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Dental Anesthesia

Carbocaine for 7 Crowns (Upper) 3 hour Appoin

09/20/2011

Question:

i am having 7 crowns done 4 on right side and 3 on left side. all front uppers, i use carbocaine or something else with out the eppy.... i have has 2 crowns and root canals done before with this all at onece, but is it ok for this much work in 1 visit i have a 3 hour appointment.. i asked if he was going to numb all at one he said yes ..... i hear that carbocaine or like substance dont last long will this be ok to use for this kind of work.. i am having crowns only no root canals.. in prep for an extraction on front tooth and grafts to result in a one piece bridge/crowns at a later time,,,,

Answer:

Carbocaine is regarded as an excellent local anesthetic for short and intermediate-lasting dental procedures. For most procedures on mandibular teeth (lower jaw), the effect of Carbocaine lasts long enough for the dentist to complete several crown procedures. However, for teeth in the maxilla (upper jaw) the duration of Carbocaine's effect is considerably shorter because there are more blood vessels in the upper jaw tissues that absorb the local anesthetic and wash the Carbocaine away, allowing the tooth to "awaken" more quickly.

The purpose of adding epinephrine, Neocobefrin or other vasoconstrictor agents to some local anesthetics is to shrink the blood vessels in order to reduce the blood flow through the area where the local anesthetic was injected. This helps to keep the local anesthetic in place longer and allows the local anesthetic to work for a longer period of time.

That is why lidocaine with epinephrine is the most popular local anesthetic in dentistry in the US. Carbocaine with Neocobefrin (levonordefrin) is also longer acting than Carbocaine Plain without Neocobefrin. If for some reason the dentist believes that the epinephrine or Neocobefrin are not good choices for you based on your medical history, the shorter duration of Carbocaine Plain will have to be supplemented by additional injections during the procedure whenever it begins to wear off and the tooth begins to become sensitive to the dentist's procedure.

Thus, the downside of doing it this way is that one could expect to have some discomfort from time to time during a long procedure whenever the anesthetic wears off and until the supplemental injections boost up the local anesthetic effect again. When the dentist using Carbocaine Plain gives more injections during long procedures, the total amount of anesthetic given during the treatment will be more than if he/she could have given an initial injection of an anesthetic that may have lasted for the entire procedure. The total amount that can be safely given is primarily based on your state of health, your lean body weight and the density of the blood vessels at the site of the injection.

If you are a small person, the maximum amount of Carbocaine that can be safely given is less than what can be given to an average or larger person. The FDA-approved labeling states the following total dosage recommendations for average-sized adults: Each cartridge contains 1.8 mL (54 mg of 3%). Maximum recommended dose for adults (400mg). Thus, the FDA would recommend about 7.5 glass cartridges as the maximum dose. Unless the dentist is very fast when doing all of the crown preps at once, he/she could numb one side of the mouth until nearly finished with those teeth and then numb up the their side just before doing those teeth. That way, the teeth on the second side will be just getting numb rather than being toward the end of the numbness period if all teeth on both sides were injected at the same time.

It is encouraging that you have apparently successfully undergone at least one other fairly long procedure without difficulty with Plain Carbocaine, so a few additional injections may be all that is necessary for a longer appointment.

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Response by:

Joel M Weaver, II, DDS, PhD
Faculty Emeritus
Dentistry Administration
College of Dentistry
The Ohio State University