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article imageEpinephrine in Dental Anesthetics Can Cause Panic Attacks

By Caroline Menzies     Feb 15, 2010 in Health
Panic attacks are so terrifying, many sufferers go to the hospital believing they are having a heart attack. They can happen suddenly, and for no apparent reason, unless you are at the dentist. In that case, blame the epinephrine in the anesthetic.
Not everyone reacts this way to dental anesthetic. Some people experience a slight surge that quickly passes. Others feel nothing at all. But for the sensitive, who go through symptoms of a panic attack right after the needle, it is quite unbearable. (Check out this related blog.)
It would also seem that not many people know about this connection. Of ten people surveyed informally, only one knew that commonly used dental anesthetics contain epinephrine.
Epinephrine is added to dental anesthetics to increase their effectiveness. It works by shutting down the small blood vessels (which keeps the freezing in your gums longer). Anesthetics without it wear off much faster and you may feel pain before the procedure is done.
It is produced naturally in your body by the adrenal glands, and is involved in the fight-or-flight response that causes your body to do all kinds of uncomfortable things in preparation for an emergency situation, where you need to either run, or stand and fight. Here is an example: your neighbour's rottweilers are loose again and come charging at you, but stop two feet away and stand snarling and growling until their owner calls them off. A surge of adrenalin races through your body so you are 'on guard' for whatever happens next.
Even after you know you are safe, the adrenalin released in your fight-or-flight response stays with you for a while. Your heart races, your muscles are taut, and the bronchioles in your lungs are expanded (which, incidentally, is why epinephrine is also used in asthma drugs). Panic attacks also make people feel as is death is imminent. You are left feel shaky and weak for some time afterward.
This fight-or-flight response is exactly what happens in a classic panic attack, in which your body thinks there is an emergency, but in this case there actually isn't. They can come out of nowhere and have no tangible biological cause. People who are already anxious are more prone to them, though that is not always the case. Even the fear of having one in people who have been through them, can be disabling, interfering with normal activities. They are also treatable.
It stands to reason, then that the addition of epinephrine to dental anesthetic can affect some people as if they are having a panic attack. While dental anesthetics are meant to react locally, the accidental injection into a vein can dramatically accentuate this effect. This is why dentists take a long time to inject freezing, to try to avoid this possibility. It won't exactly hurt you, but try to tell that to someone going through one.
Epinephrine as a drug does a lot of useful things. Topically, it can be used to stop bleeding, again by closing down blood vessels. It is used to treat anaphylactic shock caused by severe allergic reactions. It can also get the heart back on track in some instances when the rhythm goes awry.
While all of this is well and good, there are some actual published contraindications, that make it crucial for dentists to be aware of pre-existing medical conditions, such as high blood pressure and cardiac issues. Other conditions that may be not readily disclosed can result in death. For example, meth amphetamine users should not be given epinephrine, since their body is already pumped to the hilt. Cocaine users should also be cautious with it (if they even admit to their dentist that they are users).
Also listed by one source is "anyone who is prone to psychosis," which could easily be a euphemism for "anyone who has high anxiety caused by past negative dental experiences."
So what are the alternatives? Well, there is laughing gas, acupuncture (though not many dentists can be found who do this), epinephrine-free freezing and a risk of feeling pain (at which time you can just get another needle), full knock out anesthetic, or perhaps the option of popping a couple of tranquilizers before the procedure (dentists can prescribe this). There is also prevention and avoidance. While Digital Journal is not advocating the latter, where you just let your teeth rot (and some people do for fear of dental work), you could become totally obsessive about brushing and flossing, but this is not foolproof either. Some people just have softer teeth than others.The important thing is to have a heart to heart talk with your dentist and his or her assistant to work with you in finding a solution.
In any case, take comfort in knowing that the irrational feeling that you are going to die while having work done on your teeth is not all in your head. Just some of it.
More about Dental anxiety, Epinephrine, Dental anaesthetic side effects
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