Lidocaine Without Epinephrine: Pros and Cons

When you visit your dentist for a procedure other than a regular cleaning, your dentist may administer a local anesthetic to block the pain. One of the most common types of anesthesia is lidocaine. While your dentist can choose from a variety of anesthesia, lidocaine mixed with epinephrine may be used; however, there are times when the use of lidocaine without epinephrine is a better alternative for certain patients.

Why Your Dentist Uses Lidocaine with Epinephrine

In general, your dentist will use two types of lidocaine with epinephrine. You'll see either a red or green anesthesia cartridge set out on the dental tray. Red indicates 2 percent lidocaine to 1:100,000 parts epinephrine. A green cartridge has 2 percent lidocaine to 1:50,000 parts epinephrine, reports the American Dental Association.

Lidocaine functions by blocking nerve receptor responses to pain, says the Mayo Clinic. Your dentist will inject it into the area of your mouth that requires the treatment and it absorbs through your blood stream. In fact, your mouth contains more blood vessels than many other parts of your body, which makes the absorption of a local anesthetic faster, per the Magazine for Registered Dental Hygienists'.

Epinephrine, also called adrenaline, is a type of hormone that your body makes naturally, says the National Center for Biotechnology Information (NCBI). An additional small dose of it is added to a local anesthetic because it acts as a vasoconstrictor. This slows the flow of lidocaine and stretches the effect to make it last longer.

A study published in Clinics reports, the addition of epinephrine helps in a few ways:

  • Reduces toxicity
  • Extends the effects
  • Controls bleeding

But there are both upsides and downsides to the use of lidocaine without epinephrine.

When Lidocaine Is Administered Without Epinephrine

It's extremely important for your dentist to know your family history, medical conditions and allergies prior to administering an anesthetic. Here are some reasons why your dentist may decide to administer lidocaine without epinephrine.

  • Reactions to medications. According to the University of Maryland Medical Center, patients who take medicines, such as a MAO inhibitor or phenothiazine, should alert their dentists.
  • Heart disease and epinephrine effects. The NCBI reports that many clinicians believe epinephrine in a local anesthetic can cause a "rapid rise in blood pressure and heart rate," though, some studies show that nominal amounts have little to no effect. Regardless, it's best to let your dentist know if you have a history of heart disease or other cardiovascular conditions.
  • Considerations for patients with diabetes. On the whole, studies show that the combination of lidocaine and epinephrine is safe for patients with Type 2 diabetes, reports Clinics. However, your dentist will want to consider secondary conditions, such as heart disease, when administering the combination.

According to RDH, for some patients who may have an adverse reaction to epinephrine, solely using lidocaine may actually be harmful. Instead, your dentist will opt for another slowing agent in place of epinephrine that does not act as a vasoconstrictor but allows the anesthesia to last longer.

Post-Treatment Oral Care

Different dosage levels are recommended for adults as opposed to children. No matter what size or weight you are, the effect should last one to three hours, reports the American Academy of Pediatric Dentistry. Ephinephrine lowers the rate of absorption of the anesthetic in the blood stream, thus prolonging the effects of the anesthetic.

After the procedure, avoid chewing on the side work was done, so you don't bite your tongue. Children, especially, should be monitored post-treatment. You should always follow the recommendation of your dentist for cleaning the area that's been treated. The better you take care of your teeth, the better chance you have of avoiding a long dental visit that requires anesthesia.

This article is intended to promote understanding of and knowledge about general oral health topics. It is not intended to be a substitute for professional advice, diagnosis or treatment. Always seek the advice of your dentist or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment.

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LOCAL ANESTHESIAProcedure

  1. Preparation – If you need local anesthesia, your dentist will dry part of your mouth with air or use cotton rolls. Then your dentist will swab the area with a gel to numb the skin.

  2. Injection – Next, your dentist will slowly inject the local anesthetic into the gum tissue. Most people don't feel the needle. Instead, the sting they feel is caused by the anesthetic moving into the tissue.

  3. After effects – An injection of local anesthesia can last up to several hours. After you leave the dentist's office, you may find it difficult to speak clearly and eat or drink. Be careful not to bite down on the area that is numbed. You could cause damage to yourself without realizing it.