Articaine/surgical grade numbing and amitriptyline??

[nikki06]

Hi,

I have had to find a new dentist as I cant keep up with the private costs.. and Ive lost trust because theyve took advance payment for something, that they wont refund..
I digress.. Anyway, Ive not yet had any actual treatment with my new NHS dentist, the private dentist had planned some fillings but the NHS dentist said to keep a watch on the offending teeth instead.. Im not yet sure if the private one wanted to be thorough or if the NHS one is reluctant, due to costs or something! Who knows!
Anyway, at my checkup she asked if there was anything she should know, I mentioned that I had trouble getting numb so the last dentist had to use a surgical grade anesthetic which was Articaine.. she said they didnt stock anything surgical grade and had to order those in - which immediately prompted me to worry what Id have to do in an emergency when I couldnt wait for the order to come in!??

However, Ive since been put on Amitryptline 50mg for pain.. It states not to be used with anesthetic? Ive looked into it and its because of the epinephrine in the anesthetic, I believe Articaine contains that - so thats something else for me to worry about!

During the last 2 times of anesthetic injections (2 separate occasions, 1st with Lidocaine, 2nd with articaine) my face swelled up, my heart was racing both times and I just felt lightheaded/faint. I already suffer from panic attacks, so who knows what was what, the anesthetic or me.. but feeling and seeing my face swelling def set off my panic!
I already have ectopic beats in my heart, that coupled with the panic; the fear of my reaction to the anesthetic again, the worry she wont have strong enough numbing injections, and now the fear of how my body will react because Im on medication!

I have one tooth that keeps hurting off and on, and now it appears I have chipped a tooth or have a loose filling or something on the 'good side' of my mouth because I feel a sharp pain when chewing. Im just sick of my teeth, no matter what I do they keep paining every so often.


Is there a name of some injections I could look into/ask for? I dont want to get fobbed of with something that wont get me properly numb, or go in with no knowledge and find out it could react with my tablets (Ive already had a GP tell me I could take something with my tablets, Ive since found that out infact you shouldnt take the two together, so Id like to prepare!)

If anyone could help, that would be great

 

[Gordon]

Oh boy... this is going to be a long answer

1) Articaine is nothing special. Your dentist has been spinning you a line. It may be slightly more effective than lidocaine at diffusing through tissues but there's nothing magical or "surgical grade" about it, that's a load of rubbish.
2) You're quite right, you shouldn't mix amitriptyline with local anaesthetic containing epi if you can possibly avoid it. It's easy enough to avoid, you need a local called "Citanest 4% Plain". It's not life threatening or anything to mix the two, but best avoided since it's easy enough to use non-epi local.
3) Your new dentist should be able to get this easily, all the dental suppliers stock it.
4) Pretty much any local anaesthetic properly placed will get you numb.

 

[nikki06]

Thank you for your answer, thats really helpful. Interesting that its not 'Surgical grade' because he said it was, more than once!
I'll make a note of that anesthetic you mentioned too, thank you again

Sorry to bother you with another (possibly silly) question.. But that 4% one, it that something my NHS dentist is likely to have do you think? I dont know if its an expensive one or something..? its just that she made it sound as though they only carry one type?! Obv you dont know whats in stock so to speak, because you're not my dentist (hence the possibility of it being a silly question!)
..I could just call and ask my dentist, but Id rather hide somewhere and ask here instead!

Thanks

 

[Gordon]

It's not a silly question, it's a perfectly reasonable one. I would hope that your dentist carries it in stock, it's just good practice to carry a few different types of local so as to select the best one for the purpose. Even if your dentist doesn't have it, most dental suppliers can deliver within 48 hrs these days. Even up here in the Highlands

 

[nikki06]

Hi Gordon..

I hope I can ask you another question please?

My Dentist said I should ask my GP if its ok to have 'Scandonest Mepicavaine - no vasoconstrictor' or 'Octoppressin - no adrenaline' with my Amitriptyline. Id rather ask you, I'm not sure my GP will have any idea about dental numbing?!

