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Dental Anesthesia

Citanest Forte

11/03/2011

Question:

I was wondering about the side effects of the anesthesia called citanest forte 4%,1.200 (the one that has no epinephrine on it).  It sounds like it is a strong anesthesia.  What are its side effects and how safe is it, can it harm the body organs,heart, cause strong heart palpitations, etc. in any way? I would appreciate your help,thanks.

Answer:

Citanest is a local anesthetic commonly used for dentistry. It comes in 2 formulations: 4% Citanest (without epinephrine) and 4% Citanest Forte with 1:200,000 epinephrine.

In the usual doses used in most dental procedures, either is very safe. The epinephrine can sometimes cause a short period of increased heart rate because of the systemic absorption of the epinephrine, but the epinephrine prolongs the duration of numbness so that the dentist can finish longer procedures while the patient remains comfortable because the epinephrine constricts the blood vessels in the area of the injection which traps the anesthetic around the nerve for an extended period of time.

Epinephrine also increases the maximum amount of Citanest that the dentist can give when multiple injections are needed for complex procedures compared to 4% Citanest without epinephrine because there is a less rapid absorption of the anesthetic into the blood because of the epinephrine.

High blood levels of local anesthetics can cause problems, such as unconsciousness and seizures,and in extraordinary overdoses, can stop the heart, but fortunately this would be very rare in dentistry because the dentist typically does not need much drug to numb the mouth.
 
2% Lidocaine with 1:100,000 epinephrine is the most common local anesthetic used in dentistry. Because the 1:200,000 concentration of epinephrine in 4% Citanest Forte is one-half the concentration compared to the 1:100,000 concentration of epinephrine in 2% lidocaine, the more dilute epinephrine in Citanest is less likely to increase heart rate but still prolongs the duration of numbness equal to the standard drug.
 
The maximum recommended dose of either formulation of Citanest, like any local anesthetic, is primarily based on the patient's weight (or in the case of a very obese person, it is based more on ideal body weight), assuming that they are reasonably healthy. Thus the maximum recommended dose for small adults and children is less than for a larger adult. It is rare that the dentist would come close to giving the maximum recommended dose, but if that were to occur, a drug overdose would be more likely with the 4% Citanest Plain because there is a more rapid absorption into the blood stream from the injection site when epinephrine is not present to constrict the blood vessels.
 
For a 150 lb adult in reasonable health, a dentist could inject 5 or 6 cartridges of 4% Citanest Forte with 1:200,000 epinephrine and be well within the maximum recommended dose. For a 30 pound child, the maximum recommended dose would be a little more than one cartridge.

To put this into proper perspective, approximately one million dental injections are made each day by American dentists and fortunately overdose reactions are exceedingly rare, perhaps one in 300,000,000 injections cause serious overdose reactions.

For more information:

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

Response by:

Joel M Weaver, II, DDS, PhD
Faculty Emeritus
Dentistry Administration
College of Dentistry
The Ohio State University