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Dental Anesthesia

Methahemoglobinemia & dental work?

04/30/2009

Question:

A few years ago I had to go into the hospital for emergency surgery. After the surgery, I was given a substance called Hurricane Spray to help deal with a sore throat caused by a tube running down my nose.

After an hour or so of using the Hurricane Spray my lips and fingernails started turning blue. My oxygen stats were also plummeting fast. To make a long story short, I ended up spending the night in the ICU where I was eventually diagnosed with Methahemoglobinemia (this where there is not enough hemoglobin to carry oxygen to the body, a result from a medication causing an increase in methahemoglobin, which cannot carry oxygen. Therefore, Methahemoglobinemia can be a life-threatening condition). My ER doctors said that this reaction was likely caused by the benzocaine found in the Hurricane Spray. They handed us a list of other things that could cause Methahemoglobinemia and "caine" medications were present on that list. To my understanding it was all caine-family medications that could cause this reaction, though I never saw the list myself as they gave it to my family. I have read online that methahemoglobinemic responses are relatively rare but are "commonly" caused by Benzocaine, Prilocaine and Articaine. Any "caine" (I assume) can cause it but those were the big three most commonly mentioned in my research.

The problem is, I`m now looking at having dental work done for possible cavities and eventual extraction of all four of my wisdom teeth. Obviously, dentists use things such as novocaine, benzocaine, prilocaine, ect. as a local anestetic during procedures. What can I do? Is there any safe "caine" I can have?

I have high blood pressure and mitral valve prolapse and I really don`t want to go under general anestesia for something as simple as a cavity filling.

Answer:

Thank you for your question. I am quite familiar with methemoglobinemia. You are correct that benzocaine topical anesthetic is commonly used in dentistry and should be avoided in someone with particular congenital enzyme deficiencies or under special circumstances of oxidative stress. One of the products that prilocaine is metabolized to can induce the condition, and it is speculated that articaine can as well as there is an ester in the structure, but some studies do not support a connection.

The good news is that some standard local anesthetics in dentistry, lidocaine and mepivicaine, are safe for you so it should be no problem having local anesthetic at the dentist.

For more information:

Go to the Dental Anesthesia health topic, where you can:

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