Novocaine/Lidocaine and Epinephrine

[lisasg]

I had a bad experience about 10 years ago. My last experience with getting numb. It was horrible. I felt flushed, dizzy, rapid heart beat, full panic attack and almost fainted within 3 minutes of getting injected. Found out later it was from the Epinephrine used in the anesthetic. Now, I have to go back to the dentist, not the same one mind you. But I'm trying to do everything I can to avoid getting that anesthetic. I know there is an anesthetic without the Epinephrine but then that could allow my gums to bleed and only give short term numbness, which means more needles during the procedure. I guess, Idk....I'm terrified. I know those moments right after the injection, I'm going to imagine the worst and think its happening even when its not, if I get the Epinephrine-free anesthetic. How can I trust that my bad reaction before won't happen again? What if they make a mistake or forget? There is one dentist who will do the procedure with just the topical numbing gel. He said its my choice. Should I just grin and bear the pain ? Another dentist said she will just give 2 small injections around the tooth, not in the back nerve and we can see how it goes? But still...what if the Epinephrine -free anesthetic still gives me a bad reaction? I've talked to 3 different dentists who have all seen my xrays. I can't trust one. They all say something different. I have no pain right now. where I chipped my tooth 4 years ago, got a filling there just using topical numbing gel, and no drill....well, that filling came out a few weeks ago and now there is a hole and decay under the rest of the filling so it all needs to come out, get cleaned up and refilled. I have an appointment to get a porcelain onlay next week if I want it. I have so much anxiety over this. Help!! Thanks!!

 

[Gordon]

First of all, the reaction to the epinephrine is a normal response when it has been accidentally injected into a blood vessel. It's a bit (OK a LOT) scary but totally harmless. Despite everybody's best efforts, it happens occasionally. It doesn't mean it'll happen again.

Next, the local anaesthetics without epinephrine are just as effective as the ones with it and will not cause your gums to bleed. They do wear of a little bit faster, but we're talking a few minutes over the course of a couple of hours, nothing relevant to your treatment. If there's no epinephrine in the solution then it's pretty impossible that you'd get the same symptoms as last time.

I would be wary of doing the treatment without local. Statistically it doesn't work as well as treatment with local, so apart from being painful, it's likely to need done again more quickly. Doesn't seem a great idea to me...

 

[lisasg]

Thank you, Gordon!! I also just discovered the laser dentistry option. ONe of my old dentists works now at a practice that offers it and I have contacted her office, sent over my xrays and photos of the tooth, hoping they can let me know if I am a candidate for the laser without anesthetic. I'm really hoping my case will be appropriate for it. In the meantime, thank you for your candid explanation. I started reading studies from the NIH and getting myself really freaked out over the worse case scenarios. Statistically, still 1 in one million people do die from side effects of Lidocaine with Epinephrine. I always think I'll be that 1 person. Its horrible that I do this to myself, this type of thinking.

 

[Gordon]

Trouble with lasers is they are very very limited at what they can do, removing old fillings for instance is impossible for them, which is annoying as that's about the commonest restorative job in dentistry
Are you sure you're not getting confused with your stats? The deaths are down to being injected with topical lidocaine (hopefully!) by mistake, which is about 1000 times stronger than the stuff dentists use.

 

[lisasg]

All of my old fillings have been replaced with the tooth colored ones. I just need the chip/hole filled that popped out. So, they cant remove the tooth colored fillings with laser?
Whose been injecting people with the topical!?

 

[Gordon]

Nope, I don't think so.

Surgeons mostly going by the literature.

 

[lisasg]

Ok, but not dental surgeons?

Well, for what I need done, I was just told, can be accomplished without anesthesia or drills. So, woo hoo, I'm happy! I'll update after my procedure. Still somewhat nervous of course, but much more relieved.

 

[lisasg]

With the Solea Laser

 

[Gordon]

Not as far as I can make out.

That's good, looking forward to hearing how it goes and now I'm off to google that laser

 

[lisasg]

The procedure was a success. A filling without any anesthetics! However, once, I felt an ungodly awful sharp shooting pain the worst thing I ever felt in my life. It was quick though and she immediately stopped and said she would go slower. Then I didn't feel it again. Felt something much less a few moments later but it was very brief and she kept going. Prior to the procedure, you could see the pink pulp, I guess it was, down in the hole where the filling popped out. Was that the pulp? I imagine any water shooting it, in a pressurized stream, is going to be painful and it was . But again, just for a moment that made me jump. Then I told myself, if it happens again, grin and bear it! Thank god, it didn't happen again.

So, she prepared the hole where the filling had popped out but I had another much larger filling on the tooth as well and she was able to get under that and clean out the decay, all without anesthetics and just the laser. She did have to use the drill to file the new filling down to fit my bite but it didn't take long and it did hurt. I just dont like the sound Oh and she had to use these things to spread my 2 teeth apart and fit a band so the filling didn't reach the other tooth next to it. She numbed the gums first with the topical stuff and it was fine. When I got home and took a bite of a sandwhich, that shooting pain happened again. She said I would feel that for a few weeks! a few weeks?! Why? Can you explain that Gordon? Is it because the weight of the filling is being pressed down on the nerves, when I bite down? Thanks!


I have a cavity on my back wisdom tooth, on the surface, thats deep she said. She said, I will have to get numb for that one. She explained the Epinephrine thing and will use the one without it.
I think a huge part of the fear is not feeling comfortable with your dentist. My advice is to find a sweet, mild mannered person who isn't all about trying to sell you something.
I would recommend the laser for minor things, like mine was surprisingly. She said she will still use the laser on my next filling, but I will need to get numb.

 

[Gordon]

Thank you very much for the follow up.
The biting thing is I suspect the result of the thing that spreads your teeth apart, puts a bit of strain on the periodontal ligaments that support the tooth in the jaw.
It's a necessary evil if you're doing composite fillings as otherwise you can't get good contact between the teeth.

 

[lisasg]

Ok, thank you, Gordon!

 

[lisasg]

She did have to use the drill to file the new filling down to fit my bite but it didn't take long and it did hurt.

I meant to say, it did NOT hurt.