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Wednesday, December 11, 2013
What are the Options?
Nearly 1 years ago I had a reaction epinephrine in the Dentist`s office. I got pale, heart beat became very fast. He stopped and recommended an Oral Surgeon. Since then, I have been diagnosed with Hypertensive heart disease and Diabetes 2, I also have obstructive sleep apnea. I had never had a bad reaction before this, now, frankly , I am afraid to get my teeth worked on with these health issues. What options exist that take these issues into account because I have some serious issues with my teeth needing resolution. ie, broken teeth etc.
The most common reason for palpitations at the dental office is rapid absorption of epinephrine added to local anesthetics to increase duration and effectiveness. Epinephrine is the same thing as "adrenaline" that naturally makes your heart race. This can occur if the medication is injected into, or very close to, a blood vessel in the mouth. It is not at all clear that you cannot receive local anesthetic with epinephrine in the future. Your medical conditions are very common. The dentist, knowing that you had such a reaction, would consider non-epinephrine containing local anesthetics, although this may not be as effective, particularly in the upper jaw.
However, the medication can still be used with some precautions: 1) The dentist injects very slowly as well as tries to ensure that the medication is not injected into a blood vessel. 2) The dentist can use low concentration epinephrine solutions, like bupivicaine or atricaine with 1:200,000 epinephrine (or some anesthetic with epinephrine and some without), 3) the dentist can monitor your blood pressure and heart rate before and after injections to ensure you can tolerate increasing dosages.
If your main treatment involves tooth extraction, then an oral surgeon is fine. They can provide advanced monitoring and IV sedation. However, if you need other types of dental work, the oral surgeon will not be able to help.
Another option is to have a dentist anesthesiologist come to your dentist's office and provide advanced monitoring and IV sedation or general anesthesia so you can have your dental work done in one or a very small number of appointments.
So, there are many options: Have the work done in a regular dental office with precautions due to your medical conditions (which is pretty standard), or go the oral surgeons for extractions, or have a dentist anesthesiologist come to your dentist's office.
To find an anesthesiologist, go to http://www.asdahq.org/. If possible, and particularly if you are not anxious about dental treatment, having you dentist take care of you is probably the easiest. Good luck.
Steven I Ganzberg, SB, DMD, MS
Formerly, Clinical Professor of Dentistry
College of Dentistry
The Ohio State University