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Monday, December 9, 2013
Do I Need To Be Cautious If I Have Asthma?
Is it true that person with chronic asthma should avoid local anesthetics? I was refused a local anesthetic for a minor surgical procedure when I revealed my history of asthma. I will be getting some cavities filled in two weeks and if the information about local anesthetics and asthma is true, I would like to discuss other anesthesia options with my dentist.
In almost all cases, local anesthesia is safe for patients with asthma. The exception would be those patients allergic to the local anesthetic agents themselves (very, very rare) or to some components added to the local anesthetic solutions (also very rare but can occur). The common dental local anesthetics are drugs such as lidocaine, mepivacaine, bupivacaine and etidocaine.
Although it is possible to be allergic to these drugs, this is very rare when administered in dental cartridges. Dental cartridges no longer contain an antibacterial agent, since they are for single patient use, so this more common source of allergic response is not a concern.
Of course, if you, as an asthmatic, are allergic to local anesthetics, then this could be life-threatening. If you have had several dental or medical procedures in the past with local anesthesia, this is reasonable assurance that you are fine in this regard.
The other commonly added agents are epinephrine with a preservative, usually metabisulfite. Epinephrine is used to provide a longer duration of local anesthesia and sometimes to control local bleeding during, for instance, gum surgery. Epinephrine is also used to treat acute asthma attacks and is a naturally occurring substance in the body, so allergy is not a concern.
Some patients may be allergic to the sulfite however. If this is the case, then epinephrine containing local anesthetic solutions should be avoided. With that caution, I would not hesitate to use any local anesthetic solution, with or without epinephrine, to asthmatic patients except perhaps poorly controlled, or very difficult to control, asthmatics or steroid (oral prednisone by mouth, not inhaled steroids) dependent asthmatics.
There are local anesthetic solutions that have no epinephrine or sulfites. These work well, especially for shorter procedures, but may be redosed for longer procedures within accepted guidelines.
So, the bottom line is, you should be able to have local anesthesia for almost any routine dental procedure. If you are an unstable asthmatic, I recommend that you be monitored during your dental treatment, but mainly if a lengthy surgical procedure is required (use of epinephrine). A dentist anesthesiologist in your area should be able to help. One can be contacted at the web site below.
Steven I Ganzberg, SB, DMD, MS
Formerly, Clinical Professor of Dentistry
College of Dentistry
The Ohio State University