How this tool works

The calculator turns every published limit that fits your patient into mg for their weight, then uses the lowest one. It never rounds up: every mg and cartridge figure is rounded down to one decimal.

Limits used. For adults, the calculator uses the current FDA label and the maximums in Becker and Reed's 2012 review in Anesthesia Progress. In child mode it adds the AAPD pediatric table and any pediatric rule on the label. Where a source gives both mg/kg and mg/lb, both are checked, so the stricter conversion wins.
mg per cartridge = concentration (%) × 10 × volume (mL). For example, 2% lidocaine is 20 mg/mL, or 34 mg in 1.7 mL.
Cartridges by dose = maximum mg ÷ mg per cartridge.
Cartridges by epinephrine = epinephrine budget ÷ epinephrine per cartridge. A 1:100,000 solution holds 0.01 mg/mL; 1:50,000 holds 0.02 mg/mL; 1:200,000 holds 0.005 mg/mL.
The headline is the lower of the two cartridge counts. With doses already given, it's the allowance still left (see below).

Agent (1.7 mL)	mg per cartridge	FDA label	Becker & Reed 2012	AAPD, children
Lidocaine 2% + epi 1:100k or 1:50k	34	7 mg/kg, below 500 mg	7 mg/kg (500 mg)	4.4 mg/kg
Articaine 4% + epi 1:100k or 1:200k	68	7 mg/kg, no total cap	5–7 mg/kg (500 mg)	7 mg/kg
Mepivacaine 3% plain	51	3 mg/lb, 400 mg	6.6 mg/kg (400 mg)	4.4 mg/kg
Mepivacaine 2% + levonordefrin 1:20k	34	3 mg/lb, 400 mg	7 mg/kg (550 mg)	4.4 mg/kg
Prilocaine 4% plain or + epi 1:200k	68	8 mg/kg, 600 mg	6 mg/kg (400 mg)	not listed
Bupivacaine 0.5% + epi 1:200k	8.5	90 mg per sitting	(90 mg)	1.3 mg/kg

With 1.8 mL cartridges, multiply the mg column by 1.8 ÷ 1.7 (lidocaine 36 mg, articaine 72 mg, and so on). US prilocaine (Citanest) and bupivacaine (Vivacaine) cartridges are labeled 1.8 mL, so 72 mg and 9 mg are the figures for those.

Where the label and the textbooks differ

We show every figure in the "How the maximum was set" table and use the most conservative:

Prilocaine. The label allows 8 mg/kg and 600 mg. Becker and Reed list 6 mg/kg and 400 mg as the conservative figure, so the calculator uses 6 mg/kg and 400 mg.
Articaine. The US label has no total cap. Becker and Reed suggest 500 mg, which is 7 mg/kg for a 70 kg adult, and the calculator applies it. Their 5 mg/kg lower bound is a Canadian pediatric figure, so it isn't applied.
Mepivacaine. The label states 3 mg/lb, which is 6.61 mg/kg. That is slightly above the review's 6.6 mg/kg for the 3% solution, so 6.6 mg/kg governs. For 2% with levonordefrin, the label's 3 mg/lb and 400 mg are lower than the review's 7 mg/kg and 550 mg.
Bupivacaine. Neither the label nor the review gives a mg/kg figure, only 90 mg per sitting. We also apply the AAPD figure of 1.3 mg/kg to adults, so lighter patients get a weight-based limit. From about 69 kg up, the 90 mg cap governs.

Epinephrine budget

The calculator uses 0.2 mg of epinephrine per appointment for a healthy adult and 0.04 mg when you tick cardiovascular-compromised. Both figures come from Malamed's textbook and are repeated in a 2014 systematic review (Godzieba and colleagues). Becker and Reed call 0.04 mg (40 µg) the most conservative and a frequently cited limit for these patients. They add that it fits a 30-minute window better than a whole appointment. For articaine, the label also limits epinephrine to 0.0017 mg/kg, and the calculator uses that when it is lower.

