1
Alternate Approaches to Dental Anesthetics
Jamie Anderson
Wayne State University
2
ABSTRACT
In the field of dentistry, there is a need for anesthetics for certain procedures.
There are three main types of dental anesthetics that include analgesics, local anesthetics,
and sedatives (general anesthetics). The most common type of dental anesthetics is local
anesthetics. Although anesthetics are very beneficial in a sense that they prevent the
sensation of pain during dental extraction or surgery by numbing the nerve, there are
certain consequences that affect patients. Anesthetics contain epinephrine that is the agent
that constricts blood vessels and decrease the chances of bleeding during surgery.
Epinephrine also reduces the amount of toxicity that is allowed to enter the body. This
agent may have positive effects but also has negative effects as well. Epinephrine can
cause anxiety attacks and the medicine used to preserve it may cause rashes. I will
explain alternative anesthetics and examine which is presently the best solution.
3
Anesthesia is the loss of sensation and usually of consciousness without loss of
vital functions artificially produced by the administration of one or more agents that
block the passage of pain impulses along nerve pathways to the brain
(www.merriamwebster.com). Dental anesthetics were first introduced in the 1840’s when
a doctor by the name of William Morton searched for a solution to the agonizing pain
associated with tooth extraction. Dr. Morton was familiar with Nitrous Oxide, but
continued his search for a stronger agent. When Dr. Charles T. Jackson suggested that he
use Ether to soothe his patients’ pain, Dr. Morton began experimenting with the solvent.
He started with his dog and then began to experiment on himself, and after he developed
a “comfort level” with using the substance he asked one of his patients’ if they would
allow him to try the new found anesthetic on them. On September 30, 1846, Eben Frost
walked into the dental office with a toothache that Dr. Morton treated with Ether
(dentistry.com/treatments). This would be the first documented use of anesthetic on a
patient for dental purposes and was quickly embraced by other dentists of that era.
Presently, there are many different agents within dental anesthetic other than Ether.
In dentistry, anesthetics are used for a number of reasons such as, relief for
dentures, braces, sores of the mouth, and before dental surgery procedures
(www.webmd.com/oral-health /medications). There are also many different methods of
anesthetic medicine used in dentistry. Some of these include “Anbesol, Chloraseptic,
Orajel, and Xylocaine” and come in various forms such as aerosol spray, gel, paste,
ointments, and lozenges (webmd.com/oral-health /medications). The three main types of
anesthesia used are analgesics, local anesthesia, and sedation and general anesthesia.
Analgesics are drugs such as aspirin, ibuprofen, and acetaminophen. These drugs are
4
given to patients for minor irritations such as toothaches or pain after a dental procedure.
(dentistry.com/treatments)
Without the use of anesthetics in dentistry, patients suffering from certain painful
conditions would simply have to endure the discomfort. Also, dental surgery would be
close to impossible if not for the numbing agents within anesthetic medicine. Therefore,
anesthesia is often viewed as a positive and successful method of averting pain.
According to the British Dental Journal, it is found that patients actually prefer local
anesthetics to sedatives. Local anesthetics numb only a small portion of the body, while
sedatives (general anesthetics) numb the body as a whole i.e. Nitrous Oxide or Valium.
Local anesthetics are given by either injection or swabbing painful the area. The most
commonly used injected anesthetic is Novocain. “This medicine works by blocking the
nerves that sense or transmit pain and numbing mouth tissues”(dentistry.com/treatments).
Sedatives can be administered by inhalation or injection. Sedatives leave patients feeling
weak because the medicine takes its course throughout the entire body as oppose to the
one region in which the pain occurs. For example, local anesthetics are injected into the
mouth in order to numb only the surrounding tissue before the removal of any teeth.
