Local anesthetics are drugs used topically to provide pain relief for limited time and least invasively. Even though they are considered to be safe drugs they can cause side effects and toxicity. This can present as involvement of multiple systems such as: CNS, CVS, hematological and local tissue changes. The common presentations are: tongue numbness, metallic taste, dizziness, difficulty focusing eyes, tinnitus, disorientation and drowsiness, convulsions, respiratory depression, hypotension, chest pain, cyanosis, local discoloration, urticaria or hives. Management is done according to the sign symptom after stopping application. Good oxygenation is ensured, an injection of epinephrine, steroid or ant allergic is administered as needed.