Myotonic dystrophy (dystrophia myotonica; DM) is an uncommon progressive hereditary muscle disorder that can present with variable severity at birth, in early childhood, or most commonly as an adult. Patients with DM, especially type 1 (DM1), are extremely sensitive to the respiratory depressant effects of sedative-hypnotics, anxiolytics, and opioid agonists. This case report describes a 37-year-old male patient with previously undiagnosed DM1 who received dental care under minimal sedation using intravenous midazolam. During the case, the patient experienced 2 brief episodes of hypoxemia, the second of which required emergency intubation after propofol and succinylcholine and resulted in extended hospital admission. A lipid emulsion (Liposyn II 20%) infusion was given approximately 2 hours after the last local anesthetic injection due to slight ST elevation and suspicion of local anesthetic toxicity (LAST). Months after treatment, the patient suffered a fall resulting in a fatal traumatic brain injury. Complications noted in this case report were primarily attributed to the unknown diagnosis of DM1, although additional precipitating factors were likely present. This report also provides a basic review of the literature and clinical guidelines for managing myotonic dystrophy patients for dental care with local anesthesia, sedation, or general anesthesia.

BACKGROUND: Allergy to lidocaine is extremely rare but if it occurs, one should switch to an alternative drug and discontinue the use of lidocaine so that adverse consequences do not occur.
METHODS: We present the case of a 70 year old male patient who had come to our department to undergo extraction of his decayed teeth under local anesthesia.
CONCLUSIONS: He had history of allergy to lidocaine. Type IV hypersensitivity to lidocaine was confirmed by positive skin prick testing to the drug. Skin prick testing was also performed for articaine that was available with us, and the test was found to be negative without any wheal or flare reaction even after 72 h. Thus it was confirmed that he was non-allergic to articaine and successfully underwent exodontia by using the same.
CONCLUSIONS: Articaine can be a suitable alternative in patients with true lignocaine allergy and vice-versa. No cross-reactivity has been reported between lidocaine and articaine so far. However, the number of cases reported in the past are limited, hence more cases are required in the future to prove its authenticity.

OBJECTIVE: Local anaesthesia is the standard of care during dental extractions. With the advent of newer local anesthetic agents, it is often difficult for the clinician to decide which agent would be most efficacious in a given clinical scenario. This study assessed the efficacy of equal-milligram doses of lidocaine and articaine in achieving surgical anaesthesia of maxillary posterior teeth diagnosed with irreversible pulpitis.
METHODS: This case-series evaluated a total of 41 patients diagnosed with irreversible pulpitis in a maxillary posterior tooth. Patients randomly received an infiltration of either 3.6 mL (72 mg) 2% lidocaine with 1:100,000 epinephrine or 1.8 mL (72 mg) 4% articaine with 1:100,000 epinephrine in the buccal fold and palatal soft tissue adjacent to the tooth. After 10 minutes, initial anaesthesia of the tooth was assessed by introducing a sterile 27-gauge needle into the gingival tissue adjacent to the tooth, followed by relief of the gingival cuff. Successful treatment was considered to have occurred when the tooth was extracted with no reported pain. Data was analyzed with the Fisher\'s exact test, unpaired t-test and normality test.
RESULTS: Twenty-one patients received lidocaine and 20 received articaine. Forty of the 41 patients achieved initial anaesthesia 10 minutes after injection: 21 after lidocaine and 19 after articaine (P = 0.488). Pain-free extraction was accomplished in 33 patients: 19 after lidocaine and 14 after articaine buccal and palatal infiltrations (P = 0.226).
CONCLUSIONS: There was no significant difference in efficacy between equivalent doses of lidocaine and articaine in the anaesthesia of maxillary posterior teeth with irreversible pulpitis.