Use of Plain Mepivicaine or Prilocaine for lower non-impacted wisdom tooth extraction

[cober6711]

Use of Plain Mepivicaine or Prilocaine for lower non-impacted wisdom tooth extraction

Hello,

I want to know if using plain Mepivicaine or Prilocaine will provide sufficient numbing power to complete a lower (fully erupted) wisdom tooth extraction, assuming someone is also having nitrous oxide.

I've had plenty of fillings done with these and have had no issues, even on top teeth.

I would prefer not to use something with epinephrine for various reasons.

I was watching a video by Dr. Jerry Gordon where he was completing a very similar case using (what appeared to be) a block on the lower jaw using Lidocaine and then he injected around the tooth with Articaine.

Say I was to ask for Mepivicaine to be used for the block (which is what my dentist usually uses on my lower jaw) and once the block takes effect to inject either Prilocaine or more Mepivicaine around the tooth...would that work well enough?

Any advice would be appreciated.

 

[comfortdentist]

Re: Use of Plain Mepivicaine or Prilocaine for lower non-impacted wisdom tooth extraction

sure its possible but I wouldn't use prilocain but why?

 

[cober6711]

Re: Use of Plain Mepivicaine or Prilocaine for lower non-impacted wisdom tooth extraction

sure its possible but I wouldn't use prilocain but why?

I always say 'no adrenaline please' for several reasons:

1. I once had a reaction to Lidocaine with 100,000 epi where I felt absolutely HORRIBLE for the rest of the day...this included nausea and just feeling like crap! When plain Mepivicaine or Prilocaine are used I don't get this feeling. I believe it might be the preservatives in the Lidocaine, whereas the latter don't have preservatives.

2. I would rather not have a block that leaves my face frozen for 5 hours after the procedure. I have found that Mepivicaine lasts about 3 hours afterwards when used for a lower block, which is certainly a lot better.

3. I won't have a racing heart following the injection (and trust me, it's not the needle that causes the racing heart seeing as my dentist uses The Wand on fearful patients like myself...and I don't mind it at all).

BTW what's the issue with Prilocaine? I've never had an issue with it. My dentist uses it when working on the top teeth and lasts just long enough to do a quick filling or two.

 

[decan]

Re: Use of Plain Mepivicaine or Prilocaine for lower non-impacted wisdom tooth extraction

BTW what's the issue with Prilocaine? I've never had an issue with it. My dentist uses it when working on the top teeth and lasts just long enough to do a quick filling or two.

In a small % of patients prilocaine has been associated with an increased risk of methemoglobinemia.

 

[cober6711]

Re: Use of Plain Mepivicaine or Prilocaine for lower non-impacted wisdom tooth extraction

In a small % of patients prilocaine has been associated with an increased risk of methemoglobinemia.

Interesting...

Now what do you do when you have a patient needing an extraction that can't have epinephrine?

Do you find that injecting around the tooth after the block sets helps at all?

 

[decan]

Re: Use of Plain Mepivicaine or Prilocaine for lower non-impacted wisdom tooth extraction

Now what do you do when you have a patient needing an extraction that can't have epinephrine?

3% Mepivicaine...although a true allergy to epinephrine is incredibly rare.

Do you find that injecting around the tooth after the block sets helps at all?

While the guys here have WAY more experience than me, when doing extractions I almost always give a PDL block (injecting around the tooth) after I've already given a standard block. Works well unless a tooth is really infected.

 

[cober6711]

Re: Use of Plain Mepivicaine or Prilocaine for lower non-impacted wisdom tooth extraction

3% Mepivicaine...although a true allergy to epinephrine is incredibly rare.

While the guys here have WAY more experience than me, when doing extractions I almost always give a PDL block (injecting around the tooth) after I've already given a standard block. Works well unless a tooth is really infected.

I doubt I have an allergy to epinephrine...but perhaps a slight sensitivity to the preservatives if anything.

Thank goodness my tooth isn't infected (for now anyway). My dentist does have The Wand, so perhaps I will ask him to do this once the regular block has taken effect.

 

[cober6711]

Re: Use of Plain Mepivicaine or Prilocaine for lower non-impacted wisdom tooth extraction

Oh yes...

Is there actually a difference in the effectiveness of various solutions when used for blocks (eg Mepivicaine vs. Lidocaine and Lidocaine vs. Articaine) or are they all the same except they last for different amounts of time?

 

[decan]

Re: Use of Plain Mepivicaine or Prilocaine for lower non-impacted wisdom tooth extraction

The major differences lie in the concentration of drugs, duration of action, and onset of action. For example, a 4% solution of articaine has ~72 mg of drug/carpule and is more potent than 2% lidocaine (36 mg drug/carpule) or 3% mepivacaine (54 mg drug/carpule). Articaine also starts working faster than either. Mepivacaine only has SLIGHT vasodilation properties when compared to lido without epi, which is why it is can be offered in a plain solution.

 

[comfortdentist]

Re: Use of Plain Mepivicaine or Prilocaine for lower non-impacted wisdom tooth extraction

In a small % of patients prilocaine has been associated with an increased risk of methemoglobinemia.

True and also is associated with a higher incidence of nerve damage like articain in the most recent study published this year

 

[decan]

Re: Use of Plain Mepivicaine or Prilocaine for lower non-impacted wisdom tooth extraction

True and also is associated with a higher incidence of nerve damage like articain in the most recent study published this year

Good to know...I hadn't heard that. Do you happen to remember the name of the article? I'd love to give it a read!

 

[comfortdentist]

Re: Use of Plain Mepivicaine or Prilocaine for lower non-impacted wisdom tooth extraction

I was afraid that someone would ask Sorry but it was a good article. I read a lot but only remember what I need to know.

 

[cober6711]

Re: Use of Plain Mepivicaine or Prilocaine for lower non-impacted wisdom tooth extraction

Thank you for answering this.

I had the tooth extracted yesterday using Mepivicaine plain and it worked well. Hardly felt any pressure (and most importantly no pain) and I didn't even know the tooth was out.

I think it took him 25 seconds to accomplish...

 

[comfortdentist]

Re: Use of Plain Mepivicaine or Prilocaine for lower non-impacted wisdom tooth extraction

nice to hear a typical story