Although, in many instances, people avoid making trips to the dentist altogether
for fear of anesthetic, it is found that most patients are more comfortable with the use of
local anesthetic than the use of sedatives to remove a single tooth (Chetan, 2009). It is
found that local anesthetics often times reduce anxiety of the patient because he/she can
be awake for an entire dental procedure and not feel the pain and irritation he/she expects
to feel (Chetan, 2009). While this particular anesthetic is favored over sedation and does
have very beneficial effects, some patients simply cannot withstand certain additives that
5
these anesthetics contain. Cases of allergic reaction to dental anesthetics have been
revealed. Worldwide, there have not been many cases regarding allergic reaction to
dental anesthetic, but cases none the less. Although according to Dr. David Cotrell,
chairman of the department of oral and maxillofacial surgery at Boston University School
of Medicine, “people with uncontrolled high blood pressure, those taking trycyclic
antidepressants, and those with atrial fibrillation, should not receive anesthetic containing
epinephrine (Foreman, 2009). Most symptoms include skin rashes and temporary itching
after the injection has been administered. So what exactly causes this allergy? Well local
anesthetics are composed of two main active ingredients: the actual anesthetic (i.e.
lidocaine, novocaine) and epinephrine.
Patients who suffer from these allergic reactions are not in fact allergic to the
“caine” portion of the anesthetic or the epinephrine, but the added preservatives. It is in
fact impossible to be allergic to epinephrine because our bodies make it all the time. So
why are preservatives added to anesthetic in the first place? Well, additives, which
include sodium bisulfite or metabisulfite, have to preserve the epinephrine within the
numbing treatment so that the numbing sensation will last long enough for the dentist to
finish his/her procedure. Epinephrine is the agent within the anesthetic that allows it to
last (helium.com). For example, added to one of the most common dental anesthetics,
lidocaine, epinephrine enables the medicine to numb the tooth for exactly one hour before
it starts to wear off. Without the use of epinephrine, the anesthetic will only numb the
area for about 5-10 minutes (dentalfearcentral.org). While epinephrine does play a vital
role in dental anesthetics, is it the main cause of the problems patients are having with the
treatment?
6
On March 20, 2006, a patient wrote an email to Dr. Gareth S. Kantor, MD
Department of Anesthesiology, School of Medicine, Case Western Reserve University,
asking for advice. In the email the patient describes her GYN surgery procedure. She
explains that she was injected with lidocaine and how “the first 10cc`s were fine, but the
second 10cc`s immediately gave her a feeling of a giant panic attack, racing heart,
shivering, dizziness and tongue numbness and a metallic taste in the
mouth”(netwellness.org). After about a half an hour, the episode was over and her doctor
concluded that the epinephrine within the lidocaine was the cause of the terrible reactions
and advised her not to use any medication that contained epinephrine as an ingredient.
A short while later the patient went to the dentist to receive four crowns for her
upper teeth. The patient informed the dentist that she was not to use any medication that
contained epinephrine and the dentist proceeded to inject her with carbocaine, which the
dentist explains is epinephrine-free. The patient continues to explain in the email that the
dentist had to inject her with six shots of carbocain because the medicine was not taking
effect at first. After the sixth shot, the patient felt “dizzy, nauseated, felt like fainting,
rapid heart, and shaking!” She explains how she took a Xanax pill, which calmed her
down, and rescheduled the appointment.
When the patient returned to the dentists’ office to receive her new crowns, she
was injected once again with the same treatment that initially left her with the horrible
symptoms. Yet this time, she was advised by her doctor to take the Xanax pill before
receiving the anesthetic. She still felt symptoms but not nearly as frightening as the first
visit to the dentist, yet was not satisfied with her bodies’ reaction to the anesthetic. After
reading the patients’ email, Dr. Kantor suggested that she get tested to see if the
7
epinephrine had a profound effect on her body. Dr. Kantor did explain that epinephrine
can leave patients with the physical experience of a panic attack, which in turn may cause
a real anxiety attack to take place. Dr. Kantor also explains how dental anesthetic,
without epinephrine only lasts a very short while and is sometimes not sufficient for oral
surgery (netwellness.org).
