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Dental Anesthesia

True Allergic Reaction to Mepivicaine

07/08/2010

Question:

Last month I received multiple injections of mepivicaine and priolocaine to numb my lower jaw for a root canal. Within minutes of receiving the first 2 injections, my eyes became extremely itchy, I became disoriented and began to have some difficulty breathing. I temporarily stopped the procedure and used my inhaler (Xopenex)in order to ease my breathing. The dentist finished the root canal and I left his office. Half way home, I again had to use my inhaler and took a Benadryl because I felt as if I were having an allergic reaction. When I reached my home, I looked in the mirror and my eyes had swollen shut and my cheeks looked like a pumpkin. I called my allergist, who immediately told me to take more Bendryl, continue to use the inhaler, and ordered a prednisone pack for me. Yesterday (1 month after this happened), I finally had a full 3 hour allergic reaction test and found out I am, indeed, allergic to mepivicaine and septocaine and now carry a precautionary epi pen. Is this unusual? And, even though I don`t appear to be be allergic to prilocaine, should I consider IV sedation for future dental work?

Answer:

Thank you for your question. It is unusual to be allergic to local anesthetic but this can occur. It is more unusual to be allergic to mepivicaine, for instance, and not to prilocaine but all things are possible. Personally, when I do allergy testing, it is important for me to know if the local anesthetic was from a multi-dose vial or from a dental cartridge or from a vial of preservative free local anesthetic. The multi dose vial contains methylparaben and the others do not. So, this is important to know.

Assuming that you were in fact allergic to the two local anesthetics and not prilocaine, you could receive that drug and have most dental work done with good local anesthesia. The duration of action may not be as long so the treatment may need to be appointed carefully.

Was lidocaine tested? This is very important as this drug, besides being the most common local anesthetic used in medicine and dentistry, is also used for acute cardiac conditions, like heart attack, so that is important to know and hopefully your allergist tested this. This is the most standard 'dental" local anesthetic.

As to IV sedation, the benefit of this, especially if you have a dentist anesthesiologist administering the sedation, is that an allergic reaction can be treated immediately with IV medications. The dentist anesthesiologist (DA) can also place a breathing tube and provide other supportive measures as needed until EMS arrives. The DA brings full operating room monitoring, equipment and expertise to the dental office. Many dentists who are trained in IV conscious sedation are not trained to provide this level of care in an emergency. To find a DA, go to http://www.asdahq.org/ 

Good luck

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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