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Dental Anesthesia

Anesthesias for extractions.

10/11/2011

Question:

I have a question. I have heard that the anesthesia lidocaine can cause heart damage or heart problems. I read about it in wikipedia,is that true? What side effects does it cause (I don`t suffer from heart disease I am just scared of that anesthesia). Also what side effects does zavicor and novicaine cause (I have also heard about those). I would appreciate your prompt reply, thanks.

Answer:

Lidocaine is a local anesthetic drug that temporarily interferes with nerve function so that operations can be done painlessly. The original local anesthetic was cocaine but because it has some significant safely issues, it was replaced in the early 20th century by a second generation local anesthetic drug called procaine which was marketed with the trade name of "Novacaine".

Novacaine had a fairly slow onset of numbing effect when used in the mouth by dentists and was associated with allergic reactions.

Thus in the 1950s, lidocaine replaced Novacaine as the premier local anesthetic in dentistry, and it still is the worldwide standard drug to which other local anesthetic drugs are compared.

Lidocaine is the leading local anesthetic in dentistry in the United States. It has an excellent safety profile. In addition to its local anesthetic effect, lidocaine is given intravenously (injected into the vein) specifically to manage certain emergencies arrhythmias.

Of course, like every drug, too much of it can be harmful. A large overdose of lidocaine, which would be exceedingly unusual in a dentist's office, could lead to inhibition of the brain's normal functioning and cause serious problems such as unconsciousness, decreased breathing and seizures, and in even greater overdoses can stop the function of the heart's electrical system, causing it to stop beating.
 
Fortunately in dentistry, to numb a tooth with lidocaine, the dentist typically uses a dose of only 20 to 40 mg of lidocaine. The maximum recommended dose for lidocaine is typically in the range of 10 times greater than that needed to numb a tooth.
 
In medical anesthesiology, the amount of lidocaine to numb the arm or leg is often near the maximum recommended dose, and therefore more extensive cardiovascular monitoring and an I.V. is usually in place before the physician injects the lidocaine for these medical purposes.

Lidocaine is a very safe drug. Documented cases of an acute allergic reaction to lidocaine are essentially non-existent. To make the lidocaine numbing effect last longer, a drug called epinephrine is sometimes added to the lidocaine.

In large doses, epinephrine can increase the heart rate and blood pressure, so the dentist must consider the patient's health when using this combination. However, lidocaine with epinephrine is the most widely used local anesthetic in dentistry in the U.S., and its safety record is superb.
 
The most common reaction to lidocaine or lidocaine with epinephrine is the patient fainting due to the anxiety associated with the needle used for its injection. Also a brief period of heart palpitations can occur. Dentists are trained to manage these complications.

I cannot find any internet information on a drug called zavicor, so perhaps it has another spelling.

For more information:

Go to the Dental Anesthesia health topic, where you can:

Response by:

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