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Back when I was in dental school, the instructors told us to always pull back on the anesthetic syringe before injecting. By doing this, we would make sure that we weren't injecting the anesthetic into a blood vessel, which would cause the epinephrine in the anesthetic to make the patient's heart feel like it was beating out of their chest.
They called this the epinephrine reaction, and I blindly believed it. I even wrote a post about why dental anesthetic makes your heart beat faster. Until one day, this belief was questioned by a comment on that article (which actually caused Gavin to post a rather entertaining comment). I realized that I'd blindly believed what I'd been taught without doing any research of my own.
In this follow-up article, I'll answer the question: Can dental anesthetic really make your heart beat faster?
A few weeks ago, a woman told me that she hates getting injections because it makes her heart beat really fast. I asked her if a dentist had ever offered her the anesthetic brand Carbocaine (a type of dental anesthetic without any added epinephrine). She told me that she'd never heard of it. I tried it on her and she told me that it was the first injection she could remember where she didn't feel like her heart was beating out of her chest.
Naturally, this (along with other similar experiences) made me a believer that regular dental anesthetic with epinephrine can indeed make your heart beat faster. As a dentist I realize that stories, while fun and exciting, may not be a very good source of evidence, so I decided to do some more in-depth research.
The main question here is whether or not the small amount of epinephrine inside the dental anesthetic makes your heart beat faster or if it's simply caused by the epinephrine your body releases in response to being afraid of the crazy dentist that's about to poke you.
Many years ago, it was thought that the tiny amount of epinephrine in the dental anesthetic made no difference in your heart rate, and any change in your heart rate was simply caused by the "fight or flight" response.
Many studies have since confirmed that the epinephrine in dental anesthetic can cause an increase in your heart rate.
One study states that "intravenous administration of 0.015 mg of epinephrine with lidocaine results in increase in the heart rate ranging from 25 to 70 beats per minute, with elevations in the systolic blood from 20 to 70 mm Hg." For your information, one cartridge of dental anesthetic contains 0.018 mg of epinephrine — that's even more than the amount that has been shown to increase the heart rate by 25 to 70 beats per minute. Here's a link to one of those studies that discusses this.
Malamed's dental textbook on anesthetic even confirms what I'd discovered. It says, "Contrary to a previously held position that the intraoral administration of "usual" volumes of epinephrine produced no cardiovascular response and that patients were more at risk from endogenously released epinephrine than they were from exogenously administered epinephrine, recent evidence demonstrates that epinephrine plasma levels equivalent to those achieved during moderate to heavy exercise may occur after intraoral injection."
That simply says that the epinephrine in dental anesthetic can make your heart beat very fast, even tricking it into beating as fast as it would if you were exercising.
The author goes on to state that even if your dentist does inject slowly and "pull back" to ensure that they don't inject into a blood vessel, your heart can still beat faster: "However, even following usual precautions (e.g. aspiration, slow injection), sufficient epinephrine can be absorbed to cause sympathomimetic reactions such as aprehension, tachycardia, sweating, and pounding in the chest (palpitation): the so-called "epinephrine reaction."
Even more evidence that dental anesthetic can make your heart beat faster comes from the American Heart Association. They recommend that any patients with heart disease receive a maximum of 0.04 mg of epinephrine from dental anesthetic. That's usually the equivalent of just two cartridges of dental anesthetic. For comparison's sake, a normal person without heart disease can receive up to eleven cartridges of anesthetic.
This shows that the AHA believes that the epinephrine in dental anesthetic can have an effect on the heart, and that's why they recommend limiting it so strictly.
The textbook Dental Management of the Medically Compromised Patient confirms this by stating "If [a vasoconstrictor] is considered essential, use cautiously (maximum 0.036 mg epinephrine or 0.20 mg levonordefrin)." Levonordefrin is similar to epinephrine, but it is mostly used in European countries, not in the U.S.
Lastly, the American Acamedy of Pediatric Dentists even has guidelines for dentists telling us what to do when a patient has a reaction to the epinephrine in dental anesthetic. They say to reassure the patient, ensure they're breathing well, and to check their vital signs if necessary.
In summary, the most recent studies and evidence all point to the fact that the epinephrine (or levonordefrin for my European friends) can definitely make your heart feel like its beating out of your chest!
