Evaluating complications of local anesthesia administration and reversal with phentolamine mesylate in a portable pediatric dental clinic

Gen Dent. 2013 Aug;61(5):70-6.


This study sought to identify and quantify complications with local anesthetic administration and reversal on consecutive patients seen for comprehensive dental care in a school-based, portable dental clinic, and includes data on the patients seen by the participating portable dental providers. In 923 dental visits where local anesthetic was administered, a standardized form was used to gain further information and identify any complications; this was accompanied by a questionnaire for the student's teacher, in order to quantify the student's distraction and disruption ratings following the dental visit. After statistical analysis of the 923 consecutive cases, the overall complication rate was 5.3%. All of the complications were considered to be mild or moderate, and there were no severe event reports. The complications encountered most frequently (n = 49) were associated with self-inflicted soft tissue injury. The results of this study indicate that comprehensive care with local anesthesia delivered by a school-based portable dental clinic has a low risk of complications. Whereas safe administration of dental care is achievable with or without phentolamine mesylate as a local anesthetic reversal agent, its use was determined to improve safety outcomes. Three factors appeared to directly increase the incidence of complications: the administration of an inferior alveolar nerve block, attention deficit disorder, and obesity. Teacher evaluations demonstrated that children receiving care by a portable dental team were able to reorient back to classwork and were not disruptive to classmates.

Keywords: community health; complications; dentistry; local anesthesia; phenotolamine.

MeSH terms

  • Adolescent
  • Adrenergic alpha-Antagonists / therapeutic use*
  • Anesthesia Recovery Period
  • Anesthesia, Dental / adverse effects*
  • Anesthetics, Local / administration & dosage
  • Anesthetics, Local / adverse effects*
  • Attention / drug effects
  • Attention Deficit Disorder with Hyperactivity / complications
  • Bites, Human / etiology
  • Child
  • Child Behavior / drug effects
  • Child, Preschool
  • Comprehensive Dental Care
  • Dental Care for Children*
  • Female
  • Humans
  • Male
  • Mandibular Nerve / drug effects
  • Mobile Health Units*
  • Mouth Mucosa / injuries
  • Nerve Block / adverse effects
  • Obesity / complications
  • Phentolamine / therapeutic use*
  • Safety
  • School Dentistry
  • Self-Injurious Behavior / etiology


  • Adrenergic alpha-Antagonists
  • Anesthetics, Local
  • Phentolamine