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Dental Anesthesia

Dental injection with an aneurysm

02/05/2009

Question:

When having an injection during a any type of dentistry work including a root canal, is it wise not to have anything with epinephrine in it if you have an ascending aortic aneurysm. The many injections I received did not have epinephrine and were only good for about 10 minutes. I cannot remember the name. It started with a C. My dentist told me that the reason novacaine and lidocaine are more potent is because of the epinephrine. My internist was the physician who said not to use epinephrine. However, the injection I did receive without the epinephrine did not work very well. I would like to hear your opinion. Thank you in advance

Answer:

Thank you for your question. The concern with an aortic aneurysm and epinephrine in general is that the drug can increase blood pressure and thereby may induce leakage or rupture of the aneurysm.

Epinephrine in local anesthetic solutions for dentistry significantly increases the effectiveness and duration of the anesthetic effect, as you know! Your physician's concern is understandable but if you are in pain during your dental procedure, your own secreted adrenaline (epinephrine released from your adrenal gland) may far exceed that from the administered local anesthetic solution. Therefore, these issues all need to be balanced.

Certainly, epinephrine use should be minimized if possible. There are currently two local anesthetic solutions with very low-dose epinephrine that are available in dental cartridges, 4% articaine with 1:200,000 epinephrine and 0.5% bupivicaine with 1:200,000 epinephrine. The total epinephrine dose for a single cartridge, which is fine for most dental procedures, is 9 micrograms. Both of these solutions should allow for acceptable duration and depth of local anesthesia for dental or oral surgery of the vast majority of procedures.

Your dentist should, in addition to helping ensure that the needle is not in a blood vessel which is routinely done, inject very slowly. This limits the systemic, of general body uptake, of the drug and thus, the drug stays in the mouth area rather than traveling to your aorta to any significant degree.

I think this will solve your problem. That being said, I suspect that your dentist will not want to go against your physician's advice. May I suggest you bring this note to the attention of your physician and see if he or she finds this approach acceptable.

You may be taking other drugs or have other conditions that may have impacted your physician's recommendation that I am not aware of but this may still be an acceptable approach under these circumstances.

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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