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Dental Anesthesia

Possible epinephrine reaction

06/03/2008

Question:

Hi, I am 21 years old & suffer from severe Chrinic Fatigue Syndrome. I am on a treatment which my dentist knows about & none of the medications interfere with any work he needs to do.

However, I have been warned by my Doctor that I may have an adverse reaction to epinephrine. Under this warning I had a filling done a couple of months ago with epinephrine-free anaesthetic.

It was terrible. The anaesthetic lasted about 10 minutes & I felt msot of the drilling, it had to be topped up constantly. & when I say I suffer from severe CFS - I have the dentist visit at home & even hearing voices increases my symptoms.

I need another filling in a couple of weeks & my dentist told me that as the filling is in a top tooth, it is unlikely the epinephrine will get into the blood stream & therefore unlikely it`ll give me a reaction.

My questions are -

Do you agree with my dentist? If so, what are the chances of the epinephrine getting into the blood stream ina top tooth filling?

If I do have an adverse reaction to the epinephrine, can it be dangerous (ie. a need for hospital) or jsut scary & uncomfortable?

Do you have any other suggestions for my situation?

I really appreciate any advice you can give. I am not nervous about dental work (I had 11 fillings prior to becoming ill) but the thought of tachycardia etc that other CFS patients have experienced after epinephrine does scare me!

Thanks, Natalie

Answer:

Thank you for your question. I am not sure of the reason your physician says that epinephrine would not be an acceptable medication for you if there are no drug interactions. It would be of interest to know your drugs, as many doctors are not fully aware of significant likely interactions versus interactions that may occur but are very unlikely with the doses given during dental procedures.

Local anesthetic without epinephrine does have a shorter duration of action than those with the drug added. However, in the lower jaw, tooth anesthesia for 3% mepivicaine, the most commonly used non-epinephrine anesthetic in dentistry, usually lasts for about 30 - 40 minutes, although lip anesthesia may last for up to three hours. In the upper jaw, there may only be 15 minutes of tooth anesthesia.

As to uptake of epinephrine, this is probably more likely in the upper jaw than the lower jaw as the upper jaw has a higher blood supply. Still, there are things that can be done which I am sure your dentist knows. First, a small of amount of local anesthetic with epinephrine can be injected and allowed to work for a couple minutes. This will cause the blood vessels in the area to constrict and decrease uptake of further injected epinephrine. Then, the dentist can inject very, very slowly the total amount needed or better yet, divide the dose in two. Once your gum is numb, you will not feel the other injections.

Another option is to have the dentist use bupivicaine with epinephrine which contains half the epinephrine in standard solutions.

You may also benefit from sedation with nitrous oxide or an oral benzodiazepine but I do not know if you are concerned about this either. This is a complicated issue and requires very individualized attention that only your dentist and physician can provide. I hope this general information helps.

For more information:

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Response by:

Steven I Ganzberg, SB, DMD, MS Steven I Ganzberg, SB, DMD, MS
Formerly, Clinical Professor of Dentistry
College of Dentistry
The Ohio State University