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I've had issues with epi a few times, as well as cases where Carbocaine and Prilocaine plain haven't gotten me numb enough on the upper jaw to do a filling (strange since I managed to get my wisdom teeth out with Carbocaine)
On one appointment, I decided to bite the bullet and I allowed the use of Prilocaine 4% with epi 1:200,000, which has half of the epi of most types of local. Although I did not have palpitations or any other very serious reactions, it still made my blood pressure go quite high, and at the end I took 40mg of Propranolol. Within 30 minutes all was back to normal. On the other hand, it was very effective. So effective that when some unexpected decay was found on a neighbouring tooth he didn't even need to give another shot.
Had a lower tooth filled yesterday, and they used Carbocaine plain, which did nothing to my blood pressure. Apparently if you are getting the horrible mandibular block, all of the drugs are the same in terms of effectiveness.
I was also told that if you see a cartridge with a green stripe on it, this is the one to really watch out for as it actually has a lot more epi in it, although it isn't used often (mostly by Periodontists for gum surgery)
A couple of years ago I had some skin cancer removed. They used Lidocaine that they mix there own with Epinephrine in it. I had horrible side effects that have been described by others. Blood pressure sky rocketed, sweating and heart beating and etc. I did some research and found that it was the Epinephrine in the Lidocaine. I thought back on dental injections and how terrible they had been and the side effects. During the past year I have gotten CARBOCAINE plain. I check the vials myself. While CARBOCAINE plain is short acting most procedures are done well before it wears off. And when it wears off, it goes away completely instead of a frozen tongue and lip for 4 hours.
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