (P < .0001). Recovery from actual functional deficits and subject-perceived altered function, sensation and appearance also showed significant differences between the PM and the sham groups. Conclusions. PM was efficacious and safe in reducing the duration of local anesthetic-induced soft-tissue numbness and its associated functional deficits. Clinical Implications. Clinicians can use PM to accelerate reversal of soft-tissue anesthesia and the associated functional deficits.

Original languageEnglish (US)
Pages (from-to)1080-1093
Number of pages14
JournalJournal of the American Dental Association
Issue number8
StatePublished - Aug 2008


  • Articaine
  • Epinephrine
  • Levonordefrin
  • Lidocaine
  • Local anesthesia
  • Mepivacaine
  • Phentolamine mesylate
  • Prilocaine

ASJC Scopus subject areas

  • General Dentistry


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