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Old 07-17-2009, 03:54 PM
 
1 posts, read 22,164 times
Reputation: 16
I just went to a new dentist and had 3 small cavities filled, all on he lower right. My old dentist usually only gave me 1 or 2 shots of Novocain and waited a while before drilling and I NEVER felt any pain during drilling. This new guy gave me 2 shots of Novocain waited 5 min and started drilling. I still felt some pain so he gave me 2 MORE shots and stated drilling again after about 2 min. What the heck 4 shots of Novocain and only waiting 5 min before drilling...is that normal?
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Old 07-18-2009, 08:51 AM
 
1,644 posts, read 2,746,277 times
Reputation: 419
Quote:
Originally Posted by hoosuredaddy View Post
You must also consider the possibility of an allergy to the anesthetic itself - though the
greatest majority of these 'reactions' described here (preexisting cardiac conditions
excepted!) appear to be more truly within the spectrum of 'side effect.'
It is not unusual for the small injection of epinephrine to "trigger" a sympathetic reaction
[literally]. Especially given the particular situation: At the dentist, facing a needle and
then perhaps a drill - or even worse..."You're not NERVOUS at all, ARE YOU?" he suddenly
asks...
If you do the math, the actual dose of epi. you might expect at the dentist is quite small
as compared to a typical therapeutic or 'rescue dose' given for life-threatening allergic
reaction:
That would be 3mg epi. in a standard concentration: 1:1,000 = 0.1% concentration x 0.3ml
(needed volume) = 3mg (required dose)

Compare to epi from the dentist:
Bottle is labeled
"Lidocaine with epinephrine 1:100,000 parts. 0.01% solution."
...which makes the epi actually 1 part in 10 million.
1 dental cartridge = 1ml; given typical dose 3ml = 10X volume BUT 1/1000 the concentration
-- it still gives only 1/100th of a dose -- or 1% of a dose, or 0.03mg compared to 3mg.
Even so, how remarkable that some people are able to 'key in' on that small sensation; that
'jump' in arousal that was keyed by the pain, the anxiety, the needle, the situation -
whatever. When that happens it can potentially trigger a familiar upwards spiral of ever-
increasing arousal...
Frequently this is a kind of mini-panic attack - or even a full-blown one.
Yeah, but I wouldn't want lidocaine in my bloodstream either, as it's used in cardiac rescue if there are certain types of fast irregular heart beats to slow it down! So not all of the reactions here are just due to the epineprine, may also be the local itself.
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Old 07-18-2009, 08:55 AM
 
1,644 posts, read 2,746,277 times
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Quote:
Originally Posted by susan42 View Post
Yeah, but I wouldn't want lidocaine in my bloodstream either, as it's used in cardiac rescue if there are certain types of fast irregular heart beats to slow it down! So not all of the reactions here are just due to the epineprine, may also be the local itself.
I also wanted to add that epinephrine is a naturally ocurring substance that we produce when faced with fear as part of the "fight or flight" response.It increases heart rate and BP,concentrates blood supply to the vital organs and muscles away from peripheries,slows the digestive processes to prepare us to run or stay and fight.
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Old 07-18-2009, 02:10 PM
 
Location: NY
1,416 posts, read 3,282,119 times
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I can speak to this firsthand since I too cannot tolerate even the smallest amount of epinephrine or any other adrenergic (i.e., produces an adrenaline-like effect) medication. I even experience a reaction to pseudoephedrine which is the ingredient used in the majority of over-the-counter "non-drowsy" allergy/cold medications, because pseudoephedrine is also adrenergic. Therefore I can't take any of those.

I have vaso-vagal syncope which can have different triggers depending on the individual. My syncope is caused by an underlying medical condition which is a hypersensitivity of the tenth cranial nerve and although the more common triggers of syncope (fainting; see Vasovagal episode - Wikipedia, the free encyclopedia) don't bother me, my trigger is the sudden production of any amount of excess adrenaline -- which is why epinephrine, which produces the same effect as adrenaline but in a sudden rush rather than a more gradual buildup as happens in our bodies in most cases of stress, causes me to have a syncopal episode. That's why I can handle stressful situations as long as they don't happen suddenly with no warning. That particular cranial nerve of mine doesn't know the difference between a sudden adrenaline spike from an injection and one from, say, turning a corner and coming face to face with a dead body. It will react the same way and the syncopal mechanism is the same.

It took many years before one of my doctors had the sense to order the kind of tests that correctly diagnosed what I had. Ever since, I am extremely careful to specify that I must be given only straight Lidocaine (no epi) and that any other meds I am given cannot contain epi or anything that produces an adrenaline-type reaction. Even though it's always on my chart, I remind the doctor AND remind them again as they are literally reaching for the bottle and syringe (because habits are hard to break!).