Thats how its written on the card she gave me. She said she wasn't sure why I wasn't supposed to have Articaine as that's the one she wanted to try.

I'm having a tooth removed.. So obviously I want to be totally numb.. I'm petrified after the previous 2 times of not getting numb, and not to mention how scared I am about the effects of any anesthetic because I'm on medication, I've only ever taken regular medication twice in my life (I hate taking pills!).

Thank you.

 

[comfortdentist]

Here's my take:
First everything that Gordon said is right and secondly I don't like the fact that your dentist is asking your physician if he can give you mepivacaine. What is wrong with your dentist? The dentist should know if you can have any drug that is within the practice of dentistry. It is appropriate for your dentist to consult on your medical and even mental health condition. It is appropriate for the dentist to discuss the level of surgery and stress involved with a given procedure if the dentist chooses to but ultimately the dentist is responsible for drug selection and patient evaluation.
This is the same if the patient on on blood thinners. The question is not to stop a medication or not. The question that dentist needs to know is what drug(s) the patient is on and perhaps get an updated INR level.
Here in the states at least dentists have the title doctor and are expected to act like one.

 

[Gordon]

What he said!

Just for clarity, the problem with your Amitryptiline is epinephrine. Since neither of those 2 locals contains epinephrine, or adrenaline as it used to be called in the UK, then it's going to be OK to use them, I'm a bit disappointed in your dentist, please tell me they didn't train in Scotland

 

[nikki06]

I *think* she was on the right track, it was me that had my wires crossed.. she was right in saying 'Its probably the epi thats the problem' because I had my wires crossed thinking I couldn't have any caine injections (if that makes any sense?!). I would rather she told me though, instead of her initially asking why I couldnt have the two together..
It was my fiance that first bought up my medication/anesthetic worry, because even though its one of my main concerns, oddly, it completely slipped my mind when I was in the chair and Id not mentioned it! Thankfully he bought up that I was worried and spoke of my medication and the caine problem, then I added my bit, so she was yet to speak at that point.. She ended up looking a bit confused (which Im used to because I have the knack of making little sense at the best of times!), she then asked why I couldn't have them together.. Anyway, Im hoping I threw her a bit and she was being polite, rather than not really knowing (until 5 mins later when the penny seemed to drop)!

Gordon I re-read your initial reply, and the clarification.. Thank you, I understand now

Shes probably the 4th dentist Ive tried and Im praying its the right thing to do by seeing her.. She seems nice enough and for once I dont feel rushed, so thats a plus. I don't think Ive had a truly sympathetic dentist yet and Im almost resigning myself to the fact I wont get one, and instead I just want to get it all over with.. not that I will put up with being treated badly, but Ive certainly lowered my expectations. Im sick of my teeth ruling my life, its a daily thing where I have niggles or pains, Ive just had enough and its making me miserable, I want it all to be over.

Thank you again for taking the time to reply, I do appreciate it.

 

[nikki06]

Oh, and she may have also wanted me to check with my GP because I also mentioned my low blood pressure and irregular heartbeat.. So that, coupled with my babbling about the caines she probably just wanted me to check I wouldn't drop dead with a heart problem perhaps (or get rid of me because I was talking rubbish lol)!?
Maybe the point remains that she should be the one to talk to my GP, but even my GP has been known to give me medication with lactose in (I cant tolerate it), and the other GP at the surgery has given my partner medications that shouldn't have been mixed (the pharmacist was the one who picked up on it), so Im used to having little faith in the medical professionals I see and I try to cover myself instead! I just need a real-live Gordon in my life and Id be ok then!

 

[Gordon]

You need a real live grumpy old git in your life? I hope not!

 

[nikki06]

Well my extraction was meant to be today, she gave me two lots of Citanest(?) and it didn't work!