Cartridge (1.7 mL)	Epinephrine	Healthy: 0.2 mg	Cardiac: 0.04 mg
1:50,000	0.034 mg	5.8 cartridges	1.1 cartridges
1:100,000	0.017 mg	11.7 cartridges	2.3 cartridges
1:200,000	0.0085 mg	23.5 cartridges	4.7 cartridges

Levonordefrin (1:20,000, 0.085 mg per 1.7 mL) is shown but not counted against the epinephrine budget. Patients with significant cardiovascular disease, thyroid disease, diabetes or sulfite sensitivity, or taking interacting drugs such as tricyclic antidepressants, may need a medical consultation to decide whether to use an anesthetic without a vasoconstrictor. The AAPD lists these groups.

More than one anesthetic

Local anesthetic toxicity adds up across agents. Add each cartridge already given under "Already given this appointment". The calculator works out what share of that agent's own maximum each dose used, adds the shares, and gives the planned agent only what's left of its maximum.

For example, a 70 kg adult who has had 2 cartridges of 3% mepivacaine (102 mg of a 400 mg maximum, so 25.5%) has 74.5% left. For 2% lidocaine with 1:100,000 epinephrine that is 74.5% of 490 mg = 365 mg, or 10.7 cartridges. The epinephrine left is counted the same way.

Children

Child mode adds the AAPD table, which is more conservative than the labels for lidocaine and mepivacaine (4.4 mg/kg).
AAPD advises cutting the calculated maximum by 30% in infants younger than 6 months. Enter the age and the calculator applies the cut.
Articaine is not recommended under 4 years, and bupivacaine is not recommended under 12.
The maximum should also be reduced when local anesthetic is given with sedatives or other CNS depressants. The AAPD gives no figure for this, so the calculator can't apply it for you.
Weigh the child and record the planned maximum before you start. AAPD notes this can help prevent overdose in young or sedated patients.

Limits

This tool does arithmetic on published maximums. It doesn't know your patient's liver, kidney or heart function, their other medicines, or the injection site. It is for licensed clinicians and dental students learning dose calculation, not for patients. Always check the product label of the cartridge you use. For how long numbness lasts after each agent, see the Dental Numbness Calculator.

Frequently asked questions

How many cartridges of 2% lidocaine with 1:100,000 epinephrine can a healthy adult have?

For a 70 kg adult the label limit is 7 mg/kg = 490 mg, which is 14.4 cartridges of 34 mg (1.7 mL). The 0.2 mg epinephrine budget is reached first, at 11.7 cartridges (0.017 mg each). The calculator rounds down and shows which limit governs.

What is the maximum epinephrine dose for a cardiac patient?

A frequently cited limit is 0.04 mg (40 µg) per appointment for cardiovascular-compromised patients, against 0.2 mg for healthy adults. That is about 2.3 cartridges of 1:100,000 or 4.7 of 1:200,000 in 1.7 mL cartridges. Becker and Reed note the 0.04 mg figure is conservative and better fits a 30-minute window.

Why is the pediatric lidocaine limit 4.4 mg/kg when the label says 7 mg/kg?

AAPD, with the American Academy of Pediatrics, keeps the long-established pediatric dental maximum of 4.4 mg/kg for lidocaine and mepivacaine, which is more conservative than the manufacturers' figures. In child mode the calculator applies both and uses the lower.

How do I combine two different anesthetics?

Treat their effects as additive. Work out what share of its own maximum each dose already given used, add those shares, and give the next agent only the remaining share of its maximum. For example, after half the lidocaine maximum, only half the bupivacaine maximum is left.

Should I calculate with 1.7 mL or 1.8 mL cartridges?

Use the volume printed on your cartridge. US lidocaine, articaine and mepivacaine labels state 1.7 mL, while US prilocaine (Citanest) and bupivacaine (Vivacaine) labels state 1.8 mL. Many older charts assume 1.8 mL for everything. Becker and Reed suggest counting about 2 mL when doing quick mental math, since overestimating the dose is the safe direction.