Once the reaction starts, the only way to avoid it progressing to brief unconsciousness is to immediately have someone lift the feet ABOVE the head and keep them there until the episode is over and blood pressure/heart rate is back to normal. Sitting up or standing while in a syncope episode is the worst thing you can do; what you want is for the blood that has rushed to your stomach and feet to get back up to your brain and heart ASAP. If you're sitting or standing, gravity is working against you! Most people with VV syncope can feel it starting but there are some who pass right out almost instantly with no warning right after the med is administered; if you're one of them, best to ALWAYS have any procedure done lying down flat if possible (gravity again!). If not, then at least somewhat leaning back and always tell the doctor about the feet-higher-than-head thing beforehand... just in case.

susan42 is right about the fight-or-flight reactions but there are also other chemicals that are released by the adrenergic nerves. These include norepinephrine (aka noradrenaline) and dopamine. The reason that the allergy med Chlor-Trimeton (chlorpheniramine) makes people sleepy is that it interferes with the normal levels of norepinephrine in the body. The makers of Sudafed had the bright idea of including an adrenergic drug (pseudoephedrine) to counteract the norepinephrine-depressing effect of the antihistamine ingredient . To paraphrase Janis Joplin, "One med makes you sleepy, one med wakes you up" .... both working at the same time.

People such as myself who are supersensitive to adrenergics react way out of proportion to the "wake up" part of the combo, which is why I can't take anything that has a "non-drowsy" effect.

And nope, I can't drink anything that has caffeine in it either.

Anyway, if you've ever had an unpleasant reaction to standard novocaine, just make sure your dentist or doctor uses straight Lidocaine instead. And give them a heads-up. Nobody likes surprises.
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Old 07-18-2009, 04:47 PM
 
Location: Florida
6,271 posts, read 11,768,125 times
Reputation: 4517
thank you so much for such a detailed explanation. It will surely help others and I am grateful because it will definitely help my daughter!!!

Quote:
Originally Posted by totallyfrazzled View Post
I can speak to this firsthand since I too cannot tolerate even the smallest amount of epinephrine or any other adrenergic (i.e., produces an adrenaline-like effect) medication. I even experience a reaction to pseudoephedrine which is the ingredient used in the majority of over-the-counter "non-drowsy" allergy/cold medications, because pseudoephedrine is also adrenergic. Therefore I can't take any of those.

I have vaso-vagal syncope which can have different triggers depending on the individual. My syncope is caused by an underlying medical condition which is a hypersensitivity of the tenth cranial nerve and although the more common triggers of syncope (fainting; see Vasovagal episode - Wikipedia, the free encyclopedia) don't bother me, my trigger is the sudden production of any amount of excess adrenaline -- which is why epinephrine, which produces the same effect as adrenaline but in a sudden rush rather than a more gradual buildup as happens in our bodies in most cases of stress, causes me to have a syncopal episode. That's why I can handle stressful situations as long as they don't happen suddenly with no warning. That particular cranial nerve of mine doesn't know the difference between a sudden adrenaline spike from an injection and one from, say, turning a corner and coming face to face with a dead body. It will react the same way and the syncopal mechanism is the same.

It took many years before one of my doctors had the sense to order the kind of tests that correctly diagnosed what I had. Ever since, I am extremely careful to specify that I must be given only straight Lidocaine (no epi) and that any other meds I am given cannot contain epi or anything that produces an adrenaline-type reaction. Even though it's always on my chart, I remind the doctor AND remind them again as they are literally reaching for the bottle and syringe (because habits are hard to break!).

Once the reaction starts, the only way to avoid it progressing to brief unconsciousness is to immediately have someone lift the feet ABOVE the head and keep them there until the episode is over and blood pressure/heart rate is back to normal. Sitting up or standing while in a syncope episode is the worst thing you can do; what you want is for the blood that has rushed to your stomach and feet to get back up to your brain and heart ASAP. If you're sitting or standing, gravity is working against you! Most people with VV syncope can feel it starting but there are some who pass right out almost instantly with no warning right after the med is administered; if you're one of them, best to ALWAYS have any procedure done lying down flat if possible (gravity again!). If not, then at least somewhat leaning back and always tell the doctor about the feet-higher-than-head thing beforehand... just in case.

susan42 is right about the fight-or-flight reactions but there are also other chemicals that are released by the adrenergic nerves. These include norepinephrine (aka noradrenaline) and dopamine. The reason that the allergy med Chlor-Trimeton (chlorpheniramine) makes people sleepy is that it interferes with the normal levels of norepinephrine in the body. The makers of Sudafed had the bright idea of including an adrenergic drug (pseudoephedrine) to counteract the norepinephrine-depressing effect of the antihistamine ingredient . To paraphrase Janis Joplin, "One med makes you sleepy, one med wakes you up" .... both working at the same time.

