# Comparative Effects of 4% Articaine and 2% Lignocaine on Salivary Biomarkers of Pain and Stress in Surgical Extraction of Impacted Mandibular Third Molars: A Prospective Observational Study

## TL;DR

This study compares 4% articaine and 2% lignocaine for their effects on pain and stress during tooth extraction, finding articaine more effective.

## Contribution

The study introduces a comparison of two anesthetics using salivary biomarkers to assess pain and stress modulation during dental surgery.

## Key findings

- 4% articaine reduced postoperative pain more effectively than 2% lignocaine.
- Articaine led to lower cortisol and sAA levels, indicating reduced stress response.
- Significant group and interaction effects were observed for cortisol and sAA over time.

## Abstract

Introduction: Surgical extraction of impacted mandibular third molars is a common dental procedure associated with significant pain and stress, which can be modulated by local anesthetics. This study aimed to assess the influence of 2% lignocaine versus 4% articaine on salivary biomarkers of pain and stress in patients undergoing surgical extraction of impacted mandibular third molars. The specific objective was to measure and compare the baseline and postoperative levels of cortisol and salivary alpha-amylase (sAA), along with the pain and anxiety scores, between the two anesthetic groups.

Materials and Methods: This prospective observational study was conducted at the Department of Oral and Maxillofacial Surgery between January and December 2022. 40 patients (aged 18-40 years, American Society of Anesthesiologists (ASA) I/II) with mesioangular impacted third molars were allocated to receive 2% lignocaine (n = 20) or 4% articaine (n = 20) based on clinical practice. Baseline pain (Visual Analog Scale (VAS) <10 mm), anxiety (Modified Dental Anxiety Scale (MDAS) 5-14), and unstimulated saliva (5 mL, 8-10 AM) were assessed. Saliva was collected at baseline (T0), 1-h post injection (T1), and 24-h post extraction (T24). The cortisol (enzyme-linked immunosorbent assay) and sAA (kinetic colorimetric assay) levels were measured in salivary samples. Pain was assessed using the VAS at same time intervals. Surgical complexity was standardized and data were analyzed using independent t-tests, repeated-measures (RM) analysis of variance (ANOVA), and two-way ANOVA (p < 0.05).

Results: Baseline characteristics were comparable (p > 0.05). RM ANOVA showed significant changes over time in pain, cortisol, and sAA levels in both groups (p = 0.001). Two-way ANOVA revealed significant group effects for cortisol (p = 0.008) and sAA (p = 0.021), and interactions (cortisol: p = 0.038; sAA: p = 0.047). 4% articaine showed lower pain (16.25 ± 5.72 vs. 20.5 ± 3.68, p = 0.008), cortisol (0.15 ± 0.06 µg/dL vs. 0.24 ± 0.13 µg/dL, p = 0.009), and sAA reductions (T24-T0) (22.63 ± 8.6 units/mL vs. 45.03 ± 16.01 units/mL, p = 0.001) compared to 2% lignocaine.

Conclusion: Compared to 2% lignocaine, 4% articaine demonstrated superior modulation of pain and stress biomarkers, supporting its preferential use in impacted mandibular third molar extraction.