Which Local Anesthetic to Choose, and How the Brands Compare

Every dental anesthetic cartridge comes down to three decisions: which drug, which vasoconstrictor, and which brand. Get those right and the rest is technique. This guide compares the five local anesthetics a practice actually buys, organized by the questions clinicians ask most, and shows where the brand on the box changes what you get and where it only changes the price.

These cartridges are one part of the injection setup, alongside needles, syringes, and topicals, and they are a recurring, high-volume purchase, which is why the brand-versus-price question below weighs as much as the clinical one. The drugs are sold as injectable anesthetics under many labels, and the closest head-to-head among them, articaine versus lidocaine, is the comparison clinicians ask about most. For a given patient and procedure, the first question is narrower: what goes in the syringe

What local anesthetics do dentists use?

Five amide anesthetics cover almost all general practice, and each has a brand a buyer will recognize. Lidocaine 2% with epinephrine 1:100,000 is the workhorse, sold under many house and national labels at near-commodity prices. Articaine 4% with epinephrine is the most-stocked option in many offices, where Septocaine and Orabloc are the leading brands, and it is sold only with epinephrine, never plain. Mepivacaine 3% is the plain choice with no vasoconstrictor, best known as Carbocaine. Bupivacaine 0.5% with epinephrine 1:200,000 is the long-acting option, sold as Marcaine. Prilocaine 4% is the other plain-capable amide, stocked as Citanest Plain. These five, in their 1.7 mL cartridges, are the shelf a practice chooses from.

Articaine vs lidocaine: which works better?

This is the most-asked comparison, and the answer depends on the case. According to a meta-analysis, 4% articaine with epinephrine reached a higher anesthetic success rate than 2% lidocaine in teeth with irreversible pulpitis (PMID 27062318), which is why many clinicians reach for articaine in hot teeth and difficult infiltrations. In children the two are closer, with a systematic review finding similar efficacy and adverse-event rates and somewhat less postoperative pain after articaine (PMID 29635712). The reliability of articaine versus lidocaine in the inferior alveolar nerve block is less settled, and a long-debated reported association between 4% formulations and post-block paresthesia keeps that choice case-dependent rather than automatic.

Is Articaine the same as Septocaine?

Yes. Septocaine is a brand of 4% articaine with epinephrine, and Orabloc is another; a generic articaine cartridge is the same molecule at the same concentration. The brand changes the label and the price, not the drug. The same holds for lidocaine 2% with 1:100,000 epinephrine, which meets one specification across many labels. This is the single most useful fact for buying anesthetic: once you know the molecule and concentration you want, the brand becomes a price decision rather than a clinical one. Septocaine carries the largest share of articaine use in US practices, yet on the molecule it is identical to its generic equivalents, which is what makes the comparison worth running.

Do you always need epinephrine?

No, and the choice changes how the drug behaves. Epinephrine constricts local vessels, which deepens and prolongs anesthesia and reduces bleeding in the field, which is why most cartridges carry it at 1:100,000 or the more dilute 1:200,000. The plain options, Carbocaine and Citanest Plain, drop it for a shorter duration and a cleaner cardiovascular profile. For cardiac patients the evidence is reassuring within limits: a controlled study in coronary patients found that extraction under 1:100,000 epinephrine added no ischemic risk when technique was good and the patient's prescribed cardiac medication was maintained (PMID 17589623). The practical rule is to limit the epinephrine dose and avoid intravascular injection in at-risk patients, rather than to default to a plain cartridge in every complex case. When a short, vasoconstrictor-free anesthetic is genuinely wanted, Carbocaine is the usual plain choice.

How long does each anesthetic last?

Duration is how you match the drug to the appointment. Plain mepivacaine 3%, the Carbocaine option, gives the shortest pulpal anesthesia and suits quick procedures. Lidocaine and articaine with 1:100,000 epinephrine sit in the standard range that fits most restorative work. Bupivacaine, sold as Marcaine, is the long-acting choice, extending soft-tissue anesthesia and postoperative comfort well beyond the others, at the cost of a slow recovery the patient should be warned about. As a planning rule, choose the shortest duration that covers the procedure, since lingering numbness is a common patient complaint and, in children, a soft-tissue injury risk.

How many cartridges are safe?

The maximum is set by the drug, its concentration, and the patient's weight, not by a single number, and a 4% drug reaches its milligram ceiling in fewer cartridges than a 2% drug, so the limits are not interchangeable between articaine and lidocaine. Two safety flags belong on the decision. Prilocaine, and high doses of articaine, carry a recognized risk of methemoglobinemia, a reduced oxygen-carrying state that dentistry is warned to recognize and treat promptly (PMID 20831930). And the common belief that articaine is unsafe in a sulfa allergy is a misconception, since articaine is an amide and shares no cross-reactivity with sulfonamides. Follow each drug's maximum recommended dose by weight and the safe count follows from it.

Comparing brands on price

Anesthetic is a high-frequency consumable bought by the box, so a few cents per cartridge compounds across a year. Once the molecule and concentration are set, Septocaine, Orabloc, and generic articaine are interchangeable on clinical grounds, and lidocaine 2% with epinephrine is a true commodity across labels. Reordering one brand out of habit leaves that saving on the table. On Alara the same molecule from 15+ verified vendors appears side by side, so a practice keeps the drug it trusts and orders it from whichever verified vendor is cheapest.

Practical takeaways

1. Pick the drug by case: lidocaine or articaine with 1:100,000 epinephrine for routine work, Marcaine for long cases, plain Carbocaine for short procedures or limited epinephrine.
2. Articaine edges lidocaine in hot teeth and infiltrations; in children the two perform similarly.
3. Septocaine, Orabloc, and generic articaine are the same molecule, so the brand is a price decision.
4. Limit epinephrine with good technique in cardiac patients rather than defaulting to a plain anesthetic.
5. Watch methemoglobinemia with prilocaine and high articaine doses, and disregard the sulfa-allergy myth.