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Dental Anesthesia

7 Crowns/ Carbocaine

11/09/2011

Question:

WHAT A GREAT DETAILED ANSWER! THANK YOU SO MUCH... I DID HAVE THE 7 CROWNS DONE AND IT WENT VERY WELL,THE DENTIST DID NUMB ONE SIDE THEN THE OTHER LIKE YOU SUGGESTED.. I FOUND OUT ALL THIS TIME HE WAS NOT USEING CARBOCAINE BUT SOMETHING ELSE THAT HAS WAY LESS EPI THAN THE REGULAR STUFF IN WHAT I THOUGHT WAS CARBOCAINE,, I HAVE A PROBLEM WITH MY HEART RACING AFTER THE REGULAR NUMBING AGENT.. I FORGOT THE NAME HE SAID IT WAS BUT DID REASURE ME IT HAS WAY LESS EPI AND WOULD NOT CAUSE HEART TO RACE....IAM NOW GOING NEXT WEEK TO HAVE THE GRAFT AND EXTRACTION DONE IN SAME OFFICE BUT WITH A DIFFRENT DOCTOR I JUST HOPE HE CAN GIVE THE INJECTION THE SAME WAY MY DENTIST DOES WITHOUT THE HEART RACING EVEN IF HE USES THE SAME THING MY DENTIST USES BECAUSE I THINK IT HAS TO DO WITH THE TECHNIQUE ALSO IS IT THE AGENT THEY USE OR THE TECHNIQUE IN THE INJECTION?

Answer:

NetWellness Reader,

The short period of a racing heart associated with the injection of a local anesthetic depends on:
 
1. Your level of anxiety, as epinephrine is liberated in your body from the adrenal gland during stressful times.
 
2. The concentration of epinephrine in the local anesthetic. More dilute concentrations contain less epinephrine and are likely to cause less heart side effects.

3. The dose of the local anesthetic needed. More anesthetic means more epinephrine being given.

4. Nervous patients want the injection over as quickly as possible, but a rapid injection is more likely to increase heart rate. A nice slow injection, over a minute, is ideal.

5. Almost all dentists use an injection technique called "aspiration before injecting" to decrease the chance of injecting the anesthetic into a blood vessel. Injecting into a blood vessel would increase the heart rate.
 
6. Injecting one area of the mouth and then injecting later in the appointment a different area, if needed for another tooth, would be less likely to increase heart rate than numbing up both areas at the same time at the beginning of the appointment.

7. The sensitivity of individual patients to small amounts of epinephrine varies. Some people are more susceptible than others.

8. The density of blood vessels in the area of injection. Typically upper jaw injections are into areas with more blood vessels that can suck up the local anesthetic and carry it to the heart. The lower jaw has less blood flow, so perhaps these injections cause fewer rapid heart beats.
 
9. Some injections such as the "intraosseous injection" are more likely to cause a brief period of rapid heart beat, but this injection is great if the regular types of injections do not totally numb the tooth. An intraosseous injection goes directly into the bone so more of the anesthetic can get through the bone to get to the tooth's nerve. The short period of rapid heart beat may be worth it if the numbness improves from this injection technique. Additionally the intraosseous injection typically numbs up only a few teeth instead of the much larger area with traditional techniques.

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