Cocaine and Dentistry

Most people are unaware that cocaine was used in dentistry as a local anesthetic. During the height of its use, cocaine was considered remarkably effective for both dental procedures and curing toothaches.  Cocaine was a critical part of the history of local anesthetics in dentistry!

Cocaine and Dentistry in the 1800s

Print ad for Cocaine tooth drops used for teething pain

Print ad for Cocaine Tooth Drops for teething pain in children, circa 1885.

In 1860, a young German chemist named Albert Niemann isolated cocaine from the leaves of the South American coca bush.  He called the new compound “Cocain.” After his discovery, chemists in Europe and the U.S. began to experiment with it.  Sigmund Freud was an early proponent of its medicinal uses and encouraged a physician colleague Dr. Karl Koller to experiment with its analgesic properties.

Koller experimented with cocaine and then demonstrated the local anesthetics effects at an Ophthalmic meeting in 1884.  News spread quickly to the United States and only a couple of weeks of Koller’s demonstration, it was used in dentistry. William Haldsted MD injected cocaine into the lower jaw of a patient and then extracted a tooth with no pain or sensation felt by the patient. Thus marked the beginning of the use of local anesthetics in dentistry.

Drawbacks of Dental Use of Cocaine

News of this spread quickly and soon cocaine was widely adopted as an anesthetic by dentists and physicians starting in the late 1880s. It is important to remember that prior to the introduction of cocaine, dental procedures were done without any numbing at all!

Key properties of cocaine included:

  • Quick onset and short duration of action.
  • Localized effects.
  • Feelings of euphoria in the individual receiving the cocaine.
  • Certain cardiovascular effects such as increased heart rate.
Coca leaves used to make cocaine which was the first local anesthetic used in dentistry

Coca leaves used to make cocaine

The feelings of euphoria were not lost on those dentists and physicians administering the cocaine.  Soon, many dentists and physicians developed a dependency upon it, including Halsted himself. In fact, three of his colleagues actually died without recovery from the addiction of cocaine. Once this was observed on a large scale, chemists quickly sought to develop an alternative to cocaine for use as local anesthetic.

Next Step: Novocaine

In 1905, a new local anesthetic, Procaine, was introduced. Procaine had all the desired effects of cocaine as a local anesthetic, but did not posses the addictive potential nor the other negative side effects. Procaine then quickly replaced cocaine as the local anesthetic of choice in dentistry.  One company then made the fateful decision to market procaine under a new brand name: Novocain. From that point on, the name Novocaine has become synonymous with “the shot you get at the dentist”, a phenomenon I documented in this Dental MythBuster post.

Carpule of lidocaine and epinephrine the most popular dental local anesthetic used in dentistry for numbing

Lidocaine with epinephrine

Novocaine had its own drawbacks so a new generation of local anesthetics were then developed many years later. Today, lidocaine (pictured on the left) is the most popular local anesthetic used in dentistry in the United States. I routinely use lidocaine and another local anesthetic, articaine (brand name septocaine), on a daily basis in my practice in Orange, CT. Both are extremely effective and it is rare that I observe any complications.

Interestingly, redheads have a well documented resistance to dental local anesthetics, research I documented in one blog post about redheads and then another recent article.  I always explain to red haired patients the research on this subject and they are fascinated to learn about it.  It is likely that red haired individuals would have a resistance to the anesthetic properties of cocaine as well.

But all patients – regardless of hair color – are glad that they do not have to be injected with cocaine in order to have dental procedures done!

Comments

  1. Could you imagine is cocaine was still the best available option! It’s amazing how far medical and dental science has come in the last 100 years or so and what leaps we’re making every day.

    • Good points. I wonder how much longer it would have taken to develop novocaine had cocaine not been discovered first. Chemically, novocaine and cocaine are similar. Cocaine was still being used in the 1960s in certain nasal procedures. Interesting stuff!

  2. latanya powell says:

    Can local anesthesia like novacaine and lidocaine cause you to fail a drug test

  3. Douglas Barker says:

    Thanks for sharing history of dental use of cocaine, unbelievable dental history but true 🙂 cocaine was best at that time to reduce dental pain during treatment but problem with cocaine was it last very short and in result patient feel half dead and half alive after dental treatment. Cocaine is replace by anaesthetic in modern century.

  4. Hi there,
    i was honestly curious about those anesthetics,namely lidocaine,novocaine,xylocaine etc.. how true that those drugs has a cocaine ingredients?
    if its true that those have cocaine, then why does cocaine not to be legalize? in the fact that cocaine can cure a pain?

    Thanks for reading my mail.
    Hope my questions would be answered.

    • There is no cocaine in any of the modern dental local anesthetics.

      There is a chemical similarity between cocaine and local anesthetics such as lidocaine, benzocaine, etc.

      Cocaine has among its many properties a local anesthetic effect. It is still used in very specific circumstances in nasal surgery.

  5. Michael Zalob says:

    When was the disposable anesthetic cartridge available?

    Thanks

    • My source says 1920. From the “bible” on dental local anesthetics:

      The dental cartridge is, by common usage, referred to by dental professionals as a carpule. The term carpule is actually a registered trade name for the dental cartridge prepared by Cook-Waite Laboratories, which introduced it into dentistry in 1920.

      From Handbook of Local Anesthesia, 6th edition, by Dr. Stanley Malamed.

      • Michael Zalob says:

        Thank you for responding quickly.
        Actually researching when disposable needles and carpules were used in practice.
        Doing a museum project for a l943 dental office.

Trackbacks

  1. […] Dr. Thomas probably wasn’t actually “insane.” I wonder if perhaps he hadn’t been turning to his own medicine chest and availing himself of the cocaine that most dentists of the time used as a painkiller during dental procedures? An interesting article on just that topic is here. […]

  2. […] dental field has seen many advances over the years. It used to be that dental procedures were done without any anesthetics at all! Thankfully, that is no longer the case. Most dental procedures can be performed simply with local […]

  3. […] Cocaine was widely used in dentistry and sadly a lot of dentists became addicted to it. Cocaine: Dentistry's First Local Anesthetic | Novocaine | Lidocaine […]

  4. […] Cocaine was the first local anaesthetic, although procaine, also called novocaine, was invented in 1905 and was used widely by 1945. […]

  5. […] once the effects of the drug wore off. Even today, dentists use a modified form of cocaine known as Lidocaine to numb nerves before […]

  6. […] oggi, i dentisti usano una forma modificata di cocaina conosciuta come lidocaina per intorpidire i nervi prima di un intervento […]

  7. […] once the effects of the drug wore off. Even today, dentists use a modified form of cocaine known as Lidocaine to numb nerves before […]

  8. […] once the effects of the drug wore off. Even today, dentists use a modified form of cocaine known as Lidocaine to numb nerves before […]

  9. […] droga desaparecerem. Ainda hoje, os dentistas usam uma forma modificada de cocaína conhecida como Lidocaína para entorpecer os nervos antes da […]

Speak Your Mind

*