Archives for November 2013

Dental MythBuster #10 – I’m allergic to epinephrine!

For this 10th Dental MythBuster, I’ve decided to tackle one of the greatest ones out there: The mythical epinephrine allergy!

Epinephrine used at the dentist photo people think they are allergic

Epinephrine for injection.

I consistently hear some variation of the following at least twice a month in my office in Orange, CT:

“Doc, for the shot, don’t use the one with epinephrine. I’m allergic to it.”

Upon hearing that, I always use a dental local anesthetic that does not contain epinephrine. But in all cases, the patient is improperly using the word “allergy.” Let’s see why.

About Epinephrine

Epinephrine, also called adrenaline, is a naturally occurring hormone and neurotransmitter in the body. It plays a critical role in the “fight or flight” response. Epinephrine has a number of different functions, including increasing the heart rate, regulating lung capacity, increasing the amount of available glucose, and many others.

Picture of epinephrine used in dentistry by dentists

Structure of Epinephrine

In addition to being naturally released by the body, epinephrine can be administered by health care providers in many situations. Epinephrine is given in many situations of acute cardiac arrest (a heart attack). It is also given in the treatment of an acute allergic reaction called anaphylaxis. It is frequently sold in an injectable form called EpiPen for those people susceptible to these types of reactions. We have an EpiPen in our office in Orange, CT as part of our emergency kit.

But the critical thing to keep in mind is that every single person produces and releases epinephrine all the time.

Why Dentists Use Epinephrine

As a dentist, I inject local anesthetic containing epinephrine at least ten times per day. Epinephrine is used because it acts to constrict the blood vessels in that area. By doing so, the local anesthetic remains in that area longer, because there is less blood flow to take the local anesthetic away. Simply stated, the epinephrine helps you feel and stay number longer.

As anyone can imagine, a dentist who does not get their patients adequately numb will soon find themselves with an empty chair! And epinephrine is a key factor in keeping patients adequately numb for procedures.

An Epinephrine Allergy?

So how can you have an allergy to a substance that your own body produces and uses every second of the day? The answer is it’s impossible! If you were allergic to it, you would be developing symptoms all the time! I won’t bore people with the technical definition of an allergy, but this is a good summary.

Carpule of lidocaine and epinephrine used by dentists in our Orange CT practice

Lidocaine with epinephrine.

So where did this myth originate? Well, most people confuse an adverse reaction with an allergic reaction. Common adverse reactions to an injection of epinephrine at the dentist can include:

  • Your heart starts to beat much more rapidly.
  • Your heart starts to beat much more forcefully.
  • The skin on your cheek – near the injection site – gets very pale.
  • You become suddenly dizzy.
  • Your shirt becomes wet from sweating (called diaphoresis).
  • You become very nervous.
  • You develop a headache.
  • And many others.

In addition, many other patients are unable to receive epinephrine due to certain medical conditions and/or medications they are taking. But this is NOT because they are allergic to it!

Dental Myth Busted!

Just like the other dental myths that I have written about (dentists no longer use novocaine, the dentist put his knee on my chest to pull my tooth, etc.), let’s bust this myth! So the next time you are at the dentist and you don’t want epinephrine, you should say:

“Doc, for the shot, don’t use the one with epinephrine. I had an adverse reaction to it.”

Until the next Dental MythBuster…

Note: since publishing this post there have been literally dozens of comments and posts which attacked me personally and/or used profanity. These comments prompted me to publish a sequel to this titled More on the Fabled “Epinephrine Allergy”. Please note that any/all comments with personal attacks and/or profanity will not be published.