She did a cleaning on my teeth.. on both sides I should add, when at the last appointment im sure we agreed on only one side at a time (as I need a tooth extracting in the other side too. So it was supposed to be a cleaning on one side including an extraction, then same again next time on the other side). The cleaning hurt and made me bleed, maybe that's normal, she said last time my gums are sensitive. I have two teeth that are deeply filled and cold hurts on them so the water made them hurt to be cleaned..then there's the ones that are decayed and meant to be coming out and they obv hurt too.. As it hurt all over and I was flinching it seemed to be to be a bit rushed. the assistant began leaving water to mount up in my throat it was just pretty unpleasant. Since the numbing wore off my tongue I was able to feel there's still plaque on the inside of the lower teeth, but again, as it felt rushed I'm not surprised.. Maybe it wasn't rushed and that's the length of time it's supposed to take, it's been over 10 years since I last had a scale and polish so I can't remember, it just felt like a quick skim over my teeth that's all.

Anyway, I digress.. The numbing injections both prior to and after my cleaning didn't work. I felt a shooting pain up my cheek with the first injections, they were painful in the roof of my mouth too.. after the cleaning was done she gave me the second lot and at that point sent me out to wait.. So I sat in the waiting room still feeling pretty lightheaded and nauseous (I took my fiancé with me so at least I had someone there).
My appointment was at 11.30 and at 1.30 I was called back in (after my 2nd wait).. So obv time was an issue. as i was waiting for the numbing to work there was another two people waiting and they were seen before me, so when i was called back in I could feel it was wearing off anyway!
Is it supposed to make you feel sick? Apparently she said to eat beforehand because it makes you feel sick.. I didn't hear this, my fiancé says he heard her say it at my last appointment.. Having him tell me that only compounded my fears and has put me off having anything stronger because that's sure to make me feel even sicker, right?

So the outcome is that I'm being 'referred to an oral surgeon as he will have the stronger anaesthetics'.. And this could take anything up to 2 months.

As I was leaving she handed me My dental plan, it consists of these two extractions and that's it. I mentioned the black dot on a back tooth, and at the last appointment I mentioned two recent deep fillings that hurt to chew on.. but there was no mention of these teeth, just another 'wait and see' 6 month check up. Why does it all have to be such hard work to be heard!? Is it normal to keep having to repeat yourself? Tbh by the end I just wanted to get out of there so I just signed it so I could go!
Don't get me wrong, she seems like a nice woman, out of the 3 or 4 Nhs dentists I've seen over the last 18 months she seems the best, but its almost as though all of them want to get away with doing as little as possible, yet all of them have said how bad my teeth are/too many fillings for my age!


Seriously though, what do I do in the future should there be an emergency where a tooth pain keeps me awake, will I have to be be referred every single time!? do I just endure sleepless nights while referrals are made!?? My fiancé spent the whole of 2012 in pain, popping codeine like smarties because he was waiting on his hospital referral (due to gagging).
She said 'its strong painkillers until you can be seen' I've already told her that I can't take anything stronger that paracetamol due to my medication.

This is the 3rd dentist that has struggled to get me numb. The first one carried on anyway, luckily a private dentist managed it second time around with trying a different injection - but with my new medication that anaesthetic he used won't be suitable now! I feel lost (and pretty fed up if I'm honest).

If anyone is handing out free cuddles, I'll take two please!

 

[brit]

This is the 3rd dentist that has struggled to get me numb. The first one carried on anyway, luckily a private dentist managed it second time around with trying a different injection - but with my new medication that anaesthetic he used won't be suitable now! I feel lost (and pretty fed up if I'm honest).

I don't think it is the LA type so much that is the issue here (any dentist can get the epi free stuff), it is the skill of the dentist in placing the anaesthetic and I think your best bet is to return to dentist 2 tbh.
Your clean sounds like an inadequate NHS clean but given that you were in pain and the local didn't work, that was probably just as well; but you are right, you need a dentist with the skill to get you numb and not to have to rely on being referred to the hospital. From what you said that means you would have to economise somewhere else to make private dentistry one of your 'priority areas'.
I would suggest it may be worth doing this given the numbing issue.
Best of luck, you must feel very miffed. I have removed her from the recommendations as she caused you lots of pain and removed her actual details as stated in your first post.