People such as myself who are supersensitive to adrenergics react way out of proportion to the "wake up" part of the combo, which is why I can't take anything that has a "non-drowsy" effect.

And nope, I can't drink anything that has caffeine in it either.

Anyway, if you've ever had an unpleasant reaction to standard novocaine, just make sure your dentist or doctor uses straight Lidocaine instead. And give them a heads-up. Nobody likes surprises.
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Old 07-19-2009, 04:18 AM
 
Location: NJ
78 posts, read 221,621 times
Reputation: 25
Quote:
Originally Posted by findingmesomeday View Post
I have a standing "NO EPI" order on my dental chart. I'm prone to panic attacks and the epinephrene will put me over the edge every time. I've never had a problem with "no epi" novocaine on upper or lower jaw. It works equally as well. The reason the novocaine lasts longer in the lower jaw is that the dentist has to hit a major nerve that feeds the entire side of your face in order to numb the tooth. On the upper jaw, he/she can isolate the tooth--almost. That's why I end up with numb earlobes when I have my lower teeth worked on.
Thank God. I was treated last year for panic, anxiety and only depression when I have the anxiety no other time. I was on natural stuff and doing much better from it after 10 months of treatment from my doctor. Well, I had a cavity filled (I have to go back for 2 more). The novocaine lasted for 5 hours after the procedure!!!!! And the filling was done in 5 minutes!!!!! When it wore off that night I felt miserable, nauseous, yuck. And during it? I got depressed and anxious. I kept thinking, I thought this was gone, now it's happening again? I just felt so depressed and sad when I had it and my whole body wanted to explode, I was dizzy, etc. Then I posted on yahoo answers and was told the novocaine has epinephrine in it!! After I told the dentist what I had gone through with anxiety and she still gave me it! I will DEFINITELY get it without epi. for the next two. (My mom doesn't even use novocaine when she goes!)
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Old 07-19-2009, 04:24 AM
 
Location: NJ
78 posts, read 221,621 times
Reputation: 25
Quote:
Originally Posted by DreamWeavin View Post
ok, thanks for your input. And I believe you know what you're talking about. Having said that though--I just don't think it's anxiety. That's the problem--we don't know what it is. She's not the type person to get excited,anxious,afraid of medical procedures...............she said she was relaxed-he gave her the numbing med and left the room. Within a few moments she was feeling her chest tighten,feeling faint and nauseated.........
When she was in her early teens she had to see cardiologists due to her heart beating too fast. They never did determine the actual problem but put her on Topral, which regulated it. She took that for about 3 years until they had her wean herself off.
You're right though in that she needs to see or speak to a family physician and address the issue.
It's the epinephrine! It causes anxiety-like symptoms which you described above. Don't listen to anyone who tries to tell you it's not. They don't know much about anxiety!
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Old 07-19-2009, 04:27 AM
 
Location: NJ
78 posts, read 221,621 times
Reputation: 25
Quote:
Originally Posted by Elipar View Post
Sorry, didn't see your question until now. With any anesthetic administration, there's always a risk of paresthesia. It's extremely low. I can't tell you what it is off the top of my head though, but it's definitely less frequent than 1 in 100,000. When paresthesia occurs, it is usually temporary, coming back sometime within 6 months. Rarely it is permanent. You could also have altered sensations or hyper-sensation as well. Again, extremely rare stuff.

As was said earlier, epinephrine is produced by your own body, so you can't be allergic to it. You feel the effects of epinephrine if it is injected into the bloodstream, where it makes its way to your heart. Someone wrote that it should never happen. That's not true. Dentists should be careful, but to say it's completely avoidable is false. Whenever a needle is inserted, it should always be aspirated to check for blood. If it's negative, then the dentist will go ahead and push the anesthetic in. However, it's possible to get a false negative and inject it into a blood vessel.

What happens if you get epi into a blood vessel? Other than the reactions people have described, usually nothing of consequence. There have been studies where 10 times the epinephrine was injected directly into the blood stream. Most people felt the same reaction, but no one had any problems.

The bottom line is that epinephrine usage is safe in healthy persons, and fairly safe even in those with heart problems. The amount used in dentistry is very safe. The ideal is always to avoid injecting epinephrine in the bloodstream, but that's not always possible.

