Bupivacaine is indicated for local, infiltrative, or conductive anesthesia in both simple and complex dental procedures.

Dental Surgery

Infiltrative Dental Anesthesia

• Bupivacaine is for adults only.
• An average dose of 1.8 mL (9 mg) per injection site is usually sufficient; if necessary, a second dose of 1.8 mL (9 mg) may be used to produce adequate anesthesia after allowing for a 2 to 10 minute onset time.
• The lowest effective dose should be employed and time should be allowed between injections; it is recommended that the total dose for all injection sites, spread out over a single dental sitting, should not ordinarily exceed 90 mg for a healthy adult patient (ten 1.8 mL injections of 0.5% BUPIVACAINE HCl

The following side effects may occur in cases of overdosage-

• nervousness
• dizziness
• blurred vision
• tremors
• drowsiness
• nausea
• vomiting

Nervousness	Dizziness	Blurred vision
Tremor (Shaking)	Drowsiness	Nausea

Only clinicians who are well versed in the diagnosis and management of dose-related toxicity and other acute emergencies that may arise from the block to be used should use local anesthetics, and only after ensuring the immediate availability of oxygen, other resuscitative drugs, cardiopulmonary resuscitation equipment, and the personnel resources needed for proper management of toxic reactions and related emergencies (see also adverse reactions and precautions). Delays in treating dose-related toxicity, underventilation from any cause, and/or altered sensitivity may result in acidosis, cardiac arrest, and, possibly, death.

• Articaine, like other local anesthetic solutions containing a vasoconstrictor, can cause methemoglobinemia, particularly in conjunction with methemoglobin-inducing agents. 
• It is essential that aspiration for blood or cerebrospinal fluid (where applicable) be done prior to injecting any local anesthetic, both the original dose and all subsequent doses, to avoid intravascular injection. However, a negative aspiration does not ensure against an intravascular injection. 
• Changes in sensorium, such as excitation, disorientation, drowsiness, may be early indications of a high blood level of the drug and may occur following inadvertent intravascular administration or rapid absorption of BUPIVACAINE HCl. 
• Local anesthetic procedures should be used with caution when there is inflammation and/or sepsis in the region of the proposed injection. 
• Serious dose-related cardiac arrhythmias may occur if preparations containing a vasoconstrictor such as epinephrine are employed in patients during or following the administration of chloroform, halothane, cyclopropane, trichloroethylene, or other related agents