Posted by mattdds on January 28, 2003, at 18:18:18
In reply to Nardil and Dentistry, posted by victoria1063 on January 27, 2003, at 22:02:42
Victoria,
Hi. I'm a dental student going into my fourth year. When patients come in to our school clinic taking MAOI's, we usually give them Carbocaine 3%, which is mepivacaine without a vasoconstrictor. I bet your dentist used that too. I suspect that this is more of a medicolegal thing, because there is no evidence that the amount of epinephrine in local anesthetics that dentists use is capable of inducing a hypertensive crisis. Yes, you read that correctly. So if lidocaine with epinephrine works, use it! Tell your dentist to read about it in Malamed's Handbook of Local Anesthesia, as there is pretty good evidence provided there that epinephrine is not contraindicated in patients taking MAOI's
YMMV, but Carbocaine sucks! At least that has been my experience with it. Most times that I use it I get inadequate anesthesia. When it does work, it usually wears off during the middle of the procedure. Lidocaine with epinephrine 1:100,000 is so much more effective, at least in my hands. Also, epinephrine does indeed help potentiate the effects of the local anesthetic, by keeping it in the area and concentrating it. Also, it reduces the systemic toxicity and provides hemostasis (controls bleeding).
Yagiela, a dental researcher, did a study showing that blood epinephrine levels of people taking MAOI's who received epinephrine in an anesthetic did not rise significantly. There was, however, an interaction with phenylephrine. But phenylephrine is no longer used as a vasoconstrictor in local anesthetics.
I'm sure your dentist was just trying to protect you, and even some of our clinic faculty aren't aware that this is no longer considered a contraindication.
You can also ask her about intrapulpal anesthesia; which is a technique where the anesthetic is injected under pressure, right into the pulp of the tooth after opening it up. This usually works for me when I'm doing root canals, and fail to get good anesthesia with other techniques.
Best of luck!
Matt
P.S. I'm guessing that the tooth with the root canal to be done is a lower tooth? Those are usually harder to anesthetize.
poster:mattdds
thread:137858
URL: http://www.dr-bob.org/babble/20030125/msgs/138006.html