 

[nikki06]

Thank you for your reply, I'm sorry I haven't responded sooner.. I just find it all thoroughly depressing tbh, I tend to try and ignore it all, that way I won't feel like crying (like I am doing now)!

So far I've tried.. mr MTV dentist - who was more interested in the telly than what I was saying.. I didn't go back despite paying out for an initial consultation etc, so £18 odd paid there for nothing.

Mr carry on regardless - who couldn't seem to accept I was in pain - another £50 + spent there. Needless to say I didn't go back seeing as he ignored me. The tooth he filled has began to cause me more pain recently.

Mr private dentist - who was nice enough and manged to get me numb second time around.. But what I didn't like was their lack of understanding when I was ill. They charged me for missing two cleaning appointments - despite my requests to wait for cleaning/scaling etc until my teeth were free of pain, the receptionist kept insisting on booking it and so I caved in, trusted her judgment and booked it (but judging by how painful the recent cleaning was, I was probably right to try and wait for one). But yeah.. I can appreciate you have to pay when you miss an appointment, but I honestly couldn't give 48 hours notice as I was poorly both times and my body didn't give me 48hrs notice! On one of the cancellations I kept my prescription details just to prove I wasn't fibbing and just chickening out (in case they assumed I may be trying to back out due to the fact id previously said I didn't want a cleaning yet). I did end up at the doctors due to stomach pain, and i wasnt not giving 48hr notice just to be awkward! I had a rough time for a while, none of it was helped by them pestering me every week for 6 weeks for the £80 for a missed appointment, I was just doing school runs as everything else was too much, I couldn't face the hour drive there and back.. Yet all this seemed to fall on deaf ears and after the final letter (by recorded post) they sent me, I sent them a cheque so I could feel less like a criminal! Going back there makes me feel really uncomfortable because of that tbh.. I wasn't trying to get out of paying! It was my Christmas money I was spending, ie I had it put aside.
So £450-£500 spent there for a missed cleaning, three fillings, one white one on a front tooth that's ok and the two deep ones that appear to be failing as my teeth still hurt.

Then there's this dentist.. Barely anything done and yet another £50 spent. I know people spend thousands when they can't afford it, I've not spent that much in comparison I guess.. but its all of it, from the money, time, all sorts.. I've nothing to show for it, Im still in pain, i have no dental plan taking all issues into consideration.. it all feels like its been for nothing, im still in pain and still miserable.
I feel like I'm going to be on the lookout for yet another dentist..I can't even face mentioning another private dentist to my fiancé after all he's helped with. I just want one nice Nhs dentist, one who wants to address all my problems, not fob me off with 6 monthly wait and watch check ups, one who can assure me I won't be in any pain and one who can see how miserable I am and want to help.
It's like I'm trying to push through this anxiety and I just feel that little bit worse each time.. Not to mention it spoiling my time with my family because im a miserable cow..I'm sure my fiancé will begin to hate me soon, I'm hardly fun to be around ATM!

I'm still waiting for the referral, I've not heard anything since.. But presumably when it finally arrives he will only address the 2 teeth she's looked at - she had nothing but a wait and watch approach for the rest. I guess it's my own fault for having problems in all four quadrants, no wonder the dentists don't want to know, there's too much going on.


Anyway, thank you again for replying. I'm sorry I wrote too much about her details and the recommendation (I don't remember what, if anything I wrote in that thread, it's all become a bit of a blur!), thank you for removing/editing etc.
Sorry for waffling too, I have no one else to talk to.


Nikki.

 

[carole]

In brits absence at the moment I hope she doesn't mind me answering for her on the issue of you thinking that you put too much information of the dentist you visited. I am sure she removed details of that dentist because if someone on here decided to try and got the same treatment it would just cause them to be miserable and maybe be left as you are.

