Oral Surgery · patient case question
What is the maximum recommended dose of articaine for a healthy adult?
Patient case: Extraction, infection and a difficult healing
demo: 44-year-old female
chief: Severe throbbing pain and a foul taste four days after an extraction, plus swelling from a separate upper tooth.
history: Osteoporosis treated with intravenous zoledronic acid for three years. She smokes. She had corrective surgery for tetralogy of Fallot in childhood with no residual defect.
meds: Zoledronic acid, calcium and vitamin D.
findings: The socket at site 32 is empty of clot with exposed bone and exquisite tenderness. There is no purulence. Separately, tooth 4 is grossly carious with vestibular swelling and tenderness.
Show answer and explanation
Correct answer: B. 7 mg per kg
- A. 4.4 mg per kg is the maximum for lidocaine with epinephrine, capped at 500 mg.
- B. Correct. The maximum for articaine in a healthy adult is 7 mg per kg, with an absolute ceiling of 500 mg. A 4 percent cartridge of 1.7 mL contains 68 mg, so a 70 kg adult may receive up to about 7 cartridges. For children under 4, articaine is not recommended, and the paediatric maximum is also 7 mg per kg.
- C. 2 mg per kg is close to the bupivacaine limit, which is 1.3 mg per kg to a maximum of 90 mg.
- D. 10 mg per kg exceeds every local anaesthetic maximum in dental use.