Q. Should some people avoid anesthesia containing epinephrine during dental procedures?
A. Yes, and fortunately most dentists now offer epinephrine-free anesthesia if you need it.
Epinephrine (adrenaline) is often added to anesthesia injections for dentistry because it constricts blood vessels. This reduces bleeding and helps the pain-dampening effects of the anesthesia stay where it's needed. But people with uncontrolled high blood pressure - or those taking tricyclic antidepressants such as Elavil, MAO inhibitors, or non-specific beta-blockers - should avoid epinephrine-containing anesthesia because it can raise blood pressure too much, says Dr. David Cottrell, chairman of the department of oral and maxillofacial surgery at the Boston University School of Dental Medicine.
People with atrial fibrillation, a type of heart arrhythmia, may also want to stay away from epinephrine-containing anesthesia because it could make an already "irritable" heart even more prone to arrhythmia, adds Dr. Thomas Kilgore, also an oral and maxillofacial surgeon at BU.
Alternatives to epinephrine-containing anesthesia include Prilocaine and Carbocaine, or even nitrous oxide ("laughing gas"). Plain old Lidocaine is also a decent choice.
Bottom line: Although the small amount of epinephrine in most dental anesthetics probably won't cause trouble (as long as your dentist injects it into your gums, not mistakenly into blood vessels), to be on the safe side, tell your dentist about your medical conditions and medications you're taking. Then discuss your options.
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