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Terrified of Local anaesthetic side effects and drug interactions

S

silvercat

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Hi I have been told I need a crown on a right rear molar and it has got me so stressed and uptight im having panic attactks and can't sleep. I'm not actually scared of the dentist or the procedure, what I'm scared of is the local anaesthetic and any side effects or reactions I may have to it. I have very severe GAD and OCD and a phobia of taking new medications. I currently take fluoxetine 50mg per day, Proprananol 20mg sometimes 40mg per day, and valium 2.5mg per day but can take more if i need it.

I'm very bad for googling stuff when I'm told I need it and again it has sent me into panic mode. I have read that anyone on proprananol can't take Lidocaine with adrenalin in it as it can cause very high blood pressure and bradycardia. I know that before I get the Jag I will be nervous uptight and my heart rate will be elevated, so I'm very very worried about getting a local with adrenaline in it. My second fear is that of any occular side effects I have read online that there are a whole host of eye complications that can occur even people loosing their sight temporarily or permanently this has got me absolutely terrified.

I saw my dentist on Tuesday to have the crown prep done and never went through with it due to my dentist being very offhand, abrupt and not taking any time to calm my nerves or answer any questions about the procedure. Her attitude was I'm your dentisit I say you need this treatment so just get it done. She was actually offering to do the crown prep without numbing me up can this be done? I actuallly went to see my Girlfriend's dentist yesterday for a 2nd opinion and he agreed I needed the crown but he would not feel comfortable doing it without numbing me up. He aslo said that the Local with adrenaline in it was safe for me. Any advice will greatly appreciated as I reallly need it thanks
 
Gordon

Gordon

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As I already said in your other thread. Local with adrenaline is perfectly fine to use with propranolol, but there are plenty of adrenaline free locals you could have instead.

Eye problems following local are due to the local inadvertently freezing the facial nerve, usually because of a slight variation in the direction the facial nerve takes coming out of the skull. They are completely harmless (albeit scary!) and will wear off very quickly, normally less than 20 minutes. They are also extremely, extremely rare, I think I've seen it happen twice in 40 years practicing dentistry...
 
S

silvercat

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Jul 3, 2022
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Location
Edinburgh
@Gordon Thanks again for you your reply your advice is pricless in helping me with this current situation if you don't mind can I ask another couple of questions re proprananol as you know Ive been getting all my info online and most of what I read says Proprananol and adrenaline are a no go. Even the BNF website says that these two drugs have a severe interaction (which has really worried me) However what I can't find anywhere online is info about if this reaction is dose related or not. A lot of the info is referring to Cosmetic surgery procedures using larger amounts of local than a dentist would use and for longer periods (a lot of the cases are on much much higher daily doses for heart issues and migaines etc). I only take 20mg per day is this even enough to cause a interaction. I do suffer from ectopic heartbeats is this anything to worry about re the local. Also how much local is my dentist likely to need to use for the crown prep. As ive said this whole situation is driving me mad Im not scared of the detist or having drills etc in my mouth its the fear of having a panic attack or worse adverse reaction with the jag that is scaring me!!
 
Gordon

Gordon

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Sorry, had to go out for a bit. Neighbours got married on Thursday and are having a small party out back :)
Dental use of adrenaline is a very low dose, 1:80,000 concentration in 2ml of solution. Much less than your adrenal glands would produce.
For a lower molar crown prep I'd use 1 cartridge of 2ml of local, maybe a little less. Same as for a filling or whatever on the lower arch. Crowns don't need any more local than fillings btw.
Again, if it worries you that much, then adrenaline free local is perfectly acceptable as a substitute and all dentists should have some.
 
S

silvercat

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Jul 3, 2022
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Location
Edinburgh
Thanks I presume that an impacted wisdom tooth removal requires more local than a crown prep and is a far more painful procedure. I ask as this is the procedure I had done 26 years ago that triggered my fear of Locals and being numbed up. The whole experience was horrendous it took the dentist ages to get the tooth out he had to cut my gums with a scalpel. He ended up with one knee on my chest so he could get enough leverage to extract it.
 
Gordon

Gordon

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Yes, sort of. To remove a lower tooth you need to freeze up 2 nerves, the inferior dental nerve, which supplies sensations to the teeth themselves and the long buccal nerve, which supplies the gum around the cheek area. So you need to inject twice, usually using 1 2ml cartridge each time. If you're doing a crown you don't need to freeze the long buccal, so 1 cartridge will do it.
I've never been able to get my knee onto a patient's chest, I guess I'm just not that flexible. I also don't see why anyone would need to :)
 
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