Anesthetic can last a short time to a long time, depending on which anesthetic is given and how it is administered. For those that are recommending Carbocaine and any non-epinephrine containing anesthetics, be aware that these have the shortest anesthesia times when injected near the tooth. They numb the tooth for approximately 15 minutes on the upper teeth. If you add epinephrine, it constricts the blood vessels so that the anesthetic stays put longer. In contrast, bupivacaine with epinephrine will keep your teeth numb for 90-120 minutes. If the dentist injects the anesthetic near the nerve (called a nerve block), the effects last much longer. If the dentist injects the anesthetic near the tooth it's called "infiltration" and usually doesn't last as long. The lower jaw bone is so dense that typically a nerve block is the only thing possible. Hence anesthesia typically lasts ~60 minutes. You can also get a nerve block on the upper teeth, but it's less common since injection near the tooth is much simpler to administer and works just as well.
I disagree. Mine lasted 5 hours. I was miserable. The procedure was over in a flash.
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Old 07-22-2009, 04:00 PM
 
1,644 posts, read 2,746,277 times
Reputation: 419
Quote:
Originally Posted by totallyfrazzled View Post
I can speak to this firsthand since I too cannot tolerate even the smallest amount of epinephrine or any other adrenergic (i.e., produces an adrenaline-like effect) medication. I even experience a reaction to pseudoephedrine which is the ingredient used in the majority of over-the-counter "non-drowsy" allergy/cold medications, because pseudoephedrine is also adrenergic. Therefore I can't take any of those.

I have vaso-vagal syncope which can have different triggers depending on the individual. My syncope is caused by an underlying medical condition which is a hypersensitivity of the tenth cranial nerve and although the more common triggers of syncope (fainting; see Vasovagal episode - Wikipedia, the free encyclopedia) don't bother me, my trigger is the sudden production of any amount of excess adrenaline -- which is why epinephrine, which produces the same effect as adrenaline but in a sudden rush rather than a more gradual buildup as happens in our bodies in most cases of stress, causes me to have a syncopal episode. That's why I can handle stressful situations as long as they don't happen suddenly with no warning. That particular cranial nerve of mine doesn't know the difference between a sudden adrenaline spike from an injection and one from, say, turning a corner and coming face to face with a dead body. It will react the same way and the syncopal mechanism is the same.

It took many years before one of my doctors had the sense to order the kind of tests that correctly diagnosed what I had. Ever since, I am extremely careful to specify that I must be given only straight Lidocaine (no epi) and that any other meds I am given cannot contain epi or anything that produces an adrenaline-type reaction. Even though it's always on my chart, I remind the doctor AND remind them again as they are literally reaching for the bottle and syringe (because habits are hard to break!).

Once the reaction starts, the only way to avoid it progressing to brief unconsciousness is to immediately have someone lift the feet ABOVE the head and keep them there until the episode is over and blood pressure/heart rate is back to normal. Sitting up or standing while in a syncope episode is the worst thing you can do; what you want is for the blood that has rushed to your stomach and feet to get back up to your brain and heart ASAP. If you're sitting or standing, gravity is working against you! Most people with VV syncope can feel it starting but there are some who pass right out almost instantly with no warning right after the med is administered; if you're one of them, best to ALWAYS have any procedure done lying down flat if possible (gravity again!). If not, then at least somewhat leaning back and always tell the doctor about the feet-higher-than-head thing beforehand... just in case.

susan42 is right about the fight-or-flight reactions but there are also other chemicals that are released by the adrenergic nerves. These include norepinephrine (aka noradrenaline) and dopamine. The reason that the allergy med Chlor-Trimeton (chlorpheniramine) makes people sleepy is that it interferes with the normal levels of norepinephrine in the body. The makers of Sudafed had the bright idea of including an adrenergic drug (pseudoephedrine) to counteract the norepinephrine-depressing effect of the antihistamine ingredient . To paraphrase Janis Joplin, "One med makes you sleepy, one med wakes you up" .... both working at the same time.

People such as myself who are supersensitive to adrenergics react way out of proportion to the "wake up" part of the combo, which is why I can't take anything that has a "non-drowsy" effect.

And nope, I can't drink anything that has caffeine in it either.

Anyway, if you've ever had an unpleasant reaction to standard novocaine, just make sure your dentist or doctor uses straight Lidocaine instead. And give them a heads-up. Nobody likes surprises.
And epinephrine, norepinephrine and dopamine are drugs that are used in critically ill to maintain or improve BP.
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Old 07-25-2009, 09:54 AM
 
Location: Somewhere in northern Alabama
11,100 posts, read 24,024,770 times
Reputation: 13156
I once had some work done at a dental school, had the dentist hit the vein accidentally, and had the epi reaction. I totally freaked him out because I was so calm about it (it didn't hurt that I had been reading a tome on Zen Buddhism that I happened to have brought in) . I just sat there and waited it out. I seriously do not like the way adrenalin (even my own) works in me, and avoid situations where it can get generated. The dentist became my regular dentist for a number of years, and whenever he would see me he would go "no epi. I know."

Can't generally do the psuedoepi either. I was very thankful when before one operation the nurse told me to pee beforehand, since until it works out of my system I don't go.

It all goes to show that everyone reacts differently.
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