Sources

U.S. FDA label via DailyMed (Dentsply). XYLOCAINE Dental (lidocaine HCl 2% and epinephrine 1:50,000 or 1:100,000) injection. updated August 13, 2026. Not to exceed 7 mg/kg (3.2 mg/lb); keep below 500 mg in healthy adults; 1.7 mL cartridges. Accessed October 26, 2026.
U.S. FDA label via DailyMed (Septodont). LIGNOSPAN STANDARD (lidocaine HCl 2% and epinephrine 1:100,000) injection. updated March 20, 2025. Same limits as Xylocaine Dental. Accessed October 26, 2026.
U.S. FDA label via DailyMed (Septodont). SEPTOCAINE (articaine HCl 4% and epinephrine 1:100,000 or 1:200,000) injection. revised September 2024. 7 mg/kg articaine and 0.0017 mg/kg epinephrine for adults and ages 4 to 16; 68 mg per 1.7 mL. Accessed October 26, 2026.
U.S. FDA label via DailyMed (Septodont). CARBOCAINE (mepivacaine HCl 3%, and 2% with levonordefrin 1:20,000) injection. updated February 21, 2024. Up to 3 mg/lb; 400 mg per sitting in adults; pediatric table capped at 5.3 cartridges (270 mg of 3%, 180 mg of 2%). Accessed October 26, 2026.
U.S. FDA label via DailyMed (Dentsply). CITANEST PLAIN Dental (prilocaine HCl 4%) injection. updated November 10, 2021. 8 mg/kg (4 mg/lb) under 70 kg; 600 mg from 70 kg; 1.8 mL cartridges. Accessed October 26, 2026.
U.S. FDA label via DailyMed (Dentsply). CITANEST FORTE Dental (prilocaine HCl 4% and epinephrine 1:200,000) injection. updated February 29, 2024. Same limits as Citanest Plain; 1.8 mL cartridges. Accessed October 26, 2026.
U.S. FDA label via DailyMed (Septodont). VIVACAINE (bupivacaine HCl 0.5% and epinephrine 1:200,000) injection. updated February 16, 2024. Total per dental sitting should not ordinarily exceed 90 mg; not recommended under 12 years; 1.8 mL cartridges. Accessed October 26, 2026.
American Academy of Pediatric Dentistry. The Reference Manual of Pediatric Dentistry 2025:407-14. Use of Local Anesthesia for Pediatric Dental Patients (latest revision 2023). 2023. Table of pediatric maximums (mg/kg and mg/lb); 30% reduction under 6 months; articaine not under 4 years, bupivacaine not under 12. Accessed October 26, 2026.
Becker DE, Reed KL. Anesthesia Progress 59(2):90-102. Local Anesthetics: Review of Pharmacological Considerations. 2012. Table 2 maximum doses; dose arithmetic (Table 1); 40 µg epinephrine limit for cardiovascular patients; combined doses are additive. Accessed October 26, 2026.
Godzieba A, Smektała T, Jędrzejewski M, Sporniak-Tutak K. Medical Science Monitor 20:393-398. Clinical assessment of the safe use local anaesthesia with vasoconstrictor agents in cardiovascular compromised patients: a systematic review. 2014. States the maximum epinephrine dose as 0.2 mg for a healthy subject, lowered to 0.04 mg with severe cardiovascular disease (ASA III and IV). Accessed October 26, 2026.
Malamed SF. St. Louis, MO: Mosby (Elsevier). Handbook of Local Anesthesia, 7th edition. 2020. Textbook source of the 0.2 mg (healthy) and 0.04 mg (cardiovascular-compromised) epinephrine limits per appointment.

Last reviewed October 26, 2026 by the Dental Health Time editorial team, against the sources above. How we review.