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Dental Anesthesia

Caine allergy

12/26/2006

Question:

I have had numerous reactions to dental treatment in which I develop swelling, itchy, blisters. Finally, I was sent to an allergist who says I am allergic to "caine mix," nickel and EDD. The allergist recommends "extreme avoidance" of these three substances, and yet the literature provided states that dental anesthetics and dental tools are "generally" not a problem.

I am "extremely" confused. What is causing my reactions?

Does this mean I should avoid all dental anesthesia and/or dental tools made with nickel?

Answer:

Thank you for your question.  This is a difficult one. Firstly, there is no group of drugs that is named the "caines".  For instance cocaine, procaine (Novacaine) and lidocaine (Xylocaine) are all different structures, although all are local anesthetics.  So, I am not sure what your allergist is getting at in regard to not really the "caines" but the more obscure "caine mix".  Does this mean the preservatives in various local anesthetics in multi-dose vials or the antioxidants added to preparations with epinephrine?  Very confusing. 

As far as I understand nickel allergy in dentistry, and I am not an expert on this, the problem is not with the dental instruments but with crowns and other devices that stay in contact with the oral soft tissues for long periods of time.  I do not know what EDD is.

So, it is not clear what your reaction is actually caused from.  Did your allergist actually test "dental" local anesthetics from dental anesthetic cartridges?  Did he/she test local anesthetics with and without epinephrine?  This all makes a difference.  I assume subdermal injections were done?  If not, then have your allergist go back and test in this way with dental local anesthetics.  True allergy is very, very, very, rare.  If in fact you are allergic to common amide local anesthetics (like lidocaine and mepivicaine), then possibly procaine can be tried, although it doesn't last very long.  There are other choices. 

Lastly, you could have general anesthesia and have all your dental work done at once.  This is an issue if you need only a filling or two.  But this is always an option.

For more information:

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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