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Dental and Oral Health (Adults)

Alternatives to novocaine with epi

04/12/2007

Question:

Dear Expert,

I have tachycardia and severe anxiety when I am given anesthetic with epinephrine in it. When I recently had my last wisdom tooth pulled, my dentist tried to not have to use it, but the bleeding and the speed with which the anesthetic wore of caused her to have to use it anyway, which was very unpleasant. I have a filling scheduled soon and I wonder if there are alternatives to the caine+epi formula, other ways to ameliorate bleeding and increase durability of local anesthesia.

Best.

Answer:

Thank you for your question. I am replying on the assumption that you are healthy and taking no medications which might exaggerate or in some other way interact with epinephrine in local anesthetic solutions.

With a filling that needs to be done, which is generally a short procedure, epinephrine is generally not necessary, as bleeding is not an issue. Even in the upper jaw, 3% mepivicaine plain can be used with about 20 minutes of dental surgical anesthesia and 2+ hours of soft tissue anesthesia. In the lower jaw, this increases to 60 minutes of surgical anesthesia and about the same amount of soft tissue anesthesia.

If a longer duration of anesthesia is needed in the upper jaw, 3% mepivicaine with 1:20,000 levonordefrin can be used. This is likely to have less tachycardia and "anxiety" associated with its administration, assuming that the anxiety is related pharmacologically to the epinephrine and not to the anticipation of the injection and reaction. This anesthetic was discontinued but has recently made a come back.

Another option in either jaw is 0.5% bupivicaine with 1:200,000 epinephrine. This gives a long duration of surgical anesthesia, but very long soft tissue (like lip and/or tongue) anesthesia of 5 or more hours. This amount of epinephrine is half what is typically used (1:100,000).

Discuss these options with your dentist. If there is a drug interaction or other medical issue that might affect this, certainly this should be discussed as well.

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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