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Dental Anesthesia

Caine anectine allergy

02/19/2006

Question:

I have a root canal and other extensive dental work scheduled, however, I am allergic to all caines and possibly anectines. I have Multiple Sclerosis and experience "seizure-like" episodes when administered a caine. Is there anyway to determine what I am NOT allergic to or if I am allergic to preservatives added to the anesthetic? I have for several years, had all my dental work done without any anesthetic. I use a mind over matter approach. Thank you.

Answer:

This is an interesting history. "Seizure-like" episodes could be many things. Even pseudoseizures are rare with local anesthetics. It may be a reaction to epinephrine in local anesthetic solutions which can cause an "adrenaline-like" feel with palpitations, bounding pulse, shaking, and shortness of breath. With conventional doses of local anesthetic, seizure-like activity should not occur, even with your history of MS, the severity of which I do not know.

You can certainly have allergy testing by an allergist or with a dentist anesthesiologist at a dental school if there is one in your area. Typically, cardiac lidocaine (without epinephrine or a preservative) is skin tested first, then lidocaine with epinephrine (which also contains bisulfites as a stabilizer for the epi) and then possibly other local anesthetics such as mepivicaine which does not use epinephrine, so the dentist has a choice. All these solutions do not contain the typical antibacterial agent, methylparaben, since the cartridges the dentist uses are single patient use only. Obtain some from your dentist and have the allergist test these.

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Response by:

Steven I Ganzberg, SB, DMD, MS Steven I Ganzberg, SB, DMD, MS
Formerly, Clinical Professor of Dentistry
College of Dentistry
The Ohio State University