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Dental Anesthesia

What Are the Adult Reactions to Septocaine?

10/27/2011

Question:

I was wondering what are the reactions to septocaine in adults. Can it negatively affect the organs of the body in any way including the heart,lungs,etc.? Also,what is epinephrine? What are its effects when a dentist puts septocaine in a tooth extraction? Thanks.

Answer:

What are the adult reactions to septocaine? Also,what is epinephrine?

Septocaine (articaine) is a local anesthetic used in dentistry to numb the teeth and gums so that dentistry can be performed painlessly. It is in the same general class as Xylocaine (lidocaine).

Local anesthetics temporarily block pain nerve impulses from reaching the brain where pain is recognized. Eventually the blood circulation system washes the anesthetic out of the nerve and the numbness wears off and normal feeling returns.

Septocaine in some situations may be a little more effective than lidocaine and is sometimes used if lidocaine does not totally numb the patient. However, there could be a very slight increased risk that articaine may cause prolonged numbness or even more rarely permanent numbness, especially when used to numb teeth and gums in the lower jaw, but this can actually occur with any local anesthetic.

The risk might be less than one incident during the entire 30 or 40 year career of a dentist, so the likelihood of it happening to you is exceedingly small, and obviously a risk worth taking considering how painful dentistry could be without it.

This is called the ratio of the benefit vs. the risk and in the case of all local anesthetics, the benefits are great and the risks of a bad outcome are very, very small.

This is like when you judge the benefits of driving a car vs. the risks of an accident and then you make a decision whether or not you want a car. Most people have a car and most want local anesthesia for dental work. The most common side effect of any dental local anesthetic is the patient fainting because they are nervous about getting the injection with the needle. Driving a car is considerably more risky than having a local anesthetic injection for dentistry.

Fortunately the dose of septocaine or any local anesthetic needed for painless dentistry is very small compared to the large dose that might be an overdose. That makes the use of local anesthesia in dentistry very, very safe. The typical dose in dentistry is at least 10 times less than what an anesthesiologist must use for labor epidural analgesia for childbirth. However overdoses have occurred in dentistry if the dentist has a long complicated procedure and uses more local anesthetic than is recommended.

Because small children are much smaller than adults, the maximum recommended dose of any local anesthetic for them is also less, so dentists sometimes can only do part of the needed treatment before having to stop because he or she does not want to come even close to the maximum recommended dose.

Overdoses can interfere with brain functioning, making patients very sleepy, perhaps even unconscious and maybe even having a seizure (convulsion) or stop breathing.

Dentists in the U.S give approximately one million local anesthetic injections every day and deaths due to local anesthetic overdoses do not happen even on a yearly basis, so maybe there is one overdose case for every 500 million injections or more.

Septocaine and lidocaine have the same maximum recommended dose. Epinephrine is essentially the same drug as adrenaline, the body's hormone released by the adrenal glands during stress to elevate heart rate, increase the blood pressure, increase the lung's ability to oxygenate blood and to constrict blood vessels in the skin in order to shunt more blood to muscles to give the body more muscle power.

In the very dilute concentrations of epinephrine found in some local anesthetics, the epinephrine is used to constrict the blood vessels at the site of the local anesthetic injection to keep the local anesthetic there longer so that it doesn't wear off before the dentist is finished.

Some people who are very sensitive to epinephrine, immediately following the injection of the local anesthetic containing epinephrine can sense a brief feeling of their heart pounding. Usually this goes away in a few minutes. However this can also be due to anxiety associated with the needle used for the injection. Several local anesthetics are available that do not contain epinephrine, but the shorter duration of the numbness may cause them to wear off prematurely.

In summary, septocaine with epinephrine is a very safe and effective local anesthetic in dentistry with few side-effects when used within the accepted dose range. My dentist uses it on me.

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