Archives for April 2013

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!

Dentistry and Art: Caravaggio The Tooth Puller

This dental masterpiece happens to be one of the most famous paintings by the Italian Baroque painter Caravaggio (Michaelangelo Merisi da Caravaggio 1571 – 1610).  It is also one of my favorite Baroque paintings depicting dentistry.  The Tooth Puller is believed to have been painted in 1609.  As a painting known worldwide, it has different names in different languages, including The Tooth Puller and Il Cavadenti and L’arracheur de dents and Der Zahnzieher.

The “dentist” here is pictured with a slight smile or even smirk on his face.  The onlookers – from the very young boy at left foreground to the older individuals – look on with both anxiety and curiosity.  There is some light in the room, presumably from candles or a fireplace. The woman on the right, with her sunken-in profile indicating she likely has no teeth herself, is probably comparing her experiences having teeth extracted to this scene.  The “patient” is grabbing the chair with one hand and his left hand is open and stiff. He is in obvious pain from the tooth extraction.

The Tooth Puller by Caravaggio, Il Cavadenti, Der Zahnzieher, L'arracheur de dents

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