It seems as if epinephrine is a major problem when it comes to dental anesthetics.
This is a problem in and of itself because; epinephrine is one of the main components of
anesthetic medicine. On one hand, if epinephrine is used, patients may have allergic
reactions to the additives that preserve epinephrine, which can result in a rash and
itchiness. Not to say that epinephrine does not have positive effects. It does in fact
decrease toxicity and reduces bleeding by constricting blood vessels, yet epinephrine may
also cause anxiety attacks in some patients. On the other hand, there are dental
anesthetics that do not contain epinephrine, yet only lasts short to moderate periods of
time. This is poses a dilemma, that is in need of a solution.
Therefore the question that must be posed is; is there an alternative ingredient to
epinephrine that lasts just as long, and does not have harmful effects? After researching
this topic, I have come to the conclusion that there is no greater alternative solution to
epinephrine that would in fact have all of the benefits and none of the consequences.
There is however the solution of using anesthetics without epinephrine. Yet, the question
now becomes; is it worth having to stop multiple times during the surgery to inject the
patient with anesthetic, in order to make sure that the patient still can not feel pain? In a
study carried out to investigate if plain anesthetics (anesthetic without epinephrine) were
a suitable alternative to lidocaine which contained epinephrine, two hundred and four
8
patients were injected with the anesthetics. “A single periodontal ligament injection of
any of the solutions tested resulted in a low incidence of anesthesia. The success rate of
lidocaine without epinephrine was consistently poor”(R. J. Gray, A. M. Lomax, and J. P.
Rood, 1990). Therefore logically it is not worth the hassle to continue to inject a patient
with anesthetic whenever it wears out. It is more efficient to use anesthetic containing
epinephrine although, there may be side effects in certain patients.
9
1. Merriam-Webster Online. Web. 07 Nov. 2010. <http://www.merriam-webster.com/>.
2. "Dentist - Dental Procedures & Treatments." Dentistry - Your Guide to Dentistry and
Dental Care. Web. 07 Nov. 2010.
<http://dentistry.about.com/od/dentalprocedures/Dentist_Procedures_Treatments.htm
>.
3. What Your Teeth & Gums Say About Your Health." WebMD - Better Information.
Better Health. Web. 07 Nov. 2010. <http://www.webmd.com/oral-health/healthymouth-and-body-9/slideshow-teeth-gums>.
4. "Anesthetic Solutions for Dental Treatments | Dental Articles | Dr. Chetan." Dr.
Chetan - Chetan Bhawani - Dental Care Tips - Dental Blog. Web. 07 Nov. 2010.
<http://www.drchetan.com/anesthetic-solutions-for-dental-treatments.html>.
5. Wilson, Elizabeth K. "Dental Anesthetics." Science &Technology, June-July 2009.
Web. 7 Nov. 2010. <http://pubs.acs.org/cen/science/87/8726sci3.html>.
6. "Local Anesthesia." Faculty of Columbia University College of Dental Medicine.
Web. <www.colgate.com/app/colgate/us/oc/information>.
7. "Allergy to Local Anaesthetics." Dental Phobia and Dental Anxiety. Web. 07 Nov.
2010. <http://www.dentalfearcentral.org/allergy_novacaine.html>.
8. Gray, R. J., A. M. Lomax, and J. P. Rood. "Periodontal Ligament Injection:
Alternative Solutions." Nov.-Dec. 1990. Web. 7 Nov. 2010.
<http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2162543/>.
9. NetWellness Homepage. Web. 07 Nov. 2010. <http://www.netwellness.org/>.
10. "Common Problems Faced during Dental Anesthesia - by Ty Fillers - Helium."
Helium - Where Knowledge Rules. Web. 07 Nov. 2010.
<http://www.helium.com/items/1319589-common-problems-faced-during-dentalanesthesia>.
10