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Dental Anesthesia

Pseudocholinesterase Deficiency

03/29/2010

Question:

Hi, I was tested and confirmed with pseudocholinesterase deficiency about 31 years ago after my aunt had the issue under GA.

My question is about local anaesthetics - is it safe to have dental procedures performed with any of the `caine` drugs or should I continue with none? (my dentist refuses to use anything with me!) Also any `caine` topical creams before cosmetic procedures?

I have two operations done under local in hospital and they seemed relaxed about it, I assume because either it wasn`t well known or that it was controlled. (These ops resulted in 25 stitches between them if that helps.

Lastly what is known about botox type therapies with this problem?

Thanks

Answer:

Pseudocholinesterase (PC) deficiency would affect ester local anesthetics, like procaine (Novicaine) that is no longer used in dentistry. The amide local anesthetics that are used, such as lidocaine, articaine, mepivicaine, etc, are not metabolized by this enzyme. Topical anesthetics that are used prior to the injection to numb the gum are metabolized by PC. This should be avoided even though excessive doses are unlikely to be used.

BoTox affects the neuromuscular junction but is not affected by PC. Instead, the acetylcholine that is released is metabolized by acetylcholinesterase. I am not an expert on BoTox but this should not be a problem.

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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