Do you have any questions about dental anesthetic and how it affects your heart? Feel free to leave them in the comments section below. Thanks for reading!
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In short, debridement is the removal of large amounts of plaque and tartar from your teeth. People who have not visited a dentist in several years may experience heavy plaque and tartar (calculus) build-up. Before a dentist can do an exam, the plaque and tartar has to be removed with a deep cleaning, referred to as debridement.
If you are very sensitive to pain, you may need local anesthesia for this procedure.
Debridement is performed by using a combination of hand instruments and an ultrasonic device. The ultrasonic device uses high-frequency vibrations and water to eradicate plaque and tartar from the teeth.
Usually debridement is the first step in a comprehensive dental treatment. When the teeth are clean, the dentist can then evaluate the teeth to begin a course of therapy which may include scaling and root planing or sometimes periodontal surgery.
If you have inflamed gums, they may bleed during the procedure. After your procedure, you may notice sensitivity to hot or cold. This may mean that the roots of the teeth are more exposed following the removal of plaque and tartar.
If you have had a debridement and experience bleeding that doesn’t stop, what appears to be an infection, excessive swelling or discharge or your lymph nodes beneath your jaw or in your neck become swollen, call your dentist.
The post What Is Debridement? appeared first on Gentle Dental.
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People who are in need of nourishment tend to have oral health issues as well. The thought process of “since I am not eating, I don’t need to brush my teeth” or, even worse, “I don’t have the money for a good toothbrush and toothpaste” tend to overtake those in need of food. Those who suffer from repeated hunger sometimes grind their teeth (known as bruxism) and wear down the enamel. Food and water stimulate the saliva glands, which also break down the cavity-causing bacteria in the mouth. Without that stimulation, saliva glands are dormant, which causes dry mouth, leading to caries as well.
Join Gentle Dental and Feeding South Florida in helping end hunger in your community. From October 1st through November 15th, we will be collecting non-perishable items at all of our 24 offices.
The post Food Shortage And Oral Health appeared first on Gentle Dental.
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A recent survey by the American Dental Association found that just under half of all Americans floss their teeth daily.
What about the other half?
My guess is that they're the ones who floss twice a year — right before their dental checkups. They think they can pull a fast one on us, but here's a little secret: dentists can tell when you've been flossing and when you haven't.
The way we can tell if you're not flossing is if your gums are bleeding. Although there are other, less common conditions that can make your gums bleed, gingivitis is the main cause. Gingivitis is when the gums are inflamed due to all of the bacteria in your mouth collecting right between the gums and the teeth.
The problem is that it takes about a week of daily flossing for gingivitis to go away and make it so your gums don't bleed when they are cleaned.
The most authoritative book on the gums — that's 1,328 pages dedicated to your gums! — states the following:
The presence of plaque for only 2 days can initiate gingival bleeding on probing, whereas once established, it may take 7 days or more after continued plaque control and treatment to eliminate gingival bleeding.
So, if you end up brushing and flossing really well right before your dental cleaning and exam, your teeth will be clean, but your gums will still show the main sign of inflammation: bleeding.
If you really want to trick your dentist into thinking you're brushing and flossing regularly, you'll have to do it for at least seven days before your visit. And if you're gonna do that, why not simply brush and floss every day?
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The phony dentist who put hundreds of patients at risk by running an illegal practice out of his Burnaby basement suite is now behind bars in B.C.Wu Tung Sheng, 62, appeared in B.C. Supreme Court on Friday before beginning his three-month sentence. He did not have a lawyer.After bringing in a Mandarin interpreter, Associate Chief Justice Austin Cullen read Mr. Wu, also known as David Wu, the reasons for judgment first announced in October, when he was convicted in absentia for continuing to practise without a licence despite a 2003 court order.
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A few years ago, Mearlin Griffin was at her dentist’s office, all set to have a tooth extracted.”I was sitting in the chair and before they numbed me up they took my blood pressure,” she recalled. “I was shocked that it was high. Too high.”She felt fine, but accepted her periodontist’s recommendation that she get her blood pressure resolved before having the tooth pulled.Many people think dentists are only interested in teeth and gums. The idea of a dentist asking about blood pressure and medical history may surprise some…
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