The use of mepivacaine in dentistry has remained strong since its introduction in the 1960s. It has retained its place as a valuable local anesthetic, either as a primary agent or as an alternative to lidocaine or articaine. Mepivacaine is commonly used in medically compromised patients--for whom elevations in blood pressure or heart rate are not advisable--in a formulation with a vasoconstrictor, or in pediatric populations in a formulation without a vasoconstrictor. Pharmacologically, these are the 2 groups most susceptible to side effects and toxicity, thus mepivacaine is commonly indicated. Most often the decision to use mepivacaine is based on its vasoconstrictor effect or lack thereof (depending on the formulation). However, the pharmacokinetics of mepivacaine are not well understood or assumed to be similar to that of other local anesthetics. It is important to understand the unique pharmacologic characteristics of mepivacaine in order to minimize the potential for inadvertent toxicity.