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Dental Anesthesia

Plain Carbocaine for Upper Tooth Extraction?

12/10/2009

Question:

Hi! I have an upper molar which needs to be extracted. It is not a wisdom tooth and is not curved or impacted, etc. but it is broken off at the gumline so my Oral Surgeon will have to make a small incision in the gum to get it out.

I am on certain medications that contraindicate Epinephrine in my shots. I can not tolerate it, either. Even before the medications, my health problems made it almost impossible to get any work done with epinephrine in the shot. (tachycardia of 180 bpm, sweaty hands, panic attack, elevated blood pressure).

My question, relative to the information I just provided, is: Can plain Carbocaine be used on an upper (or lower) tooth extraction that is "technically" surgical since there will be a tiny incision?

If so, what should somebody do if it is contraindicated for them?

Thanks so, so much!

Answer:

Thank you for your question. Firstly, mepivicaine (Carbocaine is a brand name and there are others) is not "contraindicated", meaning you absolutely should be administered the medication, but rather, it may not be preferred by your oral surgeon. Your oral surgeon knows that the duration of profound local anesthesia with mepivicaine is short in the upper jaw, perhaps only 15 minutes or less with an infiltration technique. Additionally, there may be inadequate depth of local anesthesia for the surgical extraction. That being said, some people will have adequate local anesthesia in both duration and depth for the procedure in question. 


I wish you would have told me which medications you are on that "contraindicate" epinephrine in local anesthetic solutions since there are no absolute contraindications with any medication. There are some people, such as yourself, where this should be avoided but can be judiciously used when needed. 


In your situation, a medication that could be considered is 4% articaine with 1:200,000 epinephrine (half the epinephrine found typically in dental local anesthetics). A small amount of this low concentration solution can be given, waiting a minute or two for the blood vessels in the area to constrict, limiting uptake to your circulation and heart, and then full, slow injection of the remainder of the anesthetic. This may work well for you and the surgeon. If this is a second or third molar, a true nerve block (posterior superior alveolar) with mepivicaine can be given with good results and reasonably long lasting effects (as much as 45 minutes). 


These are some of the options you have. I think you should discuss this with your surgeon. One of the benefits of seeing an oral surgeon is that they can place monitors on you (EKG, continuous blood pressure, oxygen levels in your blood, etc.) and even start an IV. If needed, medications can be given to counter the effects of epinephrine, if your surgeon is comfortable with this. 


You should discuss your options with the surgeon. 

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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