TAC 20 Topical Anesthetic

Description: TAC 20 is the name given to the dental topical anesthetic formulation that includes lidocaine 20%, tetracaine 4%, phenylephrine 2% as a topical anesthetic.  TAC 20 is a misnomer as the ingredients are not exactly the same as when the name was created. The original formulation stood for tetracaine, adrenaline (epinephrine), and cocaine and was most often used in the hospital setting for pain management prior to suturing. The formulation was obviously modified over time but the name stuck. Now TAC 20 is used predominantly in dentistry – being used in dental offices across the country for a variety of oral procedures.

Formulation Uses

The uses of TAC 20 in dentistry are numerous. It is often used in dentistry for numbing prior to an injection of local anesthetic. Scaling and root planing (deep cleaning) can be made more comfortable with the use of a topical. It is also used for reducing discomfort associated with taking impressions and x-rays. Many types of instrumentation of the oral mucosa may benefit from the use of a topical anesthetic. Orthodontists frequently use compounded topical anesthetics for TAD placement and other procedures.

What is TAC 20?

TAC 20 is a compounded topical anesthetic similar to Profound gel. The formulation includes lidocaine and tetracaine in strengths that are higher than typically found in over-the-counter forms of topical anesthetic you may get from a dental supplier. Phenylephrine is added to the formulation as well as a vasoconstrictor to improve retention in the treatment area, reduce bleeding, and lower systemic effects. The standard formula for TAC 20 includes lidocaine 20%, tetracaine 4%, and phenylephrine 2%. It is compounded in a gel or ointment base and can be made in multiple flavors (mint, strawberry, grape, and more) to improve palatability.

Safety of Compounded Topical Anesthetics

Compounded topical anesthetics are generally safe when they are used by trained dentists, when they are made by licensed compounding pharmacies using high quality processes, and when they are given to patients without sensitivities or allergies to the ingredients. Patients should always let their dentist know about any allergies they have in addition to their full medical history and current health conditions.

How is TAC 20 Applied?

To apply this formulation, dentists and dental hygienists will typically place a small amount of gel on a gauze which is held on the area to be numbed. Another method is to use a cotton swab to apply the gel to the area. It will usually take 2-3 minutes for the anesthetic to work. The gel should then be removed completely to prevent any sloughing of tissue and to prevent the gel from being swallowed.

Research and Articles

Update on Dental Topical Anesthetics – Decisions in Dentistry

The use of compound topical anesthetics: a review – Kravitz Orthodontics

Recent advances in topical anesthesia – Journal of Dental Anesthesia and Pain Medicine