You have done nothing wrong. If finding the money for private treatment is proving too much, there are nhs denitsts around that are very good. I don't know what area you are in but if there aren't any on the find a dentist section on here, have a look on the nhs site, contact all the dentists that say they do nhs whether or not they are saying that they are accepting new patients. Sometimes they have a list you can go on and when it is your turn they contact you and let you know. Also you could ring around and ask if they are taking new patients on and ask if they aren't at the moment if they would mind if you kept trying every now and again.

I am nhs and have managed with a bit of trouble to find a good understanding dentist, it may take a bit of time but once you start you will be nearer than you are now to finding a dentist.

Is there a dental school you could ring also, sometimes they take patients on.

I would feel as rotten as you do in your circumstances, it isn't your fault and you did really well to get treatment after such a bad experience.

If it is too much for you to contact them by phone, you can e mail dentists and explain how you have on here how you feel and what has happened to you and what it is you fear the most. A good dentist and there are a lot out there, will listen and help you get the treatment you may need to get you out of the pain you are in at the moment.

Let us know how you get on Good luck

I know it is really hard at the moment for you but don't give up, try and find a considerate dentist and don't let the staff bully you into things you don't want. YOU ARE IN CONTROL of what happens at appointments they need your consent to even look in your mouth, do things at a pace that you can cope with.

 

[nikki06]

Thank you for replying

I decided to try a new one, this time its the dentist that I've been referred to. It seems pointless making further appointments at the last dentist if she can't get me numb, she didn't seem to offer up any info on future work and being unable to get numb, so I'm assuming each time would be a referral..? So I figured it might be worth joining the dental practise that I've been referred to, in the hopes they would be able to treat me on a permanant basis because in the words of the last dentist 'they carry different numbing injections for complicated extractions'.. But when I told the referral dentist this she just looked as if to say 'yeah right..!' So i think ive been given false information, but at this point I just can't be bothered to chase it up and ask her why she said it, my partner and I both agree that in the end she appeared to just want to be rid of me!
I feel, as an initial impression anyway, that this new dentist seems nice. She actually reminded me of a dentist I was seeing years ago before I moved, her looks and manner seems the same as her.. In a weird way that's a big comfort.

She did tell me (after chasing up my referral over the phone) that the papers were sent on the 21st feb, keeping in mind my failed appointment of the extractions was on the 25th jan they've definitely not rushed!

I had a filling with this new dentist a few days ago. It was on the back tooth - the one I mentioned to the previous dentist who told me to mention it at the referral (even though she didn't write this down on my referral notes) she then said see me in 6 months about it.......? Anyway(!) at least this dentist spotted the black mark herself without needing to be told about it. In her words she wanted to 'address it now so it doesn't get to the point of the other teeth' ie needing deep fillings. She said I didn't need to be numb as it wasn't near the nerve and shouldn't hurt, but she did say that if I did feel anything that I was to put up my hand and she would stop.. something no one else has said to me. So she started drilling and I did feel a little something, a sharp pain but I could bear it (just), however I did clench my hand in anticipation that if it got any worse it would be going up! Well she must've noticed me clench and she stopped, took a look, said shed drilled enough and she filled it. That was it, done!

I have to see someone else for my referral which is disappointing as she seems so nice (she was also an hour or more behind but she still gave me time), but the referral guy (oral surgeon?) deals with complicated extractions etc. Either way I'm hoping it will hurry up as one of the teeth are hurting on an almost constant level now and there's some real sharp pains coming here and there.

I just hope that I'm able to get numb.. Or else I assume I will be in for another wait to be referred for a general!



I do have one question if that's ok? I wonder if the amitryptlene could be the cause of me being unable to get numb? On one hand I couldn't get numb even before I was on that medication, but I just wonder if now its because they both work on nerve pain.. could they be cancelling each other out meaning I'm still feeling pain?

Thank you

 

[brit]

Hi Nikki
I am so sorry to hear you are still struggling with this dental stuff. Carole was correct, it is fine for you to give details of dentist - but I removed them as I don't want others going there, to have to endure painful cleans.

TBH I am not very impressed with this new dentist either.....she said your filling didn't need local and then hurt you to do it . At least she gave you a stop signal but that's only any good if they do stop and/or if they then know they need to numb you more/rethink and not just carry on.

I am angry on your behalf as well. Sorry but can't answer the drug question but have bolded it in the hope Gordon will see it.
My amateurish guess though would be that if you always had issues with numbing that probably your nerves are slightly differently placed (anatomic variation). You need a dentist who knows a bit about advanced local anaesthesia techniques rather than someone just relying on the basics. It is a shame about the private dentist who did get you numb but who chased you for the broken appointment fee. You were unlucky there as i.m.e. re the 48 hour cancellation private dentists who want to retain you as a patient will waive it if you are ill or if there is a snowstorm or whatever...it would be unreasonable not to and cutting off their nose to spite their face. Having said that I would also cheerfully pay up to stay with a dentist I liked as they do lose business if you no show for whatever reason.
You could maybe go back there as your issue was with the receptionist and the dentist may be completely unaware that it happened i.y.s.w.i.m..
It is impossible to be relaxed about dentistry if you cannot get numb...so this really does need to be your priority.
Good luck.

 

[Gordon]

No, the amitriptyline won't have any effect on your ability to get numb (could you ask your GP to prescribe something with a shorter name please? )

 

[brit]

No, the amitriptyline won't have any effect on your ability to get numb (could you ask your GP to prescribe something with a shorter name please? )

So I think Nikki the problem is that the LA isn't being injected into the right place...not that the numbing won't work on you.

 

[nikki06]

No, the amitriptyline won't have any effect on your ability to get numb (could you ask your GP to prescribe something with a shorter name please? )

I'm with you on that! Or at least one that I can spell properly (without googling first!)

 

[nikki06]

So I think Nikki the problem is that the LA isn't being injected into the right place...not that the numbing won't work on you.

It just seems odd that 8 (ish) years ago when I was having treatment I had no problems getting numb.. I saw one dentist who began work and then a second to correct that initial work (ie fillings joined over teeth), so up until that point no problems (That 2nd dentist turned out to be a god send but she left to go private miles away and I moved counties). But cut to recent years and I'm really struggling, surely nothing anatomical in your mouth changes in your thirties?? I know things on the outside aren't where they were when I was 21(!), but changes in the position of my nerves etc!? I dunno, I'd have thought it would be something to do with the fact I'm so highly strung over the last few years.. Panic and I are best friends now plus I'm a dab hand at mentally scanning and noting any pains etc in my body!


I'm *still* waiting for my referral, everyday I get my hopes up that the letter drops through but it never does.. Then every Friday I get into a mild panic that the ache will turn into something bigger over the weekend when no one is around.. And here we are, bank holiday weekend and I'm experiencing a bigger pain than usual, brilliant. I have everything crossed that this all holds out even longer, but I do fear I'll just end up with this other guy being unable to get me numb too, then have him give up on me as well, resulting in a further wait for a referral to get a hospital general anaesthetic! I really don't want to be held hostage at a private dentist, the fees are just crazy.. It's not like I can cut back on drinking/smoking/going out when I don't do any of that in the first place, not even holidays! But as I stuck out 2012 with my partner - watching him being passed from pillar to post, endless paperwork and being passed around/dismissed I know only too well how some NHS dentists don't want to know when youre not a straight forward case.. Which is partly why I feel so miserable about it, despite my best efforts there's still not a proper plan in place to get me pain free

I officially hate my teeth!


On another note, although still on the medication route.. Gordon, is there anything I can do about the dry mouth situation. I know it's bad to have a dry mouth as far as your teeth are concerned. During the day it's not so bad because I can drink etc, but what about during the night, is there anything I can do then to protect my teeth? 7hours of dry mouth can't be doing me any favours? I have applied a bit of duraphat (sp) toothpaste as a kind of barrier but it seems like it quickly wears off and I'm left parched again!
(P.s if you fancy ripping this tooth out for me too I'll happily pay in endless amounts of cakes etc, im partial to a bit of baking and I'm sure that's an acceptable form of payment..! Well I can dream!)