LOCAL ANESTHETICS USED IN DENTISTRY: ALLERGY RISK, PATHOGENESIS AND PRIMARY MECHANISMS OF HYPERSENSITIVITY
Abstract
Resume. Local anesthetics are fundamental components of modern dental practice, ensuring pain control, patient comfort, and procedural efficiency. Although contemporary amide anesthetics demonstrate high safety, concerns related to allergy, hypersensitivity, and adverse reactions persist both among practitioners and patients. True IgE-mediated allergic reactions to local anesthetics are extremely rare, yet a disproportionately high number of patients report “allergic responses”, most of which represent vasovagal, psychogenic, adrenergic, or toxic reactions rather than genuine immunological hypersensitivity. This article provides an extensive analysis of the allergy risk associated with local anesthetics commonly used in dentistry, describes their pharmacological classification, examines the immunological pathogenesis of hypersensitivity, and identifies key mechanisms underlying allergic and pseudoallergic reactions. Special attention is given to the differences between ester- and amide-type anesthetics, the role of preservatives such as parabens and sulfites, and the molecular pathways responsible for immediate and delayed hypersensitivity. The paper also discusses diagnostic challenges, differential criteria, preventive measures, and evidence-based clinical implications for safe dental practice. Keywords: local anesthetics, dentistry, allergy, hypersensitivity, pathogenesis, immunology, amide anesthetics, ester anesthetics